Field Services 101 Assessment

• Conducted on

  Date

• Prepared by

• Location
  Address

• The

Field Service PPE

• Is all required PPE present and in use?

  Safe

  At Risk

  N/A

• What PPE is missing or OOS?

  Select H2S Monitor Missing H2S Monitor improperly Hard Hat FRC Outer Layer FRC Needs Replaced Safety Glasses Steel Toe Safety Vest Missing Safety Vest Needs Replaced

  • H2S Monitor Missing
  • H2S Monitor improperly
  • Hard Hat
  • FRC Outer Layer
  • FRC Needs Replaced
  • Safety Glasses
  • Steel Toe
  • Safety Vest Missing
  • Safety Vest Needs Replaced

Basic Knowledge

• What is the purpose of a filter pod?<br>

  Safe

  At Risk

  N/A

• What is H2S?

  Safe

  At Risk

  N/A

• What is Beaver Creek's Backing Policy?

  Safe

  At Risk

  N/A

• What is the purpose of the JSA?

  Safe

  At Risk

  N/A

• The JSA is filled out properly and signed?

  Yes

  No

  N/A

• What is missing?

  Select Do not have one Unsigned Incomplete Incorrect

  • Do not have one
  • Unsigned
  • Incomplete
  • Incorrect

• The Fluid Transfer Sheet is in use?

  Yes

  No

  N/A

• Valve Safety is in place? (Cam locks)

  Yes

  No

  N/A

• A fire extinguisher is in place by electric or diesel pumps?

  Yes

  No

  N/A

• What is the most dangerous task or job you perform?

  Select Open and close valves Spotting Drivers Dealing with well site traffic Fire Hazards Driving to and from location Climate Water Temperature Chemical Exposure Other

  • Open and close valves
  • Spotting Drivers
  • Dealing with well site traffic
  • Fire Hazards
  • Driving to and from location
  • Climate
  • Water Temperature
  • Chemical Exposure
  • Other

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