Field Ticket

• Dart Services Ltd.
  P.O. Box 1595
  Estevan, Sk, S4A 2L7
  Ph. (306) 634-7007
  Fax. (306) 634-7006
  email. dartservices@sasktel.net

• Field Ticket Number

• Date;

  Date

• Operator:

  Select Davin Emmel Marty Hanson Corey Kittelson Davin Kittelson EvanPranger Kelly Friess John Nixon Rodger Johnson Shawn Vermeeren David Henneberg Zacch Vandenhurk Jesse Friedrich Tyler Fenton Riley Emmel

  • Davin Emmel
  • Marty Hanson
  • Corey Kittelson
  • Davin Kittelson
  • EvanPranger
  • Kelly Friess
  • John Nixon
  • Rodger Johnson
  • Shawn Vermeeren
  • David Henneberg
  • Zacch Vandenhurk
  • Jesse Friedrich
  • Tyler Fenton
  • Riley Emmel

• Swamper :

  Select Davin Emmel Marty Hanson Corey Kittelson Davin Kittelson EvanPranger Kelly Friess John Nixon Rodger Johnson Shawn Vermeeren David Henneberg Zacch Vandenhurk Jesse Friedrich Tyler Fenton Riley Emmel

  • Davin Emmel
  • Marty Hanson
  • Corey Kittelson
  • Davin Kittelson
  • EvanPranger
  • Kelly Friess
  • John Nixon
  • Rodger Johnson
  • Shawn Vermeeren
  • David Henneberg
  • Zacch Vandenhurk
  • Jesse Friedrich
  • Tyler Fenton
  • Riley Emmel

• Customer:

• Job Location:

• AFE# :

• Description of Work:

  Select Pump Concrete Line Pump Concrete Install/Remove Screw Piles Install Driven Piles Cut Piles or Weld Pile Caps Haul Product (eg. Screws/Pipe) Haul Equipment Excavation of Soil

  • Pump Concrete
  • Line Pump Concrete
  • Install/Remove Screw Piles
  • Install Driven Piles
  • Cut Piles or Weld Pile Caps
  • Haul Product (eg. Screws/Pipe)
  • Haul Equipment
  • Excavation of Soil

• Other Work Not Listed Above:

Hazard Assessment Checklist

• Distance from Overhead Lines (Ensure Minimum 17ft)

• Solid Ground for Outriggers Prepared/Used

• Safe Distance Clearance Observed Between Pump and All Overhead Hazards

• Swing Radius Clear

• Spotter

• Proper Excavation Clearance Observed Between Boom and Objects

• Proper PPE Worn on Site

• Operator Initals

  Sign

• Swamper Initals

  Sign

Travel and Volumes

• Travel Time

• Time Worked On Site

• Km Traveled

• Volume Of Material Pumped

• Meters or Yards

  Meters

  Yards

Equipment Used

• Truck Used

  Select 41 Meter Pump Truck 40 Meter Pump Truck 38 Meter Pump Truck Mack Pile Truck Kenworth Highway Tractor Green Peterbuilt Highway Tractor White Perterbuilt Highway Tractor White Dodge 1 Ton Black Dodge 1 Ton White Ford 1 Ton Shop Truck

  • 41 Meter Pump Truck
  • 40 Meter Pump Truck
  • 38 Meter Pump Truck
  • Mack Pile Truck
  • Kenworth Highway Tractor
  • Green Peterbuilt Highway Tractor
  • White Perterbuilt Highway Tractor
  • White Dodge 1 Ton
  • Black Dodge 1 Ton
  • White Ford 1 Ton
  • Shop Truck

• Powered Equipment Used

  Select Large Jutton Pounder Small Jutton Pounder Komatsu Excavator Doosan Excavator Bobcat Skid Steer Kobota Skid Steer Cat Zoom Boom Loader Bobcat Portable Welder

  • Large Jutton Pounder
  • Small Jutton Pounder
  • Komatsu Excavator
  • Doosan Excavator
  • Bobcat Skid Steer
  • Kobota Skid Steer
  • Cat Zoom Boom Loader
  • Bobcat Portable Welder

• Trailer Used

  Select Large Heavy Haul Trailer Small Heavy Hall Trailer Steel Tri Axle Equipment Deck Aluminum Tri Axle Drop Deck Aluminum Tandem Axle Drop Deck Tandem Pintle Hitch Trailer Tri Axle Goose Neck Trailer Tandem Bumper Tow Trailer

  • Large Heavy Haul Trailer
  • Small Heavy Hall Trailer
  • Steel Tri Axle Equipment Deck
  • Aluminum Tri Axle Drop Deck
  • Aluminum Tandem Axle Drop Deck
  • Tandem Pintle Hitch Trailer
  • Tri Axle Goose Neck Trailer
  • Tandem Bumper Tow Trailer

• Other Equipment

  Select Large Skid Steer Srew Head Small Skid Steer Screw Head Post Hole Auger Ice/Rock Drill Bit Large Smooth Skid Steer Bucket Small Toothed Skid Steer Bucket Skid Steer Pellet Forks Skid Steer Street Sweeper Concrete Pile Crusher Smooth Excavator Bucket Toothed Excavator Bucket Ripping Toth

  • Large Skid Steer Srew Head
  • Small Skid Steer Screw Head
  • Post Hole Auger
  • Ice/Rock Drill Bit
  • Large Smooth Skid Steer Bucket
  • Small Toothed Skid Steer Bucket
  • Skid Steer Pellet Forks
  • Skid Steer Street Sweeper
  • Concrete Pile Crusher
  • Smooth Excavator Bucket
  • Toothed Excavator Bucket
  • Ripping Toth

• Please note any equipment not listed above.

Screw Piles and Screw Pile Components

• 12 3/4"x25'(3/4"x24") Screw pile

• 7"x20'(1/2"x16"x16") Screw Pile

• 7"x15'(1/2"x16") Screw Pile

• 4 1/2"x15'(1/2"x16") Screw pile

• 4 1/2"x15'(1/2"x16"x16") Screw Pile

• 3 1/2"x10'(1/2"x14") Screw Pile

• 2 7/8"x8'(3/8"x8") Screw Pile

• 3/4"x12"x12" Pile Cap

• 1/2"x12"x12" Pile Cap

• 1/2"x6"x6" or Oval Pile Caps

• 3" Sliders

• 4" Sliders

• 3" Extensions

• Bolts Supplied?

  Yes

  No

• Please list all specialty piles, pile caps and components or Name of specialty order.

Field Risk Level Assessment

• Tasks

  Select Travel to and from site. Load & Unload Equipment Load & Unload Pipe/Pallets Lift & Install Piles Remove & Lay Down Piles Excavate, Dig, Move Load Soil or Aggregate Pump Concrete/Material Setting pump truck outriggers Unfold & fold pump truck boom Thread pump truck boom through door, access hole, or around obsticles Cut installed piles to grade Weld pile caps on site

  • Travel to and from site.
  • Load & Unload Equipment
  • Load & Unload Pipe/Pallets
  • Lift & Install Piles
  • Remove & Lay Down Piles
  • Excavate, Dig, Move Load Soil or Aggregate
  • Pump Concrete/Material
  • Setting pump truck outriggers
  • Unfold & fold pump truck boom
  • Thread pump truck boom through door, access hole, or around obsticles
  • Cut installed piles to grade
  • Weld pile caps on site

• Other Tasks

• Hazards

  Select Equipment Damage Building Damage Worker Injury or Death Strike Buried Service/Obsticle Load Shifting During Load/Unload Procedure Load Shifting During Transport Unstable Ground Conditions Cave In/Destabilization Obstacles To Unit Movment Overhead Lines Weather Conditions Other Road Users

  • Equipment Damage
  • Building Damage
  • Worker Injury or Death
  • Strike Buried Service/Obsticle
  • Load Shifting During Load/Unload Procedure
  • Load Shifting During Transport
  • Unstable Ground Conditions
  • Cave In/Destabilization
  • Obstacles To Unit Movment
  • Overhead Lines
  • Weather Conditions
  • Other Road Users

• Other Hazards

• Plans to Eliminate / Control Risk

  Select Wear/use appropriate personal protective equipment. Drive for weather conditions. Use defensive driving techniques. Use spotter when backing up. Use spotter in tight conditions. Use spotter to ensure proper loading/unloading alignment. Ensure proper line locate and exposure is done. Ensure cut backs / bunkers are used to prevent cave in. Secure load as loading/unloading when possible Secure load according to regulations. Inspect load secument while in transit Inspect chains and straps for damage before use. Inspect all lifting rigging and devices before use.

  • Wear/use appropriate personal protective equipment.
  • Drive for weather conditions.
  • Use defensive driving techniques.
  • Use spotter when backing up.
  • Use spotter in tight conditions.
  • Use spotter to ensure proper loading/unloading alignment.
  • Ensure proper line locate and exposure is done.
  • Ensure cut backs / bunkers are used to prevent cave in.
  • Secure load as loading/unloading when possible
  • Secure load according to regulations.
  • Inspect load secument while in transit
  • Inspect chains and straps for damage before use.
  • Inspect all lifting rigging and devices before use.

• Other Plans to Eliminate / Control Risk

Authorization And Client Signature

• Work Ordered By:

• Work Authorized By:

• Signature of Customer or Customer Representative On Site :

  Sign