Company Info

Conferred with:

Description of Operations

Job Site Visit

  • Job Site Visit Completed

  • Job site visit not conducted due to:

  • Job Site Specific Observations

Employee Screening

  • Who does the screening?

  • Screening methods

  • Written Application?

  • Criminal Background Check

  • MVR Check?

  • Past employer references?

  • Interview?

  • Pre-employment physical?

  • Pre-employment drug screening?

  • Probationary Period?

  • Random Drug and Alcohol Screening?

  • Does insured use a consortium for drug screening? If so, which one?

  • Post Accident Drug Screening

  • Reasonable Cause Drug Screening?

Oil & Gas Specifics

Oil & Gas Services

  • Drilling

  • Drilling contractors usually have 3 shifts of drill employees that would consist of a motorman, general laborer, driller (who operates the drill controls), derrick man ( who works from heights on the rig tower), mud tender (who maintains drilling mud materials in the mud tanks), tool pusher and drilling superintendent. Exposures for a drilling contractor would include: fire and explosion hazards, falling objects hazards, fall hazards, back injuries, lifting heavy objects, rotating machinery hazards, being struck by heavy objects, overhead hazards, hose ruptures, exposures to muds and drilling fluids, unguarded machinery hazards, electrical hazards and flying objects.

  • Roustabout Services

  • General maintenance, painting, fence installation and repair, plumbing, changing drive belts, minor pump repair, packing bearings, changing out drive motors, replacement and repair of gathering lines.

  • Lease Operator Services

  • Placing the pump on the well, contracting with lease workers, contracting with trucking operations, contracting to set tank batteries.

  • Pumper/ Gauger Services

  • Routinely Check tank batteries for fluid levels, check on wells and compressor facilities, report gauged tank fluid levels, check well site for security, packing pump bearings with grease, changing drive belts, replacing fuses in electrical fuse boxes, repacking above- ground valves and minor repair and replacement of above ground plumbing and connections.

    Exposures for these employees include: falls from heights, H2S inhalation, rotating machinery hazards, electrical hazards, caught in between moving counterweights, fire hazards from propane powered pumping units.

  • Fluid Hauling Services

  • Hauls water from well tank batteries to disposal wells, hauls oils. Exposures include: over the road exposures, operating in remote locations, fatigued driving, distracted driving, chemical exposures, large animals (wells on cattle ranches).

  • Well work-over

  • Rig up a work over unit, pulls well heads, swabs, pulls out production tubing and rods, hook up well pumps, installs production tubing, set packers, cements casing.
    Exposures include: fire, rotating machinery hazards, overhead hazards, H2S hazards, perforating operations hazards, over the road driving hazards, exposures to chemicals, inclement weather hazards, high turnover.

  • Dirt construction

  • Construction of lease roads, digging of slush pits, preparation of drilling site, excavation and back filling of gathering lines, construct dikes, clearing of pipeline easements.
    Exposures include: heavy equipment hazards, fire, explosions, cave-ins, under ground utilities hazards, over the road driving hazards.

Operator of Wells

  • Does the insured operate any wells?

  • Does insured assume any liability of contractors performing seismic operations on their behalf?

  • Does insured use IADC contract for drillers?

  • Other types of drilling contracts

  • Will any wells drilled have fracking?

  • Are any of the wells in PA, WV, or NY?

  • How many wells will involve fracking?

  • Are all wells fenced and dyked with an approved containment system?

  • Is there a formal spill prevention plan in effect?

  • Is there a formal emergency response plan in effect?

  • Are any wells near rivers, streams, lakes, etc?

  • How many?

  • Is a well maintenance program in effect that checks all storage tanks, flow lines, and equipment on a regular basis?

  • How often?

  • Are all tanks equipped with lightning protection equipment?

  • What type?

  • Are any explosives hazardous materials kept at well sites?

  • Any off shore or wet operations?

  • Environmental impact studies done on any newly acquired wells?

Well Servicing/ Workover

  • Does the insured do well servicing and/ or workover?

  • Cleaning/ swabbing?

  • Acidizing/ Fracking?

  • Hot Oiling?

  • Wireline/ Logging?

  • Installation or removal of casing?

  • Setting of packers?

  • Squeezing jobs?

  • Shooting?

  • Cementing?

  • Perforating?

  • Refinery of petrochemicals?

  • Welding/ cutting?

  • Painting, sandblasting, or tank cleaning?

  • General lease work?

  • Pipeline construction?

  • Type: steel or poly

  • Type: gathering or transmission

  • Type: oil or gas

  • Type: new construction or repair

H2S Wells and Salt Water Disposal Wells

  • Does the insured own any H2S wells?

  • Are all employees and contractors trained and certified on H2S awareness on an annual basis?

  • Are all H2S well sites marked with proper warning signs?

  • Do any well sites have H2S concentration levels of 10 ppm or higher?

  • Are any wells inside city limits?

  • Are gas detection devices in place?

  • Are wells fenced and gated?

  • How close is the nearest home or building?

  • Who is responsible for monitoring H2S detection devices?

  • How often are wells checked?

  • Does the insured own any disposal wells?

  • Site name and address:
  • How many acres are owned at this site?

  • Is the property fenced and gated?

  • Is the site for 3rd party use?

  • Is the site lighted and posted?

  • Is there 24/7 personnel at the site?

  • Is there a formal spill prevention plan?

  • Is there an approved containment system?

  • Are any hazardous materials accepted at the sites?

  • Is there a gathering system over 6 inches?

  • Is the facility operated and maintained by employees?

  • Does the insured haul saltwater to the disposal site?

  • Surrounding exposures:

Supplying of Gas

  • Does the insured supply gas to customers?

  • Commercial or residential customers?

  • Is there a pressure regulator for each tap?

  • Is there a written Hold Harmless agreement in place?

Hydraulic Fracturing

  • Does the insured conduct hydraulic fracturing (fracking)?

  • Details:

Sub-contractors & Tools

Sub-contractors

  • Does the insured use the services of sub-contractors?

  • Types used:

  • Are certificates of insurance required and on file?

  • Does the insured require a minimum of $1 million for a sub-contractor's General Liability coverage?

  • Is there a written Hold Harmless agreement with each sub-contractor?

  • Does the insured have an approved contractor list?

  • Does the insured have Master Service Agreements with all approved contractors?

Equipment and Tools

  • Does the insured have any specific equipment or tools necessary to their line of work?

  • Types:

  • Is there a formal preventative maintenance program?

Safety

Safety

  • Is there a designated Safety Director?

  • Name of Safety Director?

  • Is there an Emergency Action Plan?

  • Is is reviewed regularly?

  • Reviewed by:

  • Is there a Safety Incentive Program?

  • Does the insured conduct Safety Meetings?

  • Are the meetings documented?

  • How often are meetings conducted?

  • Does the insured conduct Employee Safety Training?

  • Employees Safety Training provided by:

  • Does the insured conduct:

  • New Hire Orientation?

  • H2S training?

  • HAZCOM training?

  • Fall Hazard training?

  • Lockout/ Tagout training?

  • Blood borne pathogen training?

  • First Aid/ CPR?

  • Defensive Driving?

  • Respirator training?

  • Noise/ hearing conservation?

  • Manual Lifting?

  • Office ergonomics?

  • PPE provided:

Facilities

Premises

  • Owned or leased?

  • Years at location?

  • Neighborhood is:

  • Estimated age of building(s):

  • Number of stories:

  • Square footage:

  • Type of construction:

  • Condition of structure:

  • Number of buildings at facility:

  • Air conditioned?

  • Electrical GFCI?

  • Any adjacent properties?

Fire Protection

  • Fire extinguishers?

  • Service interval and last service date:

  • Smoke Detectors?

  • Service interval/ inspection:

  • Pull Stations?

  • Fire Alarm?

  • Sprinkler system?

  • Standpipe or hydrant?

  • Smoking allowed in buildings?

Security

  • Building security:

  • Burglar alarms?

  • Yard security:

  • Worksite security:

Premises Liability- General

  • Vandalism and malicious potential exists?

  • Other tenants occupy?

  • Chemical storage?

  • Clients/ general public access to facilities?

  • Tours of facility given to others?

  • Authorized personnel only allowed on premises?

  • Are restricted areas posted?

  • Vacant buildings on premises?

  • Watch dogs on premises?

  • Elevators/ hoists/ cranes?

  • Condition of facility:

  • Exits marked and unobstructed?

  • Interior conditions:

  • Slip and fall hazards?

  • Walkway hazards/ parking area hazards?

  • Condition of structure:

  • Neighborhood is:

  • Premises maintained and in good condition?

Product Liability Exposure

  • Does the insured sell any items?

Workers Compensation

Workers Compensation

  • Does the insured have a formal return to work program?

  • Who administers the return to work program?

  • Does the insured have formal accident investigation procedures?

  • Who conducts the investigation?

  • Does the insured have formal accident reporting procedures?

  • Who investigates near misses?

  • Who conducts/ provides safety training?

  • OSHA 300 log maintained by whom? What was on the log for the past year?

  • Are employees exposed to high noise levels?

  • Are employees exposed to chemicals or drilling mud?

  • Are employees exposed to dust or fumes?

  • Are there high concentrations of employees at a site?

  • Are there any know occupational diseases associated with your work?

  • Are employee benefits paid by the company?

  • Are employees required to do any manual lifting?

  • Are there any office employees?

  • Are employees exposed to any radioactive substances?

  • Does the insured do any Hot Shot (expedited) delivery for others?

  • Are any employees on call after hours?

  • Does insured have a respirator program?

  • Are employees exposed to heights greater than 6 feet?

  • Does the insured have seasonal hires?

  • Does the insured lease employees to other companies?

  • Are employees required to work over water?

Company Auto

Company Auto

  • How many authorized drivers?

  • How many CDL drivers?

  • Any drivers with less than 1 year of service?

  • Driver Qualification files maintained?

  • MVRs checked?

  • By whom? How often?

  • Any employees on the Do Not Drive list?

  • How is the Do Not Drive list maintained?

  • Is there personal use of company vehicles?

  • Is there a written policy in effect and signed by the driver?

  • Are family members allowed to operate company vehicles?

  • Vehicle count/ type?

  • Vehicles owned or leased?

  • Average radius of travel:

  • Does the insured do any trucking/ hauling for others?

  • Tow truck operations?

  • Haul hazardous materials? ( vehicles require placards )

  • Does insured have HAZMAT trained drivers?

  • Does insured transport employees to job sites in company vehicles?

  • Does insured pick up employees at home with company vehicles?

  • Haul commodities?

  • Does insured use any non-owned or hired autos?

  • Are employees required to use personal vehicles for work purposes?

  • Does insured require employees to maintain a minimum of $500,000.00 and provide proof that is maintained in office?

  • Where are company vehicles stored?

  • Does each company vehicle have an accident reporting kit ?

  • Do all company vehicles have cameras inside or do company drivers have cell phones with camera capabilities?

  • Do company vehicles have Roadside Emergency Equipment?

  • Does insured have a Hands Free/ Distracted Driver policy in effect?

  • Who maintains the company fleet?

  • Is there a written vehicle preventative maintenance program in effect?

  • Who maintains documentation?

Risk Quality

Risk Quality

General Liability

  • Exposures consist of fire, explosion, H2S, no written contracts, livestock damage, ungrounded tanks and electrical equipment, poor workmanship, damage to others' property, unauthorized personnel on site, lack of signage, no emergency action plan, no fluid containment, transporting explosives, radioactive equipment, ground contamination, remote locations

Company Auto

  • Exposures consist of: head on collisions, side impact collisions, rear end collisions, impacts with animals, running off the road,distracted driving, fatigued driving, driving at night, driving in inclement weather, unauthorized drivers, other drivers

Workers Compensation

  • Exposures for well operators include: fires, rotating machinery hazards, H2S, fall hazards, hazards associated with propane powered drive units, driving hazards

    Exposures for drillers and workover crews include: fire, explosion, falling objects, overhead hazards, slip and fall hazards, manual lifting injuries, caught in between heavy equipment, rotating machinery hazards, unguarded machinery, driving hazards

    Exposures for welders include: fire, explosions, poor ventilation, eye flash hazards,

    Exposures for cementing include: fire, explosions, pressure fitting rupture, dust inhalation, cement/ skin contact, exposures associated with drilling

    Exposures for pipeline testing include: lifting injuries, caught between injuries, pressurized line hazards

    Exposures for Specialty tool operations include: lifting injuries, leg and hand injuries, falling objects, slip and fall hazards, over the road driving injuries

    Exposures for pipeline installations include: heavy equipment hazards, unguarded machinery, fire, underground utilities, worn or damaged equipment, cave in hazards, hauling heavy equipment over the road

    Exposures of casing crews include: fire, explosion, delayed detonation of perforating charges, handling unused explosives, falling objects, slip and fall hazards, hazards associated with being on call 24/7, over the road driving hazards

    Exposures of wireline/ logging operations include: premature detonation of explosives, delayed detonation, radioactive materials, fire, explosions, over the road driving

Environmental Impairment Liability

  • Exposures to environmental impairment include: pipeline breaks, tank truck accidents/ spills, tank battery leakage, excavation of sensitive areas,

Final Assessment

Loss Information

  • Loss information:

Management Assessment

  • Loss Control Opinion of Risk:

Recommendations

  • Recommendations:

Comments

  • Additional remarks:

Future Service

  • Follow up items:

Service Plan Schedule and Deliverables

  • Task 1

  • Month scheduled

  • Required task/ deliverable:

  • Due date:

  • Follow up required?

  • Task 2

  • Month scheduled

  • Required task/ deliverable:

  • Due date:

  • Follow up required?

  • Task 3

  • Month scheduled

  • Required task/ deliverable:

  • Due date:

  • Follow up required?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.