Information
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Document No.
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Site / Location
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Client
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Client Representative
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Conducted on
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Prepared by
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Location
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Personnel
1.0-Pre-Job Safety Meeting
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1.1 JSA Complete and signed by all employees on location? Standard: API RP 54 6.1.7
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1.2 Job Hazards Identified? Standard: API RP 54 6.1.7
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1.3 Responsibilities Outlined and understood? Standard: GWPC Standard
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1.4 Restricted work area identified? Standard: 29 CFR 1910.1200(f)(5-6)
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1.5 Emergency plan in place and understood by all employees? Standard: OSHA 29 CFR 1910.38.(b)
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1.6 Evacuation / All clear alarm Standard: OSHA CFR 1910.38(d)
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1.7 Mentor assigned to SSE's? Standard: API RP 54.6.1.7
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1.8 SIMOPS coordinated through company man? Standard: API RP 54.6.1.7
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1.9 All persons sign in/out when entering/exiting location? Standard: OSHA CFR 1910.38(c)(4)
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1.10 All personnel using designated smoking area? Standard: API RP 54.1.2-3, OSHA 29 CFR 1910.145(c)(2)(i)
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1.11 Safety briefing area designated? Standard: OSHA 29 CFR 1910.38(c)(4)
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1.12 At least 2 people on location trained in CPR/First Aid? Standard:API RP 54 4.3.1, OSHA 29 CFR 1910.151(b)
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1.13 Are 2 people on location trained in well control? Standard: API RP 54 6.4.4, 20 AAC 25.527
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1.14 Personnel H2S Awareness Trained? Standard: API RP 49 5.1
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1.15 Other
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1.16 Other
2.0 Mandatory Safety Equipment
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2.1 FRC's Properly worn by all employees? (zipped up and sleeves rolled down) Standard: OSHA 29 CFR 1910.132, NFPA 2113
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2.2 Hard Hats (Plastic no metal) being worn by all employees? Standard: API RP 54 5.2.1, OSHA 29 CFR 1910.135(a)(1-2)
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2.3 Safety Glasses - All employees Standard: API RP 54 5.2.2, OSHA 29 CFR 1910.135(a)(1-5)
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2.4 Safety boots - All employees Standard: API RP 54 5.2.3, OSHA 29 CFR 1910.136(a)
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2.5 Gloves - All employees Standard: OSHA 29 CFR 1910.132(a)
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2.6 Hearing protection available? Standard: OSHA 29 CFR 1910.95
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2.7 Fall arrest system ( inspected and labels readable) Standard: OSHA 29 CFR 1910.66 App C(f), ANZI Z359.5 1.2
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2.8 Lanyards (inspected and labels readable) Standard: OSHA 29 CFR 1910.66 App C(f), ANZI Z359.5 1.2
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2.9 Hard hat and safety glasses available for visitors Standard: OSHA 29 CFR 1910 132(a)
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2.10 Other
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2.11 Other
3.0 Rig Up - General / Wellhead
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3.1 Spotter used when backing equipment. Standard: GWPC Standard
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3.2 20# Fire extinguisher located at left front bumper of each pice of equipment. Standard: API RP 54 7.2.4 & 5
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3.2(a) Fire extinguisher annual and monthly inspections current.
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3.3 Is Fall arrest system used while working in aerial lift? Standard: OSHA 29 CFR 1926.453(b)(2)(v)
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3.4 Is Fall arrest system used from heights greater than 4 ft? Standard: OSHA 29 CFR 1910.453(b)(2)(v)
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3.5 Do Personnel using forklifts and aerial lifts have current certification cards? Standard: OSHA 29 CFR 1910.178(i) & 1926.453(b)(2)(ii)
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3.6 Was an inspection done before use on Forklift? Standard: OSHA 29 CFR 1910.178(p)(7), API RPB56.6 6.5.1-2
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3.7 Is seat belt used while operating forklift? Standard: API RP B 56.1 5.3.19
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3.8 Are ropes used on hammer wrenches? Standard: GWPC Standard
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3.9 Are endless loops used to secure iron? (Ribs & Spine) Standard: GWPC Standard
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3.10 Are lubricators permanently marked with a serial #? Standard: API RP 54 13.6.5C
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3.11 Are Lubricator Certifications current? Standard: API RP 54 13.6.2
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3.12 BOP's Tested? Standard: API 54 6.4.1
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3.13 Are all bolts in place in all flanges? Standard: API RP 54 6.4.1
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3.14 Is caution tape put up around all High Pressure and crane working area? Standard:API RP 54 16.1.10
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3.15 Are all persons not involved in pressure testing standing outside the taped off area? Standard: API RP 54 16.1.10
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3.16 Are H2S Portable Detection Devices and chargers available in CT doghouse? Standard: API RP 49 3.4
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3.17 Are at least two employees wearing four gas Portable Detection Monitors? Standard: API RP 49 3.4
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3.18 Other
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3.19 Other
4.0 Rig Up (CT Unit)
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4.1 CT unit placed up wind of the well head? Standard: API RP 49 11.6.1, API RP 68 12.7.1
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4.2 Are steps leading to doghouse secure, level, and have hand rails with keeper pins in place? Standard: OSHA 29 CFR 1910.23 ,29 & 1910.36
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4.3 Are all railings in place and keeper pins in place? Standard: OSHA 29 CFR 1910.23(c)(1)
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4.4 Are all hydraulic lines in good condition and without leaks? Standard: GWPC Standard
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4.5 Are all pins and keepers in reel saddle? Standard: GWPC Standard
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4.6 Only necessary personnel in area when rigging up. Standard: GWPC Standard
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4.7 Is the injector gooseneck pinned? Standard: GWPC Standard
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4.8 Is there a field safety guide in the CT doghouse? Standard: GWPC Standard
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4.9 Are emergence phone numbers filled out and posted? Standard: API RP 54 4.2.1 - 49 7.6-7 - 54 7.7-8
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4.10 Current MSDS book in CT doghouse? Standard: OSHA 29 CFR 19101200(g)(1), API RP 54 6.1.12
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4.11 Current emergency response plan. Standard: GWPC Standard
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4.12 First Aid kit stocked and has a bloodborne pathogen kit. Standard: OSHA 29 CFR1910.151(b), API RP 54 4.3.2
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4.13 Fire extinguisher Monthly & Annual inspection current? Standard: OSHA 29 CFR 1910.157(e)(1), 1910.157(e)(2)
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4.14 Good housekeeping practices used? Standard: OSHA 29 CFR 1910.22(a)(1), 1910.141(a)(3)
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4.15 Other
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4.15 Other
5.0 Rig Up (N2 Pump)
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5.1 Iron certifications current? Standard: API RP 54 12.5.1
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5.2 Hammer unions in goos shape and not mushroomed. APIRP 54 12.5.1
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5.2 Are steps leading to doghouse secure, level, and have hand rails with keeper pins in place? Standard: OSHA 29 CFR 1910.23 ,29 & 1910.36
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5.3 N2 PPE being used? (safety glasses, face shield and proper gloves) Standard: Osha 29 CFR 1910.133(a)(1) - 1910 138(a)
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5.4 Other
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5.5 Other
6.0 Rig Up (Fluid Pump)
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6.1 Are steps leading to doghouse Secure,Level, Have hand rails with keeper pins in place? Standard: OSHA 29 CFR 1910.23 ,29 & 1910.36
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6.2 Iron certification current? Standard: API RP 54 12.5.1
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6.3 Hammer unions in goos shape and not mushroomed. APIRP 54 12.5.1
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6.4 All chemicals labeled and MSDS's on location. Standard: OSHA 29 CFR 1910.1200(b)(1)
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6.5 All bagged materials stacked properly? Standard: OSHA 29 CFR 1910.176(b)
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6.6 Assessment for respirator conducted? Standard: OSHA 29 CFR 1910.134(b)(1-3), API RP 54 5.4.1
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6.7 Personnel wearing proper PPE per MSDS? Standard: OSHA 29 CFR 1910.1200(B)(1)
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6.8 Other
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6.9 Other
7.0 Rig Up (Crane)
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7.1 Lifting slings inspected and labels readable. Standard: OSHA 29 CFR 1910.184 - 1910.112(b)
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7.2 Chains inspected and tagged Grade 8 or better. Standard: OSHA 29 CFR 1910.112(c) - 1910.184
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7.3 Tag-lines inspected and used when lifting. Standard: OSHA 29 CFR 1910.180 (h)(3)(vi), API RP 54 6.2.12
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7.4 Only one person signaling crane operator. Industry Standard
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7.5 Outriggers fully extended and approved pads under them. Standard: OSHA 29 CFR 1910.180(h)(3)(i)(a)
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7.6 Outrigger Floats secured with pad pins. Standard: OSHA 29 CFR 1910.180(h)(3)(iv)
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7.7 Cones or CAUTION tape designating the cranes swing path. Standard: OSHA 29 CFR 1910.180(h)(3)(iii)[b]
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7.8 Hydraulic system has no apparent leaks. Standard: OSHA 29 CFR 1910.180(d)(3)(iv)
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7.9 Air system has no audible leaks. Standard: OSHA 29 CFR 1910.180(d)(3)(iv)
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7.10 Boom exhibits no damage to structure.(wear pads, boom, stops, or cylinders) Standard: OSHA 29 CFR 1910.180(h)(3)(ix)
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7.11 Wire rope free of dirt, excess lube, kinks, and spooled properly. Standard: OSHA 29 CFR 1910.180(g)
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7.12 Block in good condition and greased. Standard: Per Manufacture
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7.13 No damage to the hook and it swivels freely. Standard: OSHA 29 CFR 1910.180(d)(3)(v)
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7.14 All guards in place. Standard: OSHA29 CFR 1910. 212(a)(1)
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7.15 All hand rails in place, secured and not damaged. OSHA 29 CFR 1910.21(f)(10)
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7.16 Cab glass free of cracks and wipers working properly. Standard: Per Manufacture.
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7.17 Anti-two block in place and functioning. Standard: OSHA 29 CFR 1910.180(b)(3)(iii)
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7.18 All lights and horn working properly. Standard: OSHA 29 CFR 1910.180(b)(3)(iii)
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7.19 Fire extinguisher monthly / annual current. Standard: OSHA 29 CFR 1910.157(e)(1) & (e)(2), 1910.180(i)(5)(i) API RP 54 16.1.10
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7.20 Daily crane inspection filled out. Standard: OSHA 29 CFR 1910.180(d)(2)(i)
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7.20 Annual inspection current. Standard: OSHA 29 CFR1910.180(d)(2)(ii)
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7.21 Operators manual in cab. Standard: Per Manufacture
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7.22 Load chart legible and visible to operator. Standard: OSHA 29 CFR 1910.180(c)(2)
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7.23 Hand signal chart visible to workers. Industry Standard
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7.24 Hand held wind sped indicator available. Industry Standard
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7.25 Other
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7.26 Other
8.0 Job Execution
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8.1 Supervisor / PIC identified and in control? Standard: GWPC Standard
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8.2 Do employees work as a team? Standard: GWPC Standard
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8.3 Are there any equipment failures?
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8.4 Are regular checks of equipment done? Standard: API RP 54 8.3.3
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8.5 Are tools in good working order? API RP 54 6.8.6
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8.6 NO homemade tools on location. Industry Standard
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8.7 General housekeeping Standard: OSHA 29 CFR 1910.22(a)(1), API RP 54 6.5.1
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8.8 Fluid leaks on equipment contained EPA Standard
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8.9 Spill Kit Easily accessible Standard: GWPC Standard
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8.10 Spill containment in place.
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8.11 Safety procedures followed.
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8.12 Other
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8.13 Other
9.0 Outside Of Equipment.
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9.1 Is Equipment clean? Standard: GWPC Standard
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9.2 Fuel Tanks (Caps, Straps, Mounts) in place and in good condition. Standard: API RP 54 8.3.3
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9.3 Fuel, hydraulic, and other tanks properly labeled. Standard: OSHA 29 CFR 1910.1200(f)(5)
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9.4 All Belts, Chains, and rotating parts have guards in place. Standard: OSHA 29 CFR 1910.212(a)(2), API RP 54 .8.2-3
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9.5 All hoses on equipment in good condition. Standard: OSHA 29 CFR 1910.5(a)(1)
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9.6 At least one axle on each pice of equipment chocked. Standard: API RP 54 11.1.2
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9.7 Trailer plugs, wires, and chains in good condition and show no signs of damage. Standard: DOT
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9.8 Break away cables on light duty trailers connected and working properly. Standard: DOT
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9.9 Tool / parts boxes uncluttered and lids are able to close and lock.
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9.10 All loose items on trailers are able to be secured.
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9.11 Other
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9.12 Other
10.0 CT Unit Tractor Standard: 49 CFR (DOT)
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Picture of vehicle.
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10.1 Tractor equipment number.
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10.2 Name of GWPC employee who drove CT Unit to location.
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10.3 Does driver have a current driver's license and proper endorsements to operate vehicle?
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10.4 Does driver have a current medical card?
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10.5 Is driver's log book current?
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10.6 If the load is placarded, does the driver have the proper endorsements?
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10.7 Is there a copy of M-938 (map) in the cab?
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10.8 Is there a copy of the previous day's DVIR in the cab?
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10.9 Is the cab clean and free of trash?
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10.10 Are the windows clean and free of cracks that might impair the driver's ability to see?
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10.11 Are the mirrors clean and free of cracks that might impair the driver's ability to see?
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10.12 Is the fire extinguisher accessible, fully charged, and secured?
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10.12(a) Does the fire extinguisher have a current annual and monthly inspection?
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10.13 Are the emergency triangles present and stored properly?
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10.14 Are the vehicle's registration and insurance cards in the cab and current?
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10.15 Is there a copy of the Federal Motor Carrier Safety Regulation (green book) and a copy of the Emergency Response Guidebook (orange book) in the cab?
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10.16 Are shipping papers/Bills of Lading (w/MSDS sheets) in the cab?
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10.17 Are headlights, marker lights, and til lights clean and free from cracks or other visible damage?
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10.18 Are the license plates on the truck and trailer mounted properly and legible?
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10.19 Is the IFTA decal current and visible on both side of the tractor?
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10.20 Is the company name and DOT number visible on both side of the tractor?
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10.21 Are the tractor and trailer equipment numbers visible?
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10.22 Are fuel tanks free from leaks and equipped with caps?
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10.23 Are mud flaps present where required?
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10.24 If the vehicle is over width, are there flags on the widest points and oversize banners on front and rear?
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10.25 Are tires free of excessive wear and damage? (tread 4/32 steer, 2/32 others)
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10.26 Are all rims in good condition and free of bends and cracks?
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10.27 Are all placards in good condition and and visible on all four sides?
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10.28 Are electrical wires in good shape with no frays,cracks, or cuts?
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10.29 Other
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10.30 Other
11.0 Fluid Pump Tractor Standard: 49 CFR (DOT)
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Picture of vehicle.
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11.1 Tractor equipment number.
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11.2 Name of GWPC employee who drove Fluid Pump to location.
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11.3 Does driver have a current driver's license and proper endorsements to operate vehicle?
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11.4 Does driver have a current medical card?
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11.5 Is driver's log book current?
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11.6 If the load is placarded, does the driver have the proper endorsements?
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11.7 If the vehicle is a permitted load, is there a copy of M-938 (map) in the cab?
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11.8 Is there a copy of the previous day's DVIR in the cab?
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11.9 Is the cab clean and free of trash?
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11.10 Are the windows clean and free of cracks that might impair the driver's ability to see?
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11.11 Are the mirrors clean and free of cracks that might impair the driver's ability to see?
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11.12 Is the fire extinguisher accessible, fully charged, and secured?
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11.12(a) Does the fire extinguisher have a current annual and monthly inspection?
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11.13 Are the emergency triangles present and stored properly?
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11.14 Are the vehicle's registration and insurance cards in the cab and current?
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11.15 Is there a copy of the Federal Motor Carrier Safety Regulation (green book) and a copy of the Emergency Response Guidebook (orange book) in the cab?
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11.16 Are shipping papers/Bills of Lading (w/MSDS sheets) in the cab?
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11.17 Are headlights, marker lights, and til lights clean and free from cracks or other visible damage?
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11.18 Are the license plates on the truck and trailer mounted properly and legible?
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11.20 Is the company name and DOT number visible on both side of the tractor?
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11.21 Are the tractor and trailer equipment numbers visible?
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11.22 Are fuel tanks free from leaks and equipped with caps?
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11.23 Are mud flaps present where required?
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11.24 If the vehicle is over width, are there flags on the widest points and oversize banners on front and rear?
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11.25 Are tires free of excessive wear and damage? (tread 4/32 steer, 2/32 others)
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11.26 Are all rims in good condition and free of bends and cracks?
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11.27 Are all placards in good condition and and visible on all four sides?
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11.28 Are electrical wires in good shape with no frays,cracks, or cuts?
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11.29 Other
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11.30 Other
12.0 N2 Tractor Standard: 49 CFR (DOT)
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Picture of vehicle.
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12.1 Tractor equipment number.
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12.2 Name of GWPC employee who drove N2 Unit to location.
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12.3 Does driver have a current driver's license and proper endorsements to operate vehicle?
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12.4 Does driver have a current medical card?
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12.5 Is driver's log book current?
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12.6 If the load is placarded, does the driver have the proper endorsements?
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12.7 If the vehicle is a permitted load, s there a copy of M-938 (map) in the cab?
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12.8 Is there a copy of the previous day's DVIR in the cab?
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12.9 Is the cab clean and free of trash?
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12.10 Are the windows clean and free of cracks that might impair the driver's ability to see?
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12.11 Are the mirrors clean and free of cracks that might impair the driver's ability to see?
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12.12 Is the fire extinguisher accessible, fully charged, and secured?
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12.12(a) Does the fire extinguisher have a current annual and monthly inspection?
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12.13 Are the emergency triangles present and stored properly?
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12.14 Are the vehicle's registration and insurance cards in the cab and current?
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12.15 Is there a copy of the Federal Motor Carrier Safety Regulation (green book) and a copy of the Emergency Response Guidebook (orange book) in the cab?
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12.16 Are shipping papers/Bills of Lading (w/MSDS sheets) in the cab?
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12.17 Are headlights, marker lights, and til lights clean and free from cracks or other visible damage?
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12.18 Are the license plates on the truck and trailer mounted properly and legible?
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12.19 Is the IFTA decal current and visible on both side of the tractor?
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12.20 Is the company name and DOT number visible on both side of the tractor?
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12.21 Are the tractor and trailer equipment numbers visible?
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12.22 Are fuel tanks free from leaks and equipped with caps?
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12.23 Are mud flaps present where required?
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12.24 If the vehicle is overwidth, are there flags on the widest points and oversize banners on front and rear?
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12.25 Are tires free of excessive wear and damage? (tread 4/32 steer, 2/32 others)
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12.26 Are all rims in good condition and free of bends and cracks?
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12.27 Are all placards in good condition and and visible on all four sides?
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12.28 Are electrical wires in good shape with no frays,cracks, or cuts?
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12.29 Other
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12.30 Other
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12.27 Are all placards in good condition and and visible on all four sides?
13.0 Crane Tractor Standard: 49 CFR (DOT)
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Picture of vehicle.
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13.1 Tractor equipment number.
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13.2 Name of GWPC employee who drove Crane to location.
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13.3 Does driver have a current driver's license and proper endorsements to operate vehicle?
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13.4 Does driver have a current medical card?
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13.5 Is driver's log book current?
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13.6 If the load is placarded, does the driver have the proper endorsements?
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13.7 If the vehicle is a permitted load, s there a copy of M-938 (map) in the cab?
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13.8 Is there a copy of the previous day's DVIR in the cab?
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13.9 Is the cab clean and free of trash?
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13.10 Are the windows clean and free of cracks that might impair the driver's ability to see?
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13.11 Are the mirrors clean and free of cracks that might impair the driver's ability to see?
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13.12 Is the fire extinguisher accessible, fully charged, and secured?
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13.12(a) Does the fire extinguisher have a current annual and monthly inspection?
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13.13 Are the emergency triangles present and stored properly?
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13.14 Are the vehicle's registration and insurance cards in the cab and current?
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13.15 Is there a copy of the Federal Motor Carrier Safety Regulation (green book) and a copy of the Emergency Response Guidebook (orange book) in the cab?
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13.16 Are shipping papers/Bills of Lading (w/MSDS sheets) in the cab?
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13.17 Are headlights, marker lights, and til lights clean and free from cracks or other visible damage?
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13.18 Are the license plates on the truck and trailer mounted properly and legible?
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13.19 Is the IFTA decal current and visible on both side of the tractor?
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13.20 Is the company name and DOT number visible on both side of the tractor?
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13.21 Are the tractor and trailer equipment numbers visible?
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13.22 Are fuel tanks free from leaks and equipped with caps?
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13.23 Are mud flaps present where required?
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13.24 If the vehicle is over width, are there flags on the widest points and oversize banners on front and rear?
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13.25 Are tires free of excessive wear and damage? (tread 4/32 steer, 2/32 others)
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13.26 Are all rims in good condition and free of bends and cracks?
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13.27 Are all placards in good condition and and visible on all four sides?
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13.28 Are electrical wires in good shape with no frays,cracks, or cuts?
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13.29 Other
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13.30 Other
14.0 BOP Truck Standard: 49 CFR (DOT)
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Picture of vehicle.
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14.1 Equipment Number
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14.2 Name of GWPC employee who drove Crane to location.
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14.3 Does driver have a current driver's license and proper endorsements to operate vehicle?
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14.4 Does driver have a current medical card?
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14.5 Is driver's log book current?
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14.6 If the load is placarded, does the driver have the proper endorsements?
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14.7 If the vehicle is a permitted load, s there a copy of M-938 (map) in the cab?
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14.8 Is there a copy of the previous day's DVIR in the cab?
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14.9 Is the cab clean and free of trash?
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14.10 Are the windows clean and free of cracks that might impair the driver's ability to see?
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14.11 Are the mirrors clean and free of cracks that might impair the driver's ability to see?
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14.12 Is the fire extinguisher accessible, fully charged, and secured?
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14.12(a) Does the fire extinguisher have a current annual and monthly inspection?
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14.13 Are the emergency triangles present and stored properly?
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14.14 Are the vehicle's registration and insurance cards in the cab and current?
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14.15 Is there a copy of the Federal Motor Carrier Safety Regulation (green book) and a copy of the Emergency Response Guidebook (orange book) in the cab?
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14.16 Are shipping papers/Bills of Lading (w/MSDS sheets) in the cab?
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14.17 Are headlights, marker lights, and til lights clean and free from cracks or other visible damage?
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14.18 Are the license plates on the truck and trailer mounted properly and legible?
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14.19 Is the IFTA decal current and visible on both side of the tractor?
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14.20 Is the company name and DOT number visible on both side of the tractor?
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14.21 Are the tractor and trailer equipment numbers visible?
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14.22 Are fuel tanks free from leaks and equipped with caps?
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14.23 Are mud flaps present where required?
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14.24 If the vehicle is over width, are there flags on the widest points and oversize banners on front and rear?
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14.25 Are tires free of excessive wear and damage? (tread 4/32 steer, 2/32 others)
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14.26 Are all rims in good condition and free of bends and cracks?
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14.27 Are all placards in good condition and and visible on all four sides?
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14.28 Are electrical wires in good shape with no frays,cracks, or cuts?
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14.29 Other
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14.30 Other
15.0 Post Job
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15.1 Is area policed and all trash picked up? Standard: GWPC Standard
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15.2 Are all spills cleaned up before leaving location? Standard: GWPC Standard
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15.3 Location Clean after equipment is removed from location? Standard GWPC Standard
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15.4 Are Drivers Logs current? Standard: DOT & GWPC Standard
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15.5 Has a journey management been conducted? Standard: GWPC Standard
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Comments
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PIC Signature
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Auditors Signature