IPS Site Audit

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Vehicles- Pre-Trip

• A Pre-Trip inspection was conducted on vehicle before beginning the trip?

  Yes

  No

  N/A

• <br>A Journey management meeting was conducted and documented before beginning the trip?

  Yes

  No

  N/A

• Equipment and supplies are secured by a cargo net or properly strapped?

  Yes

  No

  N/A

• Tractor and trailer paperwork is in the tractor cab?

  Yes

  No

  N/A

• Drivers record of duty status is current indicating last status change?

  Yes

  No

  N/A

• Registration current on trailer and tractor?

  Yes

  No

  N/A

• Annual inspection is current on tractor and trailer?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Vehicle Interior

• Registration in cab and current?

  Yes

  No

  N/A

• Insurance certificate in cab and current?

  Yes

  No

  N/A

• 5# Fire extinguisher in cab and properly mounted?

  Yes

  No

  N/A

• Safety triangles in vehicle, in good condition and properly mounted?

  Yes

  No

  N/A

• Hazardous Material paperwork and bill of laden in vehicle door?

  Yes

  No

  N/A

• Accident kit in vehicle?

  Yes

  No

  N/A

• Spare fuses and spare bulbs in vehicle?

  Yes

  No

  N/A

Pre-Job safety

• Job hazards identified based on services to be performed?

  Yes

  No

  N/A

• PIC-Person in charge was identified?

  Yes

  No

  N/A

• JSA was completed properly and signed by all crew members?

  Yes

  No

  N/A

• Responsibilities/ Task outlined and delegated to responsible person ?

  Yes

  No

  N/A

• Restricted work areas identified?

  Yes

  No

  N/A

• Crew is working safely ?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Safety Equipment used

• Hard hats?

  Yes

  No

  N/A

• Safety glasses?

  Yes

  No

  N/A

• Hand protection/ gloves?

  Yes

  No

  N/A

• Hearing protection?

  Yes

  No

  N/A

• Respiratory protection?

  Yes

  No

  N/A

• Gas monitors?

  Yes

  No

  N/A

• Fire extinguishers?

  Yes

  No

  N/A

• Safety Harness available? Inspected / Current

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Rig Up

• Equipment placement / layout acceptable?<br>

  Yes

  No

  N/A

• Iron certification current?

  Yes

  No

  N/A

• Whip checks on iron?

  Yes

  No

  N/A

• Injector head / BOPS secured properly?

  Yes

  No

  N/A

• 20# Fire extinguishers placed at the left front corner of each piece of equipment ?

  Yes

  No

  N/A

• Crane inspection conducted?

  Yes

  No

  N/A

• Guard rails installed correctly and pinned?

  Yes

  No

  N/A

• Lift sling condition? Identification tags attached?

  Yes

  No

  N/A

• Injector gooseneck pinned?

  Yes

  No

  N/A

• Well head bolted properly?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

CT Operators Cab

• 5# Fire Extinguisher in cabin?

  Yes

  No

  N/A

• MSDS'S in cabin for chemicals on site?

  Yes

  No

  N/A

• Field safety manual available?

  Yes

  No

  N/A

• First aid kit available and properly stocked?

  Yes

  No

  N/A

• Emergency response plane available inclusive of emergency phone numbers available?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Job Execution

• Job started on time?

  Yes

  No

  N/A

• Employees working as a team?

  Yes

  No

  N/A

• Tools in good working order?

  Yes

  No

  N/A

• Regular check of equipment conducted?

  Yes

  No

  N/A

• Trash picked up? Good housekeeping?

  Yes

  No

  N/A

• Spill kit available in each unit?

  Yes

  No

  N/A

• Spill containment available?

  Yes

  No

  N/A

• Any visible leaks on equipment?

  Yes

  No

  N/A

• High pressure areas flagged or taped?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Outside of Equipment

• Is equipment clean?

  Yes

  No

  N/A

• IFTA decals attached and in good condition?

  Yes

  No

  N/A

• Vehicle equipment number attached and in good condition?

  Yes

  No

  N/A

• Company logo / DOT number attached and in good condition?

  Yes

  No

  N/A

• Mirrors in good condition?

  Yes

  No

  N/A

• Lights and reflectors attached, working and in good condition?<br>Including License plate lights working?

  Yes

  No

  N/A

• License plates readable and in good condition?

  Yes

  No

  N/A

• Windshield wipers I work and in good condition?

  Yes

  No

  N/A

• Windshield in good condition, free of cracks and distortions?

  Yes

  No

  N/A

• Turn and emergency signals working and in good condition?

  Yes

  No

  N/A

• Fuel tanks, tank mounts, tank caps all attached and in good condition?

  Yes

  No

  N/A

• Chock blocks in vehicle?

  Yes

  No

  N/A

• Placards firmly attached and in good condition and properly mounted and displayed?

  Yes

  No

  N/A

• Mud flaps attached and in good condition?

  Yes

  No

  N/A

• Tire chains in vehicle?

  Yes

  No

  N/A

• Tool boxes uncluttered and have secure kids?

  Yes

  No

  N/A

• 2-20# fire extinguishers on vehicle

  Yes

  No

  N/A

Post Job Responsibilities

• Area policed and cleaned up?

  Yes

  No

  N/A

• All spills cleaned up?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Audit Comments

• Supervisor comments.

  Yes

  No

  N/A

• Company man comments

  Yes

  No

  N/A

• Site auditor comments.

  Yes

  No

  N/A