IPS Well Site Audit v2

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Vehicles- Pre-Trip

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

  Yes

  No

  N/A

• 2. Up to date drivers log book- last duty status entered.

  Yes

  No

  N/A

• <br>3. A Journey management meeting was conducted and documented before beginning the trip?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 5. Tractor and trailer paperwork is in the tractor cab?

  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

• 6. Spill kit in at least one vehicle.

  Yes

  No

  N/A

• 7. Other?

  Safe

  At Risk

  N/A

Pre-Job safety Meeting

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

  Yes

  No

  N/A

• 9. Job hazards identified based on services to be performed?

  Yes

  No

  N/A

• 10. Responsibilities/ Task outlined and delegated to responsible person ?

  Yes

  No

  N/A

• 11. Restricted work areas identified?

  Yes

  No

  N/A

• 12. Emergency response plan in place and understood by all employees.

  Yes

  No

  N/A

• 13. Evacuation/All-Clear alarms

  Yes

  No

  N/A

• 14. SSE Assigned a mentor?

  Yes

  No

  N/A

• 15. SIMOPS Coordinated through company man?

  Yes

  No

  N/A

• 16. All personnel sign in / out when entering / exiting location?

  Yes

  No

  N/A

• 17. Personnel using designated smoking areas?

  Yes

  No

  N/A

• 18. Safety briefing/muster area designated?

  Yes

  No

  N/A

• 19. 2 people on location trained in CPR/First aid?

  Yes

  No

  N/A

• 20. 2 people trained in well control?

  Yes

  No

  N/A

• 21. Personnel trained in H2S?

  Yes

  No

  N/A

• 22. Other?

  Safe

  At Risk

  N/A

Mandatory Safety Equipment

• 23. FRC worn by all employees and properly (zipped up and sleeves rolled down)?

  Yes

  No

  N/A

• 24. Hard hats? All employees

  Yes

  No

  N/A

• 25. Safety glasses? All employees

  Yes

  No

  N/A

• 26. Steel toe safety boots worn by all employees?

  Yes

  No

  N/A

• 27. Hand protection/ gloves?

  Yes

  No

  N/A

• 28. Hearing protection?

  Yes

  No

  N/A

• 29. Safety Harness available? Inspected / Current

  Yes

  No

  N/A

• 30. Safety harness lanyard in good condition? Inspected / Current

  Yes

  No

  N/A

• 31. Gas monitors calibrated, inspected and being used properly? If required on location

  Yes

  No

  N/A

• 32. Hard hats and safety glasses available for visitor?

  Yes

  No

  N/A

• 33. Other?

  Yes

  No

  N/A

Rig Up- General/Wellhead

• 34. Spotters used when backing equipment.

  Yes

  No

  N/A

• 35. 20lbs Fire extinguisher located at the left front bumper of each piece of equipment.

  Yes

  No

  N/A

• 36. Fall arrest system in use while in aerial lift.

  Yes

  No

  N/A

• 37. Fall Arrest System used while working from heights greater than 4 feet.

  Yes

  No

  N/A

• 38. Personnel using fork lift and aerial lift must have current certification cards

  Yes

  No

  N/A

• 39. Fork lift inspected prior to use.

  Yes

  No

  N/A

• 40. Seat belt used while operating fork lift

  Yes

  No

  N/A

• 41. Ropes used on hammer wrenches

  Yes

  No

  N/A

• 42. Iron certification current?

  Yes

  No

  N/A

• 43. Hammer unions in good condition not mushroomed

  Yes

  No

  N/A

• 44. Whip checks on iron? Rated for that pressure

  Yes

  No

  N/A

• 45. Lubricators marked with pertinent serial number

  Yes

  No

  N/A

• 46. Lubricator certification current

  Yes

  No

  N/A

• 47. BOPs tested

  Yes

  No

  N/A

• 48. Well head bolted properly all bolts in flange?

  Yes

  No

  N/A

• 49. All personnel not involved with pressure testing outside of taped off areas

  Yes

  No

  N/A

• 50. Caution tape around high pressure and crane working areas

  Yes

  No

  N/A

• 51. Other?

  Yes

  No

  N/A

Rig up- CT Unit

• 52. CT unit placed up wind from well

  Yes

  No

  N/A

• 53. Steps leading to operators cab, secured, level, has handrail and keeper pins in place.

  Yes

  No

  N/A

• 54. All railing in place and secured with keeper pins

  Yes

  No

  N/A

• 55. All hydraulic hoses in good condition with no leaks

  Yes

  No

  N/A

• 56. All pins and keepers in reel saddle

  Yes

  No

  N/A

• 57. Only necessary personnel in area while rigging up

  Yes

  No

  N/A

• 58. Injector gooseneck pinned?

  Yes

  No

  N/A

• Injector head / BOPS secured properly?

  Yes

  No

  N/A

In CT unit operators cab

• 59. IPS Field safety manual available?

  Yes

  No

  N/A

• 60. Emergency phone numbers posted and available.

  Yes

  No

  N/A

• 61. MSDS'S in cabin for chemicals on site?

  Yes

  No

  N/A

• 62. Copy of the emergency response plan posted. If not mentioned in JSA of if more than 10 IPS employees on location

  Yes

  No

  N/A

• 63. First aid kit available and properly stocked?

  Yes

  No

  N/A

• 64. Fire extinguisher monthly and annual current.

  Yes

  No

  N/A

• 65. Good house keeping

  Yes

  No

  N/A

• 66. Other?

  Yes

  No

  N/A

Rig up N2 pump

• 67. Iron certification Current

  Yes

  No

  N/A

• 68. Hammer union in good shape and not mushroomed

  Yes

  No

  N/A

• 69. Steps leading to operators cab, secured, level, has handrail and keeper pins in place.

  Yes

  No

  N/A

• 70. N2 PPE being used

  Yes

  No

  N/A

• 71. Other

  Yes

  No

  N/A

Rig up fluid pump

• 72. Steps leading to operators cab, secured, level, has handrail and keeper pins in place.

  Yes

  No

  N/A

• 73. Iron certification current

  Yes

  No

  N/A

• 74. Hammer union in good shape and not mushroomed

  Yes

  No

  N/A

• 75. All chemical on well site clearly labeled with MSDS on site.

  Yes

  No

  N/A

• 76. All bagged/bucketed material stacked properly

  Yes

  No

  N/A

• 77. Assessment for respirator conducted

  Yes

  No

  N/A

• 78. All personnel wearing proper PPE per MSDS

  Yes

  No

  N/A

• 79. Other

  Yes

  No

  N/A

Rig up Crane

• 80. Lift sling condition? Identification tags/label attached and readable?

  Yes

  No

  N/A

• 81. Chains inspected and tagged grade 8 or higher

  Yes

  No

  N/A

• 82. Tag lines inspected and used while lifting loads

  Yes

  No

  N/A

• 83. Only one person signaling crane operator

  Yes

  No

  N/A

• 84. Outriggers fully extended and pads under them

  Yes

  No

  N/A

• 85. Outrigger floats secured with pad pin

  Yes

  No

  N/A

• 86. Cones out to identify crane swing path

  Yes

  No

  N/A

• 87. Hydraulic system has no apparent leaks

  Yes

  No

  N/A

• 88. Air system has no audible leaks

  Yes

  No

  N/A

• 89. Boom exhibits no damage to structure, wear to pads, boom stops or cylinder

  Yes

  No

  N/A

• 90. Wire rope free of dirt, excess lube, kinks and spooled correctly

  Yes

  No

  N/A

• 91. Block not damaged

  Yes

  No

  N/A

• 92. No damage to the hook and it swivels freely

  Yes

  No

  N/A

• 93. All guards in place

  Yes

  No

  N/A

• 94. Handrails in place, secured and not damaged

  Yes

  No

  N/A

• 95. Cab glass not cracked and wipers are functional.

  Yes

  No

  N/A

• 96. Anti-two block in place and functioning

  Yes

  No

  N/A

• 97. Light and horns are functional

  Yes

  No

  N/A

Crane operators cab

• 98. 5# Fire Extinguisher in cabin? Monthly/annual inspection current

  Yes

  No

  N/A

• 99. daily Crane inspection conducted and filled out?

  Yes

  No

  N/A

• 100. Annual crane inspection is current

  Yes

  No

  N/A

• 101. Crane operators manual

  Yes

  No

  N/A

• 102. Crane load chart legible and visible to operator.

  Yes

  No

  N/A

• 103. Crane hand signal chart visible to workers

  Yes

  No

  N/A

• 104. Hand held wind speed indicator

  Yes

  No

  N/A

• 105. Other

  Yes

  No

  N/A

Job Execution

• 106. Supervisor/ PIC identified and in control

  Yes

  No

  N/A

• 107. Employees working as a team?

  Yes

  No

  N/A

• 108. Any equipment failures

  No

  Yes

• Job started on time?

  Yes

  No

  N/A

• 109. Regular check of equipment conducted?

  Yes

  No

  N/A

• 110. Tools in good working order?

  Yes

  No

  N/A

• 111. Trash picked up? Good housekeeping?

  Yes

  No

  N/A

• 112. Any visible leaks on equipment? Contained?

  Yes

  No

  N/A

• 113. Spill kit available in each unit?

  Yes

  No

  N/A

• 114. Spill containment in place

  Yes

  No

  N/A

• 115. Safety procedures followed

  Yes

  No

  N/A

Outside of Equipment

• 116. Is equipment clean?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 118. Fuel, Hydraulic and other tanks properly labeled

  Yes

  No

  N/A

• 119. All drive belts and rotating lines have guards in place

  Yes

  No

  N/A

• 120. All hoses on equipment in in good condition

  Yes

  No

  N/A

• 121. wheel Chock blocks in vehicle?

  Yes

  No

  N/A

• Tire chains in vehicle?

  Yes

  No

  N/A

• 122. Trailer plug and hitch secured and not damaged

  Yes

  No

  N/A

• 123. Break away cable on light duty trailers connected and working properly

  Yes

  No

  N/A

• 124. Tool boxes uncluttered and lids able to close and latch

  Yes

  No

  N/A

• 125. Leaks on equipment

  No

  Yes

• 126. Other

  Yes

  No

  N/A

Post Job Responsibilities

• 127. Area policed and cleaned up?

  Yes

  No

  N/A

• 128. All spills cleaned up before leaving location.

  Yes

  No

  N/A

• 129. Location left clean

  Yes

  No

  N/A

• 130. Other?

  Yes

  No

  N/A

Audit Comments

• Supervisor comments.

  Yes

  No

  N/A

• Supervisor signature

  Sign

• Company man comments

  Yes

  No

  N/A

• Site auditor comments.

  Yes

  No

  N/A

• Site Auditor signature

  Sign