Key Energy Services, Work Plan System Check

• Document No.

• Conducted on

  Date

• LOB & District Numbers, City & State Names

• Marketplace

  Select WCMP CMP PBMP RMMP GCMP NEMP International

  • WCMP
  • CMP
  • PBMP
  • RMMP
  • GCMP
  • NEMP
  • International

• Customer Name

• Location of system check - select from locator icon
  Address

Work Plan Compliance Review

• Does the work plan identify journey management and DOT required information?

  Yes

  No

  N/A

• Does the work plan identify appropriate PPE and has the work site assessment been completed?

  Yes

  No

  N/A

• Has the visitors communication guide and critical activities section been completed?

  Yes

  No

  N/A

• Does the work plan list all activity & reference documents for the day?

  Yes

  No

  N/A

• Does the JSA section identify appropriate steps, hazards, hierarchy of controls, and mitigation steps?

  Yes

  No

  N/A

• Have all employees on location and all visitors to the location signed the work plan?

  Yes

  No

  N/A

Work Plan Communication Review?

• Did the employee sharing information use the communication guide while talking with you?

  Yes

  No

  N/A

• Did the employee sharing information ensure you had appropriate PPE to visit the location?

  Yes

  No

  N/A

• Was the JSA section, steps, hazards, hierarchy of controls, and mitigation steps reviewed with you?

  Yes

  No

  N/A

• Did the employee sharing information request that you repeat hazards and mitigation steps back to you?

  Yes

  No

  N/A

• Were identified reference documents available for review?

  Yes

  No

  N/A

• Can other employees on location communicate the hazards and mitigation as written and did they participate in the development process?

  Yes

  No

  N/A

Work Observation Review

• Were employees working according to the documented work activity for the day?

  Yes

  No

  N/A

• Were employees using documented mitigation for hazards identified on the work plan?

  Yes

  No

  N/A

• If a critical activity has been identified has the supervisor been notified or is a supervisor on site as identified on the work plan?

  Yes

  No

  N/A

• Were employees actively communicating while performing each job task observed?

  Yes

  No

  N/A

• Did management or the supervisor use positive reinforcement for safe behavior observed?

  Yes

  No

  N/A

Best Practices Identified While On Location

• Picture of best practices identified

  Media

• Comment supporting best practice pictures

• Drivers Signature:

  Sign

• Auditors Signature

  Sign