Information

  • Asset Number

  • Rig Number

  • Inspection date

  • Rig Series

  • Rig Model

  • Inspected by

  • Rig Make

  • Manufacturer

  • Operator

  • Date of Manufacturer

  • Supervisor

  • Derrick Manufacturer

  • Derrick Refurb Date

  • Manager

  • Derrick Rating

  • Derrick Height (ft)

  • Telescoping

  • Folding

  • Engine

  • Rig Location

General

  • Key Energy Logo & Signs

  • Distance from overhead power lines

  • Location entrance & hazard signs displayed

  • Rig driver has Class B license.

  • Fall lane of derrick clear

  • Auxiliary equipment exhaust distance.

  • Spark arrestor-exhaust system.

  • Registration & insurance card

  • Transportation permits in cab.

  • Housekeeping

  • Driver daily log & post trip current.

  • Designated muster area labeled

Guying

  • External guy lines strung out properly

  • External guy lines tightened to specifications

  • Guy lines condition

  • Turnbuckle minimum 1 1/4"

  • Guy lines flagged

  • External guy line safety anchors tested within 2 years.

  • Tubing board guy lines strung & crossed for racking & tubing

  • Internal guy lines adjusted to specifications

  • Outriggers in place and pinned

  • Proper number and spacing of cable clips

  • Crown to ground guy wires

  • Appropriate number of guy wires

Foundation

  • Rig mat condition

  • Adequate footing

  • Jack stands condition

  • Jack pad

Mast/Derrick

  • Mast/Derrick

  • Manufacturer's specifications operation plate

  • Derrick ladder

  • Tubing board

  • Rod basket/board

  • Lower derrick locking pins in place w/ safety pins

  • Scoping ram stabilizers

  • Crown-sheave guards

  • Rod, tubing fingers safety chains

  • Upper derrick locking pins in place w/ safety pins

  • Upper latch mechanism flag

  • Standpipe secured.

  • Circulating hose secured to gooseneck with safety hobbles

  • Lighting system functional, rated & adequate.

  • Crown painted a contrasting color

  • Bottom ladder rung w/i 18" of floor or ground

  • Top section breaking/landing point flagged

  • Derricks over 102' anti-crownout device installed & operational

  • KeyView CO/FO & hook load protection set.

  • All pivot pins in derrick trapped

Drawworks/Winch

  • Guards are in place

  • Drill line (less than 1 year in service)

  • Sand line

  • Winch-line, guard, & tagged Grade 80 lift chain

  • Deadline anchor & retainer uses proper pins and/or bolts

  • Tubing/sand line brake system

  • Tubing/sand line brake latch.

  • Sufficient wraps on drum to allow blocks to be in lowest position when taking on a load.

  • Sand line clutch guarded.

  • Brake linkage to drawworks

  • Drum brakes adjusted to specifications

  • Road/hoist shift lever secured.

Rig Carrier

  • Housekeeping

  • Guardrails/handrails in place with safety pins.

  • Head, tail & signal lights

  • Wheel chocks

  • Fluid systems free of leaks

  • Cab free of loose or flammable materials

  • Glass & mirrors

  • Windshield wipers & blades

  • Emergency brake set

  • Emergency reflector kit in rig cab

  • Battery covers in place

  • Hydraulic leveling jacks secured by mechanical lock nuts.

  • Seat belt

  • 6th gear locked out

  • All controls labeled

  • All gauges functioning properly

  • Road to drawworks shift lever secured

  • Brakes, tires & wheels

  • Diesel and other storage tanks are labeled

  • Kill switches functional

  • Emergency air intake shut down functional

  • Drive line recently greased

  • Low air warning device functional

Work Platform/Floor

  • Work floor condition

  • Steps/handrails/guardrails/toe boards in place & secured

  • V-door opening guard rails in place or protected with chains

  • Floor chains secured properly with support/suspension pins with keepers/clevis or clutch hooks

  • Work floors stored in the vertical or up position, are secured on both sides.

  • Work floor sliding section has stops to prevent sliding closed when floor is stored in the vertical position.

  • Work floor suspension safety hooks use 80 grade chain

Well control equipment

  • BOPs installed, tested as necessary, and operating properly

  • BOP sling

  • BOP installed with all bolts/nuts

  • Safety valve with (wrench) handle on floor

  • Accumulator valves in correct position

  • Accumulator engine/controls minimum 50' from well head

  • Crew has performed Well Control drill scenario

  • Manual BOP closing handles properly installed

  • Blow down lines are staked and hobbled

  • BOP closed sign is available and being used.

  • BOP drills performed & documented on site

Tools & Equipment

  • Tubing/Rod tongs condition.

  • Stiff arm, tong safety sling and/or snub lines are properly installed

  • Tong safety gate (door) in place

  • Tong manufacturer back ups condition.

  • Tong hanger safety cable and tongs are hung with a clutch hook

  • Hand tools condition

  • Slings condition

  • Traveling block assembly is guarded

  • Rod/tubing elevators condition

  • Air slips in good condition & not chained to the working floor.

  • Air slips positioned above work floor

  • Slip bolt in place

  • Rod hook condition

  • Rod transfers & other tools not left in derrick

  • Rod transfer condition w/ safety latch

  • Block assembly condition

  • Link latch retainer bolts (4) secured with castle nuts & pins

  • Rod torque wheel

  • Lay down dolly

Safety equipment/Practices

  • Positioning lanyards are provided at rod basket and tubing board

  • Full-body harness

  • Lanyard with soft stop

  • SRL condition

  • SRL inspected by manufacturer rep w/i two years

  • SRL/climbing device stored retracted

  • Climbing assist

  • Emergency derrick escape equipment

  • Fire extinguishers minimum 60 lbs total with current inspection

  • Static line installed from carrier to well head

  • Stored energy locked out with lock and tag

  • Pumping unit weights secured or located on bottom

  • MSDS/EAP/SPCC book on site

  • First aid and blood borne pathogen kits are stocked/available

  • Emergency derrick rescue equipment immediately available

  • JSA is current, complete & reviewed

  • Rig recently inspected by Rig Supervisor & safety rep

  • Crew's training is current in First Aid/CPR, HazCom, H2s, Confined Space Awareness

  • Static line installed

  • Emergency kill switches working & painted red

  • Look up & Live flags in place

  • OSHA/EPA inspection notice available

  • Rig Safety Man/Blue book complete & current

  • Lifting equipment annual inspection is current

  • Schedule D mast inspection current within 2 years

H2s Equipment

  • Two 30-minute air packs checked and dated monthly

  • Rig H2s monitor(s) functional, calibrated monthly w/ dated tag and sensor located downwind

  • Personal H2s monitor(s) calibrated monthly w/ dated tag

  • Crew has performed H2s drill scenario

  • H2s training cards current for all personnel

Dog House Trailer

  • Trailer hitch

  • Trailer is equipped with brakes

  • Trailer tires have at least 2/32 inch tread and chocked

  • LPG tanks are secured & labeled

  • UL approved regulator is attached to LPG tank

  • LPG hose from regulator to heater is LPG rated

  • Heater has a UL approved thermo-coupling

  • Trailer housekeeping

  • Trailer registration

  • Trash can available

  • Minimum 5 lb fire extinguisher securely mounted with a current inspection

Crew Truck

  • Registration, inspection sticker and insurance card

  • Vehicle numbers and company logo signs are visible

  • Seat belt condition

  • Truck overall appearance

  • Auxiliary fuel tanks have correct labels

  • Windshield, wipers, mirrors, and heater

  • All lights are working properly

  • Minimum 10 lb fire extinguisher securely mounted with a current inspection

  • Steering tires have a minimum 4/32 tread and other tires a minimum 2/32 tread

  • Hazardous materials weighbill in truck if transporting diesel over 119 gallons or other hazmat

  • Tie down system

  • Pre-trip/Post-trip completed

Auxiliary Equipment Standards

  • Auxiliary Equipment Standards

  • Maximum pressure rating posted

  • Fittings rated for maximum unit test pressure

  • Hoses in good condition & rated for maximum unit pressure

  • Appropriate OEM shear pin used and set for the appropriate safe work pressure

  • Pop-off discharge line anchored

  • Guards in place

  • Ladders, hand rails & walk ways installed

  • Controls labeled & working

  • Air-intake kill switches labeled, painted contrasting color & working

  • Fire extinguisher inspection tags current, extinguishers in good condition & one available for each power unit

  • Battery covers in place

  • Static line installed & attached to an approved earth ground

  • Spark arrestor & exhaust system

  • Auxiliary equipment exhaust positioned a minimum of 50 feet from gas sources

  • Power swivel host reel spokes covered

  • 5/8" minimum deadline available & used with 2.0 or larger power swivel

  • Moving parts guarded including pulleys, shafts, belts and plungers

  • Hose hobbles in place & properly connected

  • Hard line staked down or hobbled at each connection & pressure hoses hobbled

  • Date pop-off valve last tested & documented

  • Tank valves free of leaks & in good working condition

  • Transport cam-lock caps available & in use.

  • Drip pans & absorbent materials available & in use

  • Tire chocks present & installed

  • Unit clean & orderly

  • Tires, wheels & wheel lugs

  • Current registration located on unit

  • Key signs & warning signs in place

  • Gauges in good working order

  • Filter pot hatches operating, free of leaks & properly secured

  • Trailer safety slings in place

  • Tank mounting brackets in good condition

  • Equipment has adequate footing/foundation

  • Hammer unions properly rated

  • Lubricating system working

  • Fluid end free of missing nuts, bolts & leaking fluids

  • Proper eye, face, respiratory, hand and body protection and eye skin wash available, clean & serviceable for mixing hoppers

  • For caustic soda, approved mixing barrel with baffles & overflow installed.

  • Hearing protection posted

Signatures

  • Supervisor

  • Lead/Driver

  • HSE

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. You should independently determine whether the template is suitable for your circumstances.