Laydown Field Evaluation

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Pre-Job

• Did all personnel sign in when they arrived on location?

  Yes

  No

  N/A

• Was a JSA completed prior to rig up of equipment?

  Yes

  No

  N/A

• Was a JSA completed prior to beginning job?

  Yes

  No

  N/A

• Are all JSA signature sheets accounted for?

  Yes

  No

  N/A

• Have changes/additions been made to the JSA's to accommodate for specific job conditions?

  Yes

  No

  N/A

• Are there any unusual challenges present? (weather, mud, extreme temperatures, down hole problems, etc)

  Yes

  No

  N/A

Personnel

• Are all personnel utilizing required PPE?

  Yes

  No

  N/A

• Is all PPE in good repair? (clean, minimal tears/rips, etc)

  Yes

  No

  N/A

• Please select the number of SSE Employees on the Laydown Crew

  Zero

  One

  Two

  Three

Operator

• Did the operator hold a pre-job safety meeting and ensure that all lines of communication are properly established?

  Yes

  No

  N/A

• Operator inspected equipment for unsafe conditions?

  Yes

  No

  N/A

• Operator ensured that all equipment is rigged up properly?

  Yes

  No

  N/A

• Operator ensured that all Noble Casing, Inc personnel used proper procedures?

  Yes

  No

  N/A

• Operator ensured that the crew worked safely?

  Yes

  No

  N/A

• Does the Operator follow the directions of the V-Door Operator?

  Yes

  No

  N/A

• Does the Operator shut down when talking to management or while using a cell phone?

  Yes

  No

  N/A

Pipe Roller/Tub Worker

• Has the work area been cleared of trip/slip/fall hazards?

  Yes

  No

  N/A

• Is the casing/drill pipe properly blocked to prevent rolling?

  Yes

  No

  N/A

• Does the Pipe Roller/Tub Worker verify hands free policy with operator prior to moving between casing and catwalk?

  Yes

  No

  N/A

• I the Pipe Roller/Tub Worker clear of the trough as it is being set down?

  Yes

  No

  N/A

• Is the Pipe Roller/Tub Worker using his/her palms when rolling pipe?

  Yes

  No

  N/A

• Does the Pipe Roller get on top of the casing?

  Yes

  No

  N/A

• Does the Pipe Roller/Tub Worker ask for help with marker/trouble joints?

  Yes

  No

  N/A

• Does the tub worker minimize amount of time spent in the tub?

  Yes

  No

  N/A

Equipment

• Have the cables been inspected? (kinks, broken wires, etc)

  Yes

  No

  N/A

• Have pulleys and shackles been inspected and deemed adequate prior to use?

  Yes

  No

  N/A

• Were all controls function tested prior to beginning job?

  Yes

  No

  N/A

• Were all hydraulic tanks, hoses, rams, etc inspected for leaks prior to beginning job?

  Yes

  No

  N/A

• Is the truck properly aligned with the stands?

  Yes

  No

  N/A

• Were the pole and hat inspected?

  Yes

  No

  N/A

• Is danger tape in place?

  Yes

  No

  N/A

Behavior Based Safety

• Is there any indication of Rushing, Frustration, Fatigue or Complacency?

  Yes

  No

  N/A

• Is there any indication of Mind Not On Task, Eyes Not On Task, Being In The Line Of Fire or Loss Of Balance, Traction or Grip?

  Yes

  No

  N/A

Post Job

• Was a JSA completed prior to rigging down equipment?

  Yes

  No

  N/A

• I certify that I have completed this field evaluation and that all items are true and correct to the best of my knowledge.

  Sign