• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel


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

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

  • Was a JSA completed prior to beginning job?

  • Are all JSA signature sheets accounted for?

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

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


  • Are all personnel utilizing required PPE?

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

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


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

  • Operator inspected equipment for unsafe conditions?

  • Operator ensured that all equipment is rigged up properly?

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

  • Operator ensured that the crew worked safely?

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

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

Pipe Roller/Tub Worker

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

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

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

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

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

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

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

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


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

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

  • Were all controls function tested prior to beginning job?

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

  • Is the truck properly aligned with the stands?

  • Were the pole and hat inspected?

  • Is danger tape in place?

Behavior Based Safety

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

  • 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?

Post Job

  • Was a JSA completed prior to rigging down equipment?

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

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