Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Employee #1 Information
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Employee Name and Position
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Is the employee wearing all required PPE? (Hardhat, Steel Toes, Safety Glasses, FRC's)
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Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)
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Is the employee demonstrating acceptable work ability and habits? (listens to crew pusher, follows PWI's, etc)
Employee #2 Information
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Enter employees name and position
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Is the employee wearing all required PPE? (Hardhat, Steel Toes, Safety Glasses, FRC's)
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Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)
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Is the employee demonstrating acceptable work ability and habits? (listens to crew pusher, follows PWI's, etc)
Employee #3 Information
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Enter employees name and position
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Is the employee wearing all required PPE? (Hardhat, Steel Toes, Safety Glasses, FRC's)
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Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)
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Is the employee demonstrating acceptable work ability and habits? (listens to crew pusher, follows PWI's, etc)
Employee #4 Information
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Enter employees name and position
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Is the employee wearing all required PPE? (Hardhat, Steel Toes, Safety Glasses, FRC's)
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Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)
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Is the employee demonstrating acceptable work ability and habits? (listens to crew pusher, follows PWI's, etc)
Record of Driving Evaluation
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Enter Drivers Name
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Did the driver complete a pre trip inspection in accordance with DOT regulations?
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Did the driver properly hook onto the trailer?
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Did the driver utilize chocks on both truck and trailer whenever stopped?
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Did the driver keep smooth control of vehicle at all times?
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Did the driver utilize a spotter when backing trailer?
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Was the driver consistently alert and attentive?
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Did the driver maintain proper speed?
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Did the driver look back and utilize mirrors?
Truck Checklist - Lay Down Machine - Please Note: Item must be serviceable in order to receive a 'Pass' score.
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4 - 20' Chains
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2 - 10' Chains
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1 - 4' Chain
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4 - Ratchet Binders
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Tool Box
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Screwdriver Set
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Plier Set
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2 - 18" Crescent Wrenches
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18" Pipe Wrench
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24" Pipe Wrench
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4' Pry Bar
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1/2" Drive Socket Set
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3 LB Small Sledge
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Hack Saw
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Allen Wrench Set
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3/8" - 1 1/4" Wrench Set
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Vise Grip Set
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2 - Spare Cylinders
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Spare 7/8" Cable Sheave
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Spare 1/2" Cable Sheave
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3 - Hose Splices
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4 - Spare Fittings For Stands
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Cable Lube
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PB Blaster
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Starting Fluid
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Thread Tape
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2 - 100' Extension Cords
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Spare Serpentine Belt
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Grease Gun
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Grease
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Cotter Pin Assortment
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R-Pin Assortment
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3 - 1/2" Cable Clamps
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Shovel
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Broom
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Squeegee
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Top Hat
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Pipe Ramps
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Stiff Arm
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Wheel Chalks
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Danger Tape
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First Aid Kit
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Crash Kit
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Triangles
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Fire Extinguisher
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JSA Book
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Insurance
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Registration
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Wire Brush
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Tire Chains
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Diesel 911
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Spare Fuel Filter
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Seat Covers
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Floor Mats
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Line Certifications
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Shackle Assortment
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10 - Dust Caps
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Front Bumper
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Break Clean
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Antifreeze
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Jumper Cables
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AVIR
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Door Stickers
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Unit Number
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DOT Stickers
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MSDS Book
Truck Checklist - Chase Truck - Please Note: Item must be serviceable in order to receive a 'Pass' score.
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20' Chain
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2 - Ratchet Straps
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Ratchet Binder
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Spare Tire
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Seat Covers
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Floor Mats
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Triangles
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Jumper Cables
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Fire Extinguisher
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Insurance
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Registration
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AVIR
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Crash Kit
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First Aid Kit
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GPS
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JSA Book
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Door Stickers
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Unit Number
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DOT Number
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Front Bumper
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Tow Rope
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MSDS Book
Pre-Job
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Did all personnel sign in when they arrived on location?
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Was a JSA completed prior to rig up of equipment?
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Was a JSA completed prior to beginning job?
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Are all JSA signature sheets accounted for?
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Have changes/additions been made to the JSA's to accommodate for specific job conditions?
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Are there any unusual challenges present? (weather, mud, extreme temperatures, down hole problems, etc)
Personnel
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Are all personnel utilizing required PPE?
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Is all PPE in good repair? (clean, minimal tears/rips, etc)
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Please select the number of SSE Employees on the Laydown Crew
Operator
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Did the operator hold a pre-job safety meeting and ensure that all lines of communication are properly established?
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Operator inspected equipment for unsafe conditions?
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Operator ensured that all equipment is rigged up properly?
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Operator ensured that all Noble Casing, Inc personnel used proper procedures?
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Operator ensured that the crew worked safely?
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Does the Operator follow the directions of the V-Door Operator?
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Does the Operator shut down when talking to management or while using a cell phone?
Pipe Roller/Tub Worker
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Has the work area been cleared of trip/slip/fall hazards?
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Is the casing/drill pipe properly blocked to prevent rolling?
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Does the Pipe Roller/Tub Worker verify hands free policy with operator prior to moving between casing and catwalk?
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Is the Pipe Roller/Tub Worker clear of the trough as it is being set down?
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Is the Pipe Roller/Tub Worker using his/her palms when rolling pipe?
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Does the Pipe Roller refrain from getting on top of the casing?
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Does the Pipe Roller/Tub Worker ask for help with marker/trouble joints?
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Does the tub worker minimize amount of time spent in the tub?
Equipment
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Have the cables been inspected? (kinks, broken wires, etc)
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Were all controls function tested prior to beginning job?
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Were all hydraulic tanks, hoses, rams, etc inspected for leaks prior to beginning job?
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Is the truck properly aligned with the stands?
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Were the pole and hat inspected?
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Is danger tape in place?
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Have pulleys and shackles been inspected and deemed adequate prior to use?
Behavior Based Safety
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Are employees free of Rushing, Frustration, Fatigue or Complacency?
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Are employees free of Mind Not On Task, Eyes Not On Task, Being In The Line Of Fire or Loss Of Balance, Traction or Grip?
Post Job
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Was a JSA completed prior to rigging down equipment?
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I certify that I have completed this field evaluation and that all items are true and correct to the best of my knowledge.
