LEG Rig Move Inspection

• Rig Number

• Manager

• HSE Tech/Prepared by

• Location: beginning and ending
  Address

• Tool Push

• Conducted on

  Date

• Truck Push

Inside

• Parking Brake (Apply) 393.41

  Yes

  No

  N/A

• Company Name and USDOT number on door(s). 390.21

  Yes

  No

  N/A

• Secured and Charged Fire Extinguisher (5lb Non-haz;10lb Haz-mat). 393.95

  Yes

  No

  N/A

• Paperwork (Private Motor Carrier License, Haz-Mat Registration, Vehicle Registration(s), Insurance Certificate, IFTA License & Stickers, Annual Inspections(s). 392.2-396.17

  Yes

  No

  N/A

• Air Horn, City Horn in Good Working Condition -393.81

  Yes

  No

  N/A

• Seat Belt in Good Working Condition-393.93

  Yes

  No

  N/A

• Emergency Triangles, First Aid Kit, Accident Kit, Emergency Kit (fuses & spare light bulbs). 393.95

  Yes

  No

  N/A

• Comments

Start Engine

• Instrument Panel (Speedometer, Oil Pressure, Air Pressure, Ammeter, Lights).-393.82

  Yes

  No

  N/A

• Low Air Warning Device (Air pressure below 40 psi check on pressure build-up Air pressure above 60 psi deplete air until warning device works). 393.51

  Yes

  No

  N/A

• Windshield Wipers in Good Working Condition and Washer Fluid Filled-393.78

  Yes

  No

  N/A

• Heater-Defroster in Good Working Condition -393.79

  Yes

  No

  N/A

• Steering Wheel (Excess play-Manual steering movement should not exceed 30 degrees. Power steering movement should not exceed 45 degrees). 393.209

  Yes

  No

  N/A

• Apply Trailer Brakes in EMERGENCY-393.40

  Yes

  No

  N/A

• Service Brakes (Apply-air loss should not exceed-3 psi / min on single vehicles / 4 psi / min on combination).<br>393.45

  Yes

  No

  N/A

• Comments:

Tractor

• Front Lights (headlights, clearance & marker, turn signal, 4-way flashers).393.24-393.11

  Yes

  No

  N/A

• Windshield (No Cracks)-393.60

  Yes

  No

  N/A

• Mirrors in Good Working Condition (secure and no cracks) -393.80

  Yes

  No

  N/A

• Steering Axle Tires, Rims, and Lugs (Tire tread shall be at least 4/32 of an inch). 393.75

  Yes

  No

  N/A

• Fuel System in Good Working Condition (clamps secure, no corrosion and no cuts, abrasion or kinks in line)-393.65

  Yes

  No

  N/A

• Brake/Electric Lines and connections to trailer in Good Working Condition . 393.43-393.45

  Yes

  No

  N/A

• Coupling (Fifth wheel, tow bar safety chains, locking devices). 393.70

  Yes

  No

  N/A

• Body, Frame and Assembly in Good Working Condition (No Bends or Cracks) -393.203

  Yes

  No

  N/A

• Engine, Exhaust in Good Working Condition (Exhaust has no leaks)-393.83

  Yes

  No

  N/A

• Tail Lights (tail, brake, turn signal, 4-way, clearance & marker). 393.11

  Yes

  No

  N/A

• Suspension System in Good Working Condition (Shocks and seals, leave springs, U-bolts) -393.207

  Yes

  No

  N/A

• Drive Axle(s) / Other tires, Rims and Lugs (Tire tread shall be at least 2/32 of an inch). 393.75

  Yes

  No

  N/A

• Reflectors and Reflective Tape in Good Working Condition -393.13

  Yes

  No

  N/A

• License Plate in Good Working Condition -392.2

  Yes

  No

  N/A

• Comments:

Trailer

• Brakes, Brake Connections and Breakaway Systems in Good Working Condition -393.43

  Yes

  No

  N/A

• Coupling Devices; King Pin; Hitch (working properly, king pin not damaged or kinked)-393.70

  Yes

  No

  N/A

• Lights in Good Working Condition (tail, brake, turn signal, 4-way, clearance & marker). 393.11

  Yes

  No

  N/A

• Landing Gear greased, in place and in good working condition -393.201

  Yes

  No

  N/A

• Suspension System Hoses in good working condition no chafing, no leaks in couplings-393.207

  Yes

  No

  N/A

• Tires, Rims and Lugs (Tire tread shall be at least 2/32 of an inch). 393.75

  Yes

  No

  N/A

• Reflectors and Reflective Tape in Good Working Condition -393.13

  Yes

  No

  N/A

• License Plate in good condition and properly illuminated-392.2

  Yes

  No

  N/A

• Comments:

Personal Protective Equipment

• Wearing Approved Fire Retardant Clothing?

  Safe

  At Risk

  N/A

• What is the severity of Non-Compliance?

  One Short isolated Incident

  One prolonged Incident

  Multiple Incidents

  Defiance of Policy

• Short Duration Infraction. Isolated to one individual over a short period of time.

• Longer duration or multiple short duration infractions involving one individual.

• Multiple infractions involving multiple individuals.

• Disregard of policy or ignorance of policies.

• Wearing Approved Fall Protection?

  Safe

  At Risk

  N/A

• What is the severity of Non-Compliance?

  One Short isolated Incident

  One prolonged Incident

  Multiple Incidents

  Defiance of Policy

• Short Duration Infraction. Isolated to one individual over a short period of time.

• Longer duration or multiple short duration infractions involving one individual.

• Multiple infractions involving multiple individuals.

• Disregard of policy or ignorance of policies.

• Wearing Approved Safety Glasses?

  Safe

  At Risk

  N/A

• What is the severity of Non-Compliance?

  One Short isolated Incident

  One prolonged Incident

  Multiple Incidents

  Defiance of Policy

• Short Duration Infraction. Isolated to one individual over a short period of time.

• Longer duration or multiple short duration infractions involving one individual.

• Multiple infractions involving multiple individuals.

• Disregard of policy or ignorance of policies.

• Wearing Approved Reflective Vests?

  Safe

  At Risk

  N/A

• What is the severity of Non-Compliance?

  One Short isolated Incident

  One prolonged Incident

  Multiple Incidents

  Defiance of Policy

• Short Duration Infraction. Isolated to one individual over a short period of time.

• Longer duration or multiple short duration infractions involving one individual.

• Multiple infractions involving multiple individuals.

• Disregard of policy or ignorance of policies.

• Wearing Approved Foot Wear?

  Safe

  At Risk

  N/A

• What is the severity of Non-Compliance?

  One Short isolated Incident

  One prolonged Incident

  Multiple Incidents

  Defiance of Policy

• Short Duration Infraction. Isolated to one individual over a short period of time.

• Longer duration or multiple short duration infractions involving one individual.

• Multiple infractions involving multiple individuals.

• Disregard of policy or ignorance of policies.

• Wearing Approved Head Protection?

  Safe

  At Risk

  N/A

• What is the severity of Non-Compliance?

  One Short isolated Incident

  One prolonged Incident

  Multiple Incidents

  Defiance of Policy

• Short Duration Infraction. Isolated to one individual over a short period of time.

• Longer duration or multiple short duration infractions involving one individual.

• Multiple infractions involving multiple individuals.

• Disregard of policy or ignorance of policies.

• Comments:

Rigging Equipment and Trucks (Checked at Pre Trip)

• Winch Lines have No Kinks and are in Good Working Condition (no more than 5 broken wires on one strand)?

  Safe

  At Risk

  N/A

• Hooks have No Stress Cracks and are in Good Working Condition ?

  Safe

  At Risk

  N/A

• Slings have current information tag (date, weight limit and size) and are in Good Working Condition (no more than 5 broken wires on one strand)

  Safe

  At Risk

  N/A

• Truck Beds are in Good Working Condition (No holes on wood, no missing wood)

  Safe

  At Risk

  N/A

• Trucks in good working order. No leaks, body damage, lights functioning?

  Yes

  No

  N/A

• Trucks back up alarms working and audible?

  Yes

  No

  N/A

• Forklift/Loader Certification?

  Yes

  No

  N/A

• Forklift Inspection Recorded ?

  Yes

  No

  N/A

• No riders on moving equipment?

  Safe

  At Risk

  N/A

• Tag lines utilized and in good condition?

  Safe

  At Risk

  N/A

• Comments:

First Aid

• First Aid Certification (At Least Two Persons)?

  Yes

  No

  N/A

• First aid supplies adequate and up to date?

  Yes

  No

  N/A

• Comments:

Safety Meeting

• Safety meeting held and Documented / Prior to Rig up / Tear Down?

  Yes

  No

  N/A

• Workers Visibility (supervisors hand signals, critical lifting, moving equipment and workers)

  Yes

  No

  N/A

• Signal person's?

  Yes

  No

  N/A

• Over head power lines identified and safe work clearance verified?

  Yes

  No

  N/A

• Warning signs in place?

  Yes

  No

  N/A

• Critical Lift Meetings held where applicable (JSA's)?

  Yes

  No

  N/A

• Short Service Employees Identified?

  Yes

  No

  N/A

• Comments:

Lease Condition

• Entrance to lease safe and maintained, ample room, etc.

  Safe

  At Risk

  N/A

• Indicate risk level below.

  Good but some points could be improved on

  Minor Risk

  Significant Risk

  Dangerous

Rig Equipment/tools

• Lease free of debris and spills?

  Safe

  At Risk

  N/A

• Rig mats in good condition with all shackles in working order?

  Safe

  At Risk

  N/A

• Are the shackles in good working order? The matting is not broken or warped? Has the matting been cleaned for transport ?

• Select Shackles are in good working order. Matting not broken or warped. Matting Cleaned for transport.

  • Shackles are in good working order.
  • Matting not broken or warped.
  • Matting Cleaned for transport.

• Mud Tanks have been emptied and ready for transport ?

  Safe

  At Risk

  N/A

• How bad are the mixing bins?

  Mixing bins have very little debris but some remain.

  Mixing bins are not empty.

  Mixing bins are full to the point of being a weight issue.

• Pipe is ready for transport and properly stored off the ground to prevent injury during sling up?

  Safe

  At Risk

  N/A

• Illumination for work site adequate?

  Safe

  At Risk

  N/A

• How is the lighting on location.

  Decent attempt at lighting location

  Dark in a few work areas

  Dark in most areas

  No lighting

• Hand tools are in good condition?

  Safe

  At Risk

  N/A

• Pipe tubs clear of junk and not overloaded (Height and Weight)?

  Safe

  At Risk

  N/A

Sign Off

• Any Additional Comments:

• Inspected By:

  Sign

• On Site Representative:

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