Title Page

  • Conducted on

  • Prepared by

  • Location
  • Unit Number:

  • Swab Rig Operator

  • Location of Inspection:

  • Time and Date of Inspection:

  • Business Unit Supervisor:

  • LEG Team Member Conducting Inspection:


  • Are safety signs posted at entrance to location?

  • Is company vehicle in fall line of lubricator?

  • Are warning signs clear and visible?

  • Has operation area been marked off ( No Go Zone)?

  • Are work areas clean and free of trip hazards?

  • Additional Notes:

  • Additional Pictures:

General Safety

  • Are all team members CPR/ First aid certified?

  • Has JSEA been completed?

  • Are all team members wearing the appropriate PPE?

  • Is the first aid kits available and in stock?

  • Are emergency numbers posted in the cab of unit?

  • Are LOTO devices available?

  • Additional Notes:

  • Additional Pictures:

Fire Protection

  • Are all flammable stored properly in approved containers?

  • Are all fire extinguishers serviceable?

  • Are all fire extinguishers properly located on unit?

  • Are all smoking rules enforced on location?

  • Are proper spark and heat arrestors installed on exhaust?

  • Additional Notes:

  • Additional Pictures:

Carrier Inspection

  • What is the general condition of the rig cab?

  • Are hand rails installed on steps?

  • Are walkways free of slip, trips and falls?

  • Are wheels chocked off?

  • What are the condition of the tires?

  • Are tanks properly labeled?

  • Are service brakes (road) set and secured?

  • Are there any leaks identified on carrier?

  • Are road brakes operational?

  • Is suspension in good condition with no visible damage?

  • Are turn signals operational?

  • Are brake lights operational?

  • Are marker lights operational?

  • Are headlights operational and in working condition?

  • Are windshield wipers operational?

  • Is windshield damaged on unit?

  • Are there any leaks in the cab?

  • Are side mirrors damaged on unit?

  • Are tool boxes and compartment doors operational?

  • Additional Notes:

  • Additional Pictures:

Hand Tools and Power Tools

  • Are hand tools in good condition?

  • Are hand tools clean?

  • Are all tools stored properly in compartments?

  • Additional Notes:

  • Additional Pictures:

Hoisting Applications

  • Are swabbing sheaves operational?

  • Are all sheaves in good condition?

  • Are all retainer pins in place and in good condition?

  • Are all guards in place?

  • Are lifting hooks in good condition with safety latches in place?

  • Additional Notes:

  • Additional Pictures:

Wire Rope Inspections

  • Are there any visible bends or kinks in the line?

  • Are there any flat spots on the line?

  • Is there any signs of birdcage on wire rope?

  • Are there any broken strands observed on any lays?

  • Is there any massive rust or corrosion observed on wire rope?

  • Is there any other visible damage observed on the wire rope?

  • Additional Notes:

  • Additional Pictures:

Mast Structure and Sub Structure

  • Is the mast lift cylinder in good condition with no leaks?

  • Is metal fatigue or cracks observed on the mast hinge pin?

  • Is the mast hydraulic system free of any leaks?

  • Are the safety retainer in use on the mast hinge pin?

  • Are all tools secured when in use on elevated positions?

  • Additional notes:

  • Additional Pictures:

Sign Off

  • Team Member Conducting Inspection:

  • Signature of Team Member conducting Inspection:

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.