(MSPSI)

• Client / Site

• Conducted on date

  Date

• Prepared by

• Personnel

Rig Type

• 1. Location entrance sign legible/in place.<br> 1910.151

  Yes

  No

  N/A

• comments

• Tap to enter information

  Date

• 2. No Smoking areas posted.<br> RP 7.1.2-3, 1910.145

  Yes

  No

  N/A

• 3. No parking within guy wire perimeter.<br> RP54, RP59, RP68

  Yes

  No

  N/A

• 4. H2s warning signs erected, if applicable to site. <br> 1910.145, 1910.1000, 1910.1200, RP49, RP68

  Yes

  No

  N/A

• 5. H2s monitoring devices in use, if applicable.<br> RP49, RP68

  Yes

  No

  N/A

• 6. Self contained breathing apparatus available if needed.<br> 1910.134, RP49, RP68

  Yes

  No

  N/A

• 7. Emergency escape pack available if needed.<br> RP49, RP68

  Yes

  No

  N/A

• 8. Muster area designated

  Yes

  No

  N/A

• 9. Hard Hat, Safety Glasses, Steel Toe Shoe sign posted.<br> 1910.145

  Yes

  No

  N/A

Training, PPE, General Safety

• 1. First aid/CPR training provided<br> 1910.151, RP68

  Yes

  No

  N/A

• 2. H2s training provided if needed.<br> RP49, RP68

  Yes

  No

  N/A

• 3. Pre-Job safety meeting held.<br> RP54

  Yes

  No

  N/A

• 4. JSA conducted.

  Yes

  No

  N/A

• 5. OSHA poster posted.<br> 1903.2

  Yes

  No

  N/A

• 6. Hard Hat, Safety Glasses, and Steel Toe Shoes worn correctly.<br> 1910.135, 1910.136, 1910.133

  Yes

  No

  N/A

• 7. FRC clothing worn by crew and worn correctly.

  Yes

  No

  N/A

• 8. Fall protection used when required.<br> 1910.132

  Yes

  No

  N/A

• 9. Fall Protection: SLR, Harness, 6" tie-off, lanyards all inspected.<br> 1910.132

  Yes

  No

  N/A

• 10. First Aid/ Bloodborne Kits available on site.<br> 1910.151

  Yes

  No

  N/A

• 11. MSDS/Emergency Response book available for review.<br> 1910.1200, 1910.38, 1910.120

  Yes

  No

  N/A

• 12. All employees clean shaven per company policy

  Yes

  No

  N/A

• 13. 4-gas monitor functional and calibrated.

  Yes

  No

  N/A

• 14. Eye Wash station available/condition

  Yes

  No

  N/A

• Expiration Date

• 15. Unsafe acts Obseved.

  None observed

  Yes; see comments

• 16. Lockout/Tagout kit available for use.<br> 1910.151

  Yes

  No

  N/A

• 17. Hearing protection used as required in areas needed.<br> 1910.95

  Yes

  No

  N/A

• 18. Ground cable in use.

  Yes

  No

  N/A

• 19. Metal buckets in use. No plastic buckets used beyond their original intent.

  Yes

  No

  N/A

Mud Pump/Tanks/Mixing area

• 1. All belts, drive chains, gears, shafts, and drives guarded.<br> 1910.219

  Yes

  No

  N/A

• 2. Pony rods guarded.<br>1910.212

  Yes

  No

  N/A

• 3. Rotating parts guarded.<br> 1910.122, 1910.219

  Yes

  No

  N/A

• 4. Mud Pump head and valve cover fully bolted.<br>

  Yes

  No

  N/A

• 5. Shear pin pop-off valve properly guarded.<br> 1910.169

  Yes

  No

  N/A

• 6. General Housekeeping.<br> 1910.22

  Excellent

  Good

  Poor

• 7. High pressure lines, ect. secured and/or snubbed.<br> 1910.169, RP54

  Yes

  No

  N/A

• 8. Pumps, piping, valves, and other fittings are maintained and in good condition.<br> RP54

  Yes

  No

  N/A

• 9. Mud Lines properly secured.<br> RP54

  Yes

  No

  N/A

• 10. Employees using all required PPE when mixing chemicals.<br> 1910.132, 1910.133, 1910.138

  Yes

  No

  N/A

• 11. PPE properly stored.<br> 1910.132, 1910.134

  Yes

  No

  N/A

• 12. All hammer unions in good condition. (inspect for mushroomed heads)

  Yes

  No

  N/A

• 13. Test Bands on mud lines and manifolds.

  Yes

  No

  N/A

Generator Area & Electrical Systems

• 1. Generator located at least 100' from well head.<br> RP54

  Yes

  No

  N/A

• 2. All moving parts properly guarded.<br> 1910.212

  Yes

  No

  N/A

• 3. Generator properly grounded.<br> RP54

  Yes

  No

  N/A

• 4. High voltage warning signs properly erected.<br> 1910.145, 1910.305

  Yes

  No

  N/A

• 5. All electrical wires in good condition and strung correctly.<br> RP54, 1910.303, 1910.305

  Yes

  No

  N/A

• 6. Hearing protection used if needed around generator.<br> 1910.95

  Yes

  No

  N/A

• 7. General housekeeping.<br> 1910.22

  Excellent

  Good

  Poor

• 8. All lighting approved for the location provided.<br> (class 1 Div. 2)

  Yes

  No

  N/A

• 9. Fire Extinguisher rated for electrical fires if needed.<br>

  Yes

  No

  N/A

Fire Protection

• 1. ABC Fire Extinguishers available, inspected, and properly charged.<br>RP54

  Yes

  No

  N/A

• 2. Adequate number of fire extinguishers available. (minimum 3)<br> 1910.157, RP54

  Yes

  No

  N/A

• 3. Fire Extinguishers properly located and in/at their assigned locations.<br> 1910.157, RP54

  Yes

  No

  N/A

• 4. Fire Extinguishers properly tagged and/or inspection data recorded.

  Yes

  No

  N/A

Fuel And Other Flammable Liquids. Storage Tanks To Include Frac Tanks And Bulk Storage Tanks

• 1. Fuel tanks properly located and labeled.<br> RP54, 1910.106

  Yes

  No

  N/A

• 2. Flammable, No Smoking, and No Open Flame signs erected on all sides.<br> 1910.120

  Yes

  No

  N/A

• 3. General Housekeeping.<br> 1910.22

  Excellent

  Good

  Poor

Pipe Rack Area

• 1. End of pipe racks properly chocked.<br> 1910.176, RP54<br>

  Yes

  No

  N/A

• 2. Spacers used to separate layers of pipe.<br> 1910.176, RP54

  Yes

  No

  N/A

• 3. Employees not permitted on top of pipe.

  Yes

  No

  N/A

Blow out Preventer (BOP)

• 1. BOP properly installed. (100% bolts used)<br> RP54

  Yes

  No

  N/A

• 2. BOP properly tested.<br> RP54

  Yes

  No

  N/A

• 3. Wheels and stems in place if automatic device is not available.<br>

  Yes

  No

  N/A

• 4. All HYD lines connected, if not capped and secured.<br> RP54, RP53

  Yes

  No

  N/A

• 5. Accumulator unit properly located and labeled.<br> RP54, 1910.120

  Yes

  No

  N/A

• 6. Chock Manifold and lines secured and accessible.<br> RP54

  Yes

  No

  N/A

• 7. Safety valve and handle available and close by. (TIW valve)<br> RP54

  Yes

  No

  N/A

Derrick and Sub-Structure

• 1. Derrick pins in place with keepers.<br> RP54

  Yes

  No

  N/A

• 2. Derrick properly guyed.<br> RP4G

  Yes

  No

  N/A

• 3. Guy Wires properly tensioned.<br> RP54

  Yes

  No

  N/A

• 4. Condition of guy wires. Correctly clamped.<br> RP4G, RP9B

  Good

  Needs Replaced

• 5. Guy Wire turnbuckles installed with pin and keepers in place.<br> RP54, RP4G

  Yes

  No

  N/A

• 6. Guy Wires flagged and no vehicles in guy pattern.<br>

  Yes

  No

  N/A

• 7. Manufacturer's plate attached to derrick.<br> RP54

  Yes

  No

  N/A

• 8. Condition of derrick ladder and climbing assist device.<br> RP54, RP4G, 1910.27

  Good

  Needs Repair

• 9. Derrick Tubing board in good condition.<br> RP54, RP4G

  Good

  Needs Repair

• 10. Guard Rails installed on tubing board and rod basket.<br> RP54

  Yes

  No

  N/A

• 11. Pipe fingers in good condition and safety cable/chain attached.<br> RP54, RP4G

  Yes

  No

  N/A

• 12. Crown guard rails installed<br> RP54,1910.23<br>

  Yes

  No

  N/A

• 13. Manual latch dog extension/retraction device in operating condition.<br> RP4G

  Yes

  No

  N/A

• 14. Scoping ram stabilizers in good condition.<br> RP4G, RP54

  Yes

  No

  N/A

• 15. Scoping rams free from leaks.<br> RP4G

  Yes

  No

  N/A

• 16. Derrick emergency escape device (Geronimo) installed and ready for immediate access and use.<br> RP54

  Yes

  No

  N/A

Drill Floor Area/Rig Floor

• 1. Rig floor in good condition, level, and secured<br>

  Yes

  No

  N/A

• 2. All unused floor holes covered.<br> 1910.23, RP54

  Yes

  No

  N/A

• 3. Draw works operator at controls while in operation.<br> RP54

  Yes

  No

  N/A

• 4. Weight indicator installed and visible to operator.<br> RP54

  Yes

  No

  N/A

• 5. Operator control panel properly labeled/identified.

  Yes

  No

  N/A

• 6. V-Door chain or rail provided and in place when not in use.<br> 1910.23

  Yes

  No

  N/A

• 7. Air/hyd hoist line in good condition and operating properly.<br> RP9B

  Yes

  No

  N/A

• 8. Draw works cable in good condition and dead man properly anchored. (inspect dead line anchor, safety bolts, and clamps)<br> RP9B

  Yes

  No

  N/A

• 9. Crown saver device installed and operational.<br> RP9B

  Yes

  No

  N/A

• 10. TIW valve and wrench accessable.

  Yes

  No

  N/A

• 11. General Housekeeping.<br> 1910.22

  Excellent

  Good

  Poor

• 12. All chains and cables labeled and tagged.<br>

  Yes

  No

  N/A

• 13. Guard rails installed on rig floor.<br> 1910.23, RP54

  Yes

  No

  N/A

• 14. Winch Cables, Load Hooks, Swivel, Chain Choker Hooks and approved Shackles in good condition.

  Yes

  No

  N/A

• 15. Kill Switch at control panel operational.

  Yes

  No

  N/A

• 16. Brake Handle assembly, chain, linkage, pins, safety clip inspected.

  Yes

  No

  N/A

Power and Hand Tools

• 1. Hydraulic Tongs in good condition.<br> RP54

  Yes

  No

  N/A

• 2. Tongs snubbing line installed, secured, and in good condition.<br> RP54

  Yes

  No

  N/A

• 3. Tongs lift cylinder installed and free from leaks.<br> RP54

  Yes

  No

  N/A

• 4. All hand tools in good working condition and stored properly<br> RP54

  Yes

  No

  N/A

• 5. Air Slips installed and working properly.<br>

  Yes

  No

  N/A

• 6. Slips, dies/tong dies in good condition.

  Yes

  No

  N/A

Hoisting Tools, Hooks, Bales, Elevators, and other related equipment

• 1. Traveling Blocks in good condition.<br> RP54

  Yes

  No

  N/A

• 2. Traveling Blocks properly guarded.<br> RP54

  Yes

  No

  N/A

• 3. Bales and/or links in good condition.<br> RP54

  Yes

  No

  N/A

• 4. Elevators in good condition.<br> RP54

  Yes

  No

  N/A

• 5. Hoisting hook equipped with safety latch.<br> RP54

  Yes

  No

  N/A

• 6. Traveling Block, link attachment bolts secured with keeper/side plates.

  Yes

  No

  N/A

Stairs, Ladders, Hand Rails & Guard Rails

• 1. Stairs in good condition and secured to rig floor.<br> RP54

  Yes

  No

  N/A

• 2. Stair tread and hand rails not damaged.<br> RP54

  Yes

  No

  N/A

• 3. Guard rails, mid rails and toe boards installed along all open side edges of floors, platforms, ect. 4' above ground level.<br> RP54, 1910.23<br>

  Yes

  No

  N/A

• 4. All stairs and ladders have non-skid treads.<br> 1910.24

  Yes

  No

  N/A

Workover Rig Carrier and other vehicles/Trailers

• 1. Rig cab clean and good house keeping

  Yes

  No

  N/A

• 2. Seat Belt available for use while driving rig.

  Yes

  No

  N/A

• 3. Rig Carrier jacks in good condition. (no leaks and jam-nuts in proper working condition)<br>

  Yes

  No

  N/A

• 4. Hand Rails/Guard Rails installed on elevated walkways and steps.<br> 1910.23, 1910.24

  Yes

  No

  N/A

• 5. Wheels chocked.<br> RP54

  Yes

  No

  N/A

• 6. Condition of tires.

  Good

  Needs Replaced

• 7. Brake set and secure.

  Yes

  No

  N/A

• 8. Fuel, hydraulic and other tanks properly labeled. (no leaks)<br> 1910.120

  Yes

  No

  N/A

• 9. License plate current and insurance paperwork in vehicles.

  Yes

  No

  N/A

• 10. Hitches and safety chains available on all trailers.

  Yes

  No

  N/A

• 11. Dog House condition and houskeeping.<br> 1910.22

  Excellent

  Good

  Poor

Material Handling Equipment

• 1. Forklift operators trained and certified.<br> 1910.178

  Yes

  No

  N/A

• 2. Forklift equipped with seat belt.

  Yes

  No

  N/A

• 3. Forklift inspected prior to use.

  Yes

  No

  N/A

• 4. Manlift operators trained and certified.

  Yes

  No

  N/A

• 5. Manlift operators using fall protection as required.<br> 1910.132

  Yes

  No

  N/A

• 6. Manlift inspected prior to use.

  Yes

  No

  N/A

Comments

• Inspector:

• Add signature

  Sign

• Rig Supervisor:

• Add signature

  Sign