Premier Well Services, LLC - duplicate

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

Location / Site

• 1. Location entrance sign legible and in place? 1910.151

  Yes

  No

  N/A

• 2. PWS represenatitve on location?

  Yes

  No

  N/A

• 3. No parking within guy wire perimeter. 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 and worn in approved PWS designed area?<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. All work zone signage is utilized?

  Yes

  No

  N/A

• 10. All drop zone safety chains are up and signage is utilized?

  Yes

  No

  N/A

• 12. Unsafe acts Observed?

  Safe

  At Risk

  N/A

• Overall housekeeping of location clean?

  Yes

  No

  N/A

JSA, PTW, and PPE

• 1. Pre-Job safety meeting held. RP54

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 3. H2s training provided if needed. RP49, RP68

  Yes

  No

  N/A

• 4. Did crew go over JSA and understand?

  Yes

  No

  N/A

• Has a Permit to Work for all active activities on location?

  Yes

  No

  N/A

• All Permit to Work paperwork is filled out correctly?

  Yes

  No

  N/A

• Has a JSA attached to all Permit to Work paperwork?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 6. FRC clothing worn by Tool Pusher and Crew and worn correctly?

  Yes

  No

  N/A

• 7. Fall protection used when required above 4'?<br>1910.132

  Yes

  No

  N/A

• 9. SRL, Harness, 6" tie-off, lanyards and anchor plates all inspected and documented in PWS inspection book?.<br>1910.132

  Yes

  No

  N/A

• Is SRL correctly worn in the approved area according to PWS Policies and Procedures?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 12. Lockout/Tagout kit and/or box with locks available for use? 1910.151

  Yes

  No

  N/A

• 13. Hearing protection provided and available for use?<br>1910.95

  Yes

  No

  N/A

Fire Protection

• 1. ABC Fire Extinguishers available, inspected, and properly charged? 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 monthly & annually recorded?<br>

  Yes

  No

  N/A

• Pusher Truck supplied with a fire extinguisher, correctly installed, and charged?

  Yes

  No

  N/A

• Crew Truck supplied will a fire extinguisher and correctly installed, and charged?

  Yes

  No

  N/A

Fuel & Other Flammable Liquids

• 1. Diesel tanks properly secured and labeled? 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. Designated Smoking area?

  Yes

  No

  N/A

• 4. All containers that are holding a chemical are label with what is contained inside?

  Yes

  No

  N/A

• 5. General Housekeeping. 1910.22

  Yes

  No

  N/A

Pipe Racks

• 1. End of pipe racks properly chocked? 1910.176, RP54

  Yes

  No

  N/A

• 2. Spacers used to separate layers of pipe? 1910.176, RP54

  Yes

  No

  N/A

• 3. Employees not permitted on top of pipe?

  Compliant

  Non-Compliant

• 4. Pipe Racks are level and stable?

  Yes

  No

  N/A

Stairs, Ladders, Handrails, & Guardrails

• 1. Adequate stairs provided for rig and in working order?<br>

  Yes

  No

  N/A

• 2. Stairs level and no broken welds?

  Compliant

  Non-Compliant

• 3. Stair treads of uniform size and no obstructions?<br>RP54 9.3.9,11 1910.24(d)

  Yes

  No

  N/A

• 4. Guardrails, Midrails, & Toeboards installed along all open side edges of floors, platforms, etc, 4ft above ground level?<br>1910.23(c)(1) RP54 9.3.17

  Yes

  No

  N/A

• Rails that are not in use are approved in their correct storage area?

  Yes

  No

  N/A

Derrick & Sub-Structure

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

  Yes

  No

  N/A

• 14. Ground cable in use?

  Yes

  No

  N/A

• 2. Tubing board properly guyed and secure? <br>RP4G

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Compliant

  Non-Compliant

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

  Yes

  No

  N/A

• 6. Guy Wires flagged and no vehicles in guy pattern?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 8. Geronimo Line properly flagged?

  Yes

  No

  N/A

• Geronimo properly secured to concrete block with shackle and pins in place?

  Yes

  No

  N/A

• Cellar beam in good condition?

  Yes

  No

  N/A

• All shackles and/or clevis property pin and correctly used?

  Yes

  No

  N/A

Drill Floor Area & Rig Floor

• 1. Rig floor in good condition, level, and secured?

  Yes

  No

  N/A

• All hand tools when not in use away form footing and in a safe area.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• TIW valve on rig floor with Key?

  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 structure provided and in place when not in use.<br>1910.23

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 8. Crown out device installed and operational?<br>RP9B

  Yes

  No

  N/A

• 9. All cables labeled and tagged?

  Yes

  No

  N/A

• 10. Guard rails installed on rig floor?1910.23, RP54

  Yes

  No

  N/A

• 11. Spill Kits in designated area and ready to be used?

  Yes

  No

  N/A

• 12. General Housekeeping? 1910.22

  Yes

  No

  N/A

• 14.Kill Switch at control panel operational?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 15. Brake Handle assembly, chain, linkage, pins, safety clip inspected and in good condition?

  Yes

  No

  N/A

Hydraulic, Power, and Hand Tools

• Metal stiff arm and secondary cable properly used and pins/keepers in place?

  Yes

  No

  N/A

• 1. Hydraulic Tongs in good condition and free from leaks?<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

• 5. Air Slips installed and working properly?

  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

• Rod Basket in working order?

  Yes

  No

  N/A

• All rod tools in good condition?

  Yes

  No

  N/A

Workover Rig Carrier, PWS Vehicles & Doghouse

• 1. Rig cab clean and good housekeeping?

  Yes

  No

  N/A

• 3. Rig Carrier jacks in good condition. (no leaks and jam-nuts in proper working condition?

  Yes

  No

  N/A

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

  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. Doghouse wheels chocked?<br> RP54

  Yes

  No

  N/A

• 6. Condition of tires?

  Good

  Bad

• 7. Rig 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

• PWS vehicles windshields free of cracks and all pits repaired?

  Yes

  No

  N/A

• 9. All PWS vehicles and rigs license plate current and insurance paperwork in vehicles?

  Yes

  No

  N/A

• Eyewash solution available for use and not expired?<br>

  Yes

  No

  N/A

• 15. PPE properly stored. 1910.132, 1910.134

  Yes

  No

  N/A

• All Vehicle Incident Report in glove box of PWS vehicles?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 11. Dog house condition and housekeeping?<br> 1910.22

  Bad

  Fair

  Excellent

Material Handling Equipment

• 1. Forklift operators trained and have Certification of Completion?<br> 1910.178

  Yes

  No

  N/A

• 2. Forklift seat belt operational?

  Yes

  No

  N/A

• 3. Forklift inspected prior to use.

  Yes

  No

  N/A

• 4. Manlift operators trained and certified with cards?

  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

Additional Comments

• Comments:

• Tool Pusher/ Operator Signature

  Sign

• Pictures of additional comments if needed.

  Media

• Inspector Signature

  Sign