Qinterra Technologies Well Site Checklist USA

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Vehicle Safety (DOT)

• Rating 1) Awareness. 2) Partially implemented. 3) Implemented but needs improvement. 4) Fully implemented with no issues noted.<br>

  Yes

  No

  N/A

• a) Are applicable documents in vehicle? (I.e. Medical certificates)

  Yes

  No

  N/A

• b) Are DOT logs current?

  Yes

  No

  N/A

• c) Do vehicles have required emergency equipment?

  Yes

  No

  N/A

• d) Journey Management in use and trips monitored?

  Yes

  No

  N/A

SSE

• Rating 1) Awareness. 2) Partially implemented. 3) Implemented but needs improvement. 4) Fully implemented with no issues noted.<br>

  Yes

  No

  N/A

• a) Number of SSE's currently on site?<br>

  Yes

  No

  N/A

• b) Are all SSE's assigned mentors?<br>

  Yes

  No

  N/A

• d) Number of employees that have completed required Qinterra Orientation

  Yes

  No

  N/A

Housekeeping

• a) Pre-job checklist completed?

  Yes

  No

  N/A

• b)Unit-housekeeping rating 1) Poor 2) Needs Improvement 3) Good 4) Outstanding

  Yes

  No

  N/A

• c) Truck-housekeeping rating 1) Poor 2) Needs Improvement 3) Good 4) Outstanding <br>{essential safety equipment exists-fire extinguishers, First Aid Kits, eye wash & etc.}

  Yes

  No

  N/A

• d) Well-site -housekeeping rating 1) Poor 2) Needs Improvement 3) Good 4) Outstanding <br>{Confirm essential safety equipment exists-fire extinguishers, First Aid Kits, eye wash & etc.}

  Yes

  No

  N/A

• f) Perimeter Secure-rating 1) Poor 2) Needs Improvement 3) Good 4) Outstanding

  Yes

  No

  N/A

• g) Chemical Storage-rating 1) Poor 2) Needs Improvement 3) Good 4) Outstanding

  Yes

  No

  N/A

General - WellSite Safety

• a) Visitor sign-in log current<br>Rating 1) Awareness. 2) Partially implemented. 3) Implemented but needs improvement. 4) Fully implemented with no issues noted.<br>

  Yes

  No

  N/A

• b) Visitor site orientation training completed and logged?<br>Rating 1) Awareness. 2) Partially implemented. 3) Implemented but needs improvement. 4) Fully implemented with no issues noted.<br>

  Yes

  No

  N/A

• c) Safety alerts posted and current?<br>Rating 1) Awareness. 2) Partially implemented. 3) Implemented but needs improvement. 4) Fully implemented with no issues noted.<br>

  Yes

  No

  N/A

• d) State and Federal labor law posters current?<br>Rating 1) Awareness. 2) Partially implemented. 3) Implemented but needs improvement. 4) Fully implemented with no issues noted.<br>

  Yes

  No

  N/A

• Job packets completed?

  Yes

  No

  N/A

JSA's

• Rating 1) Awareness. 2) Partially implemented. 3) Implemented but needs improvement. 4) Fully implemented with no issues noted.<br>

  Yes

  No

  N/A

• a) Are JSA's available for review?

  Yes

  No

  N/A

• b) Are JSA's in approved WIS format?

  Yes

  No

  N/A

• c) Do employees understand the JSA process?

  Yes

  No

  N/A

• d) Are JSA's being reviewed and signed during safety meetings?

  Yes

  No

  N/A

Stop Work Process

• Rating 1) Awareness. 2) Partially implemented. 3) Implemented but needs improvement. 4) Fully implemented with no issues noted.<br>

  Yes

  No

  N/A

• a) Is the Stop Work process understood?

  Yes

  No

  N/A

• b) Are Stop Work's encouraged?

  Yes

  No

  N/A

• d) Are StopWorks being reviewed during safety meetings?

  Yes

  No

  N/A

Environmental Impact

• Rating 1) Awareness. 2) Partially implemented. 3) Implemented but needs improvement. 4) Fully implemented with no issues noted.<br>

  Yes

  No

  N/A

• a) Is there evidence of spills/leaks

  Yes

  No

  N/A

• b) Is there appropriate secondary containment?

  Yes

  No

  N/A

• c) Are chemicals stored properly?

  Yes

  No

  N/A

• d) Is there a current chemical inventory and supported MSDS's?

  Yes

  No

  N/A

Emergency Action Plan

• Rating 1) Awareness. 2) Partially implemented. 3) Implemented but needs improvement. 4) Fully implemented with no issues noted.<br>

  Yes

  No

  N/A

• a) Is the current Emergency Action Plan available for review?

  Yes

  No

  N/A

• b) Does the Emergency Action Plan cover all possible emergencies?

  Yes

  No

  N/A

• c) Do employees understand their roles and responsibilities?

  Yes

  No

  N/A

• d) Has a drill been completed for this year?

  Yes

  No

  N/A

Radiation Safety (3rd Party)

• Rating 1) Awareness. 2) Partially implemented. 3) Implemented but needs improvement. 4) Fully implemented with no issues noted.<br>

  Yes

  No

  N/A

• a) Is all related annual training complete?

  Yes

  No

  N/A

• b) Are all meter calibrations current?

  Yes

  No

  N/A

• c) Is permit current and posted as required?

  Yes

  No

  N/A

• d) Are logs and inventories up to date?

  Yes

  No

  N/A

• e) Leak test current?

  Yes

  No

  N/A

Explosive Safety (3rd party)

• Rating 1) Awareness. 2) Partially implemented. 3) Implemented but needs improvement. 4) Fully implemented with no issues noted.<br>

  Yes

  No

  N/A

• a) Are explosives properly stored?

  Yes

  No

  N/A

• b) Do logs match current inventories?

  Yes

  No

  N/A

• c) Is all related training complete?

  Yes

  No

  N/A

• d) Is permit current and posted as required?

  Yes

  No

  N/A

SCORE

• POSSIBLE TOTAL SCORE?<br>TOTAL POSSIBLE SCORE-100<br>TOTAL POSSIBLE SCORE LESS RADIATION-96<br>TOTAL POSSIBLE SCORE LESS EXPLOSIVES-96<br>TOTAL POSSIBLE SCORE LESS RADIATION & EXPLOSIVES-92

  Yes

  No

  N/A

• ACTUAL TOTAL SCORE?

  Yes

  No

  N/A

• AVERAGE SCORE?

  Yes

  No

  N/A