Information

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Vehicle Safety (DOT)

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

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

  • b) Are DOT logs current?

  • c) Do vehicles have required emergency equipment?

  • d) Journey Management in use and trips monitored?

SSE

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

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

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

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

Housekeeping

  • a) Pre-job checklist completed?

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

  • 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.}

  • 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.}

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

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

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>

  • 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>

  • 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>

  • 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>

  • Job packets completed?

JSA's

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

  • a) Are JSA's available for review?

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

  • c) Do employees understand the JSA process?

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

Stop Work Process

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

  • a) Is the Stop Work process understood?

  • b) Are Stop Work's encouraged?

  • d) Are StopWorks being reviewed during safety meetings?

Environmental Impact

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

  • a) Is there evidence of spills/leaks

  • b) Is there appropriate secondary containment?

  • c) Are chemicals stored properly?

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

Emergency Action Plan

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

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

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

  • c) Do employees understand their roles and responsibilities?

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

Radiation Safety (3rd Party)

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

  • a) Is all related annual training complete?

  • b) Are all meter calibrations current?

  • c) Is permit current and posted as required?

  • d) Are logs and inventories up to date?

  • e) Leak test current?

Explosive Safety (3rd party)

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

  • a) Are explosives properly stored?

  • b) Do logs match current inventories?

  • c) Is all related training complete?

  • d) Is permit current and posted as required?

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

  • ACTUAL TOTAL SCORE?

  • AVERAGE SCORE?

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