Title Page
-
Audit Title
-
Customer
-
Well Name
-
Conducted on
-
Prepared by
-
Personnel
General Job Information
-
What size casing is being run?
-
How many feet of casing is being run?
-
What type of job is this?
- Top Job
- Rat Hole (Cellar, Conductor, Mouse)
- Well Plugging
Employee #1 Information
-
Enter employees name and position
-
Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)
-
Is the employee demonstrating acceptable work ability and habits? (Listens to crew pusher, follows PWI's, etc)
-
Is the employee wearing all required PPE? (Hardhat, Steel or Composite Toes, Safety Glasses, FRC's, Impact Gloves)
Employee #3 Information
-
Enter employees name and position
-
Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)
-
Is the employee wearing all required PPE? (Hardhat, Steel or Composite Toes, Safety Glasses, FRC's, Impact Gloves)
-
Is the employee demonstrating acceptable work ability and habits? (Listens to crew pusher, follows PWI's, etc)
Employee #2 Information
-
Enter employees name and position
-
Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)
-
Is the employee wearing all required PPE? (Hardhat, Steel or Composite Toes, Safety Glasses, FRC's, Impact Gloves)
-
Is the employee demonstrating acceptable work ability and habits? (Listens to crew pusher, follows PWI's, etc)
Employee #4 Information
-
Enter employees name and position
-
Is the employee demonstrating acceptable work ability and habits? (Listens to crew pusher, follows PWI's, etc)
-
Is the employee's general appearance acceptable? (Clean, PPE in good repair, etc)
-
Is the employee wearing all required PPE? (Hardhat, Steel or Composite Toes, Safety Glasses, FRC's, Impact Gloves)
Record of Driving Evaluation for Rathole Rig
-
Vehicle Number
-
Drivers Name
-
Did you ride with the driver?
-
Did the driver utilize wheel chocks on the truck when appropriate?
-
Did the driver complete a pre trip inspection in accordance with DOT regulations?
-
Did the driver keep smooth control of the vehicle at all times?
-
Did the driver utilize a spotter when backing up?
-
Was the driver consistently alert and attentive?
-
Did the driver utilize mirrors?
Record of Driving Evaluation for Chase Truck
-
Vehicle Number
-
Drivers Name
-
Did you ride with the driver?
-
Did the driver complete a pre trip inspection in accordance with DOT regulations?
-
Did the driver utilize wheel chocks on the truck when appropriate?
-
Did the driver keep smooth control of the vehicle at all times?
-
Did the driver utilize a spotter when backing up?
-
Was the driver consistently alert and attentive?
-
Did the driver utilize mirrors?
Record of Driving Evaluation for Pipe Hauler
-
Vehicle Number
-
Drivers Name
-
Did you ride with the driver?
-
Did the driver complete a pre trip inspection in accordance with DOT regulations?
-
Did the driver utilize wheel chocks on the truck when appropriate?
-
Did the driver utilize a spotter when backing up?
-
Did the driver keep smooth control of the vehicle at all times?
-
Was the driver consistently alert and attentive?
-
Did the driver utilize mirrors?
Rathole Drill Checklist - Please Note: Item must be serviceable in order to receive 'Yes' score.
-
Wrench Set
-
Punches
-
Grease Gun
-
Shackles
-
Hammer
-
Tag Line
-
Insurance
-
Registration
-
Fire Extinguisher
-
First Aid Kit
-
Bloodborne Pathogens Kit
Chase Truck Checklist - Please Note: Item must be serviceable in order to receive 'Yes' score.
-
Wrench Set
-
Punches
-
Grease Gun
-
Tag Line
-
Shackles
-
Hammer
-
Registration
-
Insurance
-
Fire Extinguisher
-
First Aid Kit
-
Bloodborne Pathogens Kit
Pipe Hauler Checklist - Please Note: Item must be serviceable in order to receive 'Yes' score.
-
Wrench Set
-
Punches
-
Grease Gun
-
Tag Line
-
Shackles
-
Registration
-
Insurance
-
Hammer
-
Fire Extinguisher
-
First Aid Kit
-
Bloodborne Pathogens Kit
Pre-Job
-
Did all personnel sign in when they arrived on location?
-
Was a JSA completed prior to rig up of equipment?
-
Was a JSA completed prior to beginning job?
-
Are all JSA signature sheets accounted for?
-
Have changes/additions been made to the JSA's to accommodate for job specific conditions?
-
Are there any unusual challenges present? (weather, mud, extreme temperatures, down hole problems, etc)
Skidsteer
-
Is the skidsteer free from leaks?
-
Is the back-up-alarm functional?
-
Is the skidsteer clean?
-
Does it appear to be in good condition? (no flat tires, no broken windows, etc)
Augers
-
Are augers free from any cracks in the lifting points?
-
Is the hardfacing in good condition?
-
Are the teeth in usable condition?
Drill Operator
-
Did the Drill Operator inspect the Drill?
-
Did the Drill Operator ensure the rig is rigged up correctly?
-
Is the Drill Operator ensuring the crew is working in a safe manner?
Hand #1
-
Did Hand #1 inspect tools for defects?
-
Did Hand #1 communicate job responsibilities with Hand #2?
-
Did Hand #1 keep a watch on drill for leaks or problems Driller cannot see?
-
Does Hand #1 keep derrick leveled correctly?
-
While operating skidsteer, does Hand #1 keep visual contact with other personnel?
Hand #2
-
Did Hand #2 inspect tools for defects?
-
Did Hand #2 communicate job responsibilities with Hand #1?
-
Did Hand #2 keep a watch on drill for leaks or problems Driller cannot see?
-
Does Hand #2 keep derrick leveled correctly?
-
While operating skidsteer, does Hand #2 keep visual contact with other personnel?
Simultaneous Operations
-
Are there simultaneous operations (other contractors on location) occurring?
-
Did Noble Casing, Inc personnel inform other contractor(s) of hazards created by Noble Casing, Inc?
Behavior Based Safety
-
Are employees free of Rushing, Frustration, Fatigue or Complacency?
-
Are employees free of Mind Not On Task, Eyes Not On Task, Line Of Fire or Loss Of Balance, Traction or Grip?
Post Job
-
Was a JSA completed prior to rigging down equipment?
-
I certify that I completed this field evaluation and that all items are true and correct to the best of my knowledge.
