Information

  • Client

  • Conducted on

  • Prepared by

  • Location
  • Rig number?

  • Tool Push

  • Weather?

  • Truck Push

Drilling Company

Personal Protective Equipment

  • Wearing approved Reflective Vests?

  • What is the severity of Non-Compliance?

  • Short Duration Infraction. Isolated to one individual over a short period of time.

  • Longer duration or multiple short duration infractions involving one individual.

  • Multiple infractions involving multiple individuals.

  • Disregard of policy or ignorance of policies.

  • Wearing approved Head Protection?

  • What is the severity of Non-Compliance?

  • Short Duration Infraction. Isolated to one individual over a short period of time.

  • Longer duration or multiple short duration infractions involving one individual.

  • Multiple infractions involving multiple individuals.

  • Disregard of policy or ignorance of policies.

  • Wearing approved Hand Protection?

  • What is the severity of Non-Compliance?

  • Short Duration Infraction. Isolated to one individual over a short period of time.

  • Longer duration or multiple short duration infractions involving one individual.

  • Multiple infractions involving multiple individuals.

  • Disregard of policy or ignorance of policies.

  • Wearing approved Safety Glasses?

  • What is the severity of Non-Compliance?

  • Longer duration or multiple short duration infractions involving one individual.

  • Multiple infractions involving multiple individuals.

  • Disregard of policy or ignorance of policies.

  • Wearing Fall Protection?

  • What is the severity of Non-Compliance?

  • Short Duration Infraction. Isolated to one individual over a short period of time.

  • Longer duration or multiple short duration infractions involving one individual.

  • Multiple infractions involving multiple individuals.

  • Disregard of policy or ignorance of policies.

  • Wearing approved Footwear?

  • What is the severity of Non-Compliance?

  • Short Duration Infraction. Isolated to one individual over a short period of time.

  • Longer duration or multiple short duration infractions involving one individual.

  • Multiple infractions involving multiple individuals.

  • Disregard of policy or ignorance of policies.

  • Wearing approved Fire Retardant Clothing?

  • What is the severity of Non-Compliance?

  • Short Duration Infraction. Isolated to one individual over a short period of time.

  • Longer duration or multiple short duration infractions involving one individual.

  • Multiple infractions involving multiple individuals.

  • Disregard of policy or ignorance of policies.

Lease Condition

  • Entrance to lease safe? Hills maintained, ample room, etc.

  • Indicate risk level below.

Rig Equipment/tools

  • Junk boxes sufficient to hold loose misc rig equipment?

  • How was the junk box situation ?

  • Lease free of debris and spills?

  • Rig mats in good condition with all shackles in working order?

  • Are the shackles in good working order? The matting is not broken or warped? Has the matting been cleaned for transport ?

  • Mixing bins have been emptied and ready for transport ?

  • How bad are the mixing bins?

  • Pipe is ready for transport and properly stored off the ground to prevent injury during sling up?

  • Illumination for work site adequate?

  • How is the lighting on location.

  • Hand tools are in good condition?

  • Pipe tubs clear of junk and not overloaded?

First Aid

  • First aid supplies?

  • First Aid Certifcation?

  • Ambulance ?

Safety Meeting

  • Safety meeting held and copies of minutes completed / Prior to Rig up / Tear Down?

  • Workers Visibility ?

  • Workers not in unsafe Positions?

  • Sufficient signallers?

  • Over head power lines identified and safe work clearance ensured?

  • Warning signs in place?

  • Designated signal persons where applicable ?

  • Procedures in place?

  • Green hats Identified?

WHMIS

  • Work site labels in place?

  • Worker training in place?

  • Location of MSDS made known?

TDG

  • Training in place?

  • Placarding supplied to trucking company?

Trucking Company

Personal Protective Equipment

  • Wearing Approved Fire Retardant Clothing?

  • What is the severity of Non-Compliance?

  • Short Duration Infraction. Isolated to one individual over a short period of time.

  • Longer duration or multiple short duration infractions involving one individual.

  • Multiple infractions involving multiple individuals.

  • Disregard of policy or ignorance of policies.

  • Wearing Approved Fall Protection?

  • What is the severity of Non-Compliance?

  • Short Duration Infraction. Isolated to one individual over a short period of time.

  • Longer duration or multiple short duration infractions involving one individual.

  • Multiple infractions involving multiple individuals.

  • Disregard of policy or ignorance of policies.

  • Wearing Approved Safety Glasses?

  • What is the severity of Non-Compliance?

  • Short Duration Infraction. Isolated to one individual over a short period of time.

  • Longer duration or multiple short duration infractions involving one individual.

  • Multiple infractions involving multiple individuals.

  • Disregard of policy or ignorance of policies.

  • Wearing Approved Reflective Vests?

  • What is the severity of Non-Compliance?

  • Short Duration Infraction. Isolated to one individual over a short period of time.

  • Longer duration or multiple short duration infractions involving one individual.

  • Multiple infractions involving multiple individuals.

  • Disregard of policy or ignorance of policies.

  • Wearing Approved Foot Wear?

  • What is the severity of Non-Compliance?

  • Short Duration Infraction. Isolated to one individual over a short period of time.

  • Longer duration or multiple short duration infractions involving one individual.

  • Multiple infractions involving multiple individuals.

  • Disregard of policy or ignorance of policies.

  • Wearing Approved Head Protection?

  • What is the severity of Non-Compliance?

  • Short Duration Infraction. Isolated to one individual over a short period of time.

  • Longer duration or multiple short duration infractions involving one individual.

  • Multiple infractions involving multiple individuals.

  • Disregard of policy or ignorance of policies.

Rigging Equipment and Trucks

  • Condition of winch lines?

  • Condition of Hooks?

  • Condition of Slings

  • Condition of Truck Beds

  • Trucks in good working order. No leaks, body damage, lights functioning?

  • Trucks back up alarms working and audible?

  • Picker / Crane Operator Certifaction?

  • Picker / Crane Inspection Certification Valid?

  • No riders on moving equipment?

  • Tag lines utilized and in good condition?

First Aid

  • Personnel trained in required First Aid

Safety Meeting

  • Safety meeting held and copies of minutes completed / Prior to Rig up / Tear Down?

  • Workers Visibilty?

  • Workers not in unsafe positions?

  • Sufficient signallers?

  • Over head power lines identified and safe work clearance ensured?

  • Warning signs in place?

  • Designated signal persons where applicable ?

  • Critical Lift Meetings held where applicable?

  • Procedures in place?

  • Green hats Identified?

TDG

  • Personnel Trained in TDG?

  • Material Loading Tickets utilized and current ?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.