Roustabout

• Location name

• Customer Name

• Weather Conditions

• Is JSA completed?

  Yes

  No

  N/A

• Conducted on

  Date

• Prepared by

Truck Information:

• Unit #

• Odometer

• Hour Meter

• Driver completed Pre Trip inspection for truck?

  Yes

  No

  N/A

• Trucks paperwork is up to date

  Yes

  No

  N/A

• Truck has the correct fuel card

  Yes

  No

  N/A

• Truck has a fully equipped first aid kit

  Yes

  No

  N/A

• Truck has fire extinguisher /triangles/spare fuses

  Yes

  No

  N/A

• Load securement: Tool boxes, bed of truck

  Yes

  No

  N/A
Trailer Information:

• Unit #

• Paperwork is up to date

  Yes

  No

  N/A
Mobile Equipment/ PIT's/Manlifts

• Equipment being used

• Daily Inspection completed

  Yes

  No

  N/A

• Operator certified and authorized to use equipment

  Yes

  No

  N/A

• Equipment being used within its operating limits

  Yes

  No

  N/A

• Other Safety concerns:

PPE Requirements:

• Hard hat

  Yes

  No

  N/A

• FR Pants

  Yes

  No

  N/A

• Long Sleeve FR shirt or FR jacket

  Yes

  No

  N/A

• Safety toe boots

  Yes

  No

  N/A

• Appropriate glove type:

• Safety glasses (Dark/Clear)

  Yes

  No

  N/A

• Ear Plugs (if needed)

  Yes

  No

  N/A

• Other:

Operations

• Operator has taken the precautions needed for the current weather conditions?

  Yes

  No

  N/A

• Operator has gathered any missing materials before leaving to location

  Yes

  No

  N/A

• What is the job task?

• Are any Work Authorization's (Work Permits) required?

  Yes

  No

  N/A

• What permits?

• Complete and correct?

  Yes

  No

  N/A

• Are permtis being followed?

  Yes

  No

  N/A

• Other safety concerns?

• Yes

  No

  N/A