Safety and Compliance Audit 2018

• Audit Title

• Who is the driver working for?

  Beaver Creek

  Sub-Contractor

  Owner Op

• Company Name

• Truck #

• Trailer #

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

Oilfield Basics

• Is this a flowback hand?

  Yes

  No

  N/A

• Does the flowback hand have all the required safety in use?

  Yes

  No

  N/A

• What safety protocol or equipment is not being utilized?

  Select JSA Fluid Transfer Sheet Cones Fire Extinguisher Fittings Unsecure Safety Vest Back Up Spotting

  • JSA
  • Fluid Transfer Sheet
  • Cones
  • Fire Extinguisher
  • Fittings Unsecure
  • Safety Vest
  • Back Up Spotting

• Is this a sand driver?

  Yes

  No

  N/A

• Is the driver and equipment work site ready?

  Yes

  No

  N/A

• What is not work site ready?

  Select Site Ready (can't exit the vehicle) Site Readiness questionable Truck down Truck Issue Trailer Down Trailer Issue

  • Site Ready (can't exit the vehicle)
  • Site Readiness questionable
  • Truck down
  • Truck Issue
  • Trailer Down
  • Trailer Issue

• Is this an oil driver?

  Yes

  No

  N/A

• Is the driver and equipment well site and offload ready?

  Yes

  No

  N/A

• What is not well site/off load facility ready?

  Select H2S 4 gas monitor PPE Load hoses PTO Pump Centrifuge Hydrometer Woodback Viles Solvent Thief Sample Bottles Tape 50'

  • H2S 4 gas monitor
  • PPE
  • Load hoses
  • PTO Pump
  • Centrifuge
  • Hydrometer
  • Woodback
  • Viles
  • Solvent
  • Thief
  • Sample Bottles
  • Tape 50'

• Is all of the required driver certifications/documentations present?

  Yes

  No

  N/A

• What certification(s) is the driver missing?

  Select CDL Med Card JSA SR/ER/HM* HOS HOS Properly(Short haul) Marathon Hess H2S Awareness OSHA 10/ PEC Mask Fit (Correct Mask) Clean Shaving

  • CDL
  • Med Card
  • JSA
  • SR/ER/HM*
  • HOS
  • HOS Properly(Short haul)
  • Marathon
  • Hess
  • H2S Awareness
  • OSHA 10/ PEC
  • Mask Fit (Correct Mask)
  • Clean Shaving

• Is all required PPE in present and utilized correctly?

  Safe

  At Risk

  N/A

• What PPE is missing or out of compliance?

  Select H2S Monitor missing H2S monitor improperly Hard Hat FRC Outer Layer FRC needs replaced Safety Glasses Steel Toe

  • H2S Monitor missing
  • H2S monitor improperly
  • Hard Hat
  • FRC Outer Layer
  • FRC needs replaced
  • Safety Glasses
  • Steel Toe

• Is truck in good working order?

  Yes

  No

  N/A

• What truck issues are present?

  Select Body/Bumper Lights Lights/Signage clean Tires1 Tires Leaks1 Leaks Cab

  • Body/Bumper
  • Lights
  • Lights/Signage clean
  • Tires1
  • Tires
  • Leaks1
  • Leaks
  • Cab

• Is all of the truck and trailer documentation present?

  Yes

  No

  N/A

• What truck and trailer documentation is missing?

  Select Registration Insurance Annual Inspection Lease Agreement Brokerage Agreement TERO Plates/Stickers Trailer 5 YR UCR Hazmat Registration

  • Registration
  • Insurance
  • Annual Inspection
  • Lease Agreement
  • Brokerage Agreement
  • TERO
  • Plates/Stickers
  • Trailer 5 YR
  • UCR
  • Hazmat Registration

• Is the trailer equipment is working order?

  Safe

  At Risk

  N/A

• What trailer equipment is not in working order?

  Select Centrifuge Load Hoses Ground Chocks Vent Line Hoses / wiring Gauges

  • Centrifuge
  • Load Hoses
  • Ground
  • Chocks
  • Vent Line
  • Hoses / wiring
  • Gauges

• Is all Safety Equipment present?

  Yes

  No

  N/A

• What safety equipment is missing?

  Select Fire Extinguisher DOT Fire Extinguisher Trailer Triangles First Aid Kit Basic Tools Spill Kit Shovel Rake Pick Chocks

  • Fire Extinguisher DOT
  • Fire Extinguisher Trailer
  • Triangles
  • First Aid Kit
  • Basic Tools
  • Spill Kit
  • Shovel
  • Rake
  • Pick
  • Chocks

• Add media

  Media

• Add drawing

  Drawing

• Auditor Notes

• Add signature

  Sign

• Add signature

  Sign