Seismic Drill Audit - November 2013

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Vehicle Information

• Photo of Drill

  Media

• Driller

• Helper(s)

• Contractor & Unit #

• Make/Model

• Last Maintenance

• Next Scheduled Maintenance

• Hours

Safety Equipment

• Fire Extinguisher

  Yes

  No

  N/A

• First Aid Kit (type)

  Yes

  No

  N/A

• Identified Emergency Kill Switch

  Working Order

  Out of Order

  N/A

• Escape Hatch

  Safe

  At Risk

  N/A

• Seat Belts (2" AB, 3" BC)

  Safe

  At Risk

  N/A

• Two Way Radio

  Working Order

  Out of Order

  N/A

• GPS

  Working Order

  Out of Order

  N/A

• TDG Placard

  Yes

  No

  N/A

• WHMIS Labels

  Yes

  No

  N/A

• Dynamite kept away from Exhaust?

  Yes

  No

  N/A

• Powder Cap and Magazines kept safe?

  Yes

  No

  N/A

• Magazine Cleanliness

  Safe

  At Risk

  N/A

Mechanical

• Exhaust (leaks/condition)

  Safe

  At Risk

  N/A

• Fluid Leaks

  Yes

  No

  N/A

• Brakes

  Working Order

  Out of Order

  N/A

• Parking Brake

  Working Order

  Out of Order

  N/A

• Drill Control Condition

  Safe

  At Risk

  N/A

• Identified Drill Controls

  Yes

  No

  N/A

Lights/Electrical

• Headlights

  Working Order

  Out of Order

  N/A

• Brake Lights

  Working Order

  Out of Order

  N/A

• Back-up Lights and Signal

  Working Order

  Out of Order

  N/A

• Beacon

  Working Order

  Out of Order

  N/A

Visibility

• Mirrors

  Safe

  At Risk

  N/A

• Windshield (cracks/chips)

  Safe

  At Risk

  N/A

• Side Screen or Glass

  Safe

  At Risk

  N/A

Winches

• Winch Condition

  Working Order

  Out of Order

  N/A

• Winch Cable (frays/kinks)

  Safe

  At Risk

  N/A

• Cable Clamps

  Safe

  At Risk

  N/A

Miscellaneous

• Outside Appearance

  Safe

  At Risk

  N/A

• Engine Cleanliness

  Safe

  At Risk

  N/A

• Wheel/Track Condition

  Safe

  At Risk

  N/A

• No Loose Items in Cab

  Yes

  No

  N/A

• Housekeeping

  Safe

  At Risk

  N/A

• Tow Hooks

  Safe

  At Risk

  N/A

Driller PPE

• Hard Hat

  Yes

  No

  N/A

• High Visibility Vest/Clothing

  Yes

  No

  N/A

• Safety Boots

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Eye Protection

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

Helper PPE

• Hard Hat

  Yes

  No

  N/A

• High Visibility Vest/Clothing

  Yes

  No

  N/A

• Safety Boots

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Eye Protection

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Notes

• Items Needing Repair

• Auditor

  Sign