SEM 2.13.3.1

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Safety

• Legal appointments (2.6.1, 2.9.2, 2.17.1, 2.18.1)

  Yes

  No

  N/A

• H&S policy

  Yes

  No

  N/A

• Site specific induction

  Yes

  No

  N/A

• Capabile to perform task

  Yes

  No

  N/A

• Competent artisans / operators

  Yes

  No

  N/A

• Authorised to perform task

  Yes

  No

  N/A

• SLAM / JRA completed for taks

  Yes

  No

  N/A

• Safe declaration

  Yes

  No

  N/A

• PPE (Condition, use & issue)

  Yes

  No

  N/A

Permits

• Isolation / lockout

  Yes

  No

  N/A

• Live testing

  Yes

  No

  N/A

• Hot & cold

  Yes

  No

  N/A

• Working on heights

  Yes

  No

  N/A

• Working in close proximity of power lines

  Yes

  No

  N/A

• Excavation

  Yes

  No

  N/A

Site setup

• Housekeeping

  Yes

  No

  N/A

• Mobile facilities / toilets

  Yes

  No

  N/A

• Refuse bins

  Yes

  No

  N/A

• 1st aid box, stretcher, assembly point

  Yes

  No

  N/A

• Barricade & signs

  Yes

  No

  N/A

Training

• Equipment specific

  Yes

  No

  N/A

• Working on heights

  Yes

  No

  N/A

• Basic rigging

  Yes

  No

  N/A

• Isolation lockout

  Yes

  No

  N/A

• Utility knives

  Yes

  No

  N/A

• Spotters (Test & authorised)

  Yes

  No

  N/A

• Power tool training

  Yes

  No

  N/A

• Trailers

  Yes

  No

  N/A

Tools / special tools

• Condition of tools

  Yes

  No

  N/A

• Signed off drawing

  Yes

  No

  N/A

• Unique number, inspected and on file

  Yes

  No

  N/A

• Electrical tools (Grinders etc.)

  Yes

  No

  N/A

• Mobile pumps - pre-start, unique number, inspected and on file

  Yes

  No

  N/A

Equiment

• Gas cutting equipment

  Yes

  No

  N/A

• Flash back arrestors

  Yes

  No

  N/A

• Welding equipment

  Yes

  No

  N/A

• Welding - open circuit test < 30 V

  Yes

  No

  N/A

• Lifting equipment (Slings, chain blocks - condition and colour coding)

  Yes

  No

  N/A

Trailers

• Pre-shit inspection

  Yes

  No

  N/A

• GVM<br>< 750 kg - no brakes<br>750 - 3 T - inertia brake<br>> 3 T - service brake

  Yes

  No

  N/A

• Safety chain (Bolted)

  Yes

  No

  N/A

• Safety cable

  Yes

  No

  N/A

• Towing bracket

  Yes

  No

  N/A

• JRA for operation (Special trailers)

  Yes

  No

  N/A

• Towing vehicle<br>< 2 T - LDV<br>> 2 T - Hino

  Yes

  No

  N/A

• Lights / chevron board

  Yes

  No

  N/A

• Battery secured

  Yes

  No

  N/A

• CAS

  Yes

  No

  N/A

• Signs / identification

  Yes

  No

  N/A

Drills

• Tower secured / inspection / lock pins

  Yes

  No

  N/A

• Drill head guids / inspection

  Yes

  No

  N/A

• Wire line (Condition, secured & tested)

  Yes

  No

  N/A

• Hoisting cable (Condition, secured & tested)

  Yes

  No

  N/A

• CAS, revers camera, fatigue monitor

  Yes

  No

  N/A

• Oil leaks

  Yes

  No

  N/A

• Condition of casing & rods

  Yes

  No

  N/A

• Towing hinge

  Yes

  No

  N/A

• Batteries secured

  Yes

  No

  N/A

Legal compliance

• Services

  Yes

  No

  N/A

• Tyres > 25" (Nitrogen)

  Safe

  At Risk

  N/A

• Illumination test / lights operational

  Yes

  No

  N/A

• Fire suppression / extinguishers

  Yes

  No

  N/A

• Pressure vessel

  Yes

  No

  N/A

• Guards

  Yes

  No

  N/A

• Safety devices (Limits, e-stops, interlocks)

  Yes

  No

  N/A

• Drop zone & drop zone switch

  Yes

  No

  N/A

• Hose whipe (Double leg)

  Yes

  No

  N/A

• Qual rod (Replacement and hours)

  Yes

  No

  N/A

• Toolbox on rig (Inspection)

  Yes

  No

  N/A

• Tyres, wheel nut indicators, studs & tracks

  Yes

  No

  N/A

• Leveling jacks

  Yes

  No

  N/A

• Signs / identification

  Yes

  No

  N/A

• Brake & steering test

  Yes

  No

  N/A

Signatures

• 2.17.1 / 2.18.1 / operator

  Sign

• 2.6.1 / 2.9.2

  Sign

• 2.13.3.1

  Sign