SSQM Site Safety & Service Audit

• SSQM:

• Operator:

• FRAC Site:

  Select

• Date and Time:

  Date

• Equipment:

• Lease Name:

• Customer Rep Name/Ph#:

• Drivers:

• Techs:

Conditions

• Road Conditions:

• Site Conditions:

• Weather:

• Hazards Identified:

• Comments:

• Site Safety Share:

Truck #

• Truck #:

Employee Safety

• Hard Hat/Steel-toe Boots/Safety Glasses/FR Clothing

  Yes

  No

  N/A

• Appropriate Gloves/Hearing Protection

  Yes

  No

  N/A

• Face Shield/Goggles/Respiratory Mask/Reflective Material

  Yes

  No

  N/A

• H2S Monitors/4 Gas Monitors

  Yes

  No

  N/A

• Aprons available and being utilized

  Yes

  No

  N/A

• Harness available and being utilized

  Yes

  No

  N/A

• Crew awake, alert and attentive

  Yes

  No

  N/A

• Attending safety meetings

  Yes

  No

  N/A

• JSA completed

  Yes

  No

  N/A

• Pre/Post Trip completed (DVIR)

  Yes

  No

  N/A

Trucks/Tank Staging

• Wheels chocked

  Yes

  No

  N/A

• Cones placed

  Yes

  No

  N/A

• Truck properly grounded or bonded

  Yes

  No

  N/A

• Fire extinguisher placed/inspected

  Yes

  No

  N/A

• Emergency Shut Off Valve Properly Labeled & Identified

  Yes

  No

  N/A

• Hoses rolled up and stored when not in use

  Yes

  No

  N/A

• Hoses are not being run underneath equipment

  Yes

  No

  N/A

• Tank passed inspection

  Yes

  No

  N/A

• Utilizing spotter when driving on pad

  Yes

  No

  N/A

• Truck/Equipment has been inspected & is in working order

  Yes

  No

  N/A

Spill Protection

• Full size containments placed, free of product/residue

  Yes

  No

  N/A

• All nozzle locks have been removed

  Yes

  No

  N/A

• Duck ponds under connection points during transfers

  Yes

  No

  N/A

• Hose wraps in place and in good condition

  Yes

  No

  N/A

• Nozzle caps or absorbent pads used on nozzle

  Yes

  No

  N/A

I. Fueling

• “Critical 4” topped off, accounted for (blender, hydrator, data van, t-belt)

  Yes

  No

  N/A

• All units’ fuel level at 75% or better

  Yes

  No

  N/A

• Fill points identified for All Units and assigned to truck/driver

  Yes

  No

  N/A

• Equipment being checked/filled in timely manner (Every Hour)

  Yes

  No

  N/A

II. Paperwork & Process

• All paperwork Accurate and Legible

  Yes

  No

  N/A

• Personnel utilizing Unit Fill Sheet/Asset Tracker (All Units Listed)

  Yes

  No

  N/A

• Driver/Tech maintaining “Line of Site” with each other during dispenses

  Yes

  No

  N/A

• Hoses properly stored and maintained between dispensing

  Yes

  No

  N/A

III. Customer Service Excellence

• Safety Meeting Attendance

  Yes

  No

  N/A

• Personnel On-Site; Professional and Courteous

  Yes

  No

  N/A

• Communications from Field Crew/Dispatch/Operations; Professional,

  Yes

  No

  N/A

• Timely and Attentive to Details

  Yes

  No

  N/A

• Lead Driver checking-in with Data Van/CM at beginning of each shift

  Yes

  No

  N/A

• Tickets available for signature when needed

  Yes

  No

  N/A

IV. Customer Satisfaction

• Satisfied with our Services? “What can we do better?”<br>(Add comments in Note)

  Pass

  Fail

• V. Weekly Service Topic Discussion

• VI. SSQM Notes/Comments