Title Page

  • SSQM:

  • Operator:

  • FRAC Site:

  • Date and Time:

  • Equipment:

  • Lease Name:

  • Customer Rep Name/Ph#:

  • Drivers:

  • Techs:


  • Road Conditions:

  • Site Conditions:

  • Weather:

  • Hazards Identified:

  • Comments:

  • Site Safety Share:

  • Truck #
  • Truck #:

Employee Safety

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

  • Appropriate Gloves/Hearing Protection

  • Face Shield/Goggles/Respiratory Mask/Reflective Material

  • H2S Monitors/4 Gas Monitors

  • Aprons available and being utilized

  • Harness available and being utilized

  • Crew awake, alert and attentive

  • Attending safety meetings

  • JSA completed

  • Pre/Post Trip completed (DVIR)

Trucks/Tank Staging

  • Wheels chocked

  • Cones placed

  • Truck properly grounded or bonded

  • Fire extinguisher placed/inspected

  • Emergency Shut Off Valve Properly Labeled & Identified

  • Hoses rolled up and stored when not in use

  • Hoses are not being run underneath equipment

  • Tank passed inspection

  • Utilizing spotter when driving on pad

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

Spill Protection

  • Full size containments placed, free of product/residue

  • All nozzle locks have been removed

  • Duck ponds under connection points during transfers

  • Hose wraps in place and in good condition

  • Nozzle caps or absorbent pads used on nozzle

I. Fueling

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

  • All units’ fuel level at 75% or better

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

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

II. Paperwork & Process

  • All paperwork Accurate and Legible

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

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

  • Hoses properly stored and maintained between dispensing

III. Customer Service Excellence

  • Safety Meeting Attendance

  • Personnel On-Site; Professional and Courteous

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

  • Timely and Attentive to Details

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

  • Tickets available for signature when needed

IV. Customer Satisfaction

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

  • V. Weekly Service Topic Discussion

  • VI. SSQM Notes/Comments

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.