• Conducted on

  • Location:

  • Well #:

  • AFE #:

  • Statoil Site Representative:

  • Statoil Safety Representative:

  • Contractors Working on Location:

  • Status of Operations:

Inspection Checklist

Applicable Permits:

  • JSA / SJA Completed for Each Contractor on Location with Contractor Sign-In Sheet?

  • Hot Work Permit Completed?

  • Confined Space Permit Completed and Posted?

  • Critical Lift Permit Completed?

  • Ground Disturbance Permit Completed?


  • Proper Signage in Place at the Entrance to Location?

  • Designated Smoking Area Assigned?

  • Proper PPE Signage posted at entrance?

  • Warning Signs Clean and Visable?

  • Tank Battery Signs Posted?

General Site Inspection:

  • Material Safety Data Sheets (MSDS) and Shipping Papers are on Location and Easily Accessible?

  • There are No Fluid Leaks, Discharges or Spills on Location?

  • Interior / Exterior Berms Present on Location?

  • There are No Trip Hazards?

  • All Vessels Labeled as to their Contents?

  • Proper PPE/FRC being worn by all personnel on Location?

  • Is a Clean and Sanitary Portable Restroom Facility provided in close proximity to the location?

  • Erected Windsock Visable?

  • Production Equipment Set?

  • Fall Protection being utilized when Required?

  • First Aid Kit and Blood Born Pathogen Kit available on Location?

  • Are Proper Tools being Utilized for the Job at Hand?

  • Are all Tools in Proper Working Condition?

  • Adequate Handrails provided on stairs with 4 or more Risers?

  • Stairs have Non-Skid Steps and are uniform size?

  • Proper Lifting Mechanics are being Used by Personnel?

  • Housekeeping is Good in all Work Areas?

  • Backup Alarms are Working Properly on Material Handling Equipment?

  • Daily Inspection of Material Handling Equipment (Forklift / Loader) has been completed?

  • Operator of Material Handling Equipment (Forklift / Loader) has Proper Certification?

  • Material Handling Equipment (Forklift / Loader) is Parked with it Forks in the Down Position?

  • Seat-belts are being Used by Operator of Material Handling Equipment?

  • Dead-Men are Properly Marked?

  • All Parked Vehicles are Properly Chocked?

  • Back-In Parking is being Utilized on Location?

  • Spotters are being Utilized on Location?

  • Fire Extinguishers are Properly Placed and have Current Inspection Tags?

  • Whip-Check are in Place and Cement Blocks are Set on High Pressure Lines?

  • Trucks Observing 5mph Speed Limit on Location?


  • All Electrical Equipment, Trailers, Generators, Accumulators, and Pipe Wrangler are Properly Grounded?

  • All Electrical Equipment Properly Marked as to its Function?

  • "High Voltage" Warning Signs Properly Posted?

  • LOTO Devices Provided and Available?

  • All Electrical Wiring is off the Ground?

  • All Electrical Cords, Receptacles, and Plugs in Good Working Condition?

  • All Exterior Electrical Outlets are Covered?

  • Is Rig Grounded to Well-Head?

  • Are Pumping Unit Weights Secured with Chain and Binder?

Rig Inspection:

  • Wind Walls are Erected and Placed Properly?

  • Locking Nuts are Properly Tightened on All Hydraulic Leveling Jacks?

  • Safeguards Properly Installed over all Moving Parts?

  • Pipe Racks are Level and Secured with Chocks in Place for Pipe?

  • Pipe Wrangler is Level and Secure?

  • Danger Area around Pipe Wrangler is Properly Marked?

  • All Fuel Tanks are Stored at the Proper Distance from Ignition Sources?

  • Guy-lines are Properly Connected to Tested Ground Anchors?

  • Guy-Lines are Properly Clamped?

  • Statoil Safety Banners are Clean and Attached to Guy-Lines?

  • Operator is at Controls?

  • Tool Pusher is Present on Location?

  • All Equipment with Motors are Located at Least 50ft from Well-Head or Ignition Source?

  • Pump is Located at Least 50ft from Well-Head?

  • Accumulator has No Leaks, and has been Properly Charged?

  • Accumulator has Whip-Checks that are Properly Placed?

  • Is there a Clear Means of Egress from Rig and Floor?

  • Is Emergency Escape in Place for Derrick Man?

Additional Findings:

Additional Findings / Issues or Concerns:

  • Issue #1:

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  • Issue #2:

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  • Issue #3:

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  • Issue #4:

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  • Issue #5:

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  • Issue #6:

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  • Issue #7:

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  • Issue #8:

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  • Issue #9:

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  • Issue #10:

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  • Statoil Safety Representative:

  • Company Man:

  • Tool Pusher:

  • Contractor Supervisor / Foreman:

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.