Statoil Bakken Business Unit / Drilling Site Safety Report

• Conducted on

  Date

• Location:

• Well #:

• AFE #:

• Statoil Site Representative:

• Statoil Safety Representative:

• Contractors Working on Location:

• Status of Operations:

Applicable Permits:

• JSA / SJA Completed with Contractor with Contractor Sign-In Sheet?

  Yes

  No

  N/A

• Hot Work Permit Completed?

  Yes

  No

  N/A

• Confined Space Permit Completed and Posted?

  Yes

  No

  N/A

• Critical Lift Permit Completed?

  Yes

  No

  N/A

• Ground Disturbance Permit Completed?

  Yes

  No

  N/A

General Drilling Site Inspection:

• Authorized Personnel Sign Posted at entrance of site?

  Yes

  No

  N/A

• Rig signage erected at entrance to the site and at all directional changes in route to the site?

  Yes

  No

  N/A

• Proper PPE Signage posted at entrance?

  Yes

  No

  N/A

• No Smoking Signs and Designated Smoking Areas Signs posted?

  Yes

  No

  N/A

• Is there parking within 100ft of well bore?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Muster area Designated?

  Yes

  No

  N/A

• Visitor Signage (directing them to Toolpusher) upon entry to location?

  Yes

  No

  N/A

• Supply Storage House Clean and Orderly?

  Yes

  No

  N/A

• Sign-In Sheet (required upon arrival) is Available?

  Yes

  No

  N/A

• Warning Signs Clean and Visable?

  Yes

  No

  N/A

• Hazardous Locations Identified?

  Yes

  No

  N/A

• All Vessels Labeled as to their Contents?

  Yes

  No

  N/A

• Adequate Lighting Provided?

  Yes

  No

  N/A

• There are No Trip Hazards?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Erected Windsock Visable?

  Yes

  No

  N/A

• OSHA Poster Posted?

  Yes

  No

  N/A

• Safety Equipment Available on Location?

  Yes

  No

  N/A

• Fall Protection being utilized when Required?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Emergency Phone Posted on Location?

  Yes

  No

  N/A

Stairs / Ladders / Handrails / Gaurdrails:

• Adequate Stairs provided off Rig Floor?

  Yes

  No

  N/A

• All stairs on Location are Level?

  Yes

  No

  N/A

• Are there a minimum of 2 Stairways available to Drilling Floor?

  Yes

  No

  N/A

• Are the Stairs on Location Secured?

  Yes

  No

  N/A

• There are No Trip Hazards on Stairs?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Guardrails, Mid-Rails, and Toe-Boards Installed along all open side edges of Floors, Platforms, Etc...

  Yes

  No

  N/A

• Ladders on Location are Extended No More than 3.5ft above Platform?

  Yes

  No

  N/A

• All Fixed and Portable Ladders are in Good Condition and Free of Defects?

  Yes

  No

  N/A

Rig Floor:

• Rotary Floor in Good Woking Condition?

  Yes

  No

  N/A

• All Unused Floor Holes Covered?

  Yes

  No

  N/A

• Weight Indicator Installed and Visible to Driller?

  Yes

  No

  N/A

• Driller's Controls Properly Labeled?

  Yes

  No

  N/A

• Slips and Dies in Good Working Condition?

  Yes

  No

  N/A

• Racking Area in Good Working Condition?

  Yes

  No

  N/A

• V-Door Gate / Chain (Provided) In Place?

  Yes

  No

  N/A

• Air-Hoist Cable in Good Working Condition?

  Yes

  No

  N/A

• Pipe Handling Tools in Good Working Condition?

  Yes

  No

  N/A

• All Straps and Slings in Good Working Condition?

  Yes

  No

  N/A

• Housekeeping on Rig Floor is Adequate?

  Yes

  No

  N/A

• Eye Wash Station Provided?

  Yes

  No

  N/A

• Keepers and Pins Properly Installed?

  Yes

  No

  N/A

Fuel / Storage Tanks:

• Fuel Storage Tanks Properly Located and Labeled as to their Contents?

  Yes

  No

  N/A

• Discharge Valves, Nozzles and Hoses in Good Working Condition?

  Yes

  No

  N/A

• "Flammable" Warning Signs Properly Posted on All Sides of Storage Tanks?

  Yes

  No

  N/A

• LPG Storage Tanks and Compress Gas Cylinders are Properly Labeled and in Good Working Condiition?

  Yes

  No

  N/A

• Safety Caps / Bull Plugs are Properly Installed to Prevent Spills?

  Yes

  No

  N/A

Generator Area / Electrical Systems:

• Safeguards Properly Installed over all Moving Parts?

  Yes

  No

  N/A

• All Electrical Equipment and Generators are Properly Grounded?

  Yes

  No

  N/A

• All Electrical Equipment Properly Marked as to its Function?

  Yes

  No

  N/A

• "High Voltage" Warning Signs Properly Posted?

  Yes

  No

  N/A

• LOTO Devices Provided and Available?

  Yes

  No

  N/A

• "Hearing Protection Required" Warning Signs are Properly Poseted?

  Yes

  No

  N/A

• Hearing Protection Provided and Available?

  Yes

  No

  N/A

• All Electrical Wiring is off the Ground?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• All Light Fixtures are Properly Protected from Damage?

  Yes

  No

  N/A

Fire Protection:

• All Fire Extinguishers (B&C Class) are Properly Charged and in Good Working Condition?

  Yes

  No

  N/A

• All Fire Extinguishers (B&C Class) Have had their Monthly/Annual Inspection and Properly Tagged?

  Yes

  No

  N/A

• Flare Area is Clear of any Combustable Material?

  Yes

  No

  N/A

• Employees Have been Properly Trained to Operate Fire Extinguishers on Location?

  Yes

  No

  N/A

Mud Mixing Area / Tanks and Pit:

• Bagged Material Properly Stacked?

  Yes

  No

  N/A

• Are Material Safety Data Sheets (MSDS) Available?

  Yes

  No

  N/A

• Has Adequate Ventilation been Provided in the Mud Mixing Area?

  Yes

  No

  N/A

• Has an Emergency Shower and Eye Wash Station been Provided in the Area?

  Yes

  No

  N/A

• Are there Chemical Hazard Warning Signs Posted and Visable?

  Yes

  No

  N/A

• Is Safety Cabinet well stocked with Proper PPE (Respirators, Face Shields, Aprons, Rubber Boots Etc.)?

  Yes

  No

  N/A

• All Warning Signs Posted and Visable?

  Yes

  No

  N/A

• Adequate Stairs, Handrails and Guardrails Provided for Crossovers?

  Yes

  No

  N/A

• Housekeeping is Adequate in Mud Mixing Area?

  Yes

  No

  N/A

Mud Pump Area:

• All Drive Belts and Shafts have Guards Properly Installed?

  Yes

  No

  N/A

• All Rotating Parts have Guards Properly Installed?

  Yes

  No

  N/A

• Have Shear Pin Pop-Off Valves been Properly Covered?

  Yes

  No

  N/A

• Have Vibrator Hoses and High Pressure Lines been Properly Secured?

  Yes

  No

  N/A

• Have High Pressure Fittings been Used where Applicalbe?

  Yes

  No

  N/A

• Have All Discharge Lines from Relief Valves been Properly Anchored?

  Yes

  No

  N/A

• Are All Pumps, Pipes, Hoses, Valves, and Fittings have been Well Maintained and Are In Good Working Condition?

  Yes

  No

  N/A

• Are All Pumps, Pipes, Hoses, Valves and Fittings Being Operated at Pressures In Which they are Rated?

  Yes

  No

  N/A

Blow Out Preventer / Accumulator / Choke Area:

• Has the Blow Out Preventer (BOP) been tested to Function Properly?

  Yes

  No

  N/A

• Is the Blow Out Preventer (BOP) Properly Stabilzed?

  Yes

  No

  N/A

• Are All Hydraulic Lines Properly Connected?

  Yes

  No

  N/A

• Are All Unused Hydraulic LInes Capped and Properly Secured?

  Yes

  No

  N/A

• Has there been a Check Valve Installed On Kill LIne Side?

  Yes

  No

  N/A

• Have Safety Cables been Installed On the Kill Line and Choke Line?

  Yes

  No

  N/A

• Have Pollution Pans been Properly Installed?

  Yes

  No

  N/A

• Accumulator Vales have been Properly Identified as to their Purpose and Position?

  Yes

  No

  N/A

• All Gauges are Installed Properly and Located in the Correct Position?

  Yes

  No

  N/A

• Accumulator Bottles Properly Labeled with their Contents?

  Yes

  No

  N/A

• Are the Accumulator Operational Warning Signs Visible?

  Yes

  No

  N/A

• Is the Choke Manifold Accessible?

  Yes

  No

  N/A

• Are the Choke Manifold Gauges Visible and Working Properly?

  Yes

  No

  N/A

Pipe Rack Area:

• Are the Ends of the Pipe Racks Properly Chocked?

  Yes

  No

  N/A

• Are Spacers being Utilized to Separate Layers of Pipe?

  Yes

  No

  N/A

• Are Pipe Racks Stable / Level and In Good Working Condition?

  Yes

  No

  N/A

• Is the V-Door Slide and Pipe-Stops In Good Working Condition?

  Yes

  No

  N/A

Material Handling Equipment:

• Has the Forklift Operator been Certified and Properly Trained?

  Yes

  No

  N/A

• Are all Equipment Certification Documents Available for Inspection on Location?

  Yes

  No

  N/A

• Is the Proper Type of Equipment being Utilized for Handling of Material on Location?

  Yes

  No

  N/A

• Is Proper Inspection of Equipment (Forklift) Being Done Prior to Daily Use?

  Yes

  No

  N/A

• All Safety Devices on Equipment (Seat-belts, BackUp Alarms, Etc.) In Good Working Condition?

  Yes

  No

  N/A

Additional Findings / Issues or Concerns:

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• Statoil Safety Representative:

  Sign

• Company Man:

  Sign

• Tool Pusher:

  Sign

• Other (Contractor):

  Sign