Statoil Bakken Business Unit / Hydraulic Fracturing Site Safety Report Checklist

JSA / SJA Completed with Contractor 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?

No Smoking Signs and Designated Smoking Areas Signs posted?

Proper PPE Signage posted at entrance?

"Hearing Protection Required" Warning Signs are Properly Poseted?

Muster area Designated?

Warning Signs Clean and Visable?

Hazardous Locations Identified?

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

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

Adequate Lighting Provided?

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?

OSHA Poster Posted?

Safety Equipment Available on Location?

Respirators are being Utilized when Required?

Hearing Protection Provided and Available?

Fall Protection being utilized when Required?

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

Emergency Contact Information Posted on Location?

Safeguards Properly Installed over all Moving Parts?

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?

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

Wings and Lugs are Properly Dressed and in Good Condition?

Proper Lifting Mechanics are being Used by Personnel?

Dead-Men are Properly Marked with Visible Yellow Stakes?

Housekeeping is Good in all Work Areas?

Backup Alarms are Working Properly on Material Handling Equipment?

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

All Parked Vehicles are Properly Chocked?

Back-In Parking is being Utilized on Location?

Spotters are being Utilized on Location?

No Persons are Between the Wireline Truck and the Well Head while Wireline is in the hole?

No-Go Gauges Available on Location and being Utilized?

Only Essential Personnel is Located Inside the Red Zones?

All Radiation and Explosive Safety Procedures are being Followed?

Fire Extinguishers are Properly Placed and have Current Inspection Tags?

Is Fuel Transfer from Tanker Truck being Conducted Off Location?

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

Grounding and Bonding is being Utilized when Refueling Equipment or Vehicles?

Discharge Valves, Nozzles and Hoses in Good Working Condition?

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

All Electrical Equipment and Generators 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 Light Fixtures are Properly Protected from Damage?

All Exterior Electrical Outlets are Covered?

Operator is Certified and the Certification is within its 3 year Validity?

Daily Inspection of Crane has been Completed?

Crane has Annual Inspection Certification?

Lines, Tanks, Valves, Pumps, and Other Parts of the Crane's Hydraulic System are in Good Working Condition?

Lifting Hooks and Lines are in Good Working Condition Free from Defects or Cracks?

Safety Latch on Hook is in Good Working Condition?

Crane's Control Levers are Clearly Marked?

Load Charts are Legible and Near Operator Controls?

Boom Angle Indicator is Working Properly?

Slings and Straps are in Good Working Condition and Free from Defects?