Tall City Well Service Unit Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Driver

• Driver

  Media

• Driver name

• Hard hat on

  Yes

  No

  N/A

• Correct sticker for job location on hard hat?

  Yes

  No

  N/A

• Fr cloth on?

  Yes

  No

  N/A

• Driver have company uniforms or overalls

  Driver less then three month

  Driver uniforms order not received

  Uniforms not order

• Monitor properly worn?

  Yes

  No

  N/A

• Months left on monitor?

  Yes

  No

  N/A

• Monitor calibrated ?

  Yes

  No

  N/A

• Steal toe boots worn?

  Yes

  No

  N/A

• Correct fuel card for unit driven ?

  Yes

  No

  N/A

• Safety glass worn?

  Yes

  No

  N/A

• Driver clean Shaven?

  Yes

  No

  N/A

• Driver have safe land card?

  Yes

  No

  N/A

• Driver have client company required trading?

  Yes

  No

  N/A

• Driver have H2S card

  Yes

  No

  N/A

• Driver have current Fit test card?

  Yes

  No

  N/A

• Driver have current driver license?

  Yes

  No

  N/A

• Driver have current medical card?

  Yes

  No

  N/A

• DOT Drug test taken?

  Yes

  No

  N/A

Unit truck

• Add media

  Media

• Unit Number

• Any cracks on window.

  No

  Yes

• All wheels have all lug nuts ?

  Yes

  No

  N/A

• Any damage on wheels

  No

  Yes

• Tire have proper thread ?

  Yes

  No

  N/A

• DOT tape on rear mud flaps or fenders?

  Yes

  No

  N/A

• Door open properly ?

  Yes

  No

  N/A

• Tall City Logo on both doors and legible ?

  Yes

  No

  N/A

• DOT number legible on both doors?

  Yes

  No

  N/A

• Dot Tape on rear of cab and in white?

  Yes

  No

  N/A

• Clearance lights properly working

  Yes

  No

  N/A

• Head light working correctly ?

  Yes

  No

  N/A

• Emergency flashers working correctly?

  Yes

  No

  N/A

• Turn singles working correctly ?

  Yes

  No

  N/A

• Hood tie down properly placed?

  Yes

  No

  N/A

• Any cracks on frame?

  Yes

  No

• Pump has oil ?

  Yes

  No

  N/A

• Pump Clean?

  Yes

  No

  N/A

• Pump filter clean?

  Yes

  No

  N/A

• Any air leaks?

  No

  Yes

• Oil change current ?

  Yes

  No

  N/A

• Oil level correct?

  Yes

  No

  N/A

• Washer fluid level correct?

  Yes

  No

  N/A

• Coolant level correct?

  Yes

  No

  N/A

• Any leaks in engine bay?

  Yes

  No

• Are belts in good condition?

  Yes

  No

  N/A

• Are breaks in good condition

  Yes

  No

  N/A

• Mud flaps on truck?

  Yes

  No

  N/A

• Truck clean inside?

  Yes

  No

  N/A

• Current registration on truck

  Yes

  No

  N/A

• Current insurance ?

  Yes

  No

  N/A

• Current cab card?

  Yes

  No

  N/A

• Current trailer registration?

  Yes

  No

  N/A

• Current trailer insurance?

  Yes

  No

  N/A

• Current water haul permit?

  Yes

  No

  N/A

• Current inspection on truck ?

  Yes

  No

  N/A

• Current inspection on trailer?

  Yes

  No

  N/A

• Triangles in cab?

  Yes

  No

  N/A

• Fire extinguisher in cab?

  Yes

  No

  N/A

• Registration sticker on window?

  Yes

  No

  N/A

• GPS on unit?

  Yes

  No

  N/A

Trailer

• Trailer

  Media

• Trailer number

• Trailer clean?

  Yes

  No

  N/A

• Any air leaks on trailer?

  Yes

  No

• Trailer tires in good condition?

  Yes

  No

  N/A

• Glad hands connected correctly?

  Yes

  No

  N/A

• Any leaks from hot air hose?

  No

  Yes

• Sump tank drained?

  Yes

  No

  N/A

• Any cracks on walk way?

  Yes

  No

• DOT tape visible ?

  Yes

  No

  N/A

• Tall City Logo legible all three sides of trailer?

  Yes

  No

  N/A

• WHP number Legible on all three sides of trailer?

  Yes

  No

  N/A

• Driver have plenty of hoses?

  Yes

  No

  N/A

• Driver have crescent?

  Yes

  No

  N/A

• Driver have pipe wrench?

  Yes

  No

  N/A

• Driver have connections required for job?

  Yes

  No

  N/A

• Mud flaps on trailer?

  Yes

  No

  N/A

• Tool box secure?

  Yes

  No

  N/A

• Tail light working?

  Yes

  No

  N/A

• Turn signal lights working?

  Yes

  No

  N/A

• Flashers working?

  Yes

  No

  N/A

• Are brakes good on trailer?

  Yes

  No

  N/A

• All clearance lights and night lights working?

  Yes

  No

  N/A

• Any cracks on frame?

  Yes

  No

• Any loose bolts?

  No

  Yes

• Side glass working ?

  Yes

  No

  N/A

• Any issue wth valves?

  No

  Yes

• Ground cable connected?

  Yes

  No

  N/A

• Landing gear working?

  Yes

  No

  N/A

• Plate light working?

  Yes

  No

  N/A

• License plate legible?

  Yes

  No

  N/A

• DOT tape on bumper?

  Yes

  No

  N/A

Summary

• JSA completed?

  Yes

  No

  N/A

• Driver report any issues?

• Any verbal warning given to driver?

• Driver signature

  Sign

Kill Driver pick up truck

• Add media

  Media

• Pick Up #

• Oil Change current?

  Yes

  No

  N/A

• Tires in good shape?

  Yes

  No

  N/A

• Fluid good?

  Yes

  No

  N/A

• Correct fuel card for pick up

  Yes

  No

  N/A

• Truck have GPS?

  Yes

  No

  N/A

• Registration current on pick up

  Yes

  No

  N/A

• Current inspection on pick up?

  Yes

  No

  N/A

• Insurance in truck?

  Yes

  No

  N/A