Well servicing & Work over inspection

• Company

• Select date

  Date

• Lease

• Rig #

• Operation

• Operator

• Company rep.

• Rig Manager

• Driller

• Days since last recordable accident

• Days since last lost time accident

Location Safety & Safety Equipment

• Signs in place at location entrance. Std. 1910.145

  Yes

  No

  N/A

• No smoking. Std. 1910.145

  Yes

  No

  N/A

• Hard hat area. Std. 1910.145

  Yes

  No

  N/A

• Steel toe boots. Std. 1910.145

  Yes

  No

  N/A

• Eye protection required w/ side shields. Std. 1910.145

  Yes

  No

  N/A

• Authorized personnel only. Std. 1910.145

  Yes

  No

  N/A

• Cell phone use in designated area only. Std. 1910.145

  Yes

  No

  N/A

• Visitor tracking system in place. Std. 1910.38

  Yes

  No

  N/A

• Clearance from all energized power lines 10 ft. Std. RP54 10.1.1

  Yes

  No

  N/A

• Emergency escape device in place & installed properly. Std. 1910.36

  Yes

  No

  N/A

• Geronimo on-line and ready for immediate access and use. Std. RP54 6.10.1

  Yes

  No

  N/A

• All guy wires flagged & up. Std. RP4G 7.6.F

  Yes

  No

  N/A

• Fire extinguishers at each anchor min (2-30#) Std.1910.157

  Yes

  No

  N/A

• No vehicles inside of anchor pattern when possible. Std. RP545.1.15

  Yes

  No

  N/A

• First aid kit in place, full, clean, and good condition. Std. 1910.151

  Yes

  No

  N/A

• Blood borne pathogen kit. Std. 1910.151 (b)

  Yes

  No

  N/A

• Eye wash station in place. Std. 1910.151

  Yes

  No

  N/A

• Hearing protection provided. Std. 1910.95

  Yes

  No

  N/A

• Fall protection to assure 100% tie off 100% of the time. Std. 1910.66

  Yes

  No

  N/A

• Full body harness w/double climbing hook or y-lanyard. Std. 1910.66

  Yes

  No

  N/A

• Self retracting life line attachment in good condition. Std. 1910.66

  Yes

  No

  N/A

• Self retracting line used at tubing board. Std 1910.132

  Yes

  No

  N/A

• Double latch hooks on all lanyards & lifting rigging. Std 1910.66

  Yes

  No

  N/A

• Breathing packs in place @ anchors. Std. RP55 3.3

  Yes

  No

  N/A

• H2S sensors in place and calibrated, checked daily. Std. 1910.1000.E

  Yes

  No

  N/A

• Wind sock or flag in place. Std. RP55 4.5

  Yes

  No

  N/A

• Designated smoking area posted. Std. 1910.145.C.2.i

  Yes

  No

  N/A

• Safe briefing areas designated and posted. Std. 1910.38.C.4

  Yes

  No

  N/A

• Emergency phone list. Std. RP54 4.2.1

  Yes

  No

  N/A

• OSHA poster. Std. 1903.2 (A)(II)

  Yes

  No

  N/A

• Additional Comments

Guy Lines

• Minimum 4 crown guys anchored. Std. RP4G 6. 1-8

  Yes

  No

  N/A

• Tubing board guys crossed and anchored properly. Std. RP4G7. 1-8

  Yes

  No

  N/A

• Mast guy lines proper size - 5/8" min- with factory eyes @ crown (swedged & thimbled & tagged) Std. RP9B3.7.4

  Yes

  No

  N/A

• Approved clevis's attaching guy line to Derrick. Std. BP H/L TBL 5

  Yes

  No

  N/A

• Tubing board guy lines proper size - 9/16" min. - with factory eye's at board and crossed with appropriate sag (10/12). Std. RP9B3.7.4 BP H/L TBL 5

  Yes

  No

  N/A

• All guy lines in good condition- free of kinks, wickers, & corrosion. Std. RP4G 5.1.C

  Yes

  No

  N/A

• Ground anchors with weatherproof tag permanently attached to each anchor installed & pull tested every 2 years w/ documentation. Std. RP4G 14.5

  Yes

  No

  N/A

• All anchors inspected w/ tag and visible markers. Std. RP4G14.5

  Yes

  No

  N/A

• All chains secured. Std. RP4G 7.1-8

  Yes

  No

  N/A

• All non-factory ends fitted with min. 3 clamps of proper size or 4 clamps if through sheaves. Std. RP4G13.3 & RP9B 3.7.4

  Yes

  No

  N/A

• Additional Comments

Foundation

• Check location for solid footing under unit. Std. RP4G15.1

  Yes

  No

  N/A

• Steel mat under load bearing portion of rig and jacks where foundation is questionable. Std. RP4G15.1

  Yes

  No

  N/A

• Additional Comments

Mast / Derrick

• Manufacturer name and specs. Plate in place and legible. Std. RP4G52.1

  Yes

  No

  N/A

• Guying data plate on Derrick. Std. RP54-9.9.2

  Yes

  No

  N/A

• Derrick/mast certification 5yr. Std. RP54/RP4G

  Yes

  No

  N/A

• Derrick/mast load path certification 2 yr. Std. RP54/RP4G

  Yes

  No

  N/A

• No visible damage to legs, braces. Std. RP54 9.16.1

  Yes

  No

  N/A

• All welds in good condition. Std. RP54 9.2.4

  Yes

  No

  N/A

• Ladders in good condition and properly positioned. Std. RP54 9.3.1-2

  Yes

  No

  N/A

• Board properly mounted and in good condition. Std. RP54 9.2.17

  Yes

  No

  N/A

• Board fingers in good condition and snubbed. Std. RP54 9.2.17

  Yes

  No

  N/A

• Board rails in good condition and snubbed. Std. RP54 9.2.17

  Yes

  No

  N/A

• Rod board properly mounted and in good condition. Std. RP54 9.2.17

  Yes

  No

  N/A

• Rob board fingers in good condition and snubbed. Std. RP54 9.2.17

  Yes

  No

  N/A

• Rob board rails in good condition and snubbed. Std. RP54 9.2.17

  Yes

  No

  N/A

• Derrick climber and counter weight installed & properly anchored. Std. 1910.132

  Yes

  No

  N/A

• Derrick climber available at floor when Derrick is raised. Std. 1910.27(d)(5)

  Yes

  No

  N/A

• Derrick free of loose objects. Std. RP54.8.2.5

  Yes

  No

  N/A

• All board hinge points free traveling and lubricated. Std. RP54 9.2.4

  Yes

  No

  N/A

• Derrick stabilizer on scoping cylinder in good condition. Std. RP54 9.2.4

  Yes

  No

  N/A

• Insure Derrick latch dogs are in place and flagged.

  Yes

  No

  N/A

• Crown sheaves guards in place and in good condition. Std. RP54 9.7.5

  Yes

  No

  N/A

• All pins in place W/ safety pins in place. Std. RP54 9.2.8

  Yes

  No

  N/A

• Tail pin screws not screwed out over 6 inches of threads. Std. BP H/L TBL 5

  Yes

  No

  N/A

• Check all hydraulic cylinders for leaks.

  Yes

  No

  N/A

• Purge air from hydraulic rising cylinders.

  Yes

  No

  N/A

• No loose objects left in Derrick; transfers, rod shucks, chains, etc. inventory tools taken into Derrick. Std. RP54 8.2.5

  Yes

  No

  N/A

• All tie back ropes secured when not in use. Std. BP H/L TBL 5

  Yes

  No

  N/A

• All light fixtures class 1-zone 2 rating. Std. 1910.307.b.1

  Yes

  No

  N/A

• All lights secured with safety cables. Std. RP54 9.3.1

  Yes

  No

  N/A

• No splices. Std. 1910.305

  Yes

  No

  N/A

• CGB's (cord grip bushing) in place on all lights and electrical connections. Std. 1926.403

  Yes

  No

  N/A

• Additional Comments

Carrier

• Handrails and steps installed, secured with pins, and in good condition. Std. 1910.23

  Yes

  No

  N/A

• Toe boards in place on hand rails. Std 1910.23

  Yes

  No

  N/A

• All belts and fans guarded. Std. 1910.212

  Yes

  No

  N/A

• Wheels chocked. Std. RP54 11.1.2

  Yes

  No

  N/A

• Fuel tanks labeled- no smoking, flammable. Std. 1910.145(c)(2)(I)

  Yes

  No

  N/A

• No fuel leakage. Std. OSHA 14.2J

  Yes

  No

  N/A

• Tires and wheels in good condition. Std. OSHA 14.2E

  Yes

  No

  N/A

• Hydraulic leveling jacks in use. Std. OSHA 14.2G

  Yes

  No

  N/A

• Hydraulic leveling jacks secured with lock nuts. Std. OSHA 14.2H

  Yes

  No

  N/A

• Good foundation under jacks.

  Yes

  No

  N/A

• No loose or flammable material stored in cab, no starting fluid. Std. OSHA 14.1A

  Yes

  No

  N/A

• Glass and mirrors in good condition. Std. 1926.50A/R

  Yes

  No

  N/A

• Cab and carrier up to DOT specs, w/ current cert. (if required) Std. KWS

  Yes

  No

  N/A

• Emergency equipment- kill switch available & functional reflectors available or flares. Std. BP safety manual 5.1-2

  Yes

  No

  N/A

• Unit grounded w/ solid copper rod or to we'll head. Std. 1926.954

  Yes

  No

  N/A

• Seatbelt functional. Std. DWOP3.1.4

  Yes

  No

  N/A

• High noise areas posted. Std. DWOP 3.3.2

  Yes

  No

  N/A

• All vessels labeled as to their contents. Std. 1910.12

  Yes

  No

  N/A

• Additional Comments

Draw works

• All guards in place. Std. RP54 9.4.2

  Yes

  No

  N/A

• Drum guard in place to protect employees, their clothing & equipment from fouling in drum. Std. RP54 9.4.2

  Yes

  No

  N/A

• Tubing line is in good condition. Std. 1910.184

  Yes

  No

  N/A

• Date Installed

• Wire rope management system in place on tubing line etc. Std. API RP4G

  Yes

  No

  N/A

• Swab line in good condition. Std. 1910.184

  Yes

  No

  N/A

• Date Installed

• Sufficient wraps on tubing drum 5 @ ground 7 @ floor. Std. OSHA insp.

  Yes

  No

  N/A

• 2 1/2-3 wraps on dead,one anchor, correctly wrapped, clamp secured, retainer and guard bolts in place. Std. BP H/L Policy

  Yes

  No

  N/A

• Hydrostatic brake-check for leaks, good condition, anti-freeze protected. Std. OSHA Policy

  Yes

  No

  N/A

• No cathead in use. Std. BP H/L Policy

  Yes

  No

  N/A

• Brakes and brake linkage in good condition, pins secured. Std. OSHA Policy

  Yes

  No

  N/A

• Proper brake linkage adjustment. Std. BP H/L Policy

  Yes

  No

  N/A

• Brake assembly parts meet or exceed OEM specs. Std. DWOP 8.14

  Yes

  No

  N/A

• Assure road gear lockout. Std. RP54 11.1.2

  Yes

  No

  N/A

• Winch line in good condition. Std. 1910.184

  Yes

  No

  N/A

• Date Installed

• Grade 8 chain in use for all lifting operations & rigged properly & tagged correctly. Std. 1910.184

  Yes

  No

  N/A

• Proper hooks on all lifting chains. Std. 1910.184

  Yes

  No

  N/A

• Crown-o-matic inspected and tested. Std. DWOP 8.3

  Yes

  No

  N/A

• Certified lift eye on sand line. Std. BP H/L 3.1

  Yes

  No

  N/A

• Additional Comments

Operator station/work platform/floor

• All controls labeled properly. Std. OSHA Insp

  Yes

  No

  N/A

• Kill switch available, functional, and protected. Std. OSHA Insp.

  Yes

  No

  N/A

• Authorized personnel only. Std. 1910.145

  Yes

  No

  N/A

• Work floor level and properly supported and secured w/ cert tag. Std. OSHA Insp.

  Yes

  No

  N/A

• Work floor support cables with factory eyes and approved clevis's. Std. 1910.184

  Yes

  No

  N/A

• All guard rails and hand rails in place and secure. Std. 1910.23(c)(1)

  Yes

  No

  N/A

• Support/suspension pins installed w/ keepers (no bolts) Std. OSHA Insp.

  Yes

  No

  N/A

• Minimum of two stairways to floor. Std. RP54 9.3.10

  Yes

  No

  N/A

• All stairs secured. Std. 1910.36

  Yes

  No

  N/A

• Additional Comments

Racking Board & Diving Board

• Guard rails in good condition and pinned, when in use. Std. 1910.23(c)(1)

  Yes

  No

  N/A

• Holes in floor covered. Std. 1910.23(a)(8-9)

  Yes

  No

  N/A

• Good foundation under racking boards 3x12's. Std. RP4G 15.1

  Yes

  No

  N/A

• Additional Comments

Power Tongs

• Safety gate in place and functional. Std. RP54 6.8.3

  Yes

  No

  N/A

• Back up-proper type in place. Std. RP54 9.9.4

  Yes

  No

  N/A

• Stiff arm & snub line, clamps in place and in good condition. Std. RP54 9.9.4

  Yes

  No

  N/A

• Tong head guard in place and in good condition. Std. RP54 6.8.3

  Yes

  No

  N/A

• Hoses and fittings in good condition, no leaks. Std. RP54 9.9.9

  Yes

  No

  N/A

• Tong support line in good condition. Std. 1910.184

  Yes

  No

  N/A

• Tong safety hanger in good condition. Std. 1910.184

  Yes

  No

  N/A

• Additional Comments

Traveling Assembly

• Blocks in good condition. Std. RP54 9.7.1

  Yes

  No

  N/A

• Sheave guards in place. Std. RP54 9.7.4

  Yes

  No

  N/A

• Hook in good condition, lock in good condition. Std. RP54 9.7.1

  Yes

  No

  N/A

• Elevator links in good condition. Std. RP8B

  Yes

  No

  N/A

• Annual insp. date.

• Elevators in good condition. Std. RP8B

  Yes

  No

  N/A

• Annual insp. date.

• Rod hooks-latching and spring mechanism wear. Std. RP8B CAT. IV

  Yes

  No

  N/A

• Annual insp. date.

• Transfer elevators in good condition-safety latches & transfer line in good condition. Std. RP54 9.7.1

  Yes

  No

  N/A

• Annual insp. date.

• Transfer pickup eye in good condition, nut lock pin in place. Std. RP54 9.7.1

  Yes

  No

  N/A

• All bolts in place in side covers on blocks. Std. RP54 9.7.1

  Yes

  No

  N/A

• All bolts in place on all traveling equipment & tight. Std. RP54 9.7.1

  Yes

  No

  N/A

• Load rated rod transfer w/ safety latch in place. Std. BP H/L Policy

  Yes

  No

  N/A

• Rod transfer eye bolt nuts keyed. Std. Manfct. Spc.

  Yes

  No

  N/A

• No weight bars hung off rod board. Std. BP S.M. 3.4.4

  Yes

  No

  N/A

• Additional Comments

Circulating systems

• Standpipe secured to Derrick. Std. RP54 8.a

  Yes

  No

  N/A

• Rotary hose secured both ends, top end to Derrick. Std. API 7K-7L

  Yes

  No

  N/A

• High pressure fittings on all connections. Std. 1910.169

  Yes

  No

  N/A

• Safety relief valve in place and set properly. Std. 1910.169

  Yes

  No

  N/A

• Relief line properly anchored. Std. 1910.169

  Yes

  No

  N/A

• Pump guards in place. Std. 1910.212

  Yes

  No

  N/A

• Mud pit walkways and stairs in good condition & anchored. Std. 1910.22-23

  Yes

  No

  N/A

• Mud mixing area, all ppe in place. Std. 1910.132

  Yes

  No

  N/A

• Additional Comments

Well Control Equipment

• Assure test chart for all BOPE. Std. RP54 6.4.1

  Yes

  No

  N/A

• All bolts in place in all flanges. Std. RP54 6.4.1

  Yes

  No

  N/A

• Check all ring grooves and rings. Std. RP54 6.4.1

  Yes

  No

  N/A

• Floor valve in place w/ proper x-over. Std. RP54 6.4.2

  Yes

  No

  N/A

• Accumulator properly installed-no leaks. RP54 6.4.1

  Yes

  No

  N/A

• Cover over blind/shear ram control handle. Std. RP53 12.5.3.f

  Yes

  No

  N/A

• Hydraulic system charged. Std. RP54 6.4.1

  Yes

  No

  N/A

• Controls labeled. Std. RP54 6,4,1

  Yes

  No

  N/A

• All BOPE tested and functional. Std. RP54 6.4.1

  Yes

  No

  N/A

• BOP control lines and valves identified. Std. RP54 6.4.11

  Yes

  No

  N/A

• All unused accumulator lines capped. Std. RP54 6.4.18

  Yes

  No

  N/A

• Accumulator lines in open/closed position. Std. BP S.M. 5 1-2

  Yes

  No

  N/A

• Additional Comments

Safety Equipment

• Fire extinguishers minimum 30 lb. min. 2, located at guy line anchors. Std. 1910.157

  Yes

  No

  N/A

• Personal protective equipment in use, std. RP54 5.2.3

  Yes

  No

  N/A

• No loose clothing. Std. 1910.132(a)

  Yes

  No

  N/A

• Gloves. Std. 1910.132(a)

  Yes

  No

  N/A

• Hard hat worn by all (plastic). Std. RP54 5.2.1

  Yes

  No

  N/A

• Safety glasses. Std. RP54 5.2.2

  Yes

  No

  N/A

• Steel toe boots. Std. RP54 5.2.3

  Yes

  No

  N/A

• Fire retardant clothing(FRC). Std. BP Policy

  Yes

  No

  N/A

• Visitor hard hat and safety glasses required. Std. 1910.132(a)

  Yes

  No

  N/A

• Additional Comments

Procedures In Place

• Crews trained in JSA Program. Std. RP54 6.1.7

  Yes

  No

  N/A

• JSA program in use w/ written JSA's in place. Std. RP546.1.7

  Yes

  No

  N/A

• Emergency plan in place and understood by all employees. Std. 1910.38.b

  Yes

  No

  N/A

• Golden rules understood by all employees. Std. BP Policy

  Yes

  No

  N/A

• Stop program in place and in use(observation program). Std. DWOP 3.1.3

  Yes

  No

  N/A

• LOTO in place and utilized. Std. 1910.417

  Yes

  No

  N/A

• SDS/SPCC plan in place and current. Std. BP S.M. 5.1-2

  Yes

  No

  N/A

• Tool pusher and driller BOP certified. Std. DWOP 15.2

  Yes

  No

  N/A

• First aid/CPR 2 per crew w/ cert. card. Std. RP54 4.3.1

  Yes

  No

  N/A

• No jewelry policy. Std. BP S.M.

  Yes

  No

  N/A

• Full body harness available. Std. 1910.66

  Yes

  No

  N/A

• "Y" lanyards available. Std. 1910.66

  Yes

  No

  N/A

• Auxiliary lifting equipment register on-site ( wire rope, chains, hooks, chuckles). Std. BP H/L Policy

  Yes

  No

  N/A

• Additional Comments