Drilling Rig HSE Assessment
Safety Management System
Date
-
Month
-
Day
Year
Date
Rig
Nabors M7501
Patterson 271
Type of Assessment
Scheduled Safety Assessment
Walk Through
Operations
Pre-Spud
Drilling
Logging
Running Casing
Cementing
Rig Move
Progress
Draft Assessment
Closed Assessment
Drilling Supervisor on Duty
Person Performing Assessment
First Name
Last Name
Assessors Email
example@example.com
Section 1: General Site Safety, Training & PPE
1. Litter present along location entrance road
2. Rig entrance signs not in proper order
3. Parking not adequate
4. Muster area not in proper order
5. Access to offices and trailers not in proper order
6. Visitor tracking system not in proper order
7. PPE not in proper order
8. PPE not used as required
9. Workers observed at height without proper fall protection
10. Right to know center (Safety Data Sheets) not in proper order
11. Contractor training program is not in proper order
12. BOP drills are not conducted as required
13. Wildlife presents excessive threat to workers
14. Long hair or loose clothing is not contained
15. Various safety meetings are not conducted as required
16. OSHA posters not posted
17. First aid supplies not in proper order
18. No smoking rules are not enforced
19. Job Safety Analysis (JSA’s) not conducted
20. Crew members have not attended Arrow S Energy Operating Safety Orientation
21. Hot work being conducted in unsafe manner
22. Flammable storage not in proper order
23. Site Specific Safety Plan not posted as required
24. SIMOPS Management Plan not posted as required
25. Drinking water not readily available
26. Walking and working surface not in proper order
27. Electrical or grounding not in proper order on location
28. Lifting equipment not in proper order
29. Safety devices not in proper order.
30. General housekeeping not in proper order
31. The contractor does not perform regular self assessments
32. The contractor does not have required elements of an Emergency Action Plan in place as per 29 CFR 1910.38
33. Other
34. Section 1 'General Site Safety, Training & PPE' no items of non-compliance discovered!
Number of Deficiencies in This Section
Note the count for the total number of deficiencies for this section (this includes multiples of like violations)
Section 1 Notes:
Section 1 Corrective Actions: Corrected
Photos Section 1
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Section 2: H2S Operations
1. H2S warning signs not in proper order
2. H2S training not adequate for workers or visitors
3. H2S Management or Contingency Plan not available to workers
4. H2S or evacuation drills are not conducted as required
5. Evacuation/All-clear alarms not operable or understood
6. Air monitoring equipment not in proper order
7. Emergency escape PPE and breathing equipment not in proper order
8. Wind indicators not in proper order
9. Other
10. H2S gas not present on this location
11. Section 2 'H2S Operations' no items of non-compliance discovered!
Number of Deficiencies in This Section
Note the count for the total number of deficiencies for this section (this includes multiples of like violations)
Section 2 Notes:
Section 2 Corrective Actions: Corrected
Photos Section 2
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Section 3: Trailers
1. Office trailers not in proper order
2. Living quarters not in proper order
3. Change shack not in proper order
4. Other trailer/s not in proper order
5. Electrical or grounding not in proper order
6. Plumbing and liquid storage at trailers not in proper order
7. Lighting at trailers not in proper order
8. Fire Extinguishers and detectors at trailers not in proper order
9. Walking surface and pathways at trailers not in proper order
10. Signage or labeling not in proper order
11. General housekeeping not in proper order
12. Other
13. Section 3 'Trailers' no items of non-compliance discovered!
Number of Deficiencies in This Section
Note the count for the total number of deficiencies for this section (this includes multiples of like violations)
Section 3 Notes:
Section 3 Corrective Actions: Corrected
Photos Section 3
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Section 4: Pipe Rack Area
1. Pipe racks not in proper order
2. Pipe stacking spacing and securement not in proper order
3. Catwalk not in proper order
4. Wire rope including bridle lines not in proper order
5. Pipe handling equipment not in proper order
6. Lifting equipment and rigging not in proper order
7. Drill pipe not in proper order
8. Pipe tubs not in proper order
9. Drill line (dead end) not in proper order
10. Employees permitted on top of pipe without proper platform
11. V-door slide not in proper order
12. Lighting at pipe rack area not in proper order
13. Electrical or grounding not in proper order
14. Hydraulic systems not in proper order
15. Fluid leak/s or spill present at pipe rack area
16. High pressure systems not in proper order
17. Derrick stand not in proper order
18. Walking and working surface not in proper order
19. Fire extinguishers not in proper order
20. Whip checks or safety cables not in proper order
21. Overhead hazards present excessive risk
22. Signage or labeling not in proper order
23. General housekeeping not in proper order
24. Other
25. Section 4 'Pipe Rack Area' no items of non-compliance discovered!
Number of Deficiencies in This Section
Note the count for the total number of deficiencies for this section (this includes multiples of like violations)
Section 4 Notes:
Section 4 Corrective Actions: Corrected
Photos Section 4
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Section 5: Liquid & Bulk Storage
1. Fuel storage not in proper order
2. Fuel storage containment not in proper order
3. Fuel storage electrical or grounding not in proper order
4. Fuel dispense equipment not in proper order
5. General housekeeping poor at fuel storage area
6. Compressed gas storage not in proper order
7. Oil storage not in proper order
8. Oil containment not in proper order
9. Chemical storage are not in proper order
10. Bulk liquid or other tanks is not in proper order
11.Bulk liquid or other tanks not properly grounded.
12. Fluid leak/s or spill present at bulk storage or chemical storage area
13. Stairways, guardrails, handrails and ladders on bulk storage not in proper order
14. High pressure systems not in proper order
15. Electrical or grounding not in proper order at storage areas
16. Lighting in bulk storage areas not in proper order
17. Labeling or signage at storage areas not in proper order
18. Walking or working surface at bulk storage area not in proper order
19. General housekeeping not in proper order at bulk or chemical storage areas
20. Fire extinguishers not in proper order
21. Other
22. Section 5 'Liquid & Bulk Storage' no items of non-compliance discovered!
Number of Deficiencies in This Section
Note the count for the total number of deficiencies for this section (this includes multiples of like violations)
Section 5 Notes:
Section 5 Corrective Actions: Corrected
Photos Section 5
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Section 6: Mud Tanks & Pits
1. Stairways, walkways, toe-boards, guardrails and ladders not in proper order
2. Shale shaker area not in proper order
3. De-sander, de-silter, de-gasser or centrifuge not in proper order
4. Agitator shafts & couplings not properly guarded
5. Other rotating equipment not in proper order
6. Explosion proof equipment, fixtures and wiring not in proper order
7. Electrical or grounding not in proper order
8. High pressure systems not in proper order
9. Chemical hazard warning sign not erected on caustic barrel
10. Emergency Shower not in proper order
11. Lighting at mud pit not in proper order
12. PPE not used/not available or not in proper order
13. Eye wash station not in proper order
14. Hopper house not in proper order
15. Elevated loading door opening not protected
16. All unused floor holes are not covered
17. Fire extinguishers not in proper order
18. Fluid leak/s or spill present at mud tanks
19. Transfer pumps not in proper order
20. Reserved
21. Reserve pits not barricaded to prevent livestock from entering
22. Reserve pits not in proper order
23. Signage or labeling not in proper order
24. Tools not in proper order
25. Walking and working surface not in proper order
26. General housekeeping not in proper order at mud tanks and pits
27. Other
28. Section 6 'Mud Tanks & Pits' no items of non-compliance discovered!
Number of Deficiencies in This Section
Note the count for the total number of deficiencies for this section (this includes multiples of like violations)
Section 6 Notes:
Section 6 Corrective Actions: Corrected
Photos Section 6
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Section 7: Pump House & Parts House
1. High pressure systems not in proper order
2. Mud pumps not in proper order
3. Lifting devices not in proper order
4. Rotating parts not guarded
5. Plumbing not in proper order
6. Fluid leak/s or spill present at pump or parts house
7. Walking and work surfaces not in proper order
8. Electrical tools not in proper order
9. Hand tools not in proper order
10. Slings, wire rope, lifting tools and rigging not in proper order
11. Ladders not in proper order
12. Electrical or grounding not in proper order
13. Lighting not in proper order
14. Signage or labeling not in proper order
15. Fire extinguishers not in proper order
16. General housekeeping not in proper order at pump house or parts house area
17. Other
18. Section 7 'Pump House & Parts House' no items of non-compliance discovered!
Number of Deficiencies in This Section
Note the count for the total number of deficiencies for this section (this includes multiples of like violations)
Section 7 Notes:
Section 7 Corrective Actions: Corrected
Photos Section 7
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Section 8: Generator House
1. Grounding not in proper order
2. Generator Electrical or grounding not in proper order
3. Energized equipment not properly guarded
4. Coolant system in proper order
5. High pressure systems not in proper order
6. Stairways, doors, walkways, toe-boards, guardrails and ladders not in proper order
7. SCR house in proper order
8. Non-conductive floor matting not in proper order
9. Electrical controls and panels not in proper order
10. Lighting not in proper order
11. Moving/ rotating parts not guarded
12. Hot surfaces not in proper order
13. Exhaust system not in proper order
13. Gauges not in proper order
14. Water not kept away from electrical equipment
15. Fluid leak/s or spill present at gen house
16. Air compressors and air storage tanks not in proper order
17. Tools not in proper order
18. Fire extinguishers not in proper order
19. Hearing protection not in proper order
20. Signage and labeling not in proper order
21. LO/TO system not in proper order
22. Walking and working surface not in proper order
23. Fuel day tank not in proper order
24. General housekeeping not in proper order at gen house
25. Other
26. Section 8 'Generator House' no items of non-compliance discovered!
Number of Deficiencies in This Section
Note the count for the total number of deficiencies for this section (this includes multiples of like violations)
Section 8 Notes:
Section 8 Corrective Actions: Corrected
Photos Section 8
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Section 9: Top Drive
1. Top drive not in proper order
2. Top drive equipment not in proper order
3. Top drive track not in proper order
4. Top drive lifting tools not in proper order
5. Top drive house not in proper order
6. Top drive electrical not in proper order
7. Overhead falling object hazard present with topdrive
8. Fluid leak/s or spill present from top drive
9. Fire extinguisher at top drive house not in order
10. Signage or labeling not in proper order
11. Other
12. Section 9 'Top Drive' no items of non-compliance discovered!
Number of Deficiencies in This Section
Note the count for the total number of deficiencies for this section (this includes multiples of like violations)
Section 9 Notes:
Section 9 Corrective Actions: Corrected
Photos Section 9
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Section 10: Substructure
1. Manufacturer’s name plate not in proper order
2. Substructure assembly pins not in proper order
3. High pressure system not in proper order
4. Damage and/or corrosion to substructure (waste metal)
5. Walking working surface not in proper working order
6. Stairways, walkways, toe-boards, guardrails and ladders not in proper order
7. Mud bucket not in proper order
8. Drill line and/or anchor not in proper order
9. Fluid leak/s or spill present in substructure
10. Lighting not in proper order
11. Electrical or grounding not in proper order
12. Fire extinguishers not in proper order
13. Falling object hazards are present
14. Cellar not in proper order
15. Signage or labeling not in proper order
16. General housekeeping not in proper order at substructure
17. Other
18. Section 10 'Substructure' no items of non-compliance discovered!
Number of Deficiencies in This Section
Note the count for the total number of deficiencies for this section (this includes multiples of like violations)
Section 10 Notes:
Section 10 Corrective Actions: Corrected
Photos Section 10
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Section 11: Blow Out Preventer
1. BOP not in proper order
2. BOP test not current
3. Accumulator system not in proper order
4. Accumulator inspection not in proper order
5. Choke manifold not in proper order
6. Kill line not in proper order
7. Gas separator not in proper order
8. Flow line not in proper order
9. Flare line and/or flare area not in proper order
10. Valves, handles, wheels and stems not in proper order
11. High pressure systems not in proper order
12. Gauges not in proper order
13. Fluid levels not in proper order
14. Electrical or grounding not in proper order in BOP system
15. Lighting not in proper order
16. Signage and labeling not in proper order
17. Fluid leak/s or spill in the BOP system
18. Walking and work surfaces not in proper order
19. Stairways, walkways, toe-boards, guardrails and ladders not in proper order
20. General housekeeping not in proper order at BOP
21. Other
22. Section 11 'Blow Out Preventer' no items of non-compliance discovered!
Number of Deficiencies in This Section
Note the count for the total number of deficiencies for this section (this includes multiples of like violations)
Section 11 Notes:
Section 11 Corrective Actions: Corrected
Photos Section 11
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Section 12: Drill Floor and Derrick
1. Stairways, walkways, toe-boards, guardrails and ladders not in proper order
2. Wind walls not in proper order
3. Electrical or grounding at rig floor not in proper order
4. Communications devices not in proper order
5. Alarms or horns not in proper order
6. Drawworks, crown-o-matic and/or the tac-II not in proper order
7. Wire rope, slings, rigging and lifting equipment not in proper order
8. Crown-O-Matic and Tac-II system not tested tourly
9. Kelly cock wrench and/or TIW safety valve not accessible
10. Weight indicator not in proper order
11. Drillers console not in proper order
12. Derrick manufacturer plate not in proper order
13. Derrick pins not in proper order
14. Derrick lighting not in proper order
15. Derrick FAA light/s not in proper order
16. Derrick escape system not in proper order
17. Derrick iron not in proper order
18. Block and Tackle not in proper order
19. High pressure systems not in proper order
20. A-legs and derrick not in proper order
21. Monkey board not in proper order
22. Dead man anchor not in proper order
23. Tuggers, hoists, winches and other lifting equipment not in proper working order
24. Equipment guarding not in proper order
25. Jerk lines not in proper order
26. Tongs not in proper order
27. Iron Roughneck not in proper working order
28. Fluid leak/s or spill present at rig floor
29. Walking working surface not in proper order
30. V-Door not in proper order
31. Auto spinners not in proper order
32. String equipment such as slips and collars not in proper order
33. Power tools not in working order
34. Hand tools not in proper order
35. Pipe screen not in proper order
36. Lighting not in proper order
37. Fire extinguishers not in proper order
38. Electrical not in proper order
39. Rotating parts not guarded
40. Falling objects hazard present at rig floor
41. Signage and labeling not in proper order
42. General housekeeping not in proper order at rig floor
43. Derrick storage racks not in proper order at location edge
44. Other
45. Section 12 'Drill Floor & Derrick' no items of non-compliance discovered!
Number of Deficiencies in This Section
Note the count for the total number of deficiencies for this section (this includes multiples of like violations)
Section 12 Notes:
Section 12 Corrective Actions: Corrected
Photos Section 12
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Section 13: Powered Vehicles
1. Forklift not in proper order
2. Manlift not in proper order
3. Forklift left unattended while running
4. Forklift operator/s training not in proper order
5. Fire extinguisher not in proper order
6. Electrical not in proper order on powered vehicles
7. Signage and labeling not in proper order
8. General housekeeping not in proper order at powered vehicles
9. Leaks on Forklift
10. Leaks on Manlift
11. Other
12. Section 13 'Powered Vehicles' no items of non-compliance discovered!
Number of Deficiencies in This Section
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Section 13 Notes:
Section 13 Corrective Actions: Corrected
Photos Section 13
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