Completions HSE Assessment
ASE Safety Management System
Date
-
Month
-
Day
Year
Date
Location
Type of Assessment
Scheduled Safety Assessment
Walk Through
Status
Draft Assessment
Closed Assessment
Current Activity
Supervisor on Duty
First Name
Last Name
Supervisor Email
example@example.com
Person Performing Assessment
First Name
Last Name
Assessor Email
example@example.com
Section 1: General Site Safety
1. Job Safety Analysis (JSA’s) not conducted
2. Wildlife presents an elevated risk
3. Unnecessary trip hazards present
4. Site security not in proper order
5. Smoking occurring in restricted area/s
6. Lifting equipment not in proper order
7. Haul trailer decking not in proper order
8. Restrooms not available or not in proper order
9. Labeling or signage not in proper order
10. Trash present outside of containment
11. Drinking water not available
12. Electrical or grounding not in proper order
13. Flammable liquid storage not in proper order
14. Workers observed at height without proper fall protection
15. Stairways, walkways, toe-boards, guardrails and ladders not in proper order
16. Walking and working surface not in proper order
17. Spills present on location
18. Traffic control not in proper order
19. Confined space work not in proper order
20. Spill kits not in proper order
21. First aid supplies not in proper order
22. Eyewash station in proper order
23. Various safety meetings are not conducted as required
24. Crew members have not attended Arrow S Energy Operating Safety Orientation
25. PPE not in proper order
26. Visitor tracking system not in proper order
27. Personal gas monitors not in use where required
28. Worker training not in proper order
29. Housekeeping not in proper order
30. Medical services and driving directions not readily available
31. PIC not present on location (for mega pads only)
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" no items of non-compliance discovered!
Number of Deficiencies
Note the count for the total number of deficiencies for this section (this includes multiples of like violations)
Section 1. Notes:
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Section 2: Frac Tanks
1. Quick connect pipe from fresh water source leaking or damaged?
2. All lines from manifold into tank not secured to tank
3. Frac Tanks not equipped with internal anti-static build-up devices
4. Tanks set level
5. Stairs, handrails, and walkways pinned, connected and not damaged, with no open holes
6. Frac tanks grounded
7. Valves double blocked when not in use
8. Other
9. Section 2 "Frac Tanks" no items of non-compliance discovered!
Number of Deficiencies
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Section 2. Notes:
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Section 3: FR / Hydration Unit
1. Suction hoses from frac tank to FR/ Hydration unit not in proper order
2. Hoses not rated for pressures
3. Hoses do not have factory ends
4. FR / Hydration unit in does not have containment
5. Stairs and walkways with trip hazards, clutter or damage
6. Handrails not properly installed and/or pinned
7. SDS's not readily available for all chemicals on site
8. Chemicals are not properly labeled
9. All personnel not wearing proper PPE
10. Fire extinguishers not in proper order
11. FR / Hydration unit leaking
12. Hoses from FR / Hydration unit to blender not in proper order
13. Hose securement and whip checks not in proper order
14. Other
15. Section 2 "FR /Hydration Unit" no items of non-compliance discovered!
Number of Deficiencies
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Section 3. Notes:
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Section 4: Blender
1. Blender not in containment
2. Hydraulic hoses in vicinity of turbo not sheathed
3. Blender leaking
4. Radiation source (densitometer) not labeled, closed, and locked
5. All personnel not wearing proper PPE
6. Valve suction and discharge side not double blocked when not in use on
7. Hoses on discharge side of blender to missile not in proper order
8. Fire extinguishers not in proper order
9. Stairs and walkways have trip hazards, clutter or damaged
10. Rotating equipment at sand screw not appropriately guarded
11. Blender, hydration unit, and sand delivery system not caution taped off
12. Other
13. Section 4 "Blender" no items of non-compliance discovered!
Number of Deficiencies
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Section 4. Notes:
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Section 5: Pump Trucks
1. Wheel chokes not in place
2. Fire extinguishers not in proper order
3. High pressure restricted to prevent free access
4. Guards not in place over transmission and drive shafts
5. Hydraulic hoses in vicinity of turbo not sheathed
6. Iron brackets not anchored or bolted down tightly
7. Iron on pumps not certified, tested, and banded
8. Hammer unions not clean and dressed free of mushrooms
9. Other
10. Section 5 "Pump Trucks" no items of non-compliance discovered!
Number of Deficiencies
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Section 5. Notes:
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Section 6: Treating Iron to Wellhead
1. High pressure areas not restricted to prevent free access
2. Iron not certified, tested, and banded
3. Hammer unions not dressed and free of mushrooms
4. Iron and chiksans not blocked to prevent digging into ground
5. Down joints not anchored together with line restraints
6. Other
7. Section 6 "Treating Iron to Wellhead" no items of non-compliance discovered!
Number of Deficiencies
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Section 6. Notes:
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Section 7: Frac Stack
1. Hydraulic lines near BOP leaking
2. Valves on tree do not have handles or not labeled with number of turns to open and close
3. Frac stack does not have platform or man lift available for access
4. Hydraulic valves not in proper order
5. BOP hoses do not have crush proof sheaths
6. Frac head, hydraulic valve, BOP, and B section not accompanied with test chart
7. Other
8. Section 7 "Frac Stack" no items of non-compliance discovered!
Number of Deficiencies
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Section 7. Notes:
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Section 8: Wireline
1. Wireline unit not chocked
2. Wireline unit not grounded
3. Fir extinguishers not in proper order
4. Lower wire line sheave not secured to well head
5. Wireline BOP not tested in open and closed position
6. Wireline unit not caution taped off
7. Personnel not recognising radio silence
8. Warning not given prior to guns being armed ballistically
9. Lubricator not tested, banded, and inspected on annual basis
10. Lubricator does not have 2 bleed valves
11. Personnel not using tag lines and staying out from under suspended loads
12. Other
13. Section 8 "Wireline" no items of non-compliance discovered!
Number of Deficiencies
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Section 8. Notes:
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Section 9: Crane
1. Operator not certified
2. Outriggers not extended with landing pads
3. Cones/tape not in place to identify swing radius
4. Daily inspection not performed on crane
5. Annual inspection on crane not current
6. Operator leaving controls while lubricator is unsecured
7. Proper signals not exchanging w/wireline operator
8. Fire extinguishers not in proper order
9. Other
10. Section 9 "Crane" no items of non-compliance discovered!
Number of Deficiencies
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Section 9. Notes:
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Section 10: Closing Unit
1. Closing unit is leaking
2. Open/Close not clearly marked on handle
3. Valve hand does not have direct line of sight to well head
4. Closing unit does not have crush resistant sheeth over hoses
5. Other
6. Section 10 "Closing Unit" no items of non-compliance discovered!
Number of Deficiencies
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Section 10. Notes:
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Section 11: Light Plants and Generators
1. Rig lighting and fixtures not in proper order
2. Electrical extension cords not in proper order
3. Grounding not in proper order
4. Spill(s) present at light plant or generator
5. Other
6. Section 11 "Light Plants and Generators" no items of non-compliance discovered!
Number of Deficiencies
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Section 11. Notes:
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Section 12: Chemicals
1. Acid transport, tots, and tanks not in proper containment
2. Chemicals not clearly labeled
3. SDS not available for all chemicals
4. Personnel not wearing proper PPE per SDS
5. Chemical transfer lines not in proper order
6. Other
7. Section 12 "Chemicals" no items of non-compliance discovered!
Number of Deficiencies
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Section 12. Notes:
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Section 13: Fuel Trucks
1. Fuel discharge valves, hose(s), and nozzles not in proper order.
2. Fuel nozzle not equipped with auto shut off
3. Fuel tanks not properly placarded on all sides
4. "No Smoking" signs not erected on all sides
5. Vapor release vents not elevated and away from ignition source
6. General housekeeping not in proper order
7. Adequate fire extinguisher(s) not available
8. Fuel equipment and tanks not properly grounded
9. Other
10. Section 13 "Fuel Trucks" no items of non-compliance discovered!
Number of Deficiencies
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Section 13. Notes:
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Section 14: Perforating Operations & Explosives
1. Hot work or ignition sources are present near explosives operations
2. Electrical grounding of wellhead, service unit and rig not proper while using explosives
3. Perforating guns not assembled in a designated restricted area
4. Unnecessary personnel allowed near perforating operations
5. Warning signs not erected near perforating operations stating that all radios, cell phones, etc must be turned off
6. Radio transmitters, cell phones, etc not turned off during blasting operations
7. A warning signal is not sounded prior to initiating blast
8. Detonating cord and blasting caps not kept apart until assembly on location
9. Blasting caps and boosters not transported in approved cap boxes
10. During checking and/or arming, electrical blasting caps, detonators or other initiation devices not contained in safety tube
11. Explosives transport vehicle not in proper order
12. Other
13. Section 14 "Perforating Operations & Explosives" no items of non-compliance discovered!
Number of Deficiencies
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Section 14. Notes:
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