Worker Observation
Your Name
*
First Name
Last Name
Date
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Day
Year
Date
Time
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Minutes
Divison
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Abandonment
Completions
Construction
Drilling
HSE
Operations
Well Servicing
Operations Area
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Avon Hill
Coleville
Core North
Core South
Dodsland
Carrot Creek
Edgerton
Hoosier
Maintenance
Midstream
Plato
Completions Area
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AB - Completions
SK - Completions
Abandonment Area
*
AB - Abandonment
SK - Abandonment
Core South Runs
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Core South Chauvin Run #10
Core South Chauvin Run #11
Core South Chauvin Run #12
Core South Chauvin Run #13
Core North Runs
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Core North Chauvin Run #00
Core North Chauvin Run #01
Core North Chauvin Run #02
Edgerton Runs
*
Edgerton Operations
Czar Operations
Midstream Area
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Chauvin - Midstream
Well Servicing Area
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AB - Well Servicing
SK - Well Servicing
Construction Area
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AB - Construction
SK - Construction
Drilling Area
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AB - Drilling
SK - Drilling
Carrot Creek Area
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AB - Operations
HSE Area
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AB - HSE
SK - HSE
Maintenance Area
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Chauvin - Maintenance
SK - Operations - Maintenance - James Elliott
Avon Hill Runs
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Avon Hill - 2-15
Avon Hill - 2-18
Avon Hill - 5-26
Avon Hill - 7-5
Avon Hill - 8-13/14-27
Avon Hill - 8-14
Avon Hill - Kerrobert
Avon Hill - NWSU
Avon Hill - Plenty 2-34
Avon Hill - Stranraer
Avon Hill - Whiteside
Coleville Runs
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Coleville - 3-14
Coleville - Run #1
Coleville - Run #2
Coleville - Run #3
Coleville - Run #4 10-30
Coleville - Run #5
Coleville - Run #6
Dodsland Runs
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Dodsland - Run #1
Dodsland - Run #2
Dodsland - Run #3
Dodsland - Run #4
Dodsland - Run #5
Dodsland - Run #6
Dodsland - Run #7
Dodsland - Run #8
Hoosier Runs
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Hoosier - Run #20
Hoosier - Run #22
Hoosier - Run #23
Hoosier - Run #24
Hoosier - Run #25
Hoosier - Run #26
Hoosier - Run #27
Hoosier - Run #28
Hoosier - Run #29
Hoosier - Run #31
Hoosier - Run #7
Hoosier - Run #8
Plato Runs
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Plato - 11-7
Plato - 13-12 Bty
Plato - 13-12 West
Plato - 14-19
Plato - Run #1 4-7
Plato - Run #2
Plato - Run #3
Plato - Run #4
Plato - Run #5 11-12
Plato - Run #6 SUT
Plato - Run #7 13-18
Plato - Run #8 Elrose
Surface Location
*
Downhole Location (if applicable)
Who is the observation being performed on?
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Teine Worker
Vendor Worker
Was a reward given?
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Yes
No
Information
If the worker can't provide any certificates please contact the HSE team
Name of Observed Worker
*
First Name
Last Name
Can the worker produce the following valid certificates (all certificates are required. If any are missing please make a note in the comment box)?
*
CSO (Common Safety Orientation)
First Aid (must have a minimum of Level A & AED)
H2S
TDG
WHMIS
Worker can't produce certificates
Pictures of Certificates
Browse Files
Cancel
of
Certificate Comments
Years in current position
*
Name of Observed Worker (optional)
First Name
Last Name
Can the worker produce the following valid certificates (all certificates are required. If any are missing please make a note in the comment box)?
CSO
First Aid (must have a minimum of Level A & AED)
H2S
TDG
WHMIS
Pictures of Certificates
Browse Files
Cancel
of
Years in current position
Company of Observed Worker
*
Task Worker is Performing
*
Safety Contact Name
First Name
Last Name
Safety Contact Email
example@example.com
Safety Contact Number
-
Area Code
Phone Number
Comments
Which Life Saving Rules apply to the job? (Check all that apply)
*
Fit for Duty
Is the observed worker:
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Physically capable of performing the duties
Rested (not fatigued)
Mentally alert (mind on task)
Able to effectively communicate to their supervisor and co-workers
Not under the influence of drugs and alcohol
Fit for Duty Comments?
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Safe Mechanical Lifting
Safe Mechanical Lifting - what was observed?
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What type of training did the worker receive for use of the picker?
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On the job
Course
Picture of picker's inspection sticker
Browse Files
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of
What is the lift plan or critical lift plan if a man basket is used?
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Bypassing Safety Controls
Bypassing Safety Controls - what was observed?
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Who authorized the safety controls to be bypassed?
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Driving
Is vehicle fit for purpose and adequately maintained (seatbelt being used, loads are secure, no cell phone use while driving)?
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Yes
No
Driving Comments
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Driving Comments (optional)
Optional picture
Browse Files
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of
Working at Heights
Is a fall greater than 3 meters possible?
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Yes
No
Observation
*
Is the correct fall arrest equipment being used for the job?
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Yes
No
Is there a fall protection plan in place?
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Yes
No
Work Authorization
Choose all the apply (JSA is mandatory)
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JSA
Safe Work Permit or Term Safe Work Agreement
Confined Space Permit
Comment
JSA Picture
Browse Files
Cancel
of
Safe Work/Term Safe Picture
Browse Files
Cancel
of
Confined Space Picture (Optional)
Browse Files
Cancel
of
Confined Space
Picture of Confined Space Permit
Browse Files
Cancel
of
Is an air mover installed?
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Yes
No
Air Mover Comments
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Is the confined space isolated?
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Yes
No
Which method was used to isolate the confined space?
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Confined Space Comments
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Is a continuous pumping monitor being used?
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Yes
No
Make, model, bump and calibration dates(please note that personal 4 head monitors are not to be used for hot work)
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Energy Isolation
Has the equipment been locked out and tagged out? (if No please comment below)
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Yes
No
Whose locks are installed and where was the equipment bump tested?
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Select which equipment was locked out and tagged out
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Electrical
Valves
Rotating Equipment
Lock out Tag out Comments
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Line of Fire
Are workers working in the line of fire (i.e; vehicles, pressure releases, dropped objects)?
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Yes
No
What was done to make the job safe?
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Hot Work
What type of hot work is being performed?
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Was the area isolated prior to hot work starting?
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Yes
No
What method was used to isolate for hot work?
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Is a continuous monitor being used?
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Yes
No
Make, model, bump and calibration dates
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PPE
Most common PPE deficiencies includes non safety rated sunglasses being worn instead of safety glasses and personal monitors that have not been bumped in the last 24 hr or not worn at all.
Is worker wearing all Teine required PPE that is in good condition?
*
Hard Hat
FR outerwear (Non FR hoodies must be tucked into coveralls)
6" steel toe boots (with traction aid for winter season)
Safety glasses
Personal monitor that has been bumped in the last 24 hrs
Missing/condition of PPE or Monitor comments?
*
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