BONNETT'S PRE-JOB HAZARD ASSESSMENT & SAFETY MEETING FORM (WIRELINE)
Date
*
-
Month
-
Day
Year
MM-DD-YYYY
Time(H:M)
(e.g 6:30 = Day Shift, 18:30 = Night Shift)
Stars Site #
Unit(s) #
*
Station
*
Base of Operations
Division
*
Please Select
Boreal E-Line
Boreal E-Line (Pumpdown)
Well Intel
Boreal Pumping
Silverline Swabbing
Overhead/Sales
Redneckz Wireline
Client
*
PAD LSD
*
Crane Company
Wireline Unit Email
*
@bonnettsenergy.com
Client Email (for Safety Documents)
example@example.com
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GENERAL SAFETY ITEMS DISCUSSED AT JOBSITE
All known site specific hazards have been identified(prior to commencing work/task) - check all that apply
*
Pinch points – do not place body parts in these areas
Underfoot conditions are uneven or slippery – mark/flag/avoid these areas
Cords, cables, hoses, tools or equipment are tripping hazards – remove from pathway or avoid stepping over
Designated smoking area
Spotting vehicles – use hand signals as per IRP 12
Ground Stability
Congested work area – avoid striking against objects including overhead while standing from a sitting or knelt position
Elevated surfaces – use 3 point contact when entering or exiting
Overhead loads – do not walk or stand underneath, be aware of swing paths
Rotating equipment – do not enter areas without proper guards
High pressure lines – do not stand near or walk over
Fatigue – adequate rest breaks must be provided
Steam systems – avoid areas where steam clouds are (e.g. low visibility & burns)
Effective Communication
Powerline/Utility Stations
Other
Documentation (e.g Bonnett’s Procedures,IRP’s EUB Directives & OH & S )
*
Available electronically on hard drive
Available electronically on flash drive
Available in printed book on unit, rig or trailer
Available on DATS
Other
LEASE ACCESS and/or RESOURCE ROAD CONDITIONS (for general awareness for all personnel arriving and/or leaving location)
Poor
Fair
Good
Excellent
Complete journey hazard risk assessment form
New/Green Hand Employee(Including Younger workers)
Green Hat sticker
Mentor
New/Green Hand Employee Name
First Name
Last Name
Mentor Name
First Name
Last Name
PERSONAL PROTECTIVE EQUIPMENT (minimum mandatory items as per Bonnett’s PPE Standard) - check all that apply
*
Flame resistant outerwear (e.g. coveralls and/or winter parkas/overalls) with a minimum of 2” reflective striping
Protective footwear, fit for purpose (e.g. mud/ice/snow/dry conditions)
Hardhat
Safety glasses (side shields required on prescription safety glasses)
Hand protection (e.g. task specific such as leather/rubber/impact resistant)
Personal multi sensor Gas monitors (must be used where toxic gases such as H2S, combustibles & oxygen level hazards)
Cleats (if slippery Conditions)
Other
PERSONAL PROTECTIVE EQUIPMENT (additional items, as per Bonnett’s PPE Standard) - check all that apply
Face shield
Goggles
Hearing protection
Fall protection (harness & lanyard)
Respirator protection (SCBA, SABA or air purifying respirator)
Radiation protection
Other
WEATHER, VISIBILITY (current & forecasted)
Poor
Good
Fair
Excellent
Other
WIND DIRECTION(Wind coming from)
North
East
South
West
WELLSITE EMERGENCY RESPONSE PLAN AVAILABLE(From Client)
*
LOCATION OF MUSTER POINTS
*
WELLSITE ORIENTATION (from client)
Employees have received site specific safety orientation
WELLSITE SAFETY and/or MEDIC INFORMATION
WHMIS IN PLACE (for all HAZARDOUS MATERIALS on site) MSDS Location - check all that apply
Electronically on hard drive
Electronically on flash drive
Printed book on unit/rig/shack
Available on DATS
Other
PERMITS (Work and/or client specific including fire/explosion prevention plan) - check all that apply
Safe work permit completed
Fire & explosion prevention obtained/completed
SPECIFIC SAFETY ITEMS DISCUSSED AT JOBSITE
DESCRIPTION OF JOB (S) AND ASSOCIATED TASK (S)
*
check all that apply
*
Employees have been adequately trained and hold current proof of training for associated tasks
Review of standard operating procedure (SOP) required
Review of JSA required
New SOP or JSA required
Enter JSA # here
You can find JSA's in the DATS document library
Describe new JSA or SOP here
EQUIPMENT: LOCATIONS(S) OF FIRE EXTINGUISHER, FIRST AID KIT & EYEWASH STATION
*
EQUIPMENT: GROUNDING & RESISTANCE MEASURED - check all that apply
Ground clamp (s) for all equipment attached to well
Less than 0.5 ohms
EQUIPMENT: PERSONAL MULTI-GAS DETECTION - check all that apply
Available, calibrated & bump tested for employees required
EQUIPMENT: POSITIVE AIR SHUT OFF - check all that apply
Installed and function tested during routine maintenance (minimum)
EQUIPMENT: PURGE SYSTEM (S) - check all that apply
Purge (When Applicable) (including other and/or third party equipment)
Check box to enter purge resource(eg..N2,H20..ect)
EQUIPMENT: SPACING OF EQUIPMENT/VEHICLES - check all that apply
Spacing as per IRP20
EQUIPMENT: TAG LINE (S) & WHEELED DOLLY (S) - check all that apply
Tag lines used when hoisting equipment
Dollies used with Tool String
Dollies used with Lubricator
PRESSURE CONTROL EQUIPMENT - check all that apply
Rated for well pressure/conditions (e.g. “sweet” wells > 3000 psi require flange with 5K gear. “Sweet” wells > 4500 psi require flange with 10K gear)
PRESSURE EXPECTED AT SURFACE
EQUIPMENT PRE-JOB SAFETY CHECKLIST
AUXILLARY EQUIPMENT - check all that apply
All other required tools & equipment have been verified and are in good working order prior to usage
PACK OFF, LUBRICATOR, BALL VALVE, FLOW T, PURGE/PUMP IN SUB - check all that apply
Visual inspection
New rubber/packing/o-ring
Banding/cert is current
SHEAVES (all) - check all that apply
Visual inspection
Tag/certificate is current
SLING, HANGER BAR, RIG CHAIN, CLEVIS - check all that apply
Visual inspection
Tag/certificate is current
Clevis is bolt/nut/pin style
WEIGHT INDICATOR - check all that apply
Visual inspection
EXPLOSIVES SAFETY ITEMS DISCUSSED AT JOBSITE
Bonnett's Blaster in charge on Site
First Name
Last Name
Blaster Certificate #
Blaster Expiry Date
Bonnett's Alternate Blaster On Site
First Name
Last Name
Blaster Certificate #
Blaster Expiry Date
Workers authorized by blaster to work in the 45m exclusionzone during arming and/or dis-arming procedures where immediate rigging of theexplosive device in and out of wellbore is required.(enter Name(s) below)
PERFORATING SIGNAGE - check all that apply
Posted in appropriate areas (lease entrance/between unit and wellhead)
RADIO FREQUENCY (RF) MONITORING - check all that apply
All devices (e.g. cell phones, wireless home phones, two way radios, gps, vehicle tracking devices and vehicles equipped with on-star are turned off or moved to a safe distance
RF safe detonators used
GENERATORS (Bonnett’s,rig company & all others connected to well) - check all that apply
All generators must be turned off and remain off until advised by Blaster
SHOOTING PANEL SAFETY KEY - check all that apply
Locked in “safe” mode
Located with blaster/employee closest to explosive device
STRAY VOLTAGE & CURRENT (well & rig combined for both AC/DC) - check all that apply
Voltage less than 0.25 volts
Current less than 0.2 amps (200 milliamp)
MISS RUN / JOB SCOPE CHANGE (All operations must STOP. A review Procedures for handling live explosive devices must be completed) - check all that apply
All non-essential personnel clear area
Clear minimum 45 m distance
Must be followed for every explosive run in/out of wellbore including misfires
All Explosive devices have been immediately disarmed & returned /stored to their approved storage containers
Disarmed By
First Name
Last Name
Signature
Witnessed By
First Name
Last Name
Signature
MEETING ATTENDANCE RECORD (employees absent from meeting must read minutes above and record their name below)
Number of signatures required
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Name 1
Name #1
First Name
Last Name
Signature #1
Name 2
Name #2
First Name
Last Name
Signature #2
Name 3
Name #3
First Name
Last Name
Signature #3
Name 4
Name #4
First Name
Last Name
Signature #4
Name 5
Name #5
First Name
Last Name
Signature #5
Name 6
Name #6
First Name
Last Name
Signature #6
Name 7
Name #7
First Name
Last Name
Signature #7
Name 8
Name #8
First Name
Last Name
Signature #8
Name 9
Name #9
First Name
Last Name
Signature #9
Name 10
Name #10
First Name
Last Name
Signature #10
Name 11
Name #11
First Name
Last Name
#11 Signature #11
Name 12
Name #12
First Name
Last Name
Signature #12
Submissions will go to {wirelineUnit}, {email345} and pdsafety@bonnettsenergy.com
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