Pre-Drill Safety Questionnaire Form
Complete this Pre-Drill Safety Questionnaire Form to confirm all site and equipment safety checks before drilling activities begin.
Operator Full Name
*
First Name
Last Name
Operator Company/Organization
*
Drill/Job Reference Number
*
Date and Time of Safety Check
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Site Location
*
Current Site Conditions
*
Please Select
Clear and dry
Wet or muddy
Obstructed
Limited visibility
Other
Are all required safety barriers and signage in place?
*
Yes
No
Not applicable
Is all drilling equipment inspected and ready for use?
*
Yes
No
Have all team members received the pre-drill safety briefing?
*
Yes
No
Additional Comments or Observations
Submit Safety Questionnaire
Should be Empty: