Verification and Validation Observations

Date Date / MM / DD YYYY
Supervisor Name Supervisor Name First Last
Superintendent
Division
Equipment
Company
Well #
Coaching Opportunity, V1

Coaching Opportunity, V1 Job Planning/Communication Energy Control Vehicle/Condition Driving/Backing/Spotter Use Crush/Pinch Points Line of Fire Position Elbows Closer Point Your Toe and Go Use Midrange Motions Same Side Hand and Foot Big Load-Big Toe/Little Load-Little Toe Tool Selection/Condition Housekeeping Eyes on Path Climbing/Fall Protection Walking/Working Surfaces BOPE/Well Control Policies/Procedures Gas Monitoring Explosives PPE No Coaching Opportunities Lift Package Compliance Powerline Avoidance COFO Set/Use 360 Walkaround Hydration Grounding/Bonding High Consequence Activity/Start Work Check Done Electric Power Tools/Equipment Excavation Heavy Equipment Use Hot Work Hydro Testing/Pressure Dropped Object Prevention
Coaching Opportunity,

Coaching Opportunity, Job Planning/Communication Energy Control Vehicle/Condition Driving/Backing/Spotter Use Crush/Pinch Points Line of Fire Position Elbows Closer Point Your Toe and Go Use Midrange Motions Same Side Hand and Foot Big Load-Big Toe/Little Load-Little Toe Tool Selection/Condition Housekeeping Eyes on Path Climbing/Fall Protection Walking/Working Surfaces BOPE/Well Control Policies/Procedures Gas Monitoring Explosives PPE No Coaching Opportunities Lift Package Compliance Powerline Avoidance COFO Set/Use 360 Walkaround Hydration Grounding/Bonding High Consequence Activity/Start Work Check Done Electric Power Tools/Equipment Excavation Heavy Equipment Use Hot Work Hydro Testing/Pressure Dropped Object Prevention

Please answer the following questions:
Please answer the following questions:	Yes	No	Explain	N/A
Are employee following the CDC required social distancing requirements?	Are employee following the CDC required social distancing requirements?Yes	Are employee following the CDC required social distancing requirements?No	Are employee following the CDC required social distancing requirements?Explain	Are employee following the CDC required social distancing requirements?N/A
If no, are they wearing an approved face covering?	If no, are they wearing an approved face covering?Yes	If no, are they wearing an approved face covering?No	If no, are they wearing an approved face covering?Explain	If no, are they wearing an approved face covering?N/A
Are employees sharing tools?	Are employees sharing tools?Yes	Are employees sharing tools?No	Are employees sharing tools?Explain	Are employees sharing tools?N/A
If yes, are the wearing the proper PPE or cleaning the tools between use?	If yes, are the wearing the proper PPE or cleaning the tools between use?Yes	If yes, are the wearing the proper PPE or cleaning the tools between use?No	If yes, are the wearing the proper PPE or cleaning the tools between use?Explain	If yes, are the wearing the proper PPE or cleaning the tools between use?N/A
Are employees properly trained on COVID precautions?	Are employees properly trained on COVID precautions?Yes	Are employees properly trained on COVID precautions?No	Are employees properly trained on COVID precautions?Explain	Are employees properly trained on COVID precautions?N/A
If not, have you scheduled them for training?	If not, have you scheduled them for training?Yes	If not, have you scheduled them for training?No	If not, have you scheduled them for training?Explain	If not, have you scheduled them for training?N/A
Have the employees conducted the GPS required daily self-check before coming to work?	Have the employees conducted the GPS required daily self-check before coming to work?Yes	Have the employees conducted the GPS required daily self-check before coming to work?No	Have the employees conducted the GPS required daily self-check before coming to work?Explain	Have the employees conducted the GPS required daily self-check before coming to work?N/A
If not why?	If not why?Yes	If not why?No	If not why?Explain	If not why?N/A

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