Company: Date of Inspection: Year Month day Inspected By: Rig #: Model: Manufacturer: Serial #: MASTS OK Re pair N/A Groove wear in sheaves Check sheaves for cracks Warped Water table condition Side play in sheave Crown pillars Crown hand railings Fall protection anchor point(s) Guy line anchors Winch line/rod transfer sheaves Tong line anchor OK Re pair N/A Anchor point for rod transfer Anchor point for tong sheave Anchor point for rod basket Main supports Cross members Locking pins Condition of ladder OK Re pair N/A Frame Fingers Pin condition Safety chains or cables OK Re pair N/A Frame condition Fingers condition Pin condition Safety chains Handrails Sheave anchors OK Re pair N/A Locking pin saddle Anchor point for monkey board Chain for hanging blocks Stand pipe brackets Kelly hose safety chained Main supports Cross members Raising ram anchor points (remove pins to inspect) Raising ram pins (remove pins to inspect) Anchor points for scoping ram Floor brackets Tong anchor Winch anchor point Block plate Condition of ladder Manufacturers rating plate OK Re pair N/A Adjuster condition End connection pin hole End connection threads OK Re pair N/A Hydraulic system Raising ram condition Hose and hose ends Connections Pins and bolts Ram flow restrictor OK Re pair N/A Arms Locks Slides A-base OK Re pair N/A Condition Sheaves Anchor points Stoppers OK Re pair N/A Attachment lugs Mast shoes (radius base beam) Table spreader beams Setback beams Spreader legs Pins BOP carrier Condition of welds Condition of decking OVERHEAD EQUIPMENT OK Re pair N/A Top bolt covers Main sheave bolt Retaining pins Sheave grooves Make: Model: Serial #: Equip.#: Inspection Date: Insp. Comp.: Insp.#: Tonnage: OK Re pair N/A Check hook/becket bolts Check eyewear on hook/becket
Check keeper pin Make: Model: Serial #: Equip.#: Inspection Date: Insp. Comp.: – 139.7 Insp.#: Tonnage: 1 OK Re pair N/A Insert size: Check springs Check rod release springs Check elevator bail Snap rings in place Insert condition All screws in insert Check elevator body Check safety latch Are latch inserts worn Make: Model: Serial #: Equip.#: Inspection Date: Insp. Comp.: Insp.#: Tonnage: 2 OK Re pair N/A Insert size: Check springs Check rod release springs Check elevator bail Snap rings in place Insert condition All screws in insert Check elevator body Check safety latch Are latch inserts worn Make: Model: Serial #: Equip.#: Inspection Date: Insp. Comp.: Insp.#: Tonnage: 3 OK Re pair N/A Insert size: Check springs Check rod release springs Check elevator bail Snap rings in place Insert condition All screws in insert Check elevator body Check safety latch Are latch inserts worn Make: Model: Serial #: Equip.#: Inspection Date: Insp. Comp.: Insp.#: Tonnage: 4 OK Re pair N/A Insert size: Check springs Check rod release springs Check elevator bail Snap rings in place Insert condition All screws in insert Check elevator body Check safety latch Are latch inserts worn Make: Model: Serial #: Equip.#: Inspection Date: Insp. Comp.: Insp.#: Tonnage: 5 OK Re pair N/A Insert size: Check springs Check rod release springs Check elevator bail 5, Snap rings in place Insert condition All screws in insert Check elevator body Check safety latch Are latch inserts worn Make: Model: Serial #: Equip.#: Inspection Date: Insp. Comp.: Insp.#: Tonnage: 6 OK Re pair N/A Insert size: Check springs Check rod release springs Check elevator bail Snap rings in place Insert condition All screws in insert Check elevator body Check safety latch Are latch inserts worn Make: Model: Serial #: Equip.#: Inspection Date: Insp. Comp.: Insp.#: Tonnage:
Equip.#: Inspection Date: Insp. Comp.: (if applicable) Insp.#: (if applicable) Tonnage: OK Re pair N/A Check for cracks Check for scarring Check ears for gouging Make: Model: Inspection Date: Serial #: Equip.#: Inspection Date: Insp. Comp.: (if applicable) Insp.#: Tonnage: OK Re pair N/A Check for wear Check pins & bolts for wear Safety/cotter pins in place Make: Model: Serial #: Equip.#: Inspection Date: Insp. Comp.: (if applicable) Insp.#: Tonnage: OK Re pair N/A Rotate hook to check swivel Rod hook safety latch Hook wear Safety guard over latch release Bail wear Make: Model: Serial #: Equip.#: Inspection Date: Insp. Comp.: (if applicable) Insp.#: Tonnage: OK Re pair N/A Bail Pins on bail Gooseneck Upper kelly cock Thread condition on kelly cock Make: Model: Serial #: Equip.#: Inspection Date: Insp. Comp.: (if applicable) Insp.#: Tonnage: OK Re pair N/A Track condition Pins for track Safety connections inside track Crown hanger Links on top drive Pins for balls Upper kelly cock Thread condition on kelly cock Safety chains for hoses Gooseneck Make: Model: Serial #: Equip.#: Inspection Date: Insp. Comp.: (if applicable) Insp.#: Tonnage: DRAWWORKS BRAKE LOAD PATH COMPONENTS OK Re pair N/A Brake bands Brake handle Brake handle locking mechanism Brake linkage components: Welded external lugs Linkage arm Drawworks input lug Bearing blocks Washers/cotter pins or pin connections – OK Re pair N/A Pins Pinholes in lugs Threaded connections Auxiliary brake or equivalent Any other load bearing mechanical brake OK Re pair N/A Brake bands Brake links - welded Brake links – solid Brake turnbuckles Brake equalizer Threaded connections Pins Pinholes in lugs Brake block wear Flange condition Threaded connections OK Re pair N/A Brake bands Welded external lugs Linkage arm Drawworks input lug Bearing blocks Washers/cotter pins or pin connections
Pins Pinholes in lugs Threaded connections OK Re pair N/A Brake bands Brake links - welded Brake links – solid Brake turnbuckles Brake equalizer Threaded connections Pins Pinholes in lugs Brake block wear Flange condition CARRIER MOUNTED EQUIPMENT OK Re pair N/A Off Drillers side main beam Load line lugs Turnbuckle lug weld Drillers side main beam Cross member connection Turnbuckle pin connection OK Re pair N/A Pin condition Frame Threaded legs OK Re pair N/A Tie down Rack structure OK Re pair N/A Pins and lugs (outrigger to carrier) Frame condition Frame welds Guy line lugs Spreader bar condition Screw jack condition All keeper pins and chains Belly jack condition Belly jack attachment points Mat condition OK Re pair N/A Raising ram condition Raising ram connection OK Re pair N/A Drill line anchor bolts Drill line anchor welds LEVEL III INSPECTION COMPLETION This Level III Inspection been logged in the Overhead Equipment Log Book This Level III Inspection was done in accordance with CAODC RP’s: 3.0, 4.0, 10.0 and 11.0 Inspector’s Signature: Field Superintendent’s Signature: Estimated Completion Date For All Repairs: