Contractor Job Safety Plan Template - Chevron

CONTRACTOR JOB SAFETY PLAN (CJSP)

Contractor Job Safety Plan

Project Name

© 2012 Chevron Pipe Line Company. All Rights Reserved. Page: 1 of 16 Reviewed: November 2012. Uncontrolled when printed.


TABLE OF CONTENTS1.0 General Information..................................................................................................................................................................................................... 32.0 Project Tenets and Principles....................................................................................................................................................................................... 43.0 Job Scope Overview.................................................................................................................................................................................................... 54.0 Risk Assessment and Hazard Identification................................................................................................................................................................. 65.0 Certification, Education and Training........................................................................................................................................................................... 86.0 Hazard Communication................................................................................................................................................................................................ 87.0 Personal Protective Equipment (PPE)......................................................................................................................................................................... 88.0 Environmental.............................................................................................................................................................................................................. 89.0 Managing Subcontractors............................................................................................................................................................................................ 810.0 Audits, Inspections, and Planned Observations........................................................................................................................................................... 811.0 Motor Vehicle Safety.................................................................................................................................................................................................... 812.0 Security Measures....................................................................................................................................................................................................... 813.0 Short Service Employee (SSE) Training and Identification.......................................................................................................................................... 814.0 Communication............................................................................................................................................................................................................ 815.0 Incident, Injury, and Illness Management..................................................................................................................................................................... 8Table of contents can be updated by right clicking on it and choosing update field



1.0 General Information

Developed for: Chevron Pipe Line Company

Date:

Location: City: State:

Job ID:

Job Description:

Name Telephone Cell PhoneCPL ContactContractor ForemanContractor Project ManagerContractor Safety RepresentativeAdditional Contacts (if applicable)Subcontractors (if applicable)Third-Party Contacts (if applicable)Regulatory Agency Contacts(if applicable)Chevron Compliance Hotline This number is to be used to confidentially report Safety or

Environmental concerns which you feel have not been addressed.

(800) 284-3015

AXIOM Medical Consulting (877) 502-9466



2.0 Project Tenets and Principles

Stop Work Authority:Every employee and contractor for Chevron is responsible and authorized to stop any work that does not comply with Chevron’s tenets of operations. There will be no repercussions for exercising Stop Work Authority; it is a right and a responsibility.

We Believe All Incidents Are Preventable: Do it safely or not at all. There is always time to do it right. When in doubt, find out.

Always:1. Operate within design or environmental limits.2. Operate in a safe and controlled condition.3. Ensure safety devices are in place and functioning.4. Follow safe work practices and procedures.5. Meet or exceed customers’ requirements.6. Maintain integrity of dedicated systems.7. Comply with all applicable rules and regulations.8. Address abnormal conditions.9. Follow written procedures for high risk or unusual situations.10. Involve the right people in decisions that affect procedures and equipment.



3.0 Job Scope OverviewSee instructions for an example of a typical project scope breakdown needed to accomplish an effective hazard analysis.

Job Scope:

Work Activity Task Description (subsequent JSA title) Location Company Major Equipment



4.0 Risk Assessment and Hazard IdentificationSee instructions for an example of a typical risk assessment of a Work Activity/Task Description.



Work Activity: Task Description (JSA Title):Potential Hazards Mitigations

Gravity Overhead work Falling object Excavation Collapsing roof/equipment Elevated/Uneven work surface Open holes Other:

Motion Vehicle/Equipment movement Limited mobility (confined space) Material movement Water/Wind movement Body positioning/Ergonomics Manual Lifting Other:

Mechanical Rotating equipment Compressed springs Drive belts and conveyors Motors Power/Hand tools Other:

Electrical Power lines (above/below) Energized equipment Static charges Wiring Batteries Other:

Pressure Piping Cylinders Vessels/Tanks Hoses Other: Other:

Temperature Ignition source Hot/Cold surfaces Hot/Cold liquids Hot/Cold gases Hot/Cold weather conditions Other: Other:

Chemical Explosive/Flammable vapors Carcinogen Compound Toxic Compounds Corrosive Compound Reactive Compounds Pyro-phoric material Other:

Biological Animals/Insects Bacteria/Viruses Blood Borne Pathogens Contaminated food/water Other: Other:

Radiation Lighting Welding arc/flash Sunlight X-rays NORM scale Other:

Sound Equipment noise Impact noise Venting noise Communication (SimOps) Communication (Language) Other:

Hazard Controls (Engineering and Administrative) Work Permits PPE Program Warning signs Pipeline markers Spotters/Attendants Barricades Housekeeping

Ignition source controls Gas monitoring Material Safety Data Sheets Scaffolding Parking Plans Equipment Staging Plans Essential personnel only

Break Rotation Temporary Lighting Isolation of Hazardous Energy Equipment Inspections Other: Other: Other:

Safety Controls (Personal Protective Equipment) Hard hat Safety shoes Safety glasses Face shield Goggles Cotton gloves

Leather gloves Chemical gloves Electrical rated gloves Chemical suit Work vest/Life vest Full body harness

Hearing protection Fire Resistant Clothing Other: Other:

Safety Equipment Fire Extinguishers Fire retardant tarps Locks and tags Gas detectors

Personal Monitors Tag line Safety cable Safety Barricade

Caution tape Area Monitors Other: Other:

Emergency/Contingency Plans Environmental Equipment Spill Control Spill Contingency Plans Emergency Evacuation Plans

Incident Reporting Procedure Early Injury Management Other:

Absorbent pads Containment pans Other:

Certification Requirements Licensing Requirements Certified Welder Qualified Crane Operator Qualified Rigger Qualified Signal Man Competent Person Scaffolding Inspector

Qualified Gas tester Confined Space Attendant Fire Watch Equipment Operator Other:

Asbestos Abatement Lead Abatement Other:

Safe Work Practices Safe Work Bypassing Critical Protection Confined Space Diving

Electrical Safe Work Excavation Lifting and Rigging Hot Work

Isolation of Hazardous Energy Simultaneous Operations Working at Heights Other:

PLANNING HAZARD ANALYSIS

Hazard Mitigation

































Hazard Mitigation

































Hazard Mitigation



5.0 Certification, Education and Training

Description Description Description

Abrasive Blasting Hazard Identification and Awareness Safety Observation/AuditBack Injury Prevention Hazardous Energy Lock-Out Scaffolding SafetyBasic New Employee Orientation Hazmat Training Signs and BarricadesBasic Principles of Safety (e.g. OELS) HAZWOPER Training Start-up Safety WorkshopBehavior Based Safety Hearing Conservation Program Water SurvivalBenzene, Asbestos, Lead, and H2S Awareness Heat and Cold Stress Prevention Welding/CuttingBloodborne Pathogens Helicopter Safety OtherBody Positioning Training Hot Taps OtherCommercial Diving Hot Work OtherConfined Space Entry Incident Investigation and ReportingCranes and Material Handling Industrial Hygiene Exposure MonitoringDefensive Driving/Driving Safety Job Safety AnalysisElectrical Lock-Out/Tag-Out Land Transportation SafetyElectrical Safety Lifeboat SafetyEmergency Evacuation (Drills, Muster Points) Line Breaking/Opening ProcessEmergency Marine Evacuation Marine Drilling SafetyEmergency Response Plan Near Miss ReportingExcavation and Trenching Offshore DivingExplosives and Ordinance Personal Protective EquipmentFall Protection Power Actuated ToolsFire Safety Radiation ControlFire Watch Respiratory ControlFirst Aid (CPR, EMS) Respiratory Protection ProgramFlammable and Toxic Material Handling Roofing Work ProcedureFloor and Wall Opening Safety Culture/Commitment TrainingHazard Communication (MSDS), Labeling, etc. Safety Equipment Usage



6.0 Hazard CommunicationChemicals Brought on Site(By generic use name. List here or append a separate Chemical Inventory List.)

1.

2.

3.

4.

5.

Special PPE or Handling Requirements



7.0 Personal Protective Equipment (PPE)

Hazard Potential Source Known Activities that potential contain

Avenue of Exposure Personal Protective Equipment

[Add relevant PPE to mitigate hazard]Inhalation Skin/Eye Ingestion Other

Ammonia Nitrate

Asbestos

-Valve/Pump Packing

-Pipe Coating-Pipe-Insulation

-Gaskets-Brakes-Building Materials

Operations and Maintenance

Benzene

-Crudes-Products-Solvents-Condensates

-Sampling-Spill Clean up

-Checking Leaks

-Confined Space

-Tank Cleaning

-Tank Inspections

-Waste Handling

Bloodborne Pathogens Contact with blood Rescue or Emergency Activities

Burns-Welding-Hot Equipment-Sunlight

Welding and Maintenance

Carbon Monoxide-Vehicle Emissions-Fire Combustion-Product


Coal Tar Mastic -Pipe Coating Material, Herbicides, and Pesticides Maintenance

Cold-Weather-Nitrogen Trucks-Refrigeration units

Operations, Maintenance, Line Purging

Drag Reducing Agents

Dust-Weather-Abrasive blasting

-Old buildings

-Vaults


Epoxy Resins -Pipeline Coating-Sealants

Operations and Maintenance, Pipeline Repairs

Falling Object

-Over head hazards-Scaffolding-Construction zones-Cranes


Fiberglass Insulation Operations and Maintenance, Repairs

Grinding Dusts Repairs,Grinding on equipment, fabrication


H2S Crude Oil, Oil fields Operations and






Maintenance

Heat

-Environmental-Offices-Engines-Steam lines

-Furnaces-Switch Gear-Hot Crude Lines


Hydrocarbon Liquid Crude Oil, Oil fieldsOperations and Maintenance, Pipeline Repairs

Hydrocarbon Vapors Crude Oil, Oil fieldsOperations and Maintenance, Pipeline Repairs

L.P.G. LPG Facilities, pipelines, tankers


Lube Oils Engines, pumps, rotating equipment


Lyme Disease Ticks ROW clearingJob Walks in high brush

Mercury -Light Crude Oil, Oil fields,-Switches

Pipeline repairs, Operations and Maintenance

Metal Fumes Welding rods Pipeline repairs, Operations and Maintenance

Noise (> 85 dBA)

-Engines-Pumps-Compressors-Hand Tools

Heavy equipment

-Abrasive blasting

-PRVs


N.O.R.M. Scale inside pipelines Pipeline repairs, Operations and Maintenance

Oxygen (lack of) -Confined Spaces-Inert Atmospheres


Paint Dust (lead) Old Buildings and pipelines Pipeline repairs, Operations and Maintenance

PCBs Transformers Pipeline repairs, Operations and Maintenance

Pollen Vegetation Pipeline repairs, Operations and Maintenance

Sewage Sewage lines, treatment facilities

Operations and Maintenance, pipeline repairs and installs

Sharps Equipment, tools, broken glass, pipeline, etc


Silica/sand Abrasive blasting, mud mixing on drills, excavations


Snake Bites Snakes Operations and Maintenance, pipeline






repairs and installs, ROW clearings

Solvents-Lab chemicals-Degreasers-Paints


Water -Gulf of Mexico-Rivers, Stream




8.0 EnvironmentalWastes Generated:

Waste Management Procedure:

Environmental Permit Compliance:

Spill Prevention and Containment:

Sensitive Area Protection:

9.0 Managing Subcontractors

10.0 Audits, Inspections, and Planned Observations

11.0 Motor Vehicle Safety

12.0 Security Measures

13.0 Short Service Employee (SSE) Training and Identification

14.0 Communication



15.0 Incident, Injury, and Illness Management

First Aid/Minor Treatment Facility (Clinic or other treatment center) Phone

Contact (Doctor or professional medical provider’s name) Phone

Emergency Medical Treatment Facility (Local Hospital/Regional Trauma Center) Phone

Emergency Transportation Provider (Attach driving route to this plan) Phone

Medical Management Plan Provider Contact Phone

Local Law Enforcement Phone

Local Fire Department Phone

Alternate Medical Management Plan Provider Phone

AXIOM Medical Consulting 877-502-9466

Incident Response:

HAZWOPER Emergency Plan: (Refer to instructions for requirements. This section should be discussed in detail. Append additional documents as appropriate.)

Incident Reporting and Investigation: (Describe requirements and process)


Documents

Contractor Job Safety Plan Template - Chevron