contractor job safety plan template - chevron
TRANSCRIPT
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.
CONTRACTOR JOB SAFETY PLAN (CJSP)
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
© 2012 Chevron Pipe Line Company. All Rights Reserved. Page: 2 of 16 Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
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
© 2012 Chevron Pipe Line Company. All Rights Reserved. Page: 3 of 16 Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
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.
© 2012 Chevron Pipe Line Company. All Rights Reserved. Page: 4 of 16 Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
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
© 2012 Chevron Pipe Line Company. All Rights Reserved. Page: 5 of 16 Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
4.0 Risk Assessment and Hazard IdentificationSee instructions for an example of a typical risk assessment of a Work Activity/Task Description.
© 2012 Chevron Pipe Line Company. All Rights Reserved. Page: 6 of 16 Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
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
© 2012 Chevron Pipe Line Company. All Rights Reserved. Page: 7 of 16 Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
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
© 2012 Chevron Pipe Line Company. All Rights Reserved. Page: 8 of 16 Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
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
© 2012 Chevron Pipe Line Company. All Rights Reserved. Page: 9 of 16 Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
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
© 2012 Chevron Pipe Line Company. All Rights Reserved. Page: 10 of 16 Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
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
© 2012 Chevron Pipe Line Company. All Rights Reserved. Page: 11 of 16 Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
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
Operations and Maintenance
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
Operations and Maintenance
Epoxy Resins -Pipeline Coating-Sealants
Operations and Maintenance, Pipeline Repairs
Falling Object
-Over head hazards-Scaffolding-Construction zones-Cranes
Operations and Maintenance, Pipeline Repairs
Fiberglass Insulation Operations and Maintenance, Repairs
Grinding Dusts Repairs,Grinding on equipment, fabrication
Operations and Maintenance, Pipeline Repairs
H2S Crude Oil, Oil fields Operations and
© 2012 Chevron Pipe Line Company. All Rights Reserved. Page: 12 of 16 Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
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
Maintenance
Heat
-Environmental-Offices-Engines-Steam lines
-Furnaces-Switch Gear-Hot Crude Lines
Operations and Maintenance, Pipeline Repairs
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
Operations and Maintenance, Pipeline Repairs
Lube Oils Engines, pumps, rotating equipment
Operations and Maintenance
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
Pipeline repairs, Operations and Maintenance
N.O.R.M. Scale inside pipelines Pipeline repairs, Operations and Maintenance
Oxygen (lack of) -Confined Spaces-Inert Atmospheres
Pipeline repairs, Operations and Maintenance
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
Operations and Maintenance, pipeline repairs and installs
Silica/sand Abrasive blasting, mud mixing on drills, excavations
Operations and Maintenance, pipeline repairs and installs
Snake Bites Snakes Operations and Maintenance, pipeline
© 2012 Chevron Pipe Line Company. All Rights Reserved. Page: 13 of 16 Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
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
repairs and installs, ROW clearings
Solvents-Lab chemicals-Degreasers-Paints
Operations and Maintenance, pipeline repairs and installs
Water -Gulf of Mexico-Rivers, Stream
Operations and Maintenance, pipeline repairs and installs
© 2012 Chevron Pipe Line Company. All Rights Reserved. Page: 14 of 16 Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
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
© 2012 Chevron Pipe Line Company. All Rights Reserved. Page: 15 of 16 Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
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)
© 2012 Chevron Pipe Line Company. All Rights Reserved. Page: 16 of 16 Reviewed: November 2012. Uncontrolled when printed.