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CONTRACTOR JOB SAFETY PLAN (CJSP)

Contractor Job Safety Plan

Project Name:

TABLE OF CONTENTS
1.0
General Information..................................................................................................................................................................................................... 3
2.0
Project Tenets and Principles....................................................................................................................................................................................... 4
3.0
Job Scope Overview.................................................................................................................................................................................................... 5
4.0
Risk Assessment and Hazard Identification................................................................................................................................................................. 6
Revised: 11/13/2012

Page: 1 of 15

Print Date: 10/22/2015

CONTRACTOR JOB SAFETY PLAN (CJSP)


5.0
6.0
7.0
8.0
9.0
10.0
11.0
12.0
13.0
14.0
15.0

Certification, Education and Training............................................................................................................................................................................ 8


Hazard Communication................................................................................................................................................................................................ 8
Personal Protective Equipment (PPE)......................................................................................................................................................................... 8
Environmental.............................................................................................................................................................................................................. 8
Managing Subcontractors............................................................................................................................................................................................ 8
Audits, Inspections, and Planned Observations........................................................................................................................................................... 8
Motor Vehicle Safety.................................................................................................................................................................................................... 8
Security Measures....................................................................................................................................................................................................... 8
Short Service Employee (SSE) Training and Identification.......................................................................................................................................... 8
Communication............................................................................................................................................................................................................ 8
Incident, Injury, and Illness Management..................................................................................................................................................................... 8

Table of contents can be updated by right clicking on it and choosing update field
1.0

General Information
Chevron Pipe Line
Company

Date
:

Location:

City:

Job ID:

Developed
for:

State
:

Job Description:
Name

Telephone

Cell Phone

CPL Contact

Contractor Foreman

Contractor Project Manager

Contractor Safety
Representative

Additional Contacts (if


applicable)

Subcontractors (if applicable)

Third-Party Contacts (if


applicable)

Revised: 8/9/2012

Rev. 01

Page 2 of 15

Print Date: 10/22/2015

CONTRACTOR JOB SAFETY PLAN (CJSP)


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.

AXIOM Medical Consulting

2.0

(800) 284-3015
(877) 502-9466

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 Chevrons 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.
2.
3.
4.
5.
6.
7.
8.
9.
10.

3.0

Operate within design or environmental limits.


Operate in a safe and controlled condition.
Ensure safety devices are in place and functioning.
Follow safe work practices and procedures.
Meet or exceed customers requirements.
Maintain integrity of dedicated systems.
Comply with all applicable rules and regulations.
Address abnormal conditions.
Follow written procedures for high risk or unusual situations.
Involve the right people in decisions that affect procedures and equipment.

Job Scope Overview

See instructions for an example of a typical project scope breakdown needed to accomplish an effective hazard analysis.

Revised: 8/9/2012

Rev. 01

Page 3 of 15

Print Date: 10/22/2015

CONTRACTOR JOB SAFETY PLAN (CJSP)


Job Scope:
Work Activity

Task Description (subsequent JSA title)

Location

Company

Revised: 8/9/2012

Rev. 01

Page 4 of 15

Print Date: 10/22/2015

Major Equipment

CONTRACTOR JOB SAFETY PLAN (CJSP)

4.0

Risk Assessment and Hazard Identification

See instructions for an example of a typical risk assessment of a Work Activity/Task Description.

Work Activity:

Task Description (JSA Title):


Potential Hazards

Revised: 8/9/2012

Rev. 01

Mitigations

Page 5 of 15

Print Date: 10/22/2015

CONTRACTOR JOB SAFETY PLAN (CJSP)


Gravity

Temperature

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

Hazard Controls (Engineering and Administrative)

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

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

Ignition source controls


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

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:

Personal Monitors
Tag line
Safety cable
Safety Barricade

Caution tape
Area Monitors
Other:
Other:

Safety Equipment

Biological
Animals/Insects
Bacteria/Viruses
Blood Borne Pathogens
Contaminated food/water
Other:
Other:
Radiation
Lighting
Welding arc/flash
Sunlight
X-rays
NORM scale
Other:

Fire Extinguishers
Fire retardant tarps
Locks and tags
Gas detectors
Emergency/Contingency Plans
Spill Control
Spill Contingency Plans
Emergency Evacuation Plans

Environmental Equipment
Incident Reporting Procedure
Early Injury Management
Other:

Certification Requirements

Sound

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:

Electrical Safe Work


Excavation
Lifting and Rigging
Hot Work

Isolation of Hazardous Energy


Simultaneous Operations
Working at Heights
Other:

Safe Work Practices


Safe Work
Bypassing Critical Protection
Confined Space
Diving

Hazard

Rev. 01

Mitigation

Page 6 of 15

Absorbent pads
Containment pans
Other:
Licensing Requirements

PLANNING HAZARD ANALYSIS

Revised: 8/9/2012

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

Safety Controls (Personal Protective Equipment)

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

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

Piping
Cylinders
Vessels/Tanks
Hoses
Other:
Other:

Work Permits
PPE Program
Warning signs
Pipeline markers
Spotters/Attendants
Barricades
Housekeeping

Print Date: 10/22/2015

CONTRACTOR JOB SAFETY PLAN (CJSP)

Work Activity:

Task Description (JSA Title):


Potential Hazards

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

Hazard Controls (Engineering and Administrative)

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

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

Rev. 01

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)

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

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:

Personal Monitors
Tag line
Safety cable
Safety Barricade

Caution tape
Area Monitors
Other:
Other:

Safety Equipment

Biological
Animals/Insects
Bacteria/Viruses
Blood Borne Pathogens
Contaminated food/water
Other:
Other:
Radiation
Lighting
Welding arc/flash
Sunlight
X-rays
NORM scale
Other:

Fire Extinguishers
Fire retardant tarps
Locks and tags
Gas detectors
Emergency/Contingency Plans
Spill Control
Spill Contingency Plans
Emergency Evacuation Plans

Environmental Equipment
Incident Reporting Procedure
Early Injury Management
Other:

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

Sound
Equipment noise
Impact noise
Venting noise

Piping
Cylinders

Revised: 8/9/2012

Mitigations

Temperature

Safe Work Practices

Page 7 of 15

Print Date: 10/22/2015

Absorbent pads
Containment pans
Other:
Licensing Requirements

Qualified Gas tester


Confined Space Attendant
Fire Watch
Equipment Operator
Other:

Asbestos Abatement
Lead Abatement
Other:

CONTRACTOR JOB SAFETY PLAN (CJSP)


Vessels/Tanks
Hoses
Other:
Other:

Communication (SimOps)
Communication (Language)
Other:

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

Work Activity:

Task Description (JSA Title):


Potential Hazards

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

Hazard Controls (Engineering and Administrative)

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

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)

Revised: 8/9/2012

Mitigations

Temperature

Rev. 01

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)

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

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:

Personal Monitors
Tag line
Safety cable
Safety Barricade

Caution tape
Area Monitors
Other:
Other:

Safety Equipment

Biological
Animals/Insects
Bacteria/Viruses
Blood Borne Pathogens
Contaminated food/water
Other:
Other:
Radiation
Lighting
Welding arc/flash

Fire Extinguishers
Fire retardant tarps
Locks and tags
Gas detectors
Emergency/Contingency Plans
Spill Control
Spill Contingency Plans
Emergency Evacuation Plans
Certification Requirements

Page 8 of 15

Print Date: 10/22/2015

Environmental Equipment
Incident Reporting Procedure
Early Injury Management
Other:

Absorbent pads
Containment pans
Other:
Licensing Requirements

CONTRACTOR JOB SAFETY PLAN (CJSP)


Energized equipment
Static charges
Wiring
Batteries
Other:

Sunlight
X-rays
NORM scale
Other:

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

Sound

Pressure

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

Piping
Cylinders
Vessels/Tanks
Hoses
Other:
Other:

Qualified Gas tester


Confined Space Attendant
Fire Watch
Equipment Operator
Other:

Asbestos Abatement
Lead Abatement
Other:

Electrical Safe Work


Excavation
Lifting and Rigging
Hot Work

Isolation of Hazardous Energy


Simultaneous Operations
Working at Heights
Other:

Safe Work Practices


Safe Work
Bypassing Critical Protection
Confined Space
Diving

PLANNING HAZARD ANALYSIS


Hazard

Mitigation

5.0

Certification, Education and Training


Description

Description

Description

Abrasive Blasting

Hazard Identification and Awareness

Safety Observation/Audit

Back Injury Prevention

Hazardous Energy Lock-Out

Scaffolding Safety

Basic New Employee Orientation

Hazmat Training

Signs and Barricades

Basic Principles of Safety (e.g. OELS)

HAZWOPER Training

Start-up Safety Workshop

Behavior Based Safety

Hearing Conservation Program

Water Survival

Benzene, Asbestos, Lead, and H2S Awareness

Heat and Cold Stress Prevention

Welding/Cutting

Bloodborne Pathogens

Helicopter Safety

Other

Body Positioning Training

Hot Taps

Other

Commercial Diving

Hot Work

Other

Confined Space Entry

Incident Investigation and Reporting

Cranes and Material Handling

Industrial Hygiene Exposure Monitoring

Defensive Driving/Driving Safety

Job Safety Analysis

Revised: 8/9/2012

Rev. 01

Page 9 of 15

Print Date: 10/22/2015

CONTRACTOR JOB SAFETY PLAN (CJSP)


Electrical Lock-Out/Tag-Out

Land Transportation Safety

Electrical Safety

Lifeboat Safety

Emergency Evacuation (Drills, Muster Points)

Line Breaking/Opening Process

Emergency Marine Evacuation

Marine Drilling Safety

Emergency Response Plan

Near Miss Reporting

Excavation and Trenching

Offshore Diving

Explosives and Ordinance

Personal Protective Equipment

Fall Protection

Power Actuated Tools

Fire Safety

Radiation Control

Fire Watch

Respiratory Control

First Aid (CPR, EMS)

Respiratory Protection Program

Flammable and Toxic Material Handling

Roofing Work Procedure

Floor and Wall Opening

Safety Culture/Commitment Training

Hazard Communication (MSDS), Labeling, etc.

Safety Equipment Usage

6.0

Hazard Communication

Chemicals 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)

Revised: 8/9/2012

Rev. 01

Page 10 of 15

Print Date: 10/22/2015

CONTRACTOR JOB SAFETY PLAN (CJSP)

Hazard

Potential Source

Known Activities that


potential contain

Avenue of Exposure
Inhalation

Skin/Eye

Ingestion

Personal Protective Equipment


Other

[Add relevant PPE to mitigate hazard]

Ammonia Nitrate
-Valve/Pump
Packing
Asbestos

-Gaskets

-Pipe
Coating

-Brakes

-Pipe

-Building
Materials

Operations and
Maintenance

-Insulation
-Sampling
-Crudes

-Spill Clean
up

-Products

Benzene

-Checking
Leaks

-Solvents
-Condensates

Bloodborne Pathogens

-Confined
Space

Contact with blood

-Tank
Cleaning
-Tank
Inspections
-Waste
Handling

Rescue or Emergency
Activities

-Welding
-Hot Equipment

Burns

Welding and Maintenance

-Sunlight

-Vehicle Emissions
-Fire Combustion

Carbon Monoxide

Operations and
Maintenance

-Product
-Pipe Coating Material,
Herbicides, and Pesticides

Coal Tar Mastic

Maintenance

-Weather
-Nitrogen Trucks

Cold

Operations, Maintenance,
Line Purging

-Refrigeration units

Drag Reducing Agents


-Weather
Dust

Epoxy Resins

Revised: 8/9/2012

-Abrasive
blasting

-Old
buildings
-Vaults

-Pipeline Coating
-Sealants

Rev. 01

Operations and
Maintenance

Operations and
Maintenance, Pipeline
Repairs

Page 11 of 15

Print Date: 10/22/2015

CONTRACTOR JOB SAFETY PLAN (CJSP)

Hazard

Known Activities that


potential contain

Potential Source

Avenue of Exposure
Inhalation

Skin/Eye

Ingestion

Other

[Add relevant PPE to mitigate hazard]

-Over head hazards


Operations and
Maintenance, Pipeline
Repairs

-Scaffolding

Falling Object

Personal Protective Equipment

-Construction zones
-Cranes

Fiberglass

Insulation

Operations and
Maintenance, Repairs

Grinding Dusts

Repairs,Grinding on
equipment, fabrication

Operations and
Maintenance, Pipeline
Repairs

H2S

Crude Oil, Oil fields

Heat

-Offices

-Switch Gear

-Engines

-Hot Crude
Lines

Operations and
Maintenance, Pipeline
Repairs

Crude Oil, Oil fields

Operations and
Maintenance, Pipeline
Repairs

Hydrocarbon Vapors

Crude Oil, Oil fields

Operations 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

Noise (> 85 dBA)

-Engines
-Pumps
-Compressors

Revised: 8/9/2012

Rev. 01

Job Walks in high brush

-Switches
Welding rods

ROW clearing

-Light Crude Oil, Oil fields,

Metal Fumes

-Furnaces

Hydrocarbon Liquid

Mercury

Operations and
Maintenance

-Environmental

-Steam lines

Pipeline repairs, Operations


and Maintenance

Pipeline repairs, Operations


and Maintenance
-Abrasive
blasting

Pipeline repairs, Operations


and Maintenance

-PRVs

Page 12 of 15

Print Date: 10/22/2015

CONTRACTOR JOB SAFETY PLAN (CJSP)

Hazard

Potential Source

Known Activities that


potential contain

Avenue of Exposure
Inhalation

Skin/Eye

Ingestion

Personal Protective Equipment


Other

[Add relevant PPE to mitigate hazard]

-Hand Tools
Heavy
equipment
N.O.R.M.
Oxygen (lack of)

Scale inside pipelines


-Confined Spaces
-Inert Atmospheres
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 repairs and installs,
ROW clearings

Solvents

-Degreasers
-Paints

Water

-Gulf of Mexico
-Rivers, Stream

Pipeline repairs, Operations


and Maintenance

Paint Dust (lead)

-Lab chemicals

Pipeline repairs, Operations


and Maintenance

Operations and
Maintenance, pipeline
repairs and installs

Operations and
Maintenance, pipeline
repairs and installs

Revised: 8/9/2012

Rev. 01

Page 13 of 15

Print Date: 10/22/2015

CONTRACTOR JOB SAFETY PLAN (CJSP)

8.0

Environmental

Wastes 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

Revised: 8/9/2012

Rev. 01

Page 14 of 15

Print Date: 10/22/2015

CONTRACTOR JOB SAFETY PLAN (CJSP)

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

Phone

Contact (Doctor or professional medical providers 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)

Revised: 8/9/2012

Rev. 01

Page 15 of 15

Print Date: 10/22/2015