Contractor Job Safety Plan: Project Name

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

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

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

Job Scope:
Work Activity
Task Description (subsequent JSA title)
Location
Company
Revised: 8/9/2012
Rev. 01
Page 4 of 15
Major Equipment
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

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
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
Work Activity:

Potential Hazards
Gravity
Overhead work
Falling object
Excavation
Open holes
Other:
Motion
Ignition source
Hot/Cold surfaces
Hot/Cold liquids
Hot/Cold gases
Other:
Other:
Chemical
space)
Material movement
Water/Wind movement
Manual Lifting
Other:
Mechanical
Rotating equipment
Compressed springs
Motors
Power/Hand tools
Other:
Electrical
Energized equipment
Static charges
Wiring
Batteries
Other:
Pressure
Rev. 01
Work Permits
PPE Program
Warning signs
Pipeline markers
Spotters/Attendants
Barricades
Housekeeping

Gas monitoring
Scaffolding
Parking Plans
Break Rotation
Temporary Lighting
Other:
Other:
Other:
Carcinogen Compound
Toxic Compounds
Corrosive Compound
Reactive Compounds
Other:
Hard hat
Safety shoes
Safety glasses
Face shield
Goggles
Cotton gloves
Leather gloves
Chemical gloves
Chemical suit
Work vest/Life vest
Full body harness
Hearing protection
Other:
Other:
Personal Monitors
Tag line
Safety cable
Safety Barricade
Caution tape
Area Monitors
Other:
Other:
Safety Equipment
Biological
Animals/Insects
Bacteria/Viruses
Other:
Other:
Radiation
Lighting
Welding arc/flash
Sunlight
X-rays
NORM scale
Other:
Fire Extinguishers
Locks and tags
Gas detectors
Spill Control
Other:
Certified Welder
Qualified Rigger
Competent Person
Sound
Equipment noise
Impact noise
Venting noise
Piping
Cylinders
Revised: 8/9/2012
Mitigations
Temperature
Safe Work Practices
Page 7 of 15
Absorbent pads
Containment pans
Other:

Fire Watch
Equipment Operator
Other:
Asbestos Abatement
Lead Abatement
Other:

Vessels/Tanks
Hoses
Other:
Other:
Other:
Safe Work
Confined Space
Diving

Excavation
Lifting and Rigging
Hot Work

Working at Heights
Other:

Hazard
Mitigation
Work Activity:

Potential Hazards
Gravity
Overhead work
Falling object
Excavation
Open holes
Other:
Motion
Ignition source
Hot/Cold surfaces
Hot/Cold liquids
Hot/Cold gases
Other:
Other:
Chemical
space)
Material movement
Water/Wind movement
Manual Lifting
Other:
Mechanical
Rotating equipment
Compressed springs
Motors
Power/Hand tools
Other:
Electrical
Revised: 8/9/2012
Mitigations
Temperature
Rev. 01
Work Permits
PPE Program
Warning signs
Pipeline markers
Spotters/Attendants
Barricades
Housekeeping

Gas monitoring
Scaffolding
Parking Plans
Break Rotation
Temporary Lighting
Other:
Other:
Other:
Carcinogen Compound
Toxic Compounds
Corrosive Compound
Reactive Compounds
Other:
Hard hat
Safety shoes
Safety glasses
Face shield
Goggles
Cotton gloves
Leather gloves
Chemical gloves
Chemical suit
Work vest/Life vest
Full body harness
Hearing protection
Other:
Other:
Personal Monitors
Tag line
Safety cable
Safety Barricade
Caution tape
Area Monitors
Other:
Other:
Safety Equipment
Biological
Animals/Insects
Bacteria/Viruses
Other:
Other:
Radiation
Lighting
Welding arc/flash
Fire Extinguishers
Locks and tags
Gas detectors
Spill Control
Page 8 of 15
Other:
Absorbent pads
Containment pans
Other:

Energized equipment
Static charges
Wiring
Batteries
Other:
Sunlight
X-rays
NORM scale
Other:
Certified Welder
Qualified Rigger
Competent Person
Sound
Pressure
Equipment noise
Impact noise
Venting noise
Other:
Piping
Cylinders
Vessels/Tanks
Hoses
Other:
Other:

Fire Watch
Equipment Operator
Other:
Asbestos Abatement
Lead Abatement
Other:

Excavation
Lifting and Rigging
Hot Work

Working at Heights
Other:
Safe Work Practices

Safe Work
Confined Space
Diving

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

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
Hazard
Potential Source
Known Activities that

potential contain
Avenue of Exposure
Inhalation
Skin/Eye
Ingestion

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
Hazard

potential contain
Potential Source
Avenue of Exposure
Inhalation
Skin/Eye
Ingestion
Other
-Over head hazards

Operations and
Repairs
-Scaffolding
Falling Object
-Construction zones
-Cranes
Fiberglass
Insulation
Operations and
Maintenance, Repairs
Grinding Dusts
Repairs,Grinding on
equipment, fabrication
Operations and
Repairs
H2S
Crude Oil, Oil fields
Heat
-Offices
-Switch Gear
-Engines
-Hot Crude
Lines
Operations and
Repairs
Operations and
Repairs
Hydrocarbon Vapors
Operations and
Repairs
L.P.G.
LPG Facilities, pipelines,

tankers
Operations and
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

and Maintenance
-Abrasive
blasting

and Maintenance
-PRVs
Page 12 of 15
Hazard
Potential Source

potential contain
Avenue of Exposure
Inhalation
Skin/Eye
Ingestion

Other
-Hand Tools
Heavy
equipment
N.O.R.M.
Oxygen (lack of)
Scale inside pipelines

-Confined Spaces
-Inert Atmospheres
Old Buildings and pipelines

and Maintenance
PCBs
Transformers

and Maintenance
Pollen
Vegetation

and Maintenance
Sewage
Sewage lines, treatment

facilities
Operations and
Maintenance, pipeline
repairs and installs
Sharps
Equipment, tools, broken

glass, pipeline, etc
Operations and
Silica/sand
Abrasive blasting, mud

mixing on drills, excavations
Operations and
Snake Bites
Snakes
Operations and Maintenance,

pipeline repairs and installs,
ROW clearings
Solvents
-Degreasers
-Paints
Water
-Gulf of Mexico
-Rivers, Stream

and Maintenance
Paint Dust (lead)
-Lab chemicals

and Maintenance
Operations and
Operations and
Revised: 8/9/2012
Rev. 01
Page 13 of 15
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
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

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CONTRACTOR JOB SAFETY PLAN (CJSP)