North America Onshore Environment, Health and Safety (EH&S) Practices Safe Work Permits P103 SUNCOR ENERGY INC. Manager of EH&S, North America Onshore Thomas Brown 11/03/18 Reformatted into new template 11/10/29 Document Owner Document Contact Date Developed (YY/MM/DD) Revision Date (YY/MM/DD) Summary of Changes (if applicable) North America Onshore EH&S Practice Safe Work Permits Number: P103 Table of Contents 1. Purpose ..............................................................................................................................3 2. Scope ..................................................................................................................................3 3. Responsibilities .................................................................................................................3 3.1 Site Supervisor .......................................................................................................3 3.2 Operating Authority.................................................................................................4 3.3 Performing Authority ...............................................................................................5 3.4 Gas Atmosphere Tester .........................................................................................5 3.5 Safety Watch ..........................................................................................................6 3.6 Fire Watch ..............................................................................................................6 3.7 Rescue Team .........................................................................................................6 3.8 Contractors .............................................................................................................7 4. Requirements .....................................................................................................................7 4.1 Administration .........................................................................................................7 4.2 Cold and Hot Safe Work Permits .........................................................................10 4.3 Safe Work Permit from Completion ......................................................................11 4.4 Pre-Job Hazard Assessments ..............................................................................12 4.5 Confined Space Entry...........................................................................................14 4.6 Ground Disturbance .............................................................................................15 4.7 Fall Protection Rescue Plan .................................................................................15 4.8 Term Safe Work Agreements ...............................................................................16 4.9 Emergency Conditions .........................................................................................16 5. References .......................................................................................................................17 6. Definitions ........................................................................................................................17 CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 2 OF 30 North America Onshore EH&S Practice Safe Work Permits 1. Number: P103 Purpose The purpose of this Practice is to ensure accurate, effective and consistent application of Safe Work Permits, Term Work Safe Agreements and Hazard Assessments to assess risks, identify the hazards and initiate controls to manage those hazards for the assigned tasks. Safe Work Permits and Term Safe Work Agreements allow the Operating Authority the opportunity to communicate potential hazards the Performing Authority may be exposed to. Pre-Job Hazard Assessments provide an opportunity for the Performing Authority to identify potential hazards at the worksite. The application of the documents within this Practice will minimize the possibility of loss to people, environment and equipment. EH&S Practices provide interpretation of regulations, standards, and Industry recommended Practices (IRPs) and any additional Suncor requirements. All North America Onshore Business Areas are required to develop their own procedures to implement this Practice as required. Appendices A to D provide supporting information. 2. Scope 2.1 This Practice applies at all Suncor Energy North America Onshore worksites and applies to Suncor workers and contractor personnel. References in this document to “Suncor Personnel” include directors, officers, employees, contract workers, consultants and agents of Suncor. 2.2 Where a site specific procedure has been written that follows the minimum components of, and meets the intent of the criteria in this Practice, it shall take precedence over specific requirements herein. a) Appendix A provides Suncor’s Safe Work Permit (North America Onshore) standard form. This Practice applies specifically to the following: b) Cold Safe Work Permits– Work with no ignition sources within classified areas (i.e., housekeeping and inspections). c) Hot Safe Work Permits– Work where ignition sources will be intentionally introduced or anticipated within classified areas (i.e., welding and vehicle entry). d) Term Safe Work Agreements (Appendix B) – Work is low complexity, low risk, long duration and is impractical to issue other permits each time a task is undertaken (i.e., product fluid hauling and road/lease/site maintenance). e) Pre-Job Hazard Assessments (Appendix C) – Recognizes potential hazards at the worksite and allows for the identification of equipment, processes, and materials to control the anticipated hazards. 2.3 Deviations from this Practice must have a risk assessment performed and be approved by the Vice President of the North America Onshore Business Area. 3. Responsibilities The following individuals and groups have the defined responsibilities: 3.1 Site Supervisor The Site Supervisor’s specific Safe Work Permit/Term Work Safe Agreement responsibilities are: a) Administer this Practice including implementation, training, compliance, auditing and CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 3 OF 30 North America Onshore EH&S Practice Safe Work Permits Number: P103 monitoring. b) Ensure persons who sign Safe Work Permit as Operating Authority have completed Safe Work Permit, Confined Space Entry (P301), Ground Disturbance (P302) and Fall Protection (P314) Practices knowledge checks and this Practice are reviewed every three years. c) Review the Term Safe Work Agreement (Appendix B) to ensure that all requirements have been considered and issue in consultation with the respective EH&S Advisor. d) Identify training requirements and ensure all required training identified on the Term Safe Work Agreement is maintained. e) Ensure the duration of the Term Safe Work Agreement must not exceed two years but the terms of the agreement must be reviewed annually. f) Ensure a copy of the Term Safe Work Agreement is immediately available to workers and the Contractor’s employees while on Suncor worksites. g) Monitor contractor compliance to the Term Safe Work Agreement by performing field spot checks of the Contractor activities. h) Aware of all potential hazards associated with the work to be done. 3.2 i) Familiar with all procedures and precautions required to perform the work safely and must understand the importance of ensuring that these conditions are followed. j) Competent with all atmospheric testing equipment and procedures. Operating Authority The Operating Authority is the person having immediate responsibility for the operations affected by the specific Safe Work Permit. The Operating Authority must have direct control of the worksite and has the following responsibilities: a) Issue appropriate Safe Work Permits as per the decision chart. b) Identify all potential hazards and the necessary controls for the work being performed. c) Identify those areas that Performing Authority agrees to take responsibility for on the Safe Work Permit and makes sure Performing Authority initials appropriately. d) Ensure that all conditions are acceptable, completely understood and agreed to by the Performing Authority. e) Ensure atmospheric tester, safety watch and /fire watch are competent for their assigned task. f) Ensure the appropriate critical / routine safe work procedures are provided to the Performing Authority and identified on the Safe Work Permit. g) Ensure atmospheric testing is completed as required. h) Inform next shift of permits still in effect. i) Ensure that “Hand Back” is completed, signed and the agreements are properly filed. j) Ensure the Performing Authority is competent in the adequate and effective completion of Pre-Job Hazard Assessments. k) Be familiar with all procedures and precautions required to perform the work safely CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 4 OF 30 North America Onshore EH&S Practice Safe Work Permits Number: P103 and must understand the importance of ensuring that these conditions are followed. l) Aware of all potential hazards associated with the work to be done. m) Competent with all atmospheric testing equipment and procedures. n) Be responsible for any updates or changes to this Practice. 3.3 Performing Authority The Performing Authority is the person supervising or conducting the work specified in the Safe Work Permit/Agreement. Common titles are crew leader, job foreman, craftsman and worker. The Performing Authority responsibilities are below: a) Ensure that workers are properly trained or supervised. b) Assist in completion of the Safe Work Permit/Agreements. c) Ensure that all conditions and terms are acceptable and that any responsibilities identified on the agreement are completely understood and initialled to indicate understanding. d) Instruct all workers covered under this agreement of their responsibilities regarding the identified hazards and controls. e) Ensure “Hand Back” is completed and signed as specified in the Safe Work Agreement. f) Complete the hazard assessment upon arriving at site/location on the back side of white Safe Work Permit copy. g) Instruct all workers covered under the Safe Work Permit/Agreement as to their responsibilities regarding the hazards and controls identified. h) Aware of their responsibilities required by this Practice. i) 3.4 Competent in their assigned task. (This may require safety training such as, but not limited to, Confined Space Entry, Ground Disturbance, Fall Protection, WHMIS, H2S Alive, TDG, Respiratory Fit-testing and training for the respiratory apparatus used onsite). Gas Atmosphere Tester A Gas/Atmosphere Tester is the individual assigned responsibility to conduct hazardous atmosphere monitoring. The Gas/Atmosphere Tester responsibilities are: a) Monitor controls for atmospheric hazards occur as stipulated in the Safe Work Permit/Agreement. b) Perform appropriate gas/atmosphere testing recording and sign off at the required times as specified by the Safe Work Permit/Agreement. c) Ensure personal monitors are used at all times, however if workers are leaving the location for any period of time (lunch, coffee, tool run) the results of the monitoring must be documented on the Safe Permit/Agreement. d) Competent with all atmospheric testing equipment and procedures. e) Be familiar with following: CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 5 OF 30 North America Onshore EH&S Practice Safe Work Permits Number: P103 i. Work location; ii. Associated hazards; and iii. Required procedures and precautions. 3.5 Safety Watch a) Monitor the work in progress to ensure all workers are immediately alerted to hazardous conditions. b) Initiate rescue if hazardous conditions develop. c) They must not be assigned any responsibilities that interfere with the ability to monitor the task at hand. d) Competent to initiate applicable rescue procedures, under some circumstances be required to have the skill of a rescue responder. e) Be familiar with following: i. Work being performed; ii. Configuration of the work area; and iii. Potential hazards and precautions Required Safety Watch Training a) In possession of a valid First Aid Certificate unless a rescue team will be used has the required Safety Watch training. b) Note: A Safety Watch may also be a Fire Watch providing they meet the qualifications. 3.6 Fire Watch A Fire Watch is the individual assigned responsibility to watch for indications of fire, smoke or other hazardous conditions in an area defined by both the Operating and Performing Authorities. The Fire Watch responsibilities are: a) Ensure that their primary focus is the hot work in progress. b) Initiate or effect emergency response procedures in the case of fire. c) Be familiar with following: i. Work being performed; ii. Configuration of the work area; and iii. Site Method for escalating site fire alarm. Required Fire Watch Training a) Have completed a fire training course using the equipment that will be used for response and the required Fire Watch training. 3.7 Rescue Team The Rescue Team must be of sufficient size, properly equipped and trained to effectively respond to a rescue. The following qualifications must be considered for the Rescue Team: CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 6 OF 30 North America Onshore EH&S Practice Safe Work Permits Number: P103 a) Physically capable and competent to perform rescue procedures. b) In possession of a valid H2S Alive certificate if H2S may be encountered. c) In possession of a valid First Aid / CPR certificate. d) Fit-tested and trained in use of available respiratory equipment. e) Certified in high angle rescue. f) Familiar with the work being performed. g) Familiar with the configuration of the confined space if applicable. h) Competent in Confined Space Entry (see Suncor Confined Space Entry [P301]). 3.8 Contractors For the purposes of Term Agreements, the Contractor is responsible for the following: a) Ensure that staff is knowledgeable in the content and application of the Term Safe Work Agreement. b) Ensure compliance with provincial Occupational Health and Safety legislation; any Suncor Safe Work Practices and Procedures, and other regulations pertaining to the work being done. c) Review the Term Safe Work Agreement with its employees and ensure the appropriate employees sign the Agreement d) Provide the Site Supervisor with a copy of the current Term Safe Work Agreement that includes the signatures of all orientated and qualified employees. 4. 4.1 Requirements Administration 4.1.1 The Safe Work Permit Decision Chart (Figure 1) shall be used to identify the required Safe Work Permits and agreements. Once the required permit and/or agreement is identified, the details for each of these can be found in the following corresponding appendices: Appendix A – Suncor North America Onshore Safe Work Permit form Appendix B – Term Safe Work Agreements Appendix C – Pre-Job Hazard Assessments 4.1.2 Distribution a) All Safe Work Permits have three copies, white copy (Performing Authority, yellow copy (Operating Authority) and a pink copy (optional). b) The Operating Authority will complete the Safe Work Permits and sign off on the bottom. The Performing Authority will address his responsibilities and sign off on the bottom. c) The Performing Authority is given the white copy and is required to fill out the hazard assessment on backside of the white copy upon arriving at task CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 7 OF 30 Figure 1 E N E R G Y Issue Fall Protection Rescue Plan Is Fall Protection Required Issue Cold Safe Work Permit and complete documented Pre-Job Hazard Assessment at location of task Confined Space Area? Restricted, Low, Medium High. Issue Cold Safe Work Permit and complete documented Pre-Job Hazard Assessment at location of task Issue Hot Safe Work Permit and complete documented Pre-Job Hazard Assessment at location of task Confined Space Area? Restricted, Low, Medium High. Issue Hot Safe Work Permit and complete documented Pre-Job Hazard Assessment at location of task Can A term agreement be set up for this task with Contractor. Yes Create Term Agreement Term Agreement (Low Risk) No North America Onshore EH&S Practice Safe Work Permits Number: P103 destination. The Operating Authority retains the yellow copy. d) If the Performing Authority (Foreman) that is signed onto the Safe Work Permit is required to leave location and work continues, the Safe Work Permit is to stay at location and all Performing Authority responsibilities are reviewed with and assigned to a single competent Performing Authority member. e) Upon completion of work both Performing and Operating authorities sign off on the hand back section and both the white and yellow copies are to be filed together following the records management procedures outlined in this Practice. The pink copy is optional and can be given to the Performing Authority for their records. f) Hand back completion of the Safe Work Permit may be phoned in to the Operating Authority due to different circumstances (after hours, geographical location) however the white copy is required to be filed with the yellow copy in the filing system. An agreed upon method of receiving the white copy should be discussed. g) All attachments (Confined Space, Ground Disturbance, Fall Protection Rescue Plan) are to be affixed to the white Safe Work Permit copy and filed according to records management procedures outlined in Section 4.1.2 of this Practice. Term agreements upon completion will be stored electronically with all signatures. It can be printed in the event a new worker is added to the agreement. Paper copy with all signatures can also be stored for ease of Operating Authority accessibility. 4.1.3 Records Management Records of Safe Work Permits/Agreements shall be maintained as follows: Cold/Hot Safe Work Permit 3 months minimum Term Safe Work Agreement 3 months after expiry 1 Confined Space Entry Attachment and applicable Safe Work Permits 2 years minimum Ground Disturbance Attachment2 and applicable Safe Work Permits 1 year minimum Fall Protection Rescue Plan2 and applicable Safe Work Permits 1 year minimum Monitoring and Auditing records 2 years minimum Competency Checks (paper or electronic) 3 years minimum 1 Occupational Safety and Health Law minimum requirements for Confined Space Entry records. These Confined Space Entry Attachments and corresponding Safe Work Permits shall have their own file at each site; separate from the other Safe Work Permit records. 2 Ground Disturbance Attachments and Fall Protection Rescue Plans along with their corresponding Safe Work Permits should have their own file at each site; separate from the other Safe Work Permit records. 4.1.4 Safe Work Permit Evaluation a) Overall compliance to the Safe Work Permit System shall be initiated by completing a Safe Work Permit evaluation (Appendix D). The evaluation will determine whether improvement opportunities are required. b) Safe Work Permit evaluations must be completed after the booklets are finished or more often if there are compliance issues. Appendix D provides a CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 9 OF 30 North America Onshore EH&S Practice Safe Work Permits Number: P103 copy of the evaluation form. c) Only the Performing Authority (White Copy) shall be evaluated since the White Copy has all the appropriate information to be evaluated. d) Site Supervisors and or the Operating Authorities must conduct Safe Work Permit Evaluations by using the following processes: 4.2 i. Select three completed Safe Work Permit (White Copy) and fill out evaluation. ii. Review the all sections of the Safe Work Permit to determine if they are filled out properly or if improvement is needed. iii. Circle NI (needs improvement) Yes/No and provide comment for Yes findings. iv. If a section of the evaluation form does not apply to the SWP being evaluated, indicate it’s NA (not applicable). v. Enter all evaluations into an Incident Learning and Prevention (ILP) entry. vi. Include improvement opportunities identified in the evaluation process as a remedial action as an incident learning and prevention (ILP) entry for follow up. vii. Upon completion of a planned event entry into the ILP system attach copies of the evaluated Safe Work Permit to the evaluation form and forward to EH&S Advisor. Cold and Hot Safe Work Permits 4.2.1 A Cold and Hot Safe Work Permit must be issued by competent Worker who is familiar with the work or situation and under his or her control. 4.2.2 A Safe Work Permit may extend over a shift change and/or an extension time may be given to the Safe Work Permit should the job take longer than originally determined provided it must not exceed 24 hours and for the following circumstances: a) Conditions under which the original Safe Work Permit was issued have not changed; b) Operating Authorities involved in shift change review the Safe Work Permit and agree on conditions of work; and c) Operating Authority arriving on shift must also sign the Safe Work Permit confirming approval. CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 10 OF 30 North America Onshore EH&S Practice Safe Work Permits Number: P103 4.2.3 All Safe Work Permits must specify the physical boundaries of the work. These boundaries will limit the Performing Authority and workers from being exposed to conditions in areas not considered by the Operating Authority. 4.2.4 More than one location may be identified on the Safe Work Permit providing the work being done and the conditions that will be encountered are the same at each location identified on the Agreement. Although multiple locations can be added to a Safe Work Permit, Pre-Job Hazard Assessments (R.I.C.E card) are required to be completed for every location. 4.2.5 “Critical/High Risk” tasks must have work procedures for the performing personnel to follow. The corresponding procedure and number will be identified and/or attached on the Safe Work Permit. 4.3 Safe Work Permit from Completion A copy of Suncor North America Onshore’ standard Safe Work Permit form is found in Appendix A. 4.3.1 Location a) Ensure the location and description of work is adequately defined. b) Identify name of the company performing the work. c) Consider worker orientation requirements. d) Consider vehicle entry requirements. e) Specify permit duration (not to exceed 24 hours). f) Consider Management of Change and ensure all sections are complete. 4.3.2 Equipment Safety/Hazard Check a) Ensure all equipment safety hazard checks have been evaluated and when required initialled by the appropriate party. b) Identify any other equipment or safety/hazard considerations not included on the checklist. 4.3.3 Special Requirements a) Check off all special requirements applicable to the task. b) Identify special protective equipment. c) Provide or review the procedures applicable to the assigned task. d) Identify other environmental or safety considerations not included on the checklist. 4.3.4 Hot Work Considerations a) Ensure all types of hot work are considered and check off when applicable. b) Identify all ignition sources associated with the task 4.3.5 Hot Work Requirements a) Ensure all applicable hot work requirements have been evaluated and when required initialled by the appropriate party. b) Identify safety equipment and precautions necessary to reduce the risk of the hot work. 4.3.6 Confined Space Entry a) Refer to the “Confined Space Entry Decision Tree” or “Definitions” in this Practice when required. b) Ensure the Part I is complete (planning the CSE). CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 11 OF 30 North America Onshore EH&S Practice Safe Work Permits Number: P103 c) Ensure the Part II is complete (pre-entry meeting). 4.3.7 Ground Disturbance a) Complete and attach the “Ground Disturbance Attachment” when the disturbance is greater than 30 cm or any removal of cover over a pipeline. b) Ensure the Part I is complete (planning the ground disturbance). c) Ensure the Part II is complete (pre-job meeting). 4.3.8 Fall Protection a) Ensure a Fall Protection Rescue Plan is completed when required. b) Refer to the “Fall Protection Decision Tree” in the Fall Protection Practice (P314) when required. 4.3.9 Atmospheric Testing a) Trained workers must perform atmospheric testing at specific intervals using appropriate equipment. b) Identify appropriate retest frequency tested against duration of job. c) Ensure workers assigned this task are trained/competent. d) Ensure gas test monitor is calibrated and bump tested. e) Identify all special instructions. f) Record all equipment that is issued for the task. g) Identify all emergency response considerations. 4.3.10 Operating and Performing (signatures required) a) Because the Safe Work Permit is a joint agreement between the Operating and Performing Authorities, both parties must sign the Safe Work Permit, indicating they have jointly taken part in the Permit’s development, and agree with what the permit states and requires. 4.4 Pre-Job Hazard Assessments 4.4.1 A Pre-Job Hazard Assessment recognizes potential hazards at the worksite and allows for the identification of equipment, processes, and materials to control the anticipated hazards. A Pre-Job Hazard Assessment must be completed for all tasks. It must be conducted at worksite upon arrival at work location and assessed for the following conditions: a) b) c) d) A new work process is introduced; A work process or operation changes; Before construction or significant changes or alterations to a worksite; or At appropriate interval to ensure hazards do not develop. 4.4.2 The Pre-Job Hazard Assessment can be found on the back page of the white Safe Work Permit Copy (Appendix C). Stand alone copies (RICE Card) are also available. 4.4.3 Figure 2 provides a decision flow chart to assist the Operating Authority on when and who is required to complete a Pre-Job Hazard Assessment for the task the Operating and Performing Authorities are performing. If the Performing Authority is limited in his/her experience to Suncor’s Pre-Job Hazard Assessment, the Operating Authority must participate in its completion. CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 12 OF 30 Operations Permitting Hazard Assessment Decision Flowchart Does the task (work) involve anyone from the maintenance department (I&E, Mechanic, Labour Crew) or Contract services Worker has documented operator duty competency completed and is deemed capable of operating piece of equipment related to this task YES No No Is the task you are performing your daily rounds YES No No Task is being completed as part of the Suncor Contractor Term agreement. The worker has signed off on agreement and initial pre-job hazard assessment has been completed on workers first visit YES YES Will task impact other work YES Complete Safe Work Permit and documented Pre-Job Hazard Assessment. Assessment must be completed at location of task (permit writer must participate in assessment) No Does the Task you are performing include breaking integrity Add ProAct entry to eliminate or reduce potential risk YES YES No Does the task you are performing include the maintenance/ commissioning of rotating equipment Perform a documented Pre-Job Hazard Assessment at location of task YES No Is there a potential for a exposure to Chemical, Mechanical, Thermal, Biological type hazards. No YES No The task involves the transfer or decanting of fluid No Can Hazard be eliminated or risk reduced by worker intervention YES No Documented Hazard Assessment required Continue to identify hazard on pre-job hazard assessment and initiate effective controls North America Onshore EH&S Practice Safe Work Permits Number: P103 4.4.4 One Safe Work Permit may be used for similar tasks at different locations; however a Pre-Job Hazard Assessment must be completed for each and every task at the different locations. 4.4.5 Workers must only check off the potential hazards at the worksite for the task they are performing. All the controls that are required for the potential hazards that are checked off must be added and used to control the potential hazard. 4.4.6 If additional workers arrive at site after the commencement of the task, work is to stop and new workers review and sign off on the Pre-Job Hazard Assessment. 4.4.7 A Pre-Job Hazard Assessment recognizes potential hazards at the worksite and allows for the identification of equipment, processes, and materials to control the anticipated hazards. A Pre-Job Hazard Assessment must be completed for all tasks. It must be conducted at worksite upon arrival at work location for the following conditions: a) b) c) d) 4.5 A new work process is introduced; A work process or operation changes; Before construction or significant changes or alterations to a worksite; or At appropriate interval to ensure hazards do not develop. Confined Space Entry 4.5.1 The Suncor Confined Space Entry Practice (P301) must be consulted when a Confined Space Attachment is required. 4.5.2 The Confined Space Attachment is a two part attachment to either a Cold/Hot Safe Work Permit. It outlines the additional precautions required for entry into confined spaces that are classified as 3.2 (Medium) Risk and 3.3 (High Risk) in the Suncor Confined Space Entry Practice (P301). a) Part I of the Attachment outlines the requirements for a Pre-Job Planning meeting where all the following must be identified along with the appropriate control measures: i. Hazards; ii. Cleaning needs; and iii. Isolation methods. b) Part II of the Attachment outlines the requirement for a pre-entry meeting that must be conducted with all Workers immediately prior to the entry. At this meeting, all requirements of the Safe Work Permit, the Pre-Planning meeting, as well as those of the Emergency Rescue and Communication Plans must be reviewed. Examples of common confined spaces include: i. ii. iii. iv. v. vi. Vessels Towers Fireboxes Sewers Sewer man-ways Pits CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 14 OF 30 North America Onshore EH&S Practice Safe Work Permits vii. viii. ix. x. 4.6 Number: P103 Sumps Storage tanks Trenches Cellar Ground Disturbance 4.6.1 For any disturbances of the earth exceeding 30 cm in depth or any removal of initial ground cover over a pipeline, a Ground Disturbance Attachment must be completed. Examples of Ground Disturbance include: a) Pile driving b) Auguring c) Excavation d) Rat holing e) Ripping f) Trenching 4.6.2 A Ground Disturbance Attachment is a two-part attachment to either a Cold/Hot Safe Work Permit that outlines the additional precautions required for ground disturbance. a) Part I of the Attachment outlines the requirements for a pre-job planning meeting where all hazards and stakeholders must be identified along with the appropriate control measures. b) Part II of the Attachment outlines the requirement for a pre-job meeting that must be attended by the: i. Operating Authority; ii. Performing Authority; iii. Ground disturbance representative; and iv. All Workers involved in the ground disturbance. 4.6.3 At the pre-job meeting, all requirements of the Safe Work Permit and all items within the pre-planning meeting must be reviewed. 4.6.4 Refer to the Suncor Ground Disturbance Practice (P302) when a Ground Disturbance Attachment is required 4.7 Fall Protection Rescue Plan 4.7.1 A written Fall Protection Rescue Plan is required as part of the risk assessment or task analysis for the job when working at heights in excess of 3 m (10 ft) or where there is the possibility of unusual risk of injury if a worker falls from any height. It is required to ensure the following: a) A fall protection system or equipment has been properly identified and selected for working at those heights; b) Fall hazards from those listed on the Fall Prevention Flow Chart (Page 6 of the Suncor Fall Protection Practice [P314]) have been identified; and c) A Safe Work Permit and the Fall Protection Rescue Plan have been properly completed and are in place. A blank copy of the Fall Protection Plan “Attachment A” can be found in the Suncor CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 15 OF 30 North America Onshore EH&S Practice Safe Work Permits Number: P103 Fall Protection Practice (P314). 4.7.2 Workers must ensure that a Fall Protection Rescue Plan is documented and in place prior to the commencement of work, as per OH&S code requirement. 4.7.3 The Fall Protection Rescue Plan must be reviewed, each item discussed to reach agreement and responsibility established at this meeting. 4.7.4 The Performing Authority or person in charge of the job must conduct a Pre-Job Hazard Assessment meeting with all workers involved. 4.8 Term Safe Work Agreements 4.8.1 Mobile equipment requirements in Term Agreement take into account applicable considerations of Cold/Hot/ Safe Work Permit including a requirement for competent workers. It will also identify best safe work practices that will reduce the likelihood of injury, spills or other losses when it is impractical to issue a Cold/Hot/ Safe Work Permit each time the task is performed. 4.8.2 A Term Safe Work Agreement is a written agreement between Suncor and selected contractors for low complexity, low risk, and longer duration work and is used to identify: a) b) c) d) Potential hazards within the workplace Pre-requisite worker training needs PPE required Emergency information 4.8.3 Duration of Term Safe Work Agreements must not exceed two years but the terms of the agreement must be reviewed annually. 4.8.4 A Term Safe Work Agreement must specify the location and nature of the work to be done in detailed description. Failure to follow the detailed description will void Term agreement and Safe Work Permits will be used to control the contractors work direction. 4.8.5 Specific work procedures that are identified on the Term Agreement must be made available for the Performing Authority’s reference and shall be reviewed with all applicable parties as a Term Agreement requirement 4.8.6 The Site Supervisor may add to or modify the Term Safe Work Agreement requirements; however, relaxing any of the specified requirements must be done in consultation with the area EH&S Advisor. 4.9 Emergency Conditions 4.9.1 Emergency during Safe Work Permit Work a)Any emergency will automatically suspend all Safe Work Permits and attachments. b)The Operating Authority and Performing Authority must evaluate the terms and conditions for the: CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 16 OF 30 North America Onshore EH&S Practice Safe Work Permits Number: P103 i. Continuation of the work; or, ii. Re-issue of a new Safe Work Permit. 4.9.2 Emergency Conditions Requiring Immediate Work a) If there is an emergency at a facility and work must be carried out to deal with the emergency, the work can precede without formal Safe Work Permits. All safe work practices and policies must still be followed and adhered too. b) Emergency Response Plans must be in place which contains procedures to control all types of emergencies. The training of those who may be involved in special duties is identified in these plans. 5. References Suncor Energy Inc. Confined Space Entry Practice (P301) Ground Disturbance Practice (P302) Fall Protection Practice (P314) Provincial Regulations Alberta Occupational Health and Safety Act Sect. 1, 2.1, 2.2, 26. Alberta General Safety Regulations - Code for Electrical Installations at Oil and Gas Facilities (classifications) Sections 14.3, 15, 185, 187, 188, 189, 190, 191 Saskatchewan Occupational Health and Safety Act Sections 3, 4. Saskatchewan General Safety Regulations Part II, Sections 5, 6, 14, 15 and Part XIV, Sections 140, 191 BC Occupational Health and Safety Regulation Sect 3 6. Definitions The following terms are used in this Practice: Classified Area (As per the CSA C22.1 Safety Standard for Electrical Installations, Canadian Electrical Code Part 1, Section 18-004). Class I – Locations are those in which flammable gasses or vapours are or may be present in the air in quantities sufficient to produce explosive or ignitable mixtures. Class II – Locations are those which are hazardous because of the presence of combustible or electrically conductive dusts. Class III – Locations are those which are hazardous because of the presence of easily ignitable fibres of flyings but in which such fibres or flyings are not likely to be in suspension in air in quantities sufficient to produce ignitable. Cold Safe Work Permit A written agreement between the Operating Authority and the Performing Authority requires consideration of all recognized potential hazards and outlines the conditions under which the work CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 17 OF 30 North America Onshore EH&S Practice Safe Work Permits Number: P103 can be conducted with minimum risk. Competent Worker An adequately qualified and suitable trained person with sufficient experience to safely perform work without supervision or with only a minimal degree of supervision. Confined Space An enclosed or partially enclosed space large enough for a person to enter to perform assigned tasks which, is not designed or intended for continuous human occupancy, may become hazardous to a person entering it because of the contents, design, work activity or may have restricted access and egress hindering the provision for first aid, rescue or other emergency services. Confined Space Classification 3.1 – Low Risk: A confined space in which there does not exist and is not likely to exist, a hazardous gas, vapour, dust or fumes; and/or, an oxygen content less than 19.5% or more than 23% by volume. 3.2 – Medium Risk: A confined space in which there has existed or was likely to exist, a hazardous gas, vapour, dust or fumes and/or, an oxygen content less than 19.5% or more than 23% by volume. WHICH HAS BEEN PURGED, VENTILATED AND STEPS TAKEN TO PROVIDE AND MAINTAIN A NON-IDLH Atmosphere. 3.3 – High Risk: A confined space in which there now exists, a hazardous gas, vapour, dust or fumes and/or, oxygen content less than 19.5% or more than 23% by volume. Continuous Monitor A device, series of devices or combination of devices arranged around the perimeter of the work site, that will alarm the workers in advance of any contaminant or hazardous gas reaching the workers location. The arrangement shall be in such a manner that the worker or workers have adequate time to shut down, exit or make secure the work site. Continuous Monitors shall be tested daily and maintained in accordance with manufacturer’s recommendations. The installation and use of Continuous Monitors, does NOT preclude the need for a properly maintained and tested Personal Monitor. Examples are: gas testing the confined space while a worker is performing work in that confined space, piping modification inside the plant with welding required. Contractor A person, partnership or group of persons who, through a contract, an agreement or ownership, directs the activities of one or more employers involved in work at a worksite. Fall Protection Rescue Plan A written Plan is required as part of the risk assessment or task analysis for the job when working at heights in excess of 1.2 m (4 ft) from a permanent work platform or 3 m (10 ft) from a temporary work area. Refer to the Suncor Fall Protection Practice (P314) for more details. Ground Disturbance For any disturbances of the earth exceeding 30 cm in depth or any removal of initial ground cover over a pipeline, a Ground Disturbance Attachment must be completed. Refer to the Suncor CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 18 OF 30 North America Onshore EH&S Practice Safe Work Permits Number: P103 Ground Disturbance Practice (P302) for more details. Ground Disturbance Attachment A two-part attachment to either a Cold/Hot Safe Work Permit that outlines the additional precautions required for ground disturbance. High Risk / Loss Potential Working around equipment where the potential for loss is greater then normal, or where the severity of loss, should it occur, could be serious or fatal. Considerations are: the work history of loss, frequency of work, competency of the workers involved, duration of work, and the potential severity of any loss. Examples of this are: confined space entry, hot work, man basket work, hot tapping, breaking piping integrity, working around equipment with lethal levels of H2S or other toxic substances, decanting of hydrocarbon. Hot Safe Work Permit An agreement that includes all conditions listed on the Cold Safe Work Permit and includes consideration of ignition sources present or introduced in classified areas. These precautions are necessary to minimize the risk of fire or explosion. Ignition Source A hazard with a potential source of ignition such as arching/sparking of electrical equipment components, fired heater burners, internal combustion engines (vehicles), hot work activities (welding, cutting, drilling, grinding, chipping), lightning, pyrophoric (iron sulphide) deposits and electrostatic discharges from moving liquids, non-conductive material (plastic pails), clothing and the human body in any flammable or explosive environment. MSDS (Material Safety Data Sheet) A form that provides data about a particular substance. It is intended to provide workers and emergency personnel with procedures for working and handling the substance in a safe manner and includes information such as physical data (melting, boiling and flash point), toxicity, health effects, first aid, readability, storage, disposal, protective equipment and spill handling procedures. Operating Authority The person having immediate responsibility for the operations affected by the specific Safe Work Permit. The Operating Authority must have direct control of the worksite. Operator Preparation Work required preparing the site, such as isolation of equipment, depressurization, purging venting or anything that requires an operator’s specific knowledge of that facility or task. Preparation may be performed by the Performing Authority if they have specific knowledge of the facility and task. Performing Authority The person supervising or conducting the work specified in the Safe Work Permit. Common titles are crew leader, job foreman, craftsman and worker. PPE (Personal Protective Equipment) Equipment or clothing worn by a worker for protection against health or safety hazards associated with the working conditions at a worksite. Standard PPE is not specified in the Safe Work Permit but will include; approved safety Footwear, Fire Resistant Clothing outer layer, Safety Eyeglasses, Hard Hat, Gloves, Non-fusible thermal insulating layer appropriate for the season or working conditions. Special PPE and training will need to be considered CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 19 OF 30 North America Onshore EH&S Practice Safe Work Permits Number: P103 when controlling hazards like Benzene, H2S, NORMs, Confined Spaces, and Fall Hazards. Respiratory Guideline The purpose is to ensure that where respiratory protection is necessary, the proper type of respirator is correctly employed to achieve full protection of workers' health. Safe Guards A device or system intended to protect personnel, equipment or the environment from harm. Examples of common workplace safeguards include instrumentation control systems, interlocks, pressure relief devices. Safe Work Permit An agreement between the Operating Authority and the Performing Authority and be any of the following Cold, Hot, and Term Safe Work Agreements. Shift A person's scheduled period of work, esp. the portion of the day scheduled as a day's work when a shop, service, office, or industry operates continuously during both the day and night. Term Agreement A Term Safe Work Agreement will best safe work practices that will reduce the likelihood of injury, spills or other losses when it is impractical to issue a Cold/Hot/Verbal Safe Work Agreement each time the task is performed. Worker A person engaged in an occupation. CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 20 OF 30 North America Onshore EH&S Practice Safe Work Permits Number: P103 APPENDIX A – SUNCOR NORTH AMERICA ONSHORE SAFE WORK PERMIT CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 21 OF 30 Safe Work Permit (Natural Gas) 000000 E N E R G Y NI Y N Initials (it is the responsibility of the workers identified below to ensure effective controls are documented and in place for the hazard (s) identified) Oper Oper Craft N/A Craft N/A Initial Initial Chemical Hazard Precaution Control of Hazardous Energy Required NI Y N Arc Flash Consideration Personal Gas Monitor bump tested Other Safeguards bypassed Special Requirements Critical Defeat Required Barricades / signs Safety watch Procedure Available Benzene PPE Spill Containment Critical Task Procedure Number Procedure Required NI Y N Ground Disturbance attachment number If yes, complete and review applicable attachments If yes, complete and review Fall Protection / Rescue Plan If yes, complete and review Ground Disturbance Attachment. Directing or containing Sparks Continuous Gas Monitoring NI Y N Atmospheric Testing Time of day O2 % LEL % H2S PPM Toxic substance being tested Toxic Substance Concentration (PPM or %) Testers Signature NI Y N Emergency Contact NI Y N 14107 (09/03) The DATA Group of Companies (403) 272-7440 S6029143.AI-M North America Onshore EH&S Practice Safe Work Permits Number: P103 APPENDIX B – TERM SAFE WORK AGREEMENT A Term Safe Work Agreement is a written agreement between Suncor Energy Inc. (Suncor) and the selected Contractor. Term agreements are to be used where the task being performed is limited in its complexity, is low risk, and is completed frequently. Term agreement must identify required training for the tasks being performed and potential hazards workers may be exposed to and required to be prepared in the event of an emergency. Term agreements will explain (description) in detail the task to be performed as part of the agreement. Contractors are to follow Suncor’s practice, policies and standards unless specified different in the term agreement. Any work that is being performed outside of the agreed upon task description will require an issued Safe Work Permit. All tasks require a Pre-Job Hazard Assessment to be completed at each location work is being performed. The Pre-Job Hazard Assessment Appendix “A” must be used for all tasks unless the contractor’s Pre-Job Hazard Assessment has been approved by Suncor’s EH&S Department. CONDITIONS 1. The Site Supervisor must ensure all requirements of this Term Safe Work Agreement are met prior to commencement of work. 2. The Site Supervisor must identify who will provide the training and equipment required, and makes appropriate arrangements with the contractor in order to avoid confusion later regarding costs and equipment. 3. Every worker must be properly trained and shall have signed the Term Safe Work Agreement prior to commencement of work. Failing this, an appropriate Safe Work Agreement must be issued. 4. All workers signing this agreement must be knowledgeable of applicable Suncor Energy Practices / Guidelines and Provincial Occupational Health and Safety Regulations pertaining to the work being done. 5. All workers signing this agreement must be knowledgeable in applicable procedures for the task they are performing. All required procedures must accompany, and be reference in the Term Safe Work Agreement. 6. Work being performed must cease if: – Emergency alarms are activated Conditions in area become hazardous Requested to cease work by appropriate authorities 7. It is the responsibility of the Contractor to arrive with equipment in good working order and able to produce inspection and certification records for the equipment being used”. DESCRIPTION OF TASK CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 23 OF 30 North America Onshore EH&S Practice Number: Safe Work Permits P103 Hazard Identification and Controls Identify potential hazard, identify responsible person add controls for identified hazards. These are the hazards Suncor Energy recognizes as potential Hazards. Potential Hazard OPER CONT N/A Controls in Place CHEMICAL EXPOSUREMSDS REQUIRED LEL EXPOSURE H2S EXPOSURE OXYGEN DEFICIENCY WORKING AT HEIGHTS CONTROL OF HAZARDOUS ENERGY ARC FLASH CONSIDERATIONS GROUNDING NECESSARY ENTERING A CLASSIFIED AREA (25’) IMPACT ON OTHER WORK SAFETY SYSTEMS REQUIRE BYPASS CELL PHONE, PAGER RESTRICTIONS POWER TOOL USAGE WORKING ALONE CONSIDERATIONS SPILL CONTAINMENT POSITIVE AIR SHUT OFF SAFETY WATCH REQUIRED HOT WORK REQUIRED CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 24 OF 30 North America Onshore EH&S Practice Number: Safe Work Permits P103 Training Required Identify required training and responsible person or party to deliver. Required Training OPER 3rd party N/A Comments FIRST AID H2S ALIVE TDG WHMIS WORKING AT HEIGHTS FIT TESTED CONFINED SPACE ENTRY GENERAL ORIENTATION (BLUE BOOK) SITE-SPECIFIC ORIENTATION SUNCOR PRACTICES CONTROL OF HAZARDOUS ENERGY FALL PROTECTION BENZENE MMMF / NORM RESPIRATORY PRACTICE APPLICABLE DRIVERS TRAINING PPE Requirements & Emergency Preparedness Identify required PPE and who is responsible to obtain. Required Training OPER CONT N/A Comments STANDARD PPE (HARD HAT, SAFETY GLASSES, GLOVES, BOOTS, FRC, GAS DETECTOR) GAS DETECTOR FUNCTION TEST BREATHING APPARATUS ADDITIONAL PPE (IDENTIFY IN COMMENT SECTION) FALL ARREST EQUIPMENT EMERGENCY SHOWER /EYE WASH COPY OF 3 MINUTE AID RESCUE TEAM REQUIRED / IDENTIFIED CONTROL ROOM PHONE NUMBER RESPONSIBLE FOR A EMERGENCY RESPONSE ALTERNATE EMERGENCY SUNCOR CONTACT IF APPLICABLE CONTRACTOR EMERGENCY NUMBER (OFFICE) Site Supervisor: Contractor: I authorize work to proceed according to I agree that all work will be conducted as per CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 25 OF 30 North America Onshore EH&S Practice Number: Safe Work Permits P103 conditions and limitations outlined on this Term Safe Work Agreement. the conditions and limitations outlined on the Term Safe Work Agreement. SIGNED: SIGNED: PRINT: PRINT: I do understand I have the right and the obligation to refuse unsafe work. I have reviewed and understand the requirements of the Term Safe Work Agreement. I understand at any time I may be asked to produce a copy of this document when asked. PRINT NAME SIGN PRINT NAME SIGN ___________________ / ____________________ ___________________ / ____________________ ___________________ / ____________________ ___________________ / ____________________ ___________________ / ____________________ ___________________ / ____________________ ___________________ / ____________________ ___________________ / ____________________ ___________________ / ____________________ ___________________ / ____________________ ___________________ / ____________________ ___________________ / ____________________ ___________________ / ____________________ ___________________ / ____________________ ___________________ / ____________________ ___________________ / ____________________ Note: Contractor must report any unsafe condition, practice or injury immediately, to the Site CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 26 OF 30 North America Onshore EH&S Practice Safe Work Permits Number: P103 APPENDIX C – PRE-JOB HAZARD ASSESSMENT CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 27 OF 30 R oles & Responsibilities Discussed and Defined: All workers familiar with their job specific roles & responsibilities I dentify All Potential Hazards / Controls: (tick applicable hazards, note details and controls) Pressure Rain / Mud / Snow / Ice Fall Hazards Equipment Hazards Ergonomic Hazards L.E.L. O2 Level H2S Heat Overhead Hazards Fire / Explosion Noise Gas Release Cold NORMS / Benzene Conflicting Activities Task Communication MMMF / Asbestos Chemical Hazards Inexperienced workers identified and provided a mentor Notes: Additional Hazards Identified and Discussed: SAFESTART can cause or contribute to these critical errors... These four states... Eyes not on Task Mind not on Task Fatigue Complacency Rushing Frustruation ...which increase the risk of injury. C ontrols Identified to Reduce or Eliminate Risks: Type of SWP Issued Hot Critical Procedures Required Yes Cold Line-of-Fire Balance/Traction/Grip Term N/A N/A Additional Checks Task Specific PPE Confined Space Entry Job Supervision Operator Preparation Spill Containment Fire Protection Procedures Review Ground Disturbance Purging Isolation Requirements Job Specific Training Bonding & Grounding Equipment Operation Zero Energy / Lock-out E mergency Preparedness Discussed and in Place: Emergency Rescue Plan in place External Emergency Contacts First Aid & Rescue Personnel Roles identified Respiratory Protection Internal Emergency Notification understood Emergency Transportation High Angle Rescue Equipment Wind Indication Muster Area identified Spill Response Comments / Precautions Taken: Additional Controls Required, Reviewed and in Place: Personnel Present: DO C UM E N T T O BE S A VE D F OR 3 M O N T H S ! NAME (Print) SIGNATURE COMPANY Completed cards to be returned to S.E. Supervision I have participated in the Pre-job meeting, have the required industry certification and clearly understand all the above information reviewed. North America Onshore EH&S Practice Safe Work Permits Number: P103 APPENDIX D – EVALUATION OF SAFE WORK PERMITS CURRENT VERSIONS OF APPROVED DOCUMENTS ARE MAINTAINED ONLINE. PRINTED COPIES ARE UNCONTROLLED. PAGE 29 OF 30 Procedure: Supervisor/Operating Authority will: 1. 2. Reviewed SWP #: Cold Hot Evaluation Form for SWP Booklet Worksite Information Equipment / Safety Hazard Special Requirements Hot Work Considerations Hot Work Requirements Atmospheric Testing Signatures/Hand back NI NI NI NI NI NI NI Y Y Y Y Y Y Y N Location of Work N Worker Orientation N Description of Work N Number of Workers N Number of Vehicles N MOC Considered N Time and Date / Extensions Y Y Y Y Y N N Appropriately identified to the task Y Initialed appropriately to the task Y N Confined Space Attachment N Fall Protection Rescue Plan N Ground Disturbance Attachment N N Appropriately identified to the task Y Critical task procedure number information Y N N Appropriately identified to the task Y Other Considerations Y N N Appropriately identified to the task Initialed Y Y Y Y Y Y N Initial Test Y N Subsequent Tests Y N At indicated Intervals N Appropriate to Task N Equipment Issued N Site ERP Information N Authority(s) N Hand Back boxes checked Comments: Reviewer Name: Operating Authority Signature: Reviewed SWP #: Circle: Hot / Cold Equipment / Safety Hazard Special Requirements Hot Work Considerations Hot Work Requirements Atmospheric Testing Signatures/Hand back NI NI NI NI NI NI NI Y E VA L U AT I O N 2 ProAct entry # Worksite Information Y Y Y Y Y Y N Location of Work N Worker Orientation N Description of Work N Number of Workers N Number of Vehicles N MOC Considered N Time and Date / Extensions Y Y Y Y Y N N Appropriately identified to the task Initialed appropriately to the task N Confined Space Attachment N Fall Protection Rescue Plan N Ground Disturbance Attachment Y Y N N Y Appropriately identified to the task Critical task procedure number information Y N N Appropriately identified to the task Other Considerations Y Y N N Appropriately identified to the task Initialed Y Y Y Y Y Y N Initial Test Y N Subsequent Tests Y N At indicated Intervals N Appropriate to Task N Equipment Issued N Site ERP Information N Authority(s) N Hand Back boxes checked Comments: Reviewer Name: Operating Authority Signature: Reviewed SWP #: Circle: Hot / Cold Equipment / Safety Hazard Special Requirements Hot Work Considerations Hot Work Requirements Atmospheric Testing Signatures/Hand back NI NI NI NI NI NI NI Y Y Y Y Y Y E VA L U AT I O N 3 ProAct entry # Worksite Information Y Y Y Y Y Y N Location of Work N Worker Orientation N Description of Work N Number of Workers N Number of Vehicles N MOC Considered N Time and Date / Extensions Y Y Y Y N N Appropriately identified to the task Initialed appropriately to the task N Confined Space Attachment N Fall Protection Rescue Plan N Ground Disturbance Attachment Y N N Appropriately identified to the task Critical task procedure number information Y N N Appropriately identified to the task Other Considerations N Appropriately identified to the task Initialed Y Y Y Y Y Comments: Reviewer Name: Y N Operating Authority Signature: N Initial Test Y N Subsequent Tests Y N At indicated Intervals N Appropriate to Task N Equipment Issued N Site ERP Information N Authority(s) N Hand Back boxes checked Evaluation of Safe Work Permits E VA L U AT I O N 1 ProAct entry # d. Include improvement opportunities identified in the evaluation process as remedial actions in the ProAct entry for follow up. e. Attach copies of the evaluated SWP‛s to the evaluation form and forward to Loss Control Advisor. E N E R G Y Select three completed SWP (White Copies) and fill out evaluation. Review all sections of the SWP to determine if they are filled out properly or if improvement is needed. a. Circle NI (needs improvement) Yes/No and provide comment for Yes findings. b. If a section of the evaluation form does not apply to the SWP being evaluated indicate it is NA (not applicable). c. Enter all evaluations into ProAct - Planned Activity Tracking/Audit/TLM/SWP Audit - Ref. #57368 in ProAct test database.