CONTRACTOR JOB SAFETY PLAN (CJSP)
Contractor Job Safety Plan
Project Name
© 2012 Chevron Pipe Line Company. All Rights Reserved.
Page: 1 of 16
Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
TABLE OF 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
5.0
Certification, Education and Training............................................................................................................................................................................ 10
6.0
Hazard Communication ................................................................................................................................................................................................ 11
7.0
Personal Protective Equipment (PPE) ......................................................................................................................................................................... 12
8.0
Environmental ............................................................................................................................................................................................................... 15
9.0
Managing Subcontractors ............................................................................................................................................................................................. 15
10.0
Audits, Inspections, and Planned Observations ........................................................................................................................................................... 15
11.0
Motor Vehicle Safety .................................................................................................................................................................................................... 15
12.0
Security Measures ........................................................................................................................................................................................................ 15
13.0
Short Service Employee (SSE) Training and Identification .......................................................................................................................................... 15
14.0
Communication ............................................................................................................................................................................................................. 15
15.0
Incident, Injury, and Illness Management ..................................................................................................................................................................... 16
Table of contents can be updated by right clicking on it and choosing update field
© 2012 Chevron Pipe Line Company. All Rights Reserved.
Page: 2 of 16
Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
1.0
General Information
Developed for:
Chevron Pipe Line Company
Location:
Date:
City:
State:
Job ID:
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)
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
© 2012 Chevron Pipe Line Company. All Rights Reserved.
(800) 284-3015
(877) 502-9466
Page: 3 of 16
Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
2.0
Project Tenets and Principles
Stop Work Authority:
Every employee and contractor for Chevron is responsible and authorized to stop any work that does not comply with Chevron’s tenets of
operations. There will be no repercussions for exercising Stop Work Authority; it is a right and a responsibility.
We Believe All Incidents Are Preventable:



Do it safely or not at all.
There is always time to do it right.
When in doubt, find out.
Always:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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.
© 2012 Chevron Pipe Line Company. All Rights Reserved.
Page: 4 of 16
Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
3.0
Job Scope Overview
See instructions for an example of a typical project scope breakdown needed to accomplish an effective hazard analysis.
Job Scope:
Work Activity
Task Description (subsequent JSA title)
Location
Company
Major Equipment



© 2012 Chevron Pipe Line Company. All Rights Reserved.
Page: 5 of 16
Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
4.0
Risk Assessment and Hazard Identification
See instructions for an example of a typical risk assessment of a Work Activity/Task Description.
© 2012 Chevron Pipe Line Company. All Rights Reserved.
Page: 6 of 16
Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
Work Activity:
Task Description (JSA Title):
Potential Hazards
Gravity
Temperature
Overhead work
Falling object
Excavation
Collapsing roof/equipment
Elevated/Uneven work surface
Open holes
Other:
Motion
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:
Explosive/Flammable vapors
Carcinogen Compound
Toxic Compounds
Corrosive Compound
Reactive Compounds
Pyro-phoric material
Other:
Mechanical
Biological
Rotating equipment
Compressed springs
Drive belts and conveyors
Motors
Power/Hand tools
Other:
Electrical
Animals/Insects
Bacteria/Viruses
Blood Borne Pathogens
Contaminated food/water
Other:
Other:
Radiation
Power lines (above/below)
Energized equipment
Static charges
Wiring
Batteries
Other:
Pressure
Piping
Cylinders
Vessels/Tanks
Hoses
Other:
Other:
Lighting
Welding arc/flash
Sunlight
X-rays
NORM scale
Other:
Sound
Equipment noise
Impact noise
Venting noise
Communication (SimOps)
Communication (Language)
Other:
Mitigations
Hazard Controls (Engineering and Administrative)
Work Permits
PPE Program
Warning signs
Pipeline markers
Spotters/Attendants
Barricades
Housekeeping
Ignition source controls
Gas monitoring
Material Safety Data Sheets
Scaffolding
Parking Plans
Equipment Staging Plans
Essential personnel only
Break Rotation
Temporary Lighting
Isolation of Hazardous Energy
Equipment Inspections
Other:
Other:
Other:
Safety Controls (Personal Protective Equipment)
Hard hat
Safety shoes
Safety glasses
Face shield
Goggles
Cotton gloves
Leather gloves
Chemical gloves
Electrical rated gloves
Chemical suit
Work vest/Life vest
Full body harness
Hearing protection
Fire Resistant Clothing
Other:
Other:
Personal Monitors
Tag line
Safety cable
Safety Barricade
Caution tape
Area Monitors
Other:
Other:
Safety Equipment
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
Absorbent pads
Containment pans
Other:
Licensing Requirements
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




© 2012 Chevron Pipe Line Company. All Rights Reserved.
Page: 7 of 16
Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
Work Activity:
Task Description (JSA Title):
Potential Hazards
Gravity
Temperature
Overhead work
Falling object
Excavation
Collapsing roof/equipment
Elevated/Uneven work surface
Open holes
Other:
Motion
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:
Explosive/Flammable vapors
Carcinogen Compound
Toxic Compounds
Corrosive Compound
Reactive Compounds
Pyro-phoric material
Other:
Mechanical
Biological
Rotating equipment
Compressed springs
Drive belts and conveyors
Motors
Power/Hand tools
Other:
Electrical
Animals/Insects
Bacteria/Viruses
Blood Borne Pathogens
Contaminated food/water
Other:
Other:
Radiation
Power lines (above/below)
Energized equipment
Static charges
Wiring
Batteries
Other:
Pressure
Piping
Cylinders
Vessels/Tanks
Hoses
Other:
Other:
Lighting
Welding arc/flash
Sunlight
X-rays
NORM scale
Other:
Sound
Equipment noise
Impact noise
Venting noise
Communication (SimOps)
Communication (Language)
Other:
Mitigations
Hazard Controls (Engineering and Administrative)
Work Permits
PPE Program
Warning signs
Pipeline markers
Spotters/Attendants
Barricades
Housekeeping
Ignition source controls
Gas monitoring
Material Safety Data Sheets
Scaffolding
Parking Plans
Equipment Staging Plans
Essential personnel only
Break Rotation
Temporary Lighting
Isolation of Hazardous Energy
Equipment Inspections
Other:
Other:
Other:
Safety Controls (Personal Protective Equipment)
Hard hat
Safety shoes
Safety glasses
Face shield
Goggles
Cotton gloves
Leather gloves
Chemical gloves
Electrical rated gloves
Chemical suit
Work vest/Life vest
Full body harness
Hearing protection
Fire Resistant Clothing
Other:
Other:
Personal Monitors
Tag line
Safety cable
Safety Barricade
Caution tape
Area Monitors
Other:
Other:
Safety Equipment
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
Absorbent pads
Containment pans
Other:
Licensing Requirements
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




© 2012 Chevron Pipe Line Company. All Rights Reserved.
Page: 8 of 16
Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
Work Activity:
Task Description (JSA Title):
Potential Hazards
Gravity
Temperature
Overhead work
Falling object
Excavation
Collapsing roof/equipment
Elevated/Uneven work surface
Open holes
Other:
Motion
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:
Explosive/Flammable vapors
Carcinogen Compound
Toxic Compounds
Corrosive Compound
Reactive Compounds
Pyro-phoric material
Other:
Mechanical
Biological
Rotating equipment
Compressed springs
Drive belts and conveyors
Motors
Power/Hand tools
Other:
Electrical
Animals/Insects
Bacteria/Viruses
Blood Borne Pathogens
Contaminated food/water
Other:
Other:
Radiation
Power lines (above/below)
Energized equipment
Static charges
Wiring
Batteries
Other:
Pressure
Piping
Cylinders
Vessels/Tanks
Hoses
Other:
Other:
Lighting
Welding arc/flash
Sunlight
X-rays
NORM scale
Other:
Sound
Equipment noise
Impact noise
Venting noise
Communication (SimOps)
Communication (Language)
Other:
Mitigations
Hazard Controls (Engineering and Administrative)
Work Permits
PPE Program
Warning signs
Pipeline markers
Spotters/Attendants
Barricades
Housekeeping
Ignition source controls
Gas monitoring
Material Safety Data Sheets
Scaffolding
Parking Plans
Equipment Staging Plans
Essential personnel only
Break Rotation
Temporary Lighting
Isolation of Hazardous Energy
Equipment Inspections
Other:
Other:
Other:
Safety Controls (Personal Protective Equipment)
Hard hat
Safety shoes
Safety glasses
Face shield
Goggles
Cotton gloves
Leather gloves
Chemical gloves
Electrical rated gloves
Chemical suit
Work vest/Life vest
Full body harness
Hearing protection
Fire Resistant Clothing
Other:
Other:
Personal Monitors
Tag line
Safety cable
Safety Barricade
Caution tape
Area Monitors
Other:
Other:
Safety Equipment
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
Absorbent pads
Containment pans
Other:
Licensing Requirements
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




© 2012 Chevron Pipe Line Company. All Rights Reserved.
Page: 9 of 16
Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
5.0
Certification, Education and Training
Description

Description

Description
Abrasive Blasting
Hazard Identification and Awareness
Safety Observation/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
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
© 2012 Chevron Pipe Line Company. All Rights Reserved.
Page: 10 of 16

Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
6.0
Hazard 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
© 2012 Chevron Pipe Line Company. All Rights Reserved.
Page: 11 of 16
Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
7.0
Personal Protective Equipment (PPE)
Hazard
Potential Source
Known Activities that
potential contain
Avenue of Exposure
Inhalation
Skin/Eye
Ingestion
Personal Protective Equipment
Other
[Add relevant PPE to mitigate hazard]
Ammonia Nitrate
Asbestos
-Valve/Pump
Packing
-Pipe Coating
-Pipe
-Insulation
Benzene
-Crudes
-Products
-Solvents
-Condensates
Bloodborne Pathogens
Contact with blood
Burns
Carbon Monoxide
Coal Tar Mastic
Cold
-Gaskets
-Brakes
-Building
Materials
-Welding
-Hot Equipment
-Sunlight
-Vehicle Emissions
-Fire Combustion
-Product
-Pipe Coating Material,
Herbicides, and Pesticides
-Weather
-Nitrogen Trucks
-Refrigeration units
Operations and
Maintenance
-Sampling
-Tank
-Spill Clean
Cleaning
up
-Tank
-Checking
Inspections
Leaks
-Waste
-Confined
Handling
Space
Rescue or Emergency
Activities
Welding and Maintenance
Operations and
Maintenance
Maintenance
Operations, Maintenance,
Line Purging
Drag Reducing Agents
Dust
-Weather
-Abrasive
blasting
-Old
buildings
-Vaults
Epoxy Resins
-Pipeline Coating
-Sealants
Operations and
Maintenance, Pipeline
Repairs
Falling Object
-Over head hazards
-Scaffolding
-Construction zones
-Cranes
Operations and
Maintenance, Pipeline
Repairs
Fiberglass
Insulation
Grinding Dusts
Repairs,Grinding on
equipment, fabrication
H2S
Crude Oil, Oil fields
© 2012 Chevron Pipe Line Company. All Rights Reserved.
Operations and
Maintenance
Operations and
Maintenance, Repairs
Operations and
Maintenance, Pipeline
Repairs
Operations and
Maintenance
Page: 12 of 16
Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
Hazard
Heat
Hydrocarbon Liquid
Hydrocarbon Vapors
L.P.G.
Lube Oils
Lyme Disease
Mercury
Metal Fumes
Noise (> 85 dBA)
N.O.R.M.
Oxygen (lack of)
Paint Dust (lead)
PCBs
Pollen
Sewage
Sharps
Silica/sand
Snake Bites
Potential Source
Known Activities that
potential contain
Avenue of Exposure
Inhalation
Skin/Eye
Ingestion
Personal Protective Equipment
Other
[Add relevant PPE to mitigate hazard]
-Environmental
-Offices
-Engines
-Steam lines
-Furnaces
Operations and
-Switch Gear
Maintenance, Pipeline
-Hot Crude
Repairs
Lines
Operations and
Crude Oil, Oil fields
Maintenance, Pipeline
Repairs
Operations and
Crude Oil, Oil fields
Maintenance, Pipeline
Repairs
Operations and
LPG Facilities, pipelines,
Maintenance, Pipeline
tankers
Repairs
Engines, pumps, rotating
Operations and
equipment
Maintenance
ROW clearing
Ticks
Job Walks in high brush
-Light Crude Oil, Oil fields,
Pipeline repairs, Operations
-Switches
and Maintenance
Pipeline repairs, Operations
Welding rods
and Maintenance
-Engines
-Pumps
-Abrasive
-Compressors
Pipeline repairs, Operations
blasting
-Hand Tools
and Maintenance
-PRVs
Heavy
equipment
Pipeline repairs, Operations
Scale inside pipelines
and Maintenance
-Confined Spaces
Pipeline repairs, Operations
-Inert Atmospheres
and Maintenance
Pipeline repairs, Operations
Old Buildings and pipelines
and Maintenance
Pipeline repairs, Operations
Transformers
and Maintenance
Pipeline repairs, Operations
Vegetation
and Maintenance
Operations and
Sewage lines, treatment
Maintenance, pipeline
facilities
repairs and installs
Operations and
Equipment, tools, broken
Maintenance, pipeline
glass, pipeline, etc
repairs and installs
Operations and
Abrasive blasting, mud
Maintenance, pipeline
mixing on drills, excavations
repairs and installs
Operations and
Snakes
Maintenance, pipeline
repairs and installs, ROW
© 2012 Chevron Pipe Line Company. All Rights Reserved.
Page: 13 of 16
Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
Hazard
Potential Source
Solvents
-Lab chemicals
-Degreasers
-Paints
Water
-Gulf of Mexico
-Rivers, Stream
© 2012 Chevron Pipe Line Company. All Rights Reserved.
Known Activities that
potential contain
Avenue of Exposure
Inhalation
Skin/Eye
Ingestion
Personal Protective Equipment
Other
[Add relevant PPE to mitigate hazard]
clearings
Operations and
Maintenance, pipeline
repairs and installs
Operations and
Maintenance, pipeline
repairs and installs
Page: 14 of 16
Reviewed: November 2012. Uncontrolled when printed.
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
© 2012 Chevron Pipe Line Company. All Rights Reserved.
Page: 15 of 16
Reviewed: November 2012. Uncontrolled when printed.
CONTRACTOR JOB SAFETY PLAN (CJSP)
15.0
Incident, Injury, and Illness Management
First Aid/Minor Treatment Facility (Clinic or other treatment center)
Phone
Contact (Doctor or professional medical provider’s name)
Phone
Emergency Medical Treatment Facility (Local Hospital/Regional Trauma Center)
Phone
Emergency Transportation Provider (Attach driving route to this plan)
Phone
Medical Management Plan Provider
Phone
Contact
Local Law Enforcement
Phone
Local Fire Department
Phone
Alternate Medical Management Plan Provider
Phone
AXIOM Medical Consulting
877-502-9466
Incident Response:
HAZWOPER Emergency Plan: (Refer to instructions for requirements. This section should be discussed in detail. Append additional documents as
appropriate.)
Incident Reporting and Investigation: (Describe requirements and process)
© 2012 Chevron Pipe Line Company. All Rights Reserved.
Page: 16 of 16
Reviewed: November 2012. Uncontrolled when printed.