cjsp template

CONTRACTOR JOB SAFETY PLAN (CJSP)

Contractor Job Safety Plan

Project Name:

Revised: 11/13/2012 Page: 1 of 16 Print Date: 4/20/2023


TABLE OF CONTENTS1.0 General Information..................................................................................................................................................................................................... 32.0 Project Tenets and Principles....................................................................................................................................................................................... 43.0 Job Scope Overview.................................................................................................................................................................................................... 54.0 Risk Assessment and Hazard Identification................................................................................................................................................................. 65.0 Certification, Education and Training........................................................................................................................................................................... 86.0 Hazard Communication................................................................................................................................................................................................ 87.0 Personal Protective Equipment (PPE)......................................................................................................................................................................... 88.0 Environmental.............................................................................................................................................................................................................. 89.0 Managing Subcontractors............................................................................................................................................................................................ 810.0 Audits, Inspections, and Planned Observations........................................................................................................................................................... 811.0 Motor Vehicle Safety.................................................................................................................................................................................................... 812.0 Security Measures....................................................................................................................................................................................................... 813.0 Short Service Employee (SSE) Training and Identification.......................................................................................................................................... 814.0 Communication............................................................................................................................................................................................................ 815.0 Incident, Injury, and Illness Management..................................................................................................................................................................... 8Table of contents can be updated by right clicking on it and choosing update field



1.0 General Information

Developed for: Chevron Pipe Line Company

Date:

Location: 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.

(800) 284-3015

AXIOM Medical Consulting (877) 502-9466



2.0 Project Tenets and Principles

Stop Work Authority:

Every employee and contractor for Chevron is responsible and authorized to stop any work that does not comply with Chevron’s tenets of operations. There will be no repercussions for exercising Stop Work Authority; it is a right and a responsibility.

We Believe All Incidents Are Preventable:

Do it safely or not at all. There is always time to do it right. When in doubt, find out.

Always:

1. Operate within design or environmental limits.2. Operate in a safe and controlled condition.3. Ensure safety devices are in place and functioning.4. Follow safe work practices and procedures.5. Meet or exceed customers’ requirements.6. Maintain integrity of dedicated systems.7. Comply with all applicable rules and regulations.8. Address abnormal conditions.9. Follow written procedures for high risk or unusual situations.10. Involve the right people in decisions that affect procedures and equipment.



3.0 Job Scope OverviewSee instructions for an example of a typical project scope breakdown needed to accomplish an effective hazard analysis.

Job Scope:

Work Activity Task Description (subsequent JSA title) Location Company Major Equipment



4.0 Risk Assessment and Hazard IdentificationSee instructions for an example of a typical risk assessment of a Work Activity/Task Description.



Work Activity: Task Description (JSA Title):

Potential Hazards Mitigations

Gravity

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

Motion

Vehicle/Equipment movement Limited mobility (confined space) Material movement Water/Wind movement Body positioning/Ergonomics Manual Lifting Other:

Mechanical

Rotating equipment Compressed springs Drive belts and conveyors Motors Power/Hand tools Other:

Electrical

Power lines (above/below) Energized equipment Static charges Wiring Batteries Other:

Pressure

Piping Cylinders Vessels/Tanks Hoses Other: Other:

Temperature

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

Chemical

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

Biological

Animals/Insects Bacteria/Viruses Blood Borne Pathogens Contaminated food/water Other: Other:

Radiation

Lighting Welding arc/flash Sunlight X-rays NORM scale Other:

Sound

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

Hazard Controls (Engineering and Administrative)

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

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

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

Safety Controls (Personal Protective Equipment)

Hard hat Safety shoes Safety glasses Face shield Goggles Cotton gloves

Leather gloves Chemical gloves Electrical rated gloves Chemical suit Work vest/Life vest Full body harness

Hearing protection Fire Resistant Clothing Other: Other:

Safety Equipment

Fire Extinguishers Fire retardant tarps Locks and tags Gas detectors

Personal Monitors Tag line Safety cable Safety Barricade

Caution tape Area Monitors Other: Other:

Emergency/Contingency Plans Environmental Equipment

Spill Control Spill Contingency Plans Emergency Evacuation Plans

Incident Reporting Procedure Early Injury Management Other:

Absorbent pads Containment pans Other:

Certification Requirements Licensing Requirements

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

Qualified Gas tester Confined Space Attendant Fire Watch Equipment Operator Other:

Asbestos Abatement Lead Abatement Other:

Safe Work Practices

Safe Work Bypassing Critical Protection Confined Space Diving

Electrical Safe Work Excavation Lifting and Rigging Hot Work

Isolation of Hazardous Energy Simultaneous Operations Working at Heights Other:

PLANNING HAZARD ANALYSIS

Hazard Mitigation





Gravity


Motion


Mechanical


Electrical


Pressure


Temperature


Chemical


Biological


Radiation


Sound










Safety Equipment












Safe Work Practices





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

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 CommunicationChemicals Brought on Site

(By generic use name. List here or append a separate Chemical Inventory List.)

1.

2.

3.

4.

5.

Special PPE or Handling Requirements



7.0 Personal Protective Equipment (PPE)

Hazard Potential SourceKnown Activities that

potential contain

Avenue of Exposure Personal Protective Equipment

[Add relevant PPE to mitigate hazard]Inhalation Skin/Eye Ingestion Other

Ammonia Nitrate

Asbestos

-Valve/Pump Packing

-Pipe Coating-Pipe-Insulation

-Gaskets-Brakes-Building Materials

Operations and Maintenance

Benzene

-Crudes-Products-Solvents-Condensates

-Sampling-Spill Clean up

-Checking Leaks

-Confined Space

-Tank Cleaning

-Tank Inspections

-Waste Handling

Bloodborne Pathogens Contact with bloodRescue or Emergency Activities

Burns-Welding-Hot Equipment-Sunlight

Welding and Maintenance

Carbon Monoxide-Vehicle Emissions-Fire Combustion-Product


Coal Tar Mastic-Pipe Coating Material, Herbicides, and Pesticides

Maintenance

Cold-Weather-Nitrogen Trucks-Refrigeration units

Operations, Maintenance, Line Purging

Drag Reducing Agents

Dust-Weather-Abrasive blasting

-Old buildings

-Vaults


Epoxy Resins-Pipeline Coating-Sealants

Operations and Maintenance, Pipeline Repairs

Falling Object

-Over head hazards-Scaffolding-Construction zones-Cranes


Fiberglass InsulationOperations and Maintenance, Repairs

Grinding DustsRepairs,Grinding on equipment, fabrication


H2S Crude Oil, Oil fields Operations and




potential contain



Maintenance

Heat

-Environmental-Offices-Engines-Steam lines

-Furnaces-Switch Gear-Hot Crude Lines


Hydrocarbon Liquid Crude Oil, Oil fieldsOperations and Maintenance, Pipeline Repairs

Hydrocarbon Vapors Crude Oil, Oil fieldsOperations and Maintenance, Pipeline Repairs

L.P.G.LPG Facilities, pipelines, tankers


Lube OilsEngines, pumps, rotating equipment


Lyme Disease TicksROW clearingJob Walks in high brush

Mercury-Light Crude Oil, Oil fields,-Switches

Pipeline repairs, Operations and Maintenance

Metal Fumes Welding rodsPipeline repairs, Operations and Maintenance

Noise (> 85 dBA)

-Engines-Pumps-Compressors-Hand Tools

Heavy equipment

-Abrasive blasting

-PRVs


N.O.R.M. Scale inside pipelinesPipeline repairs, Operations and Maintenance

Oxygen (lack of)-Confined Spaces-Inert Atmospheres


Paint Dust (lead) Old Buildings and pipelinesPipeline repairs, Operations and Maintenance

PCBs TransformersPipeline repairs, Operations and Maintenance

Pollen VegetationPipeline repairs, Operations and Maintenance

SewageSewage lines, treatment facilities

Operations and Maintenance, pipeline repairs and installs

SharpsEquipment, tools, broken glass, pipeline, etc


Silica/sandAbrasive blasting, mud mixing on drills, excavations


Snake Bites SnakesOperations and Maintenance, pipeline repairs and installs, ROW clearings

Revised: 8/9/2012 Rev. 01 of 16 Print Date: 4/20/2023



potential contain



Solvents-Lab chemicals-Degreasers-Paints


Water-Gulf of Mexico-Rivers, Stream


Revised: 8/9/2012 Rev. 01 of 16 Print Date: 4/20/2023


8.0 EnvironmentalWastes Generated:

Waste Management Procedure:

Environmental Permit Compliance:

Spill Prevention and Containment:

Sensitive Area Protection:

9.0 Managing Subcontractors

10.0 Audits, Inspections, and Planned Observations

11.0 Motor Vehicle Safety

12.0 Security Measures

13.0 Short Service Employee (SSE) Training and Identification

14.0 Communication



15.0 Incident, Injury, and Illness Management

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

Contact (Doctor or professional medical provider’s name) Phone

Emergency Medical Treatment Facility (Local Hospital/Regional Trauma Center) Phone

Emergency Transportation Provider (Attach driving route to this plan) Phone

Medical Management Plan Provider Contact Phone

Local Law Enforcement Phone

Local Fire Department Phone

Alternate Medical Management Plan Provider Phone

AXIOM Medical Consulting 877-502-9466

Incident Response:

HAZWOPER Emergency Plan: (Refer to instructions for requirements. This section should be discussed in detail. Append additional documents as appropriate.)

Incident Reporting and Investigation: (Describe requirements and process)


cjsp template

Documents