Audit Question Bank Template 1.01: General Information Question Number Question Text C1:1 Contractor Name: C1:2 Division (if applicable): C1:3 Address: C1:4 City: C1:5 State: C1:6 Zip/Postal Code: C1:7 Represented by: C1:8 ISN Number: Question Choices 2.02: Leadership and Accountability Question Number Question Text C2:1 What is the HES vision of your company? C2:2 What are your HES objectives for this year? What are the most significant challenges in achieving these objectives? C2:3 Describe the HES culture and performance you need in your organization? C2:4 What is the key set of leading and lagging indicators that you will measure and verify to drive HES performance? How frequently are your leadership monitoring these leading and lagging indicators? C2:5 What are you learning from monitoring the metrics? C2:6 How much time do you spend visiting your operational areas and leading by example? What specific HES behaviors and results are you are looking for from others when you are there? C2:7 What is the contractor's overall rating for Leadership and Accountability? Question Choices 1) 5 2) 1 3: HES Management System Question Number Question Text Question Choices C3:1 Does company have staff personnel dedicated to HES Management? Title? Full-time? Part-time? (MSQ US:3:32) C3:2 Is HES Management their primary responsibility? Identify responsibilities other than HES management (if applicable). (US MSQ:3:18) C3:3 What is the experience level of the designated HES representative participating in this audit? C3:4 Does the company have an HES Policy Statement endorsed by upper management? (MSQ US:3:1) 1) No 2) Yes C3:5 Does the company establish documented annual HES improvement plan? (MSQ US:12:1) 1) No 2) Yes C3:6 Does the company have a process in place to measure HES improvement plan implementation progress? (MSQ US:13:3) 1) No 2) Yes C3:7 Do "Management Performance Reviews" include HES Performance criteria and/or requirements? (MSQ US:3:12) 1) No 2) Yes C3:8 Are all employees able to read or understand posted warning signs while working at a location under Chevron operational boundaries? 1) No 2) Yes C3:9 Does your company assign a translator for every non-English speaker conducting work on Chevron operational boundaries? 1) No 2) Yes C3:10 Do you notify the Chevron work owner prior to non-English speaking workers 1) No being assigned to Chevron operational boundaries? 2) Yes C3:11 Does company have a documented operations HES manual applicable to their work activities that includes assignment of responsibilities for: Management, Supervisors, Employees? C3:12 Is manual consistent with current regulatory requirements and applicable industry standards? Last Updated? C3:13 Is the HES manual communicated to all management personnel? All Employees? How? HES Manual Orientation, Employee Orientation, Management Meetings, HES Meetings, Ongoing Training? By whom? C3:14 Do all employees have access to your HES policies and procedures? How? C3:15 What is the contractor's overall rating for HES Management? 1) 5 2) 1 4.04: Employee Training Question Number Question Text Question Choices C4:1 Is there a documented Company Specific Basic Safety Orientation for employees? (MSQ:US:7:49:2) 1) No 2) Yes C4:2 Do all employees going offshore receive Safegulf, Rigpass or equivalent? 1) No 2) Yes C4:3 Is a process in place to identify applicable training needs? 1) No 2) Yes C4:4 What additional training do supervisors and management personnel attend? What type? Regulatory Compliance, Same as Employees, DOT Reasonable Cause Training, HES Leadership, Well Control, None? C4:5 How is employee training effectiveness evaluated? Written test, Oral test, Job monitoring, Performance test? C4:6 What are some job specific location/ job hazards that require specific training? C4:7 Is training conducted/documented for specific Location / Job Hazards? 1) No 2) Yes C4:8 Are proper manual lifting techniques covered through safe work procedures? 1) No 2) Yes C4:9 Is training conducted on manual lifting techniques? Is training documented on manual lifting techniques? 2) Yes C4:10 Is there a recordkeeping system? Files, Safety Training Matrix, Training Database? How does the recordkeeping system identify if someone misses or needs refresher training? C4:11 Verifying training records: Is regulatory required training current? If not, what percent current? (Estimated) C4:12 How do you ensure that workers with the appropriate vocational skills and knowledge are designated to perform assigned tasks? C4:13 What is the contractor's overall rating for Employee Training? 1) No 1) 5 2) 1 5.05: Personal Protective Equipment Question Number Question Text Question Choices C5:1 Does company have a written PPE Program? (MSQ US:5:7:25) 1) No 2) Yes C5:2 Does the PPE program reference applicable ANSI / ASTM Standards? (MSQ US:5:7:3, US:5:7:11) 1) No 2) Yes C5:3 Does company conduct / update a PPE Hazard Assessment annually and/or with changes in exposures? (MSQ US:5:7:25) 1) No 2) Yes C5:4 Does company maintain a current Certification of PPE Hazard Assessment? 1) No 2) Yes C5:5 Does PPE Hazard Assessment identify the appropriate filter lenses to be used for work activity exposures? 1) No 2) Yes C5:6 Does program include criteria for PPE inspections? 1) No 2) Yes C5:7 Does your program include guidelines for the use, inspection and maintenance for Fire Retardant Clothing? 1) No 2) Yes C5:8 Is PPE training current and documented? 1) No 2) Yes C5:9 Does Training include: When PPE is necessary? What PPE is necessary? How to properly don/doff, adjsut and wear? Limitation of PPE? Proper care/maintence and useful life of PPE? 1) No 2) Yes C5:10 Describe how the company has employees demonstrate an understanding of the training, and the ability to use PPE properly. C5:11 Does the company retrain when they believe that an employee who has already been trained does not have the understanding and skill to effectively use the PPE? 1) No 2) Yes C5:12 Does the company provide retraining to employees when changes in the workplace render previous training obsolete, changes in the types of PPE to be used render previous training obsolete, or inadequacies in an affected employee's knowledge or use of assigned PPE indicate that the employee has not retained the requisite understanding or skill? 1) No 2) Yes C5:13 Does the company verify that each affected employee has received and understood the required training through a written certification? 1) No 2) Yes C5:14 What is the contractor's overall rating for Personal Protective Equipment (PPE)? 1) 5 2) 1 6.06: Fitness for Duty Question Number Question Text Question Choices C6:1 Does your written HES Plan include a documented fitness for duty (skills, knowledge and physical/medical suitability for job) process? 1) No 2) Yes C6:2 Can the validation of the essential physical requirements be verified? 1) No 2) Yes C6:3 Does your FFD Process require a medical exam and physical evaluation post-hire/pre-placement? 1) No 2) Yes C6:4 Does your FFD Process require a medical exam and physical evaluation for a transfer? 1) No 2) Yes C6:5 Does your FFD Process require a medical exam and physical evaluation post-injury before returning the employee to work? 1) No 2) Yes C6:6 Does your FFD Process include provisions for Supervisors to work with the HR Group when they have a concern about an employee’s fitness for duty? 1) No 2) Yes C6:7 Does your FFD Process demonstrate your evaluation of the employee’s required skills? 1) No 2) Yes C6:8 Does your FFD Process reference (link to) your Drug and Alcohol Program? 1) No 2) Yes C6:9 Can this all be verified through documentation? 1) No 2) Yes C6:10 What is the contractor's overall rating for Fitness for Duty? 1) 5 2) 1 7.07: Hearing Conservation Question Number Question Text Question Choices C7:1 Has a Noise Survey been conducted of common work activities? 1) No 2) Yes C7:2 Is a Hearing Conservation Program Developed? (MSQ US:7:33:1) 1) No 2) Yes C7:3 Is Hearing Conservation training provided initially, annually and is it documented? (MSQ US:7:33:3) 1) No 2) Yes C7:4 Does the company provide hearing protection for workers? (MSQ US:5:7:13) 1) No 2) Yes C7:5 What is the contractor's overall rating for Hearing Conservation? 1) 5 2) 1 8.08: Fall Protection Question Number Question Text Question Choices C8:1 Does the company have a written Fall Protection program? (MSQ US:6:19) 1) No 2) Yes C8:2 Does your program include When Fall Protection / Arrest Equipment is Required: When working at elevations of six feet or more, or over the unprotected edge of a work platform, deck, walkway or floor? 1) No 2) Yes C8:3 "Does your program include When Fall Protection / Arrest Equipment is Required: When working in an area where it is possible to fall more than four feet through deck and floor openings? " 1) No 2) Yes C8:4 Does your program include When Fall Protection / Arrest Equipment is Required: When working on a fixed or portable ladder and the worker is above six feet? 1) No 2) Yes C8:5 Does your program include When Fall Protection / Arrest Equipment is Required: When working on the boat landing or Plus 10 level when not surrounded by handrails? 1) No 2) Yes C8:6 Does your program include When Fall Protection / Arrest Equipment is Required: When working on scaffolding that is not green-tagged? 1) No 2) Yes C8:7 Does your program state that on Personal Fall Arrest equipment, all D-Rings must be a minimum of 2 1/4 inch inside diameter and/or cannot apply pressure to the snap hook gate? 1) No 2) Yes C8:8 Verify equipment meets this requirement. 1) No 2) Yes C8:9 Does your program state that Pelican hooks are acceptable as a positioning device, but may not be used as a primary means of connection? 1) No 2) Yes C8:10 Is 2-Day “Competent Person” level Fall Protection training conducted? Does at least one person, per crew onsite have this training? 1) No 2) Yes C8:11 Is “User” Fall Protection training conducted and documented to include hands-on use and demonstration of competency by the students? 1) No 2) Yes C8:12 Does your company develop documented Fall Rescue Plans? 1) No 2) Yes C8:13 Are employees trained on Fall Protection rescue equipment? 1) No 2) Yes C8:14 Is Fall Protection training provided initially and with changes in exposures and is it documented? 1) No 2) Yes C8:15 Does the program include Fall Protection equipment inspection guidelines? 1) No 2) Yes C8:16 Verify equipment inspection records. 1) No 2) Yes C8:17 What is the contractor's overall rating for Fall Protection? 1) 5 2) 1 9.09: Respiratory Protection Question Number Question Text Question Choices C9:1 Do employees use or could they be expected to use respirators during the course of their job? (MSQ US:5:6:9) 1) No 2) Yes C9:2 Does the company have a written Respiratory Protection Program? (MSQ US:6:38) 1) No 2) Yes C9:3 Are medical evaluations conducted? (MSQ US:5:6:10) 1) No 2) Yes C9:4 Is fit testing conducted? (MSQ US:5:6:11) 1) No 2) Yes C9:5 Does program include criteria for determining “End of Service Life” for respirator cartridges? 1) No 2) Yes C9:6 Are Respiratory Protection equipment inspections conducted? Are they documented? 1) No 2) Yes C9:7 Is initial and annual Respiratory Protection refresher training conducted and documented? 1) No 2) Yes C9:8 What is the contractor's overall rating for Respiratory Protection? 1) 5 2) 1 10.10: Access to Medical Records Question Number Question Text Question Choices C10:1 Does the company have a written Access to Medical Records program? (MSQ US:7:2:1) 1) No 2) Yes C10:2 Is initial and annual notification of Right of Access to Medical Records conducted and documented? (MSQ US:7:2:2) 1) No 2) Yes C10:3 What is the contractor's overall rating for Access to Medical Records? 1) No 2) Yes 11.11: Hazard Communication Question Number Question Text Question Choices C11:1 Does company have a written Hazard Communication program? (MSQ US:6:26) 1) No 2) Yes C11:2 Does the program identify a HAZCOM program administrator? 1) No 2) Yes C11:3 Are MSDS’s available on site for employees? (MSQ US:5:1:2) 1) No 2) Yes C11:4 Is a current chemical inventory list developed and maintained? 1) No 2) Yes C11:5 Is documented Hazard Communication training conducted initially and with changes in exposure? (MSQ US:7:25:1) 1) No C11:6 What is the contractor's overall rating for Hazard Communication? 1) 5 2) Yes 2) 1 12.12: HAZWOPER Question Number Question Text Question Choices C12:1 Does the company have a written HAZWOPER program? (MSQ US:6:27; US:7:27:2; US:7:28:2; US:7:29:2; US:7:30:2; US:7:31:2; US:7:32:2) 1) No 2) Yes C12:2 Are Emergency Spill / Release Response Contacts identified in program? 1) No 2) Yes C12:3 Is HAZWOPER Training conducted and documented? (MSQ US:7:26:2; US:7:27:3; US:7:28:3; US:7:29:3; US:7:30:3; US:7:31:3; US:7:32:4) 1) No 2) Yes C12:4 What Level are they trained? C12:5 What is the contractor's overall rating for HAZWOPER? 1) 5 2) 1 13.13: HAZMAT Question Number Question Text Question Choices C13:1 Is company governed by HM 126 F HAZMAT employee regulation? 1) No 2) Yes C13:2 If no, explain. C13:3 Does company have a written program to address the use, handling, storage and transportation of Hazardous Materials? (MSQ US:7:35:1) 1) No 2) Yes C13:4 Does program include the identification of HAZMAT trained personnel? 1) No 2) Yes C13:5 Is HAZMAT training conducted and documented? (MSQ US:7:35:2) 1) No 2) Yes C13:6 What is the contractor's overall rating for HAZMAT? 1) 5 2) 1 14.14: Industrial Hygiene Question Number Question Text Question Choices C14:1 Does the company perform IH monitoring on employees? (MSQ US:5:6:3) 1) No C14:2 For which substances? 2) Yes C14:3 Does the company conduct fitness for work exams for audiograms, preemployment, re-employment, respiratory, and visual? 1) No C14:4 What is the contractor's overall rating for Industrial Hygiene? 1) 5 2) Yes 2) 1 15.15: Lockout/Tagout Question Number Question Text Question Choices C15:1 Is there a written Lockout/Tagout program? (MSQ US:6:31) 1) No 2) Yes C15:2 Does the program address the coordination of LOTO with clients on host facilities? 1) No 2) Yes C15:3 Is each authorized employee protected by an individual lock affixed to either energy isolation point or the group lockbox? 1) No 2) Yes C15:4 Are LOTO inspections conducted and documented at least annually to verify compliance of the LOTO program? Verify documents. 1) No 2) Yes C15:5 If applicable, are written equipment Lockout/Tagout procedures developed? How? C15:6 Is Lockout/Tagout training conducted and documented? (MSQ US:7:42:2) 1) No C15:7 What is the contractor's overall rating for Lockout/Tagout? 1) 5 2) Yes 2) 1 16.16: Confined Space Question Number Question Text Question Choices C16:1 Does the company perform any work activities involving entry into permitrequired confined spaces? 1) No 2) Yes C16:2 If no, Do you have a Confined Space Awareness Program? Is Confined Space awareness training conducted and documented? 1) No 2) Yes C16:3 If Yes, Does the company have a written Confined Space program? (MSQ US:6:10) 1) No 2) Yes C16:4 Does your program address coordination of entry and rescue operations with host facilities or within Chevron operational boundaries? 1) No 2) Yes C16:5 Do you allow attendants to monitor more than one confined space at a time? 1) No 2) Yes C16:6 Is the entry Supervisor trained on the Chevron Confined Space program including the Permitting process? Is it documented? 1) No 2) Yes C16:7 Does the entry Supervisor verify the Chevron Responsibilities are done prior to entry? 1) No 2) Yes C16:8 Does program include an Entry Permit process and verification of compliance? 1) No 2) Yes C16:9 Do you use your Permit process or Chevron's at the location? 1) No 2) Yes C16:10 If Chevron's Permit process is used, does program identify the Chevron permit to be used? 1) No 2) Yes C16:11 Are employees trained on the Permit process that you use? Is it documented? 1) No 2) Yes C16:12 Do you retain copies of the Permits for at least one year? 1) No 2) Yes C16:13 Do your employees use air monitoring equipment? 1) No 2) Yes C16:14 Is air monitoring equipment training conducted and documented? 1) No 2) Yes C16:15 Are calibration checks conducted at least daily and/or prior to use and documented? 1) No 2) Yes C16:16 Does the training for Entrant include: The hazards that may be faced during entry? 1) No 2) Yes C16:17 Does the training for Entrant include: Information on the mode, signs or symptoms, and consequences of the exposure? 1) No 2) Yes C16:18 Does the training for Entrant include: Proper use of safety equipment? 1) No 2) Yes C16:19 Does the training for Entrant include: Communicating with the attendant as necessary to enable the attendant to monitor entrant status and to enable the attendant to alert entrants of the need to evacuate the space? 1) No 2) Yes C16:20 Does the training for Entrant include: Alerting the attendant whenever the entrant recognizes any warning sign or symptom of exposure to a dangerous situation or the entrant detects a prohibited condition? 1) No 2) Yes C16:21 Does the training for Attendant include: The hazards that may be faced during entry, including information on the mode, signs or symptoms, and consequences of the exposure? 1) No 2) Yes C16:22 Does the training for Attendant include: Awareness of possible behavioral effects of hazard exposure in authorized entrants? 1) No 2) Yes C16:23 Does the training for Attendant include: Continuously maintaining an accurate count of authorized entrants in the permit space? 1) No 2) Yes C16:24 Does the training for Attendant include: Remaining outside the permit space during entry operations until relieved by another attendant? 1) No 2) Yes C16:25 Does the training for Attendant include: Communicating with authorized entrants as necessary to monitor entrant status and to alert entrants of the need to evacuate the space? 1) No 2) Yes C16:26 prohibited condition, if the attendant detects the behavioral effects of hazard exposure in an authorized entrant, if the attendant detects a situation outside the space that could endanger the authorized entrants, or if the attendant cannot effectively and safely perform all the duties? 1) No 2) Yes C16:27 Does the training for Attendant include: Summoning rescue and other emergency services as soon as the attendant determines that authorized entrants may need assistance to escape from permit space hazards? 1) No 2) Yes C16:28 Does the training for Attendant include: Taking the following actions when Unauthorized persons approach or enter a permit space while entry is underway; warn the unauthorized persons that they must stay away from the permit space; advise the unauthorized persons that they must exit immediately if they have entered the permit space; and inform the authorized entrants and the entry supervisor if unauthorized persons have entered the 1) No permit space? 2) Yes C16:29 Does the training for Attendant include: Performing non entry rescues as specified by the company's rescue procedure? 1) No 2) Yes C16:30 Does the training for Attendant include: Performing no duties that might interfere with the attendant's primary duty to monitor and protect the authorized entrants? 1) No 2) Yes C16:31 Does the training for Entry Supervisor include: Hazards that may be faced during entry, including information on the mode, signs or symptoms, and consequences of the exposure? 1) No 2) Yes C16:32 Does the training for Entry Supervisor include: Verifying that all tests specified by the permit have been conducted and that all procedures and equipment specified by the permit are in place before endorsing the permit and allowing entry to begin? 1) No 2) Yes C16:33 Does the training for Entry Supervisor include: Terminating the entry and cancels the permit? 1) No 2) Yes C16:34 Does the training for Entry Supervisor include: Verifying that rescue services are available and that the means for summoning them are operable? 1) No 2) Yes C16:35 Does the training for Entry Supervisor include: Removing unauthorized individuals who enter or who attempt to enter the permit space during entry operations? 1) No 2) Yes C16:36 Does the training for Entry Supervisor include: Determining, whenever responsibility for a permit space entry operation is transferred, that entry operations remain consistent with terms of the entry permit and that acceptable entry conditions are maintained? 1) No 2) Yes C16:37 Does the company ensure that each member of the rescue team is provided with, and is trained to use properly, the personal protective equipment and rescue equipment necessary for making rescues from permit spaces? 1) No 2) Yes C16:38 Does each member of the rescue team receive the training required of authorized entrants? 1) No 2) Yes C16:39 Does each member of the rescue team practice making permit space rescues at least once every 12 months, by means of simulated rescue operations from representative permit spaces? Verify documentation. 1) No 2) Yes C16:41 Is at least one member of the rescue team holding current certification in first aid and in CPR shall be available at all times during entry? 1) No 2) Yes C16:42 What is the contractor's overall rating for Confined Space? 1) 5 2) 1 17.17: Hot Work Question Number Question Text Question Choices C17:1 Does company perform "Hot Work” activities on customer locations? Welding, Burning, Grinding, Use personal electronic devices: Cameras, radios, flashlights, other... 1) No 2) Yes C17:2 Does the company have a written program addressing Hot Work Precautions and Permit Systems? (MSQ US:6:49) 1) No 2) Yes C17:3 Does company follow Chevron's Hot Work Permit Process? 1) No 2) Yes C17:4 Have employees been trained in Chevron's Hot Work Permit Process? Is it documented? 1) No 2) Yes C17:5 Does the program include Fire Watch criteria and training? 1) No 2) Yes C17:6 Does your program address Fire Retardant Tarps to include: Be red in color? 1) No 2) Yes C17:7 Does your program address Fire Retardant Tarps to include: Have fireretardant label or tag? 1) No 2) Yes C17:8 Does your program address Fire Retardant Tarps to include: Be siliconecoated or silicone-impregnated 1) No 2) Yes C17:9 Does your program address Fire Retardant Tarps to include: Have grommets 1) No 2) Yes C17:10 Are inspections of Welding and Burning equipment conducted and documented? 1) No 2) Yes C17:11 Has Welding and Burning training been conducted and documented? (MSQ US:7:36:2) 1) No 2) Yes C17:12 What is the contractor's overall rating for Hot Work? 1) 5 2) 1 18.18: Compressed Gas Cylinders Question Number Question Text Question Choices C18:1 store or transport Compressed Gas Cylinders? 1) No 2) Yes C18:2 Are guidelines developed addressing the safe use, storage and inspection of Compressed Gas Cylinders? 1) No 2) Yes C18:3 Are inspections conducted and documented of cylinders, storage area and surrounding work areas? 1) No 2) Yes C18:4 Is training conducted and documented? 1) No 2) Yes C18:5 What is the contractor's overall rating for Compressed Gas Cylinders? 1) 5 2) 1 19.19: Forklift Operations Question Number Question Text Question Choices C19:1 Do employees operate forklifts on company or client locations? 1) No 2) Yes C19:2 Are forklift operators trained / certified?(MSQ US:7:23:1) 1) No 2) Yes C19:3 Is Forklift Operator training current and documented? 1) No 2) Yes C19:4 Are Pre-Operational Forklift inspections conducted? 1) No 2) Yes C19:5 Does company retain Pre-Operational Forklift inspections? 1) No 2) Yes C19:6 What is the contractor's overall rating for Forklift Operations? 1) 5 2) 1 20.20: Crane Operations Question Number Question Text Question Choices C20:1 Does the company own or operate any cranes in Chevron operational boundaries? 1) No 2) Yes C20:2 Does the company have a written Crane Operations / Lifting program? (MSQ 1) No US:7:14:1) 2) Yes C20:3 Does the company perform a medical evaluation of Qualified Operators? (MSQ US:5:6:7) 1) No 2) Yes C20:4 Does the company's program require that Qualified Operators meet the following physical requirements: Vision of at least 20/30 Snellen in one eye and 20/50 in the other with or without glasses, and have depth perception? 1) No 2) Yes C20:5 Does the company's program require that Qualified Operators meet the following physical requirements: Be able to distinguish red, yellow, & green, if color differentiation is required for crane operations? 1) 5 C20:6 Does the company's program require that Qualified Operators meet the following physical requirements: Hearing, with or without a hearing aid, adequate for the specific operation (if hearing is required for your operation)? 1) No 2) Yes C20:7 Does the company's program require that Qualified Operators meet the following physical requirements: No history of a disabling medical condition which may be sufficient reason for disqualification? 1) No 2) Yes C20:8 How often does the company require medical re-evaluation of Qualified Operators? 1) No 2) Yes C20:9 Does Crane Operator training include the following API RP 2D standard requirements: all major crane components? 1) No 2) Yes C20:10 Does Crane Operator training include the following API RP 2D standard requirements: operational and maintenance procedures appropriate for the type and capacity of the crane to be operated? 1) No 2) Yes C20:11 Does Crane Operator training include the following API RP 2D standard requirements: all major issues and guidelines addressed in API RP 2C & 2D? 1) No 2) Yes C20:12 Does Crane Operator training include the following API RP 2D standard requirements: a written examination ? 1) No 2) Yes C20:13 Does Crane Operator training include the following API RP 2D standard requirements: coverage of lubricating points? 1) No 2) Yes C20:14 Does Crane Operator training include the following API RP 2D standard requirements: adjustments? 1) No 2) Yes C20:15 Does Crane Operator training include the following API RP 2D standard requirements: principles of crane operation? 1) No 2) Yes C20:16 Does Crane Operator training include the following API RP 2D standard requirements: boom operating procedures? 1) No 2) Yes C20:17 Does Crane Operator training include the following API RP 2D standard requirements: safety devices and anti-two blocking systems? 1) No 2) Yes 2) 1 C20:18 Does Crane Operator training include the following API RP 2D standard requirements: the proper use and understanding of crane lifting capacity and reeving charts, boom and indicator charts, and hand signals charts? 1) No 2) Yes C20:19 Does Crane Operator training include the following API RP 2D standard requirements: a hands-on workshop on the proper inspection, use and maintenance of slings, shackles, hooks, nylon slings, and etc.? 1) No 2) Yes C20:20 Does Crane Operator training include the following API RP 2D standard requirements: a hands-on demonstration of proficiency in the safe operation of the particular model of crane to be operated? 1) No 2) Yes C20:21 Have you defined your Contract Crane Operator Classifications in your program? 1) No 2) Yes C20:22 Do you know the client's expectations for crane operators who perform personnel transfers? 1) No 2) Yes C20:23 Does the program require crane operators to stop crane operations under these conditions: all dynamic crane operations shall stop if sea conditions meet or exceed 12 feet? 1) No 2) Yes C20:24 Does the program require crane operators to stop crane operations under these conditions: all crane operations, static and dynamic, shall stop if winds meet or exceed 35 mph? 1) No 2) Yes C20:25 Does the program require crane operators to stop crane operations under these conditions: all crane operations shall stop if lightning is in the vicinity? 1) No 2) Yes C20:26 Does the program prohibit the use of modified field equipment? 1) No 2) Yes C20:27 Does the program include guidelines for crane repairs and alterations? 1) No 2) Yes C20:28 Are cranes that are taken out of service for repair of critical components, approved/ authorized to return to service by a qualified crane inspector? 1) No 2) Yes C20:29 Does your program include guidelines for communication in reference to hand signals, radio communication and JSA's? 1) No 2) Yes C20:30 Does your program include Crane Operator Responsibilities in accordance with Chevron's Lifting and Rigging procedure to include Pre-Operation, During Operation, and Post-Operation? 1) No 2) Yes C20:31 Are daily pre-use, quarterly and annual inspections conducted and documented? Verify records. C20:32 What is the contractor's overall rating for Crane Operations? 1) 5 2) 1 21.21: Rigging Operations Question Number Question Text Question Choices C21:1 Do employees use or attach rigging to loads / materials in Chevron Operational boundaries? 1) No 2) Yes C21:2 Does the company have a written Rigging Operations program? (MSQ US:7:56:1) 1) No 2) Yes C21:3 Does program include sling storage? 1) No 2) Yes C21:4 Does program include sling certification? 1) No 2) Yes C21:5 Does the program include maintenance and inspection of the following: Shackles? Eyebolts? Hooks? Pad eyes? 1) No 2) Yes C21:6 Does program include tag lines to be used on all (offboard) lifts? 1) No 2) Yes C21:7 Does program require tag line to be made of 1/4 inch rope, extend at least 15 to 20 feet from load, attached to load, and free of any knots, splices or loops? 1) No 2) Yes C21:8 Does program include additional risks to be aware of when using tag lines? 1) No 2) Yes C21:9 Does your program include guidelines for communication in reference to hand signals, radio communication and JSA's? 1) No 2) Yes C21:10 Does your program include Rigger Responsibilities in accordance with Chevron's Lifting and Rigging procedure to include Pre-Operation, During Operation, and Post-Operation? 1) No 2) Yes C21:11 Are Riggers trained / certified per API RP 2D criteria? 1) No 2) Yes C21:12 Does program include visual pre-use and documented annual inspections for rigging equipment? 1) No 2) Yes C21:13 Does program include visual pre-use and documented annual inspections for rigging equipment? (MSQ US:7:56:2) 1) No 2) Yes C21:14 What is the contractor's overall rating for Rigging Operations? 1) 5 2) 1 22.22: Motor Vehicles Question Number Question Text Question Choices C22:1 Does the company have written Motor Vehicle operation rules? 1) No 2) Yes C22:2 Is driver training or testing conducted and documented? 1) No 2) Yes C22:3 Do vehicle operation rules address no use of cell phone while operating motor vehicles and other heavy equipment? 1) No 2) Yes C22:4 What is the contractor's overall rating for Motor Vehicles? 1) 5 2) 1 23.23: Bloodborne Pathogens Question Number Question Text Question Choices C23:1 Does company have a written Exposure Control Plan? (MSQ US:6:9) 1) No 2) Yes C23:2 Does the plan identify potentially exposed employees by job title? 1) No 2) Yes C23:3 Does the plan address potentially infectious materials other than blood? 1) No 2) Yes C23:4 Does the plan address exposure determination without regard of PPE? 1) No 2) Yes C23:5 Does the program stress Universal Precautions be observed? 1) No 2) Yes C23:6 Does the plan address how Hepatitis B Vaccinations are made available to employees? 1) No 2) Yes C23:7 Is employee initial and annual Bloodborne Pathogens training current and documented? 1) No 2) Yes C23:8 What is the contractor's overall rating for Bloodborne Pathogens? 1) 5 2) 1 24.24: Electrical Safety Question Number Question Text Question Choices C24:1 Does company have a written Electrical Safety Program? (Qualified or Unqualified)(MSQ US:6:16; US:6:17) 1) No 2) Yes C24:2 If you have Qualified Employees, do you have a written Arc Flash protection requirements? 1) No 2) Yes C24:3 Does the program address safe work practices to prevent electric shock? 1) No 2) Yes C24:4 Does the program include precautions for working on or near energized and deenergized equipment? 1) No 2) Yes C24:5 Does the program include inspection requirements for electrical equipment (tools, cords, GFCI's)? 1) No 2) Yes C24:6 Are guidelines developed addressing the proper use, inspection and storage of Electrical / Power Tools? 1) No 2) Yes C24:7 Do guidelines include: Referring to client Non-Welding Hot Work plan when using electric power tools 1) No 2) Yes C24:8 Do guidelines include: Power tools should be included in a planned maintenance program? 1) No 2) Yes C24:9 Do guidelines include: Power tools should be de-energized when not in use? 1) No 2) Yes C24:10 Is Portable/Electrical Power Tools training conducted and documented? 1) No 2) Yes C24:11 Does the program include guidelines for Static Electricity to include grounding, bonding, and the use of metal buckets for flammable and/or combustible liquids? 1) No 2) Yes C24:12 Is employee Electrical Safety training conducted and documented? (MSQ US:7:18:2) 1) No 2) Yes C24:13 What is the contractor's overall rating for Electrical Safety? 1) 5 2) 1 25.25: Excavation/Trenching/Shoring Question Number Question Text Question Choices C25:1 Does the company have personnel which are third-party trained to “Competent Person” level on Excavation work locations? 1) No 2) Yes C25:2 Does “Competent Person” conduct daily inspections? 1) No 2) Yes C25:3 Does the company provide confined space entry permits for excavations in excess of 5 ft. in depth? 1) No 2) Yes C25:4 Does the plan identify access and egress point requirements? 1) No 2) Yes C25:5 Does the plan include criteria for the development of site-specific Emergency Response Plans? 1) No 2) Yes C25:6 What is the contractor's overall rating for Excavation/Trenching/Shoring? 1) 5 2) 1 26.01: Environmental Management General Question Number Question Text Question Choices C26:1:1 Does the company have a written Environmental Management Policy? 1) No 2) Yes C26:1:3 Can the Company demonstrate they assess environmental hazards for their work scopes and materials and supplies used? 1) No 2) Yes 1) 4. Halon and other chlorina 2) 3. Chlorinated solvents 3) 2. Has the Contractor eliminated the procurement, supply or handling of the Asbestos 4) 1. Polychlorinated following materials from their equipment? Biphenyl C26:1:4 As above, if not elimiated, can the Company demonstrate a program to eliminate use of the above materials, or demonstrate how they can legally handle and dispose them? 1) No 2) Yes C26:1:5 Does the Contractor's pre-job planning process scoped to include sitespecific environmental concerns? 1) No 2) Yes C26:1:6 Are periodic audits conducted and documented to ensure compliance with local, state and Federal environmental regulations? 1) No 2) Yes C26:1:7 Does company have a process to track and close corrective actions resulting 1) No from environmental audit findings and compliance deficiencies? 2) Yes C26:1:8 What is the contractor's overall rating for Environmental Management General? C26:1:2 1) 5 2) 1 26.02: Spill Prevention and Pollution Control General Question Number Question Text Question Choices C26:2:1 Does the company have an Spill Prevention, Control, and Countermeasure (SPCC) Plan? (if applicable-660 gallon tank or 1320 gallons within multiple tanks? 1) No 2) Yes C26:2:2 Are inspections conducted as required by the SPCC Plan? 1) No 2) Yes C26:2:3 Does the Contractor have controls are in place to prevent spills or other releases of oil or chemical substances? 1) No 2) Yes C26:2:4 Are drip pans or equivalent used as containment devices to catch liquids which may be drained or allowed to run out of lines or equipment to allow work to progress? 1) No 2) Yes 26.03: Waste Management General Question Number Question Text Question Choices C26:3:1 Does the company have a Waste Management Plan? 1) No 2) Yes C26:3:2 Does the plan outline methods of waste disposal for all wastes generated under Chevron contract? 1) No 2) Yes C26:3:3 Does the company generate Hazardous Waste? 1) No 2) Yes C26:3:4 Is the company a Large Quantity generator? 1) No 2) Yes C26:3:5 If yes, do they have a Hazardous Waste Contingency Plan? 1) No 2) Yes 26.04: Training & Competency General Question Number Question Text Question Choices C26:4:1 Are employees trained in Waste Management and Spill Prevention? 1) No 2) Yes C26:4:2 If the company requires SPCC Plan, can the company demonstrate affected employees are trained on the SPCC plan? 1) No 2) Yes C26:4:3 Can the Contractor demonstrate that key environmental risks are addressed in Safety, HES or tool box Meetings? 1) No 2) Yes C26:4:4 Is Marine Trash and Debris training conducted annually for all Contractor employees who travel offshore? 1) No 2) Yes C26:4:5 Does the Company maintain records demonstrating Marine Trash and Debris is training conducted annually ? 1) No 2) Yes C26:4:6 Are employees trained in relation to their work scope and the facility's NPDES permit requirements? 1) No 2) Yes 27.01: Environmental Management Facility Question Number Question Text Question Choices C27:1:1 Has a Pollution Prevention Plan been developed that contains the following: 1. An environmental impact analysis or description of the work to be done under the terms of this contract 1) No 2) Yes C27:1:2 Has a Pollution Prevention Plan been developed that contains the following: Description of the regulatory setting, permits required/held, and regulatory agencies 1) No 2) Yes C27:1:3 Has a Pollution Prevention Plan been developed that contains the following: Characterization of the atmospheric emissions, liquid wastes, and solid wastes generated as a result of work conducted under this contract 1) No 2) Yes C27:1:4 Has a Pollution Prevention Plan been developed that contains the following: Description of the hazardous waste disposal practices (e.g. for batteries, solvents, paints, sand blasting wastes, etc.) 1) No 2) Yes C27:1:5 Can the contractor demonstrate compliance with all of the conditions and requirements of the permits held? 1) No 2) Yes C27:1:6 Does the Contractor have an Environmental Monitoring Program in place to assess environmental impact from execution of the Work? 1) No 2) Yes C27:1:7 Does the Environmental Monitoring Program include a description of the reporting and recordkeeping requirements? 1) No 2) Yes C27:1:8 Can the Contract demonstrate compliance with the reporting and recordkeeping requirements? 1) No 2) Yes C27:1:9 Have atmospheric emissions, liquid wastes, and solid wastes generated as a result of work conducted under this contract been identified? 1) No 2) Yes C27:1:10 What is the contractor's overall rating for Environmental Management Facilities? 1) 5 2) 1 27.02: Spill Prevention and Pollution Control Facility Question Number Question Text Question Choices C27:2:1 Have all of the components mentioned above in the Pollution Prevention Plan been Implemented? 1) No 2) Yes C27:2:2 What is the current level of compliance with the required components of the Pollution Prevention Plan? 1) No 2) Yes C27:2:3 Are work areas free of all harmful spillage, discharge, or other pollutants? 1) No 2) Yes C27:2:4 Has the SPCC been certified by a Professional Engineer? 1) No 2) Yes C27:2:5 Is the contractor facility eligible to self-certify the SPCC Plan? (i.e. Stores < 10,000 US gal of Oil and in the 3 years prior to the date the SPCC Plan is certified, the facility has had no single discharge of oil to navigable waters or adjoining shorelines exceeding 1,000 U.S. gallons, or no two discharges of oil to navigable waters or adjoining shorelines each exceeding 42 U.S. gallons within any 12-month period.) 1) No 2) Yes C27:2:6 Does the SPCC contain the following important Elements (For audit - NA, if SPCC Plan certified by PE): • Facility diagram and description of the facility 1) No 2) Yes C27:2:7 Does the SPCC contain the following important Elements (For audit - NA, if SPCC Plan certified by PE): • Oil discharge predictions 1) No 2) Yes C27:2:8 Does the SPCC contain the following important Elements (For audit - NA, if SPCC Plan certified by PE): • Appropriate secondary containment or diversionary structures 1) No 2) Yes C27:2:9 Does the SPCC contain the following important Elements (For audit - NA, if SPCC Plan certified by PE): • Facility drainage 1) No 2) Yes C27:2:10 Does the SPCC contain the following important Elements (For audit - NA, if SPCC Plan certified by PE): • Site security 1) No 2) Yes C27:2:11 Does the SPCC contain the following important Elements (For audit - NA, if SPCC Plan certified by PE): • Facility inspections 1) No 2) Yes C27:2:12 Does the SPCC contain the following important Elements (For audit - NA, if SPCC Plan certified by PE): • Requirements for bulk storage containers including inspections, overfill, and integrity testing requirements 1) No 2) Yes C27:2:13 Does the SPCC contain the following important Elements (For audit - NA, if SPCC Plan certified by PE): • Transfer procedures and equipment (including piping) 1) No 2) Yes C27:2:14 Does the SPCC contain the following important Elements (For audit - NA, if SPCC Plan certified by PE): • Requirements for qualified oil-filled operational equipment 1) No 2) Yes C27:2:15 Does the SPCC contain the following important Elements (For audit - NA, if SPCC Plan certified by PE): •Loading/unloading rack requirements and procedures for tank cars and tank trucks 1) No 2) Yes C27:2:16 Does the SPCC contain the following important Elements (For audit - NA, if SPCC Plan certified by PE): • Brittle fracture evaluations for aboveground field constructed containers 1) No 2) Yes C27:2:17 Does the SPCC contain the following important Elements (For audit - NA, if SPCC Plan certified by PE): • Personnel training and oil discharge prevention briefings 1) No 2) Yes C27:2:18 Does the SPCC contain the following important Elements (For audit - NA, if SPCC Plan certified by PE): • Recordkeeping requirements 1) No 2) Yes C27:2:19 Does the SPCC contain the following important Elements (For audit - NA, if SPCC Plan certified by PE): • Five-year Plan review 1) No 2) Yes C27:2:20 Does the SPCC contain the following important Elements (For audit - NA, if SPCC Plan certified by PE): • Management approval 1) No 2) Yes C27:2:21 Does the SPCC contain the following important Elements (For audit - NA, if SPCC Plan certified by PE): • Plan certification (by a Professional Engineer (PE) or in certain cases by the facility owner/operator) 1) No 2) Yes 27.03: Waste Management Facility Question Number Question Text Question Choices C27:3:1 Does the Waste Minimization and Disposal Plan address the following: Potential cases where a more environmentally friendly material can be substituted and associated impacts 1) No 2) Yes C27:3:2 Does the Waste Minimization and Disposal Plan address the following: Plans for reducing waste at the job site 1) No 2) Yes C27:3:3 Does the Waste Minimization and Disposal Plan address the following: Plans for returning materials to supplier where possible 1) No 2) Yes C27:3:4 Does the Waste Minimization and Disposal Plan address the following: Plans to reuse materials where possible 1) No 2) Yes C27:3:5 Does the Waste Minimization and Disposal Plan address the following: Plans to recycle or regenerate wastes for reuse 1) No 2) Yes C27:3:6 Does the Waste Minimization and Disposal Plan address the following: Plans to dispose of waste using permitted, appropriate waste disposal sites 1) No 2) Yes C27:3:7 applicable government regulations. Can the contractor demonstrate compliance with the regulations? 1) No 2) Yes C27:3:8 What is the waste generating status of the contractor (at the specific site or facility) ? (according to Federal RCRA only, State based regulations may differ): 1) Large quantity generator 2) Regulated Small quantity ge 3) Conditionally exempt small C27:3:9 If a LQG or SQG, Can the contractor demonstrate compliance with the following: 1) Identify and count waste 2) Obtain an EPA ID number 3) Comply with accumulation 4) Prepare the waste for trans 5) Track the shipment and rece 6) Meet recordkeeping and repo C27:3:10 If the contractor is a Large quantity hazardous waste generator, Can they verify hazardous waste is stored < 90 days? 1) No 2) Yes C27:3:11 If the contractor is a Large quantity hazardous waste generator, can they demonstrate compliance with the following requirements? 1. Proper Management — The waste is properly accumulated in containers, tanks, drip pads, or containment buildings. Hazardous waste containers must be kept closed and marked with the date on which accumulation began. Tanks and containers are required to be marked with the words “Hazardous Waste.” The generator must ensure and document that waste is shipped off site 1) No within the allowable 90-day period. 2) Yes C27:3:12 If the contractor is a Large quantity hazardous waste generator, can they demonstrate compliance with the following requirements? 2. Preparedness and Prevention — LQGs are required to have an emergency coordinator, and to test and maintain emergency equipment. 1) No 2) Yes C27:3:13 If the contractor is a Large quantity hazardous waste generator, can they demonstrate compliance with the following requirements? 3. Emergency Plan — LQGs are required to have formal written contingency plans and emergency procedures in the event of a spill or release. 1) No 2) Yes C27:3:14 If the contractor is a Large quantity hazardous waste generator, can they demonstrate compliance with the following requirements? 4. Personnel Training — Facility personnel must be trained in the proper handling of hazardous waste through an established training program. 1) No 2) Yes C27:3:15 If the contractor is a Small quantity hazardous waste generator, can they verify hazardous waste is stored < 180 days? 1) No 2) Yes C27:3:16 If the contractor is a Small quantity hazardous waste generator, can they demonstrate compliance with the following requirements? 1. Proper Management — The waste is properly accumulated in either tanks or containers marked with the words “Hazardous Waste.” Containers must also be kept closed and marked with the date on which accumulation began. 1) No 2) Yes C27:3:17 If the contractor is a Small quantity hazardous waste generator, can they demonstrate compliance with the following requirements? 2. Emergency Plan — The SQG requirements include specified emergency responses; however, SQGs are not required to have written contingency plans. They are required to ensure that an emergency coordinator is on the premises, or oncall at all times, and have basic facility safety information readily accessible. 1) No 2) Yes C27:3:18 If the contractor is a Small quantity hazardous waste generator, can they demonstrate compliance with the following requirements? 3. Personnel Training — SQGs are not required to have an established training program but must ensure that employees handling hazardous waste are familiar with proper handling and emergency procedures 1) No 2) Yes 27.04: Air Emission Facility Question Number Question Text C27:4:1 Specify what Air Permit/ regulations apply to facility C27:4:2 Can the contractor demonstrate compliance with permit conditions? Question Choices 1) No 2) Yes 27.05: Water/ Effluents Facility Question Number Question Text Question Choices C27:5:1 Specify what effluent/ NPDES Permits apply to facility 1) No 2) Yes C27:5:2 Can the contractor demonstrate compliance with permit conditions? 1) No 2) Yes 28: HES Work Procedures Question Number Question Text Question Choices C28:1 Are there documented job procedures / SOP's for work activity exposures? 1) No 2) Yes C28:2 How are they communicated to employees? New Employee Orientation, Safety Meetings, HES Training? C28:3 Are they reviewed and updated? 1) No 2) Yes C28:4 Does company have a written Knife policy that meets the client requirements? 1) No 2) Yes C28:5 What is the contractor's overall rating for HES Work Procedures? 1) 5 2) 1 29.29: Operating Procedures Question Number Question Text Question Choices C29:1 Have written operating procedures been developed and implemented that provide instructions for conducting safe and environmentally sound activities involved in each operation addressed in your service and/or SEMS program? 1) No 2) Yes C29:2 Your operating procedures meet the following requirements: 1. Be specific to the work being done 1) No 2) Yes C29:3 Your operating procedures meet the following requirements: 2. Break the work down into clearly defined tasks 1) No 2) Yes C29:4 Your operating procedures meet the following requirements: 3. Identify all potential safety hazards associated with each task 1) No 2) Yes C29:5 Your operating procedures meet the following requirements: 4. Define appropriate mitigations for all potential safety hazards 1) No 2) Yes C29:6 Your operating procedures meet the following requirements: 5. Identify all potential environmental hazards associated with each task 1) No 2) Yes C29:7 Your operating procedures meet the following requirements: 6. Define appropriate mitigations for all potential environmental hazards 1) No 2) Yes C29:8 Your operating procedures meet the following requirements: 7. Identify all potential health or ergonomic hazards associated with each task 1) No 2) Yes C29:9 Your operating procedures meet the following requirements: 8. Define appropriate mitigations for all potential health or ergonomic hazards 1) No 2) Yes C29:10 Your operating procedures meet the following requirements: 9. Define any required specialized work permits (Isolation, CSEP, Hot Work, etc.) 1) No 2) Yes Do the operating procedures address the following activities: startup? Initial C29:11 1) No 2) Yes Do the operating procedures address the following activities: operations? Normal C29:12 1) No 2) Yes C29:13 Do the operating procedures address the following activities: All emergency operations (including but not limited to medical evacuations, weather-related evacuations and emergency shutdown operations)? 1) No 2) Yes Do the operating procedures address the following activities: shutdown? Normal C29:14 1) No 2) Yes Do the operating procedures address the following activities: following a turnaround, or after an emergency shutdown? Startup C29:15 1) No 2) Yes Do the operating procedures address the following activities: operations? Temporary C29:16 1) No 2) Yes C29:17 Do the operating procedures address the following activities: Simultaneous operations? 1) No 2) Yes C29:18 Do the operating procedures address the following activities: and flagging out-of-service equipment? 1) No 2) Yes Bypassing C29:19 Do the operating procedures address the following activities: Operating limits, and safety and environmental consequences of deviating from equipment Operating limits and steps required for correcting or avoiding this deviation? 1) No 2) Yes C29:20 Do the operating procedures address the following activities: Precautions to be taken to prevent the exposure of chemicals used in operations to personnel and the environment? 1) No 2) Yes C29:21 Are the facility’s written operating procedures accessible to all employees involved in the operations and they have been trained about these operating procedures and they are knowledgeable of the hazards and capable of implementing the mitigating measures described? 1) No 2) Yes C29:22 Are operating procedures reviewed on a defined schedule to assure that they reflect the current and actual operating practices including changes that have been incorporated? 1) No 2) Yes C29:23 Are the reviews and any changes to the procedures documented and communicated to responsible persons? 1) No 2) Yes C29:24 What is the contractor's overall rating for Operating Procedures? 1) 5 2) 1 30.30: Start Up Question Number Question Text Question Choices C30:1 Does the company have as part of the commissioning process a requirement for pre-startup safety and environmental reviews for new or and significantly 1) No modified facilities? 2) Yes C30:2 Does the process confirm that the following criteria is met: a. Construction and equipment are in accordance with applicable standards. 1) No 2) Yes C30:3 Does the process confirm that the following criteria is met: b. Safety, environmental, operating, maintenance, and emergency procedures are in place and are adequate. 1) No 2) Yes C30:4 Does the process confirm that the following criteria is met: c. Hazard analysis recommendations have been implemented as appropriate. 1) No 2) Yes C30:5 Does the process confirm that the following criteria is met: a. Construction and equipment are in accordance with applicable standards. 1) No 2) Yes C30:6 Does the process confirm that the following criteria is met: b. Safety, environmental, operating, maintenance, and emergency procedures are in place and are adequate. 1) No 2) Yes C30:7 Does the process confirm that the following criteria is met: c. Hazard analysis recommendations have been implemented as appropriate. 1) No 2) Yes C30:8 Does the process confirm that the following criteria is met: d. Training of operational personnel have been completed. 1) No 2) Yes C30:9 Does the process confirm that the following criteria is met: e. The required alarm systems, fire protection features and systems, gas/H2S detection features and systems are in place and functioning. 1) No 2) Yes C30:10 Does the process confirm that the following criteria is met: f. The Electrical area classification, equipment arragement drawings, P&IDs, flow diagrams have been updated as built and are available in the facility. 1) No 2) Yes C30:11 Does the process confirm that the following criteria is met: g. A management of change process has been implemented. 1) No C30:12 What is the contractor's overall rating for Start Up? 1) 2 2) Yes 2) 1 31.31: Ladder Management Question Number Question Text Question Choices C31:1 Have you established written guidelines on the safe use of ladders? 1) No 2) Yes C31:2 Have employees been trained on the use of ladders to include how to recognize what type of ladder they have to use, and how they have to use it in a safe way? 1) No 2) Yes C31:3 Does your BBS crticial inventory include ladder hazards? 1) No 2) Yes C31:4 What is the contractor's overall rating for Ladder Management? 1) No 2) Yes 32.32: Short Service Employee Program Question Number Question Text Question Choices C32:1 Do you have a written Short Service Employee (SSE) Program? (MSQ US:6:40) 1) No 2) Yes C32:2 Is SSE defined as an employee with fewer than 6 months of experience in the same job type or with the contractor's present employer? (MSQ US:6:41) 1) No 2) Yes C32:3 Are SSE employee's identified with a high visibility orange hard hat? 1) No 2) Yes C32:4 What is the process for mentoring an SSE? 1) No 2) Yes C32:5 Is the mentoring process documented? 1) No 2) Yes C32:6 Do you complete the Contractor SSE Form prior to assigning SSE to client locations? 1) No 2) Yes C32:7 What is the graduation process for removing employees from SSE status? 1) No 2) Yes C32:8 What is the contractor's overall rating for Short Service Employee Program? 1) 5 2) 1 33.33: Behavior Based Safety Program Question Number Question Text Question Choices C33:1 Does company have a BBS Process? (MSQ US:6:41) 1) No C33:2 Who participates in this process? Field Employees, All Employees, Field Supervisors, All Management? 1) Field Employees 2) All Employees 3) Field Supervisors 4) All Management C33:3 Is BBS training conducted and documented? (MSQ US:6:5) 1) No 2) Yes C33:4 Are BBS Observations tracked and trended and used for action planning purposes? (MSQ US:6:7) 1) No 2) Yes C33:5 How is this information shared with your employees? C33:6 What is the contractor's overall rating for Behavior Based Safety Program? 1) 5 2) Yes 2) 1 34.34: Audits and Inspections Question Number Question Text Question Choices C34:1 Are internal HES audits and inspections conducted? (MSQ US:12:3) C34:2 Type? 1) No 2) Yes 1) Post-Job 2) Third Party 3) Facility 4) Pre-job 5) Equipment 6) Job-site 7) Corporate HES Self-Audit 8) Management System C34:2 What is the Frequency? C34:3 Are areas for improvement (deficiencies and corrections) derived from audits documented and closed-out? (tracking system) How? C34:4 Are all audit/inspection action item closed? How many open items are overdue the targeted closure date? C34:5 How is Management involved in this communication process? C34:6 What is the contractor's overall rating for Audits and Inspections? 1) 5 2) 1 35.35: Incident Reporting and Investigation Question Number Question Text Question Choices C35:1 Does the company have a written Incident Reporting and Investigation procedure? (MSQ US:11:1) 1) No 2) Yes C35:2 Do procedures/policy require the immediate reporting of all incidents to the Operator on site to include: Near Miss, Property Damage, Spills, Releases, fires, Workplace violence and permit violations? 1) No 2) Yes C35:3 Do procedures require the formal investigation of all incidents to include: Near Miss, Property Damage, Spills, Releases, fires, Workplace violence, and permit violations? C35:4 What was the last serious “near miss” or incident that was reported, and what corrective action was taken? How did you reinforce the reporting of the “near miss” and incidents? C35:5 Are Incident Investigations performed by personnel who have received formal Incident Investigation training? C35:6 If yes, what type/level of training was received? C35:7 What methods are used to determine incident causes? Statements, JSA review, Photos, Job-site review, Diagrams, Identifying contributing factors, Root Cause Analysis process, Procedure Reviews? C35:8 What are the root causes of incidents in your company? What are you doing to ensure that incidents are being eliminated or mitigated? C35:9 How do you ensure that root causes of incidents are being addressed and communicated to the workforce? C35:10 How are lessons from incidents and audits being shared? Which leading indicators will indicate improvement from corrective actions taken? C35:11 1) No 2) Yes 1) No 2) Yes Does your procedure require an authorized individual to accompany an injured employee to the medical provider for initial treatment? 1) No 2) Yes C35:12 Does the company have a written Restricted Duty / Light Duty Policy? 1) No 2) Yes C35:13 Does the company use a specific medical provider that understands your company’s Restricted Duty / Light Duty policy? 1) No 2) Yes C35:14 How are the results and corrective actions communicated to management personnel? Email, Management Meetings, Investigation Reports? 1) No 2) Yes C35:15 Review completed incident report forms. Review IIR Checklist form quality. 1) No 2) Yes C35:16 What is the contractor's overall rating for Incident Reporting and Investigation? 1) 5 2) 1 36.36: Hazard Control Question Number Question Text Question Choices C36:1 Does company have a formal process developed to identify, control, report and analyze workplace hazards? (physical conditions and activity behaviors) 1) No C36:2 Do you have regularly scheduled HES meetings? What type? Daily – onsite, Weekly, Monthly, Quarterly, Supervisor, Management HES, Company specific meetings? C36:3 Have your employees been trained in the Chevron Hazard Identification Tool? C36:4 Are recommendations generated from Hazard Control processes tracked? How? HES Dept. follow-up, Supervision follow-up, Corrective action sheet, Safety meeting minutes? 1) No 2) Yes 2) Yes C36:5 Does company have a written Job Safety Analysis (JSA) program? 1) No 2) Yes C36:6 Does management conduct periodic quality checks of the JSA's? 1) No 2) Yes C36:7 Does the JSA assign responsibilities for hazard controls? 1) No 2) Yes C36:8 Is required PPE discussed as part of each JSA? 1) No 2) Yes C36:9 What is the contractor's overall rating for Hazard Control? 1) 5 2) 1 37.37: Hazard Analysis Question Number Question Text Question Choices C37:1 Have Hazards analyses and job safety analyses been conducted for all types of offshore structures permanently or temporarily attached to the seabed (i.e. mobile offshore drilling units; floating production systems; floating production, storage and offloading facilities; tension-leg platforms; spars; and DOI regulated pipelines) used for exploration, development, production, and transportation activities for oil, gas, or sulfur from areas leased in the OCS? 1) No 2) Yes C37:2 Do hazards analyses address the following: a) Hazards of the operation? 1) No 2) Yes C37:3 Do hazards analyses address the following: b) Previous incidents related to the operation being evaluated, including any incident in which an Incident of Noncompliance or a civil or criminal penalty was issued? 1) No 2) Yes C37:4 Do hazards analyses address the following: c) Control technology applicable 1) No to the operation being evaluated? 2) Yes C37:5 Do hazards analyses address the following: d) A qualitative evaluation of the possible safety and health effects on employees, and potential impacts to the human and marine environments, which may result if the control technology 1) No fails? 2) Yes C37:6 Do hazards analyses address the following: e)Human factors? 1) No 2) Yes C37:7 Have the analyses been updated when an internal audit is conducted to ensure that the analyses are consistent with the current operations on the facility? 1) No 2) Yes C37:8 Is an orderly, systematic methodology which is appropriate to the risks of the facility utilized for hazards analyses? (Hazop, What if?, etc) 1) No 2) Yes C37:9 For hazard analyses performed on new or modified facilities, is special consideration given to the following: (a) Previous experience with a similar facility 1) No 2) Yes C37:10 For hazard analyses performed on new or modified facilities, is special consideration given to the following: (b) Design circumstances, such as changes in the design team or the design itself, after the project is underway? 1) No 2) Yes C37:11 For hazard analyses performed on new or modified facilities, is special consideration given to the following: ( c) Unusual facility location, design or configuration, equipment arrangement, or emergency response considerations? 1) No 2) Yes C37:12 For hazard analyses performed on new or modified facilities, is special consideration given to the following: (d) Any findings that need to be brought to resolution before startup or that require immediate attention should be clearly identified? 1) No 2) Yes C37:13 For hazard analyses performed on new or modified facilities, is special consideration given to the following: (e) Operating procedures and practices, including simultaneous operations guidelines? 1) No 2) Yes C37:14 Has a program been established for the periodic review and updating of hazards analyses based on priority (with typical review intervals ranging between 5 years for high-priority facilities and 10 years for low-priority facilities)? 1) No 2) Yes C37:15 Are hazards analyses performed by: a) Persons knowledgeable in engineering, operations, design, process, safety, environmental, and other specialties as appropriate? 1) No 2) Yes C37:16 Are hazards analyses performed by: b) Person(s) with experience in the operations being evaluated? 1) No 2) Yes C37:17 Are hazards analyses performed by: c) At least one person proficient in the hazards analysis methodologies being employed? 1) No 2) Yes C37:18 Are hazards analyses performed by: d) For assessment teams consisting of only one person, that person was not involved in the original design or modification? 1) No 2) Yes C37:19 Are current analyses for each operation documented and maintained for the life of the operation at the facility? (a complete hazards analysis report, including updates, should be kept on file for the life of the facility). 1) No 2) Yes C37:20 Has an initial hazards analysis been performed for offshore facilities? (facilities operated on or before November 15, 2011 must have a facility hazard assessment prior to that date) 1) No 2) Yes C37:21 What is the contractor's overall rating for Hazard Analysis? 1) 5 2) 1 38.38: Dropped Objects Question Number Question Text Question Choices C38:1 Does the contractor have a Dropped Object Policy / Procedure implemented at the location and has been communicated to all personnel? 1) No 2) Yes C38:2 Has in place a program of Dropped Object inspection which is carried out to identify and assess Dropped Object hazards? This program establish frequency of inspections and who is responsible to perform the inspections? 1) No 2) Yes C38:3 Have workgroups been detailed with sufficient ability to manage the whole Dropped Object hazard scope, not just the derrick? 1) No 2) Yes C38:4 Have maintenance schedules and inspections been implemented for identified hazards? 1) No 2) Yes C38:5 Has an inventory of equipment with the potential to become Dropped Objects been completed? 1) No 2) Yes C38:6 Has each item been identified, method of fastening assessed and inspection frequency determined? 1) No 2) Yes C38:7 Has training been identified and addressed with respect to identifying and controlling of Dropped Object hazards? 1) No C38:8 What is the contractor's overall rating for Dropped Objects? 1) 5 2) Yes 2) 1 39.39: Management of Change Question Number Question Text Question Choices C39:1 Does company have a documented Management of Change Process (MOC) that affect work activities? 1) No 2) Yes C39:2 Does the MOC Procedure identify that the MOC Process will be utilized for changes to the following: Equipment 1) No 2) Yes C39:3 Does the MOC Procedure identify that the MOC Process will be utilized for changes to the following: Operating Procedures 1) No 2) Yes C39:4 Does the MOC Procedure identify that the MOC Process will be utilized for changes to the following: Personnel Changes (Including Contractors) 1) No 2) Yes C39:5 Does the MOC Procedure identify that the MOC Process will be utilized for changes to the following: Materials 1) No 2) Yes C39:6 Does the MOC Procedure identify that the MOC Process will be utilized for changes to the following: Operating Conditions 1) No 2) Yes C39:7 Is the purpose and objective of this procedure clearly stated? 1) No 2) Yes C39:8 Is the scope of this procedure clearly defined? 1) No 2) Yes C39:9 Does this procedure identify reference materials that may be needed in order to use it correctly? 1) n C39:10 Does this procedure identify supporting documents or resources that people may need in order to carry out this procedure? 1) No 2) Yes C39:11 Does this procedure inform personnel what to do? 1) No 2) Yes C39:12 Does this procedure identify roles and responsibilities as to who does what? 1) No 2) Yes C39:13 Does this procedure require the use of subject matter experts? 1) No 2) Yes C39:14 Does this procedure outline how the company will document the MOC process? 1) No 2) Yes C39:15 Does this procedure identify the objectives that this procedure is supposed to 1) No accomplish? 2) Yes C39:16 Does this procedure identify who is expected to use it? 1) No 2) Yes C39:17 Do personnel have easy access to this procedure whenever they need to use it? 1) No 2) Yes C39:18 Have Supervisory personnel received training on this procedure? 1) No 2) Yes C39:19 Does this procedure require that MOC records are maintained for a minimum of 2-years? 1) No 2) Yes 2) Yes C39:20 Is there a formalized review process for changes to assure that changes to this procedure have gone through the proper processes and that final approval has been obtained before the revised procedure is officially issued and implemented? 1) No 2) Yes C39:21 Does the MOC Procedure identify: That the technical basis for the change will be identified 1) No 2) Yes C39:22 Does the MOC Procedure identify: That the impact of the change on safety, health, and the coastal and marine environments will be assessed 1) No 2) Yes C39:23 Does the MOC Procedure identify: The necessary time period to implement the change 1) No 2) Yes C39:24 Does the MOC Procedure identify: Management approval procedures for the changes 1) No 2) Yes C39:25 Does the procedure require that employees , including contractors whose job tasks will be affected by a change in the operation, must be informed of, and trained in, the change prior to startup of the process or affected part of the 1) No operation? 2) Yes C39:26 What is the contractor's overall rating for Management of Change? 1) 5 2) 1 40.40: Permit to Work Question Number Question Text Question Choices C40:1 Does company have a formal Work Authorization / Permit System established? (MSQ US:3:31) 1) No 2) Yes C40:2 What types of company activities require Work Authorization / Permits? Lockout / Tagout, Confined Space, Hot work? C40:3 Does this procedure outline how the company's PTW process will be utilized with the customer's process? 1) No 2) Yes C40:4 Is company or client Permit System used on work locations? 1) No 2) Yes C40:5 Does this procedure require that records are maintained? 1) No 2) Yes C40:6 How do you ensure that your permit systems are followed? Auditing of expired permits, Job-site inspections, Training, Supervision? C40:7 Has training on the PTW process been conducted and documented? 1) No 2) Yes C40:8 What is the contractor's overall rating for Permit to Work? 1) 5 2) 1 41.41: Stop Work Authority Question Number Question Text Question Choices C41:1 Do you have a documented “Stop Work Authorization” policy endorsed by upper management? (MSQ US:11:15) 1) No C41:2 How is this authorization communicated to employees? 2) Yes C41:3 Are situations of utilizing this authorization documented? 1) No C41:4 What is the contractor's overall rating for Stop Work Authority? 1) 5 2) Yes 2) 1 42.42: Preventative Maintenance Question Number Question Text Question Choices C42:1 Does contractor have a Preventive Maintenance Program ? (MSQ US:4:21) 1) No 2) Yes C42:2 Does Preventive Maintenance Program, at minimum, identify safety and/or environmentally critical items and establish a maintenance frequency for these items? 1) No 2) Yes C42:3 Does Preventive Maintenance Program identify the person or position responsible for the maintenance activity? (MSQ US:5:8:14) 1) No 2) Yes C42:4 What is the contractor's overall rating for Preventative Maintenance? 1) 5 2) 1 43.43: Mechanical Integrity Question Number Question Text Question Choices C43:1 Does the mechanical integrity program encompass all equipment and systems used to prevent or mitigate uncontrolled releases of hydrocarbons, toxic substances, or other materials that may cause environmental or safety consequences? 1) No 2) Yes C43:2 Does the mechanical integrity program include: a) The design and procurement, fabrication, installation, calibration, and maintenance of equipment and systems in accordance with the manufacturers design and materials specification. 1) No 2) Yes C43:3 Does the mechanical integrity program include: b) Training for each employee tasked in maintaining equipment and systems so that the employee can implement the program. 1) No 2) Yes C43:4 Does the mechanical integrity program include: c) Inspection and test frequency for equipment and systems which comply with BOERME regulations and the manufacturers recommendations. 1) No 2) Yes C43:5 Does the mechanical integrity program include: d) Inspection and test documentation that identifies: the date, name, position and signature of individual performing the inspection or test, equipment identifier, description of inspection or tests, and the results. 1) No 2) Yes C43:6 Does the mechanical integrity program include: e) Assurance that corrections of deficiencies associated with equipment and systems that are outside of manufacturers limits prior to further use of the equipment or system. 1) No 2) Yes C43:7 Does the mechanical integrity program include: e) The application for which new equipment and constructing systems will be used. 1) No 2) Yes C43:8 Does the mechanical integrity program include: f) Assurance that modifications to existing equipment or systems are modified for the application for which they will be used. Also an MOC process is applied prior 1) No to do theses modifications. 2) Yes C43:9 Does the mechanical integrity program include: g) Verification the test and inspections are performed And assurance that equipment or systems are installed consistent with design specifications and the manufactures instructions. 1) No 2) Yes C43:10 Does the mechanical integrity program include: h) Assurance the maintenance materials, spare parts, and equipment are suitable for the applications for which they will be used. 1) No 2) Yes C43:11 What is the contractor's overall rating for Mechanical Integrity? 1) 5 2) 1 44.44: Emergency Preparedness Question Number Question Text Question Choices C44:1 Has company developed Emergency Response Plans for work exposures? Fire, Explosion, Spills, Transportation, Bomb, Work place violence, Power disruption, Weather, Confined space, Evacuation, Radiation? (MSQ US:6:18) 1) No 2) Yes C44:2 Does Emergency Response Plans include work-site Injury Management Procedures? 1) No 2) Yes C44:3 Has training been conducted for affected personnel? Initial, Upon arrival to a location? (MSQ US:7:19:2) 1) No 2) Yes C44:4 Does company conduct and document Emergency Response Plan drills? Evacuation, Fire, Weather, Confined Space, Radiation Incident? (MSQ US:11:15) 1) No 2) Yes C44:5 Frequency? C44:6 Do company employees participate in client driven drills on work locations? 1) No 2) Yes C44:7 Are documented evaluation (critique) reviews conducted following drills? Who attends? What happens with the information? C44:8 Do company emergency response personnel have a copy of these plans? 1) No 2) Yes C44:9 Are emergency response personnel identified with clearly defined roles? Management, Regulatory Contracts? C44:10 Does the plan include necessary phone numbers for on and off site contacts? 1) No 2) Yes C44:11 Are emergency contact phone numbers posted? 1) No 2) Yes C44:12 Is emergency response equipment and supplies readily available, evaluated, inspected and tested? How often? By whom? 1) No 2) Yes C44:13 Do you have emergency or First Aid trained personnel or equipment at all work locations? 1) No 2) Yes C44:14 Is initial and annual training conducted to include the use and inspection of Fire Extinguishers? 1) No 2) Yes C44:15 Are fire extinguishers inspected monthly? 1) No 2) Yes C44:16 What is the contractor's overall rating for Emergency Preparedness? 1) 5 2) 1 45.45: Sub-Contractors Question Number Question Text Question Choices C45:1 Does company hire Sub-Contractors to perform work for client on or off client's locations? (MSQ US:8:2) 1) No 2) Yes C45:2 Has company developed Sub-Contractor performance evaluation, qualification or selection criteria? (MSQ US:8:3) 1) No 2) Yes C45:3 Does company conduct audits of sub-contractor safety processes? HES Management System Review, Employee Training, Hazard Control, QA / QC, Incident Rate History, EMR History, Substance Abuse Program, Emergency Action Planning, Incident Reporting? (MSQ US:8:3) 1) No 2) Yes C45:4 Who conducts audits / evaluations of sub-contractors? How often? 1) No 2) Yes C45:5 Do contractual agreements provide provisions to terminate sub-contractor work if company’s safety standards are not met and maintained? 1) No 2) Yes C45:6 How are your sub-contractor’s made aware of the provision to terminate the work agreement? 1) No 2) Yes C45:7 What type of training / orientation is given to sub-contractors before beginning work activities or entering facility? Task Specific, Hazard Control, Job Planning, Site Specific Emergency Action Plans? (MSQ US:7:72:4) C45:8 Are pre-job safety meetings held with sub-contractors before beginning every project? (MSQ US:4:24) 1) No 2) Yes C45:9 Do sub-contract personnel attend your scheduled safety meetings? How often? C45:10 Does company monitor the performance of sub-contractor SSE’s? 1) No 2) Yes C45:11 How does company notify client of sub-contractor SSE’s being deployed to client facilities? 1) No 2) Yes C45:12 What is the contractor's overall rating for Sub-Contractors? 1) 5 2) 1 46.46: Drilling Subpart O Program Question Number Question Text C46:1 Without in-house well control training: Does your plan include procedures for evaluating competency of employees? How? Verify that a plan is written, if needed. Who conducts the well control training? Do you have a copy of the Operator well control Subpart O training plan? What actions are taken if an employee fails competency testing? C46:2 With in-house well control training: Is certification from IADC allowing institution to teach available? Is instructor knowledgeable of the subject matter? (Confirm instructors’ qualifications). Are training records readily available? Question Choices C46:3 If a training session is in progress: Is the Well CAP curriculum being followed? Who conducts the production safety portion of training? C46:4 Is a process in place for matching the company’s program with specific operator program requirements? 1) No C46:5 What is the contractor's overall rating for Drilling Subpart O Program? 1) 5 2) Yes 2) 1 47.47: Production Subpart O Program Question Number Question Text Question Choices C47:1 Has the contractor developed and implemented a written training plan that has a process for the administration of training needs for well control and/or production safety training? 1) No 2) Yes C47:2 Does the training plan specify what type of training? 1) No 2) Yes C47:3 Does the training plan specify the method(s) of training such as classroom, computer based, on the job training, etc.? 1) No 2) Yes C47:4 Does the training plan specify the length of the training such as 8 hours, 3 days, five days, etc.? 1) No 2) Yes C47:5 Does the plan specify the frequency that training will be provided? 1) No 2) Yes C47:6 Do training records reflect that the frequency outlined in the plan is adhered to? 1) No 2) Yes C47:7 Does the plan include procedures for assessing the employee needs on a periodic basis? 1) No 2) Yes C47:8 Does the plan specify the content of training such as lesson plans depicting course content, or course outline with time schedule? 1) No 2) Yes C47:9 Does the plan specify the method of employee understanding and performance verification? 1) No 2) Yes C47:10 Does the contractor verify that employees understand and can perform their assigned duties, i.e., documented oral or hands on testing? 1) No 2) Yes C47:11 Are procedures established to verify adequate retention of knowledge and skills? 1) No 2) Yes C47:12 Does the plan include procedures for training employees in well control and/or production safety to include in order how the employee will advance through the training process? 1) No 2) Yes C47:13 Does the plan include procedures for record keeping and documentation? (Training Record retention 5 years) 1) No 2) Yes C47:14 Does the plan include procedures for internal audits? 1) No 2) Yes C47:15 Are training records maintained at minimum 5 years? 1) No 2) Yes C47:16 If alternative training methods are used, are they supplemented with appropriate demonstrations and hands-on training, and do the records indicate satisfactorily completion of both? 1) No 2) Yes C47:17 Are well control and/or production safety training provided from sources that meet the requirements of the training plan? 1) No 2) Yes C47:18 Is the contractor prepared to explain its overall well control and/or production 1) No safety training program? 2) Yes C47:19 Does the contractor have evidence to support its explanation of its training program, i.e., course outlines, records, audit reports, etc. supporting the plan? 1) No 2) Yes C47:20 Does the contractor identify personnel by current position, years of experience in present position, years of total oilfield experience, and employer name? 1) No 2) Yes C47:21 Does the contractor pay for all training costs? 1) No 2) Yes C47:22 What is the contractor's overall rating for Production Subpart O Program? 1) 5 2) 1
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