Daily Work Permit and Safety Checklist (C7007) Purpose. Scope. Roles and Responsibilities. Colonial Pipeline Company Safety Awareness Manual

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1 Daily Work Permit and Safety Checklist (C7007) Purpose This section provides instruction for completing Colonial Pipeline Company s Daily Work Permit and Safety Checklist (Form C7007) at CPC facilities and locations, and at CPC facilities covered by OSHA s Process Safety Management (PSM) rule. Scope This section applies to all Colonial operations and activities occurring both in PSM-covered facilities and non PSM-covered areas where employees perform or oversee tasks or jobs that require work permits and safety checklists. Permits are required prior to any work that may affect the integrity of the pipeline and/or associated systems; and any other hazardous work or work performed in hazardous areas. Hazardous work includes both routine and non-routine work. The Post-Work section shall be completed at the end of each day or shift. Roles and Responsibilities The Director, Health Safety & Security establishes and maintains Colonial s Daily Work Permit and Safety Checklist; reviews and updates the permit at least annually or whenever applicable standards or regulations change; and monitors effectiveness of the permit by requesting audits to ensure compliance. Supervisors assure compliance for the work activities within their span of control. This includes verifying that all requirements are met and that employees understand their responsibilities for completing and working within the parameters of the permit. They also provide the support and resources necessary for compliance through training and supervision of employees. Each day or shift, all applicable sections of the permit must be completed by CPC employees or representatives prior to: Any work that may affect the integrity of the pipeline and/or associated system Any hazardous work or work performed in hazardous areas. Hazardous work includes both routine and non-routine work Any work conducted by contractors or involving contractors (not including administrative activities) Any work requiring equipment or system isolation and lockout/tagout Any work requiring a Job Safety Analysis Permits are not required for activities covered by Normal Operating Procedures such as Tank Gauging and Sampling. Rev.3/ Company Safety Philosophy

2 The Post-Work section shall be completed at the end of each day or shift. All applicable sections shall be completed by-hand, in ink, and shall be maintained on the work site. All sections of the permit that apply to the task or job being performed shall be fully completed. Each question or item within each applicable section shall be marked accordingly. Blank responses are prohibited. For sections that do not apply to the task or job, employees shall mark the applicable N/A box. Should sections apply that have previously been marked N/A, employees shall mark the time in use box and list the time the section became applicable. Employees should contact the HSS Team for questions or concerns regarding the Daily Work Permit and Safety Checklist. General Instructions The Daily Work Permit and Safety Checklist serves as a tool for employees and contractors to ensure safe working conditions and behaviors before and during work. The permit also serves as notification to Affected Employees of work being performed and conditions of worksites in or within near proximity to Affected Employees work areas. For work within a staffed facility, the responsible individual shall complete the permit and then review the permit with local Operation s personnel. An Operation s representative shall acknowledge the review by signing the permit. For work within an unstaffed facility, the responsible individual shall call the appropriate line Controller and complete the permit. Section-Specific Instructions Description of Work Colonial Employee/ Contractors(s) Performing Work Completion of this section is required for each permit. 1. Name of the work area, facility, mile marker or other description of work location 2. Date work is to take place 3. Pipeline time work is to begin 4. Description of the task or job Rev.3/ Company Safety Philosophy

3 5. Printed name of the foreman or supervisor (Colonial or contractor) with responsibility over the work, their company, and their contact telephone number. For multicontractor worksites, each foreman or supervisor s name shall be printed 6. Printed name of the Colonial representative and their contact telephone number if not listed in block 5 7. As applicable, document the MOC number for the project or activity. Mark the N/A box if the work does not involve an MOC Pre-Work Notifications Completion of this section is required for each permit. 1. As applicable, consider the potential effects of the work on or by neighboring equipment and the public. Mark the N/A box if not working near other equipment and not near the public 2. As applicable, verify with local operations the activity occurring within the dike and in dikes adjacent to the dike. Document the active product(s). Mark the N/A box if not working in a tank dike 3. Ensure that site specific work procedures and the JSA are reviewed with all crew members 4. Ensure that the site specific evacuation plan along with muster points are reviewed with all crew members. 5. Ensure that a pre-job safety meeting is held with all crew members. 6. Ensure that job responsibilities are reviewed with all crew members. 7. As applicable, verify the status of the facility, equipment, or line segment. Document the name(s) of the individual responsible for current status. Mark the N/A box if facility, equipment, or line segment status does not apply to the work Rev.3/ Company Safety Philosophy

4 8. Notify and discuss the work to be performed with the appropriate facility Operator or stub-line Operator, or notify and discuss the work to be performed with the appropriate line Controller. The Operation s representative shall assist the Colonial representative overseeing the work by notifying all Affected Employees of the work to take place within the facility. Notify and discuss work to be performed with the appropriate line Controller if working in an unstaffed facility. Document name and time. 9. As applicable, verify the Operator Qualifications (OQ) records of all crew members for the covered tasks they are expected to perform. The Colonial Representative is responsible for verifying the OQ of all crew members. Mark N/A if no covered tasks will be performed 10. As applicable, ensure that all crew members have received Colonial s Contractor Safety orientation within the past 12 months. 11. As applicable, ensure that all required pre-work permits (environmental, road crossing(s), Army Corps of Engineers, etc.) are properly obtained for the work to be performed. Many permits must be obtained well in-advance of work beginning. Mark N/A if the task or job does not require any permits Work Authorization (Applies only to Process Safety covered areas) Completion of this section is required for all Process Safety covered areas. Mark N/A if work to be performed is not in a Process Safety covered area. 1. Permit Writers each day or shift, determine the scope of work; assess site hazards and conditions; and then fill out all applicable sections of the permit. All applicable sections shall be completed by-hand, in ink. Permit Writers shall fully complete all sections of the permit that apply to the task or job being performed. Each question or item within each applicable section shall be marked accordingly. Blank responses are prohibited. For sections that do not apply to the task or job, employees shall mark the applicable N/A box. Should sections apply that have previously been marked N/A, employees shall mark the time in use box and record the time. Permits may be written only by Colonial or contractor personnel who have successfully completed Colonial Work Permit Writing training. Colonial Representatives are responsible for ensuring work is performed in accordance with the requirements of the permit by assessing site hazards and conditions and reviewing the permit for accuracy. Rev.3/ Company Safety Philosophy

5 Colonial Representatives shall: Verify equipment is properly prepared (isolated including LOTO, drained, vented, etc.) In consultation with Operations personnel, set the conditions under which the work may be performed Notify affected personnel of the work to be performed and when work has been completed Monitor conditions within the work area and stop work if permit conditions change or if permit provisions are not being followed Verify work area has been left in a clean and safe condition upon work completion Obtain work authorization from the Permit Authorizer Verify all appropriate safeguards are in place (i.e. air monitors, barrier fencing, proper excavation sloping, etc.) See Hot Work section for additional Colonial Rep responsibilities By signing, Colonial Representatives attest that work is safe to proceed. Colonial Representatives are personnel who have: Successfully completed Colonial Work Permit Writing training; and Been designated as Colonial Representatives by the Operations Manager The Colonial Representative may also be the Permit Writer for the work. Permit Authorizers are Colonial Operations representatives in responsible control of the facility. Permit Authorizers are responsible for evaluating the scope of work, reviewing the permit, determining its impact on operations and ensuring operational safeguards are in palace. By signing, Permit Authorizers confirm that the impact of work on operations has been assessed and operational safeguards are in place to ensure the work is safe to proceed. Permits may be authorized only by personnel who have: Successfully completed Colonial Work Permit Authorization training; and Been designated as Permit Authorizers by the Operations Manager Permit Writers and/or Colonial Representatives are not permitted to authorize their own permits. Employees should contact the HSS Team or the PSM Team for questions or concerns regarding the PSM Facilities Daily Work Permit and Safety Checklist. 2. Printed name and signature of the Permit Writer. 3. Printed name and signature of the Colonial Representative responsible for the work. 4. Printed name and signature of the Permit Authorizer. Rev.3/ Company Safety Philosophy

6 Initial Air Monitoring Readings Completion of this section is required if the work to be performed requires atmospheric testing. This section is used to document initial monitoring results only. Continuous air monitoring results shall be documented independently of the permit. Continuous or periodic air monitoring may be required in addition to initial air monitoring depending on the work to be performed and the area in which work will be performed. Confined space entry is an example of work requiring continuous air monitoring. Air monitoring shall only be conducted by personnel properly trained and qualified on the monitoring device and who have knowledge of the work to be performed of the hazards associated with the work and work area. 1. Continuous or periodic air monitoring may be required in addition to initial air monitoring depending on the work to be performed and the area in which work will be performed. Confined space entry is an example of work requiring continuous air monitoring. 2. Time the initial air monitoring was completed 3. Date of most-recent calibration of the monitor used to perform initial air monitoring 4. Type of monitor used to perform initial air monitoring 5. Percent oxygen reading at the time of initial air monitoring. Colonial employees shall not enter areas that contain oxygen levels outside of the range prescribed on the permit. Special precautions must be taken for entries into such areas by qualified contractor employees 6. Percent Lower-explosive-limit (LEL) at the time of initial air monitoring. Personnel shall not enter areas that contain LEL levels of 10% or greater. See (11) for additional information 7. Concentration in parts-per-million (ppm) of Carbon Monoxide (CO) in the atmosphere at the time of initial air monitoring. Colonial employees shall not enter areas that contain CO concentrations of 25ppm or greater. Special precautions shall be taken for entries into such areas by qualified contractors 8. As applicable, document whether or not continuous air monitoring is required Rev.3/ Company Safety Philosophy

7 9. Ensure monitor to be used to perform initial air monitoring is zeroed prior to initial readings 10. As applicable, ensure monitor to be used is bump tested prior to each use 11. Any LEL reading greater than 1% could indicate the presence of harmful materials. Atmospheres that contain LEL readings greater than 1% must be investigated to determine source and appropriate action(s). All work stops at 10% or greater LEL. Hazard Exposure Assessment Completion of this section is required for each permit. Determine appropriate hazard control strategies based on the assessment. 1. Evaluate the work to be performed and determine whether or not a formal JSA is needed. If a formal JSA is needed, complete in accordance with the JSA safety practices. 2. Regardless of whether a formal JSA is completed, use this section to document the expected and potential hazards associated with the work and the worksite. Place an X by each hazard anticipated for the job or task 3. Used to document hazards not listed above Personal Protective and/or Emergency Equipment Completion of this section is required for each permit. 1. Document the PPE and/or emergency equipment required for the task or job Employee/Contractor Notification and Identification Roster Rev.3/ Company Safety Philosophy

8 Completion of this section is required for each permit. Prior to starting their shift, all workers involved in the job are required to sign their names, and document their company names. By signing, each worker acknowledges that they have been informed of: Colonial s safety rules, policies, and procedures; all site-specific emergency and evacuation plans; all known and potential site-specific hazards they may encounter; authority and responsibility to stop work when necessary; and that failure to comply with safe work practices shall result in removal from Colonial property. This section also serves as a record of accounting for all individuals working on the job. In order to communicate the known and potential hazards, the Colonial representative overseeing the work shall review the details of the JSA with all workers; and shall notify all workers of the locations and accessibility of Colonial s Safety Data Sheets (SDS). 1. By signing, each worker acknowledges that they have been informed of: Colonial s safety rules, policies, and procedures; all site-specific emergency and evacuation procedures; all known and potential site-specific hazards they may encounter; authority and responsibility to stop work when necessary; and that failure to comply with safe work practices may involve removal from the the job site and the prohibition form performing any work for Colonial in the future. This section also serves as a record of accounting for all individuals working on the job. 2. Printed name of each crew member and name of each crew member s employer (including Colonial personnel). Additional room for signatures may be found on the back page of the Daily Work Permit, or a continuation sheet may be attached to the permit to record large numbers of contractor employees, and/or track their entry of the facility or jobsite. 3. As applicable, name of the English-speaking interpreter for the job. Work Completed Checklist Rev.3/ Company Safety Philosophy

9 Completion of this section is required for all jobs. The Colonial representative overseeing the work shall ensure that this section is completed after work is ceased after each day or shift; and shall communicate the details of work completion to Operations personnel and all other Affected Employees so that all parties are aware of the status of the system and/or work area. 1. As applicable, ensure that the work area is cleaned; equipment is returned to the proper location; and that all hazardous material containers are labeled and properly secured 2. As applicable, ensure that all energy isolating devices are returned to their normal operating positions. Use the LOTO Isolation Process section of the permit to verify. Mark NO if energy isolating devices will remain in isolated positions until work resumes the next day or shift. Mark N/A if LOTO was not completed for the task or job 3. As applicable, ensure that all open excavations or confined spaces are properly barricaded to prevent entry. Mark N/A if the task or job did not involve excavations or confined spaces 4. As applicable, ensure that all equipment has been reassembled. Mark NO if equipment will remain disassembled until work resumes the next day or shift. Mark N/A if equipment was not disassembled during the task or job 5. As applicable, ensure that all locks and tags have been removed. Mark NO if locks and/or tags will remain in-place until work resumes the next day or shift. Mark N/A if LOTO was not completed for the task or job 6. As applicable, ensure that piping and/or equipment is refilled and pressurized. Mark NO if piping and/or equipment will remain drained until work resumes the next day shift. Mark N/A if drain-up/drain-down was not required for the task or job 7. As applicable, ensure that the System Controller and/or Operator is notified of system status. Mark N/A if the task or job did not involve work on a pipeline or associated system Rev.3/ Company Safety Philosophy

10 8. As applicable, ensure a Pipe Inspection Report is completed for work involving exposed pipe. Mark N/A if the task or job did not involve exposed pipe 9. As applicable, ensure that all fire extinguishers are returned to proper locations. Mark NO if fire extinguishers will remain in-place until work resumes the next day or shift. Mark N/A if fire extinguishers were not required for the task or job 10. Mark YES if work is concluded for the day. Mark NO if work is to resume the same day by a different shift 11. Mark YES if the task or job is complete. Mark NO if the task or job is not complete 12. Explain all NO answers to the previous questions 13. Printed name and the employer name of each contractor s Foreman or Supervisor 14. Signature of the Colonial representative overseeing the work 15. Printed last name of the Colonial representative overseeing the work 16. Date the permit is closed 17. Time the permit is closed 18. As applicable, ensure all buildings and gates are properly locked Asbestos-Containing Material (ACM) Completion of this section is required if the work to be performed will or may expose workers to asbestos. All pipe coatings and gaskets should be treated as though Presumed Asbestos Containing Material (PACM) unless an accurate records check (Alignment Sheet/As-Built verified against pipe coating SDS) or pre-work testing confirms the absence of asbestos. If such pre-work identification, verification, and testing does not confirm the absence of asbestos, work should proceed as though asbestos is present in the materials and all appropriate precautions taken. 1. Answer each question within the section. All answers must be YES or N/A in order to 2. Check the type of material that does or may contain asbestos. Use the section marked other to denote a type of material not listed Rev.3/ Company Safety Philosophy

11 3. As applicable, the Competent Person ensures the jobsite asbestos-containing materials involved and jobsite conditions fall within the Negative Exposure Assessment (NEA). Mark N/A if the contractor does not possess a current NEA. Answer must be YES or N/A in order to 4. Ensure the District Environmental Team is informed of removal activities prior to work beginning. Answer must be YES in order to 5. As applicable, ensure that all agency notifications are made prior to work beginning. Mark N/A if no notifications are required. Answer must be YES or N/A in order to 6. As applicable, indicate whether or not the contractor possesses the license(s) required by state/local agencies. Consult with District Environmental Team members or HSS Coordinator to determine applicable licensing requirements. Mark N/A if no licenses are required in your area. Answer must be YES or N/A in order to 7. Ensure the contractor possesses a site-specific asbestos abatement plan. The Colonial Representative should review the safety measures of the plan with the contractor prior to work beginning. Answer must be YES in order to 8. Ensure contractor employees have the applicable training required to conduct removal activities. Answer must be YES in order to 9. Printed name of the Competent Person that will remain at the job site during all removal activities Hot Work Completion of this section is required if the task or job involves any activity or equipment that may generate sparks, excessive heat, or open flames; including cutting, welding, brazing, grinding, etc. The Hot Work section shall be completed by the Hot Work Permit Supervisor during his/her inspection of the Hot Work area. In most cases, the Hot Work Permit Supervisor is the Contract Supervisor, Foreman, or Lead Welder. Upon Completion and before hot work begins, the Hot Work Permit Authorizer shall authorize the hot work after inspecting the hot work area and determining that all protections are in place in order to complete the work safely. In most cases, the Hot Work Permit Authorizer is the Colonial Representative and may be a Technician, Inspector, Corrosion Technician, or Lead Operator. Rev.3/ Company Safety Philosophy

12 1. Answer each question within the section. All answers must be YES or N/A in order to 2. As applicable, notify and discuss the work to be performed with the appropriate facility Operator, stub-line Operator, or notify and discuss the work to be performed with the appropriate line Controller. 3. As applicable, indicate the system or line that work is being done on. 4. As applicable, indicate pipeline time work is to begin and end. 5. As applicable, ensure that the work area is checked for the presence of product. Mark N/A if the task or job does not involve potential exposures to product. Answer must be YES or N/A in order to 6. Ensure that atmospheric monitoring results indicate safe working levels. Answer must be YES in order to 7. As applicable, ensure that continuous air monitoring is in-place at all times during hot work. Answer must be YES or N/A in order to 8. Ensure fire extinguishers are pre-inspected and on site.. Answer must be YES in order to 9. As applicable, ensure that proper line pressure is established with the Control Center for line welding. Mark N/A if not welding on the pipeline or if the pipeline segment is properly isolated. Answer must be YES or N/A in order to Rev.3/ Company Safety Philosophy

13 10. Ensure and document that adequate fire protection is on site including, size, type and quantity of fire extinguishers 11. As applicable, ensure that all generators, compressors, and welding machines are properly grounded and verified. Mark N/A if the task or job does not require use of such equipment. Answer must be YES or N/A in order to 12. As applicable, ensure that all air compressor airline couplings have safety clips and whip checks installed. Mark N/A if the task or job does not require the use of an air compressor. Answer must be YES or N/A in order to 13. As applicable, ensure that all compressed gas cylinders are secured outside of the work area. Mark N/A if compressed gas cylinders are not required for the task or job. Answer must be YES or N/A in order to 14. As applicable, ensure that flashback arrestors and backflow preventers are properly installed on all torch systems. Mark N/A if torch systems are not required for the task or job. Answer must be YES or N/A in order to 15. As applicable, ensure that spark travel is controlled by barriers, curtains, or other means. Mark N/A if the task or job does not involve potentials for spark travel. Answer must be YES or N/A in order to 16. As applicable, ensure that all combustible and flammable materials are a minimum of 35 feet away from the work area or are covered. Mark N/A if combustible and flammable materials are not present at the work area. Answer must be YES or N/A in order to. 17. As applicable, ensure that all welding leads, hoses, and electrical cords are in good condition. Mark N/A if the task or job does not require the use of welding leads, hoses, or electrical cords. Answer must be YES or N/A in order to 18. As applicable, ensure that all affected employees are informed of NDT testing and x-ray activities; and ensure that x-ray area(s) are properly isolated and barricaded using warning signs and barriers. Mark N/A if x-ray activities are not required for the task or job. Answer must be YES or N/A in order to Note as applicable, ensure that all required pre-work state/local notifications are made in advance of NDT testing and x-ray activities. 19. As applicable, ensure that all areas where product/vapors could be trapped (false bottoms, pontoons, low piping, etc.) have been identified and de-gassed. Mark N/A if the task or job does not involve working on or near such areas. Answer must be YES or N/A in order to Rev.3/ Company Safety Philosophy

14 20. As applicable and if operationally possible, ensure that the line segment has been purged with distillate and/or nitrogen. Mark N/A if the task or job does not involve hot work on active piping. If not operationally possible, mark N/A and document hazard mitigation strategies on JSA. Answer must be YES or N/A in order to proceed with hot work 21. As applicable, ensure that the work area has been isolated from active piping/flow using blanks, blinds, etc. Mark N/A if line segment isolation using blank, blinds, etc. are not required for the task or job. Answer must be YES or N/A in order to proceed with hot work 22. Ensure that the work area is properly ventilated to prevent the accumulation of hazardous fumes/smoke; utilize forced ventilation as-needed; and as applicable, ensure that all ventilation equipment is properly grounded. Mark N/A if the task or job does not require the use of ventilation equipment. Answer must be YES or N/A in order to 23. As applicable, ensure that the fire watch is maintained for a minimum of ½ hour after work is completed. Answer must be YES or N/A in order to 24. Signature and printed name of the Hot Work Permit Supervisor. Supervisors are responsible for the safe handling and use of all hot work equipment. By signing, the Supervisor attests that he/she has inspected the hot work area to identify combustible materials and hazardous areas present or likely to be present in the area; and that combustible materials are protected from ignition. Upon completion of their inspection, Supervisors shall secure authorization for the hot work operations from the Hot Work Permit Authorizer In most cases, the Hot Work Permit Supervisor is the Contract Supervisor, Foreman, or Lead Welder 25. Signature and printed name of the Hot Work Permit Supervisor. Supervisors are responsible for the safe handling and use of all hot work equipment. By signing, the Supervisor attests that he/she has inspected the hot work area to identify combustible materials and hazardous areas present or likely to be present in the area; and that combustible materials are protected from ignition. Upon completion of their inspection, Supervisors shall secure authorization for the hot work operations from the Hot Work Permit Authorizer In most cases, the Hot Work Permit Authorizer is the Colonial Representative and may be a Technician, Inspector, Corrosion Technician, or Lead Operator. Rev.3/ Company Safety Philosophy

15 Trenches and Excavations Completion of this section is required if the task or job involves excavation of any depth. 1. Answer each question within the section. All answers must be YES or N/A in order to 2. As applicable, ensure that one-call 811 notification has been made in advance of excavation as required. Answer must be YES or N/A in order to 3. Document one-call ticket number in the space provided 4. Ensure that the Competent Person will remain on site at all times while work is performed in the excavation. Answer must be YES in order to 5. Printed name of the Competent Person 6. Ensure Site-Specific Excavation and Backfill Plan is completed in accordance with Colonial s Excavation and Backfill Procedure and that the plan remains on-site. A Plan must be completed for each task or job that involves excavations regardless of its depths. The plan must be modified as-needed to reflect changes to the plan. The Competent Person is responsible for developing and modifying the plan. Input from excavation Operators and other team members should be obtained. As needed, document additional information on the Job Safety Analysis (JSA). Answer must be YES in order to 7. As applicable, ensure all utilities and underground piping are located and properly marked. Mark N/A if there are no utilities or underground piping in the area. Answer must be YES or N/A in order to Rev.3/ Company Safety Philosophy

16 8. As applicable, ensure that excavation evacuation routes are prepared and identified. Mark N/A if workers will not enter excavation. Answer must be YES or N/A in order to 9. As applicable, ensure that all workers have unobstructed ingress and egress within 25 feet inside of the excavation. Mark N/A if workers will not enter excavation. Answer must be YES or N/A in order to 10. As applicable, ensure that all ladders are properly secured at the top of the excavation and that all ladders extend at least three feet above the top edge of the excavation surface. Mark N/A if the excavation does not require ladders for ingress/egress. Answer must be YES or N/A in order to 11. As applicable, ensure all fittings are located and properly flagged and or protected. Mark N/A if there are no fittings in the area. Answer must be YES or N/A in order to proceed with work 12. As applicable, ensure that the excavation has been evaluated for confined space characteristics. See Confined Space Entry safety practices for additional details. Mark N/A if the excavation will not be entered by employees. Answer must be YES or N/A in order to 13. As applicable, ensure that appropriate employee protection measures (trench box, sloping, shoring, etc.) based on excavation depth and soil type. Mark N/A if the excavation will not be entered by employees. Answer must be YES or N/A in order to 14. As applicable, ensure that spoil piles and equipment are placed at least two feet away from edges of excavation. Answer must be YES or N/A in order to 15. As applicable, ensure that all third party excavations are completed in accordance with NOP-ROW-005. Mark N/A if the excavation is not a third party excavation. Answer must be YES or N/A in order to 16. As applicable, ensure that Excavation Soil Classification Form is completed in order to properly classify soil type and document soil testing results. Documentation and testing are not required if the soil is classified as Class C/Option 1. Mark N/A if the soil will be classified Class C/Option 1 or if the excavation is less than 4 feet in depth. Answer must be YES or N/A in order to Rev.3/ Company Safety Philosophy

17 17. As applicable, employers must ensure that a competent person inspects all excavations, adjacent areas, and protective systems daily for possible cave-ins, indications of failures in protective systems and equipment, hazardous atmospheres, and other hazardous conditions. Inspections must be done prior to the start of work and as needed throughout the shift. Inspections are also required after natural events, such as rainstorms, or other hazard-increasing occurrences, such as blasting work. If an inspector finds any unsafe conditions during an inspection, the employer must clear workers from the hazardous area until the necessary safety precautions have been taken. Mark N/A if workers will not enter excavation. Answer must be YES or N/A in order to 18. Completion of this section is required if the task or job involves the use of trench box or shoring. Answer each question within the section. All answers must be YES or N/A in order to 19. As applicable, ensure that all trench box and shoring components (locking pins, data plates, etc.) are present and are not damaged. Mark N/A if the excavation does not require trench box or shoring. Answer must be YES or N/A in order to 20. As applicable, ensure that trench box or shoring will extend at least 18 inches above the top edge of the excavation surface. Mark N/A if the excavation does not require trench box or shoring. Answer must be YES or N/A in order to 21. As applicable, ensure that the trench box meets or exceeds requirements for the excavation depth and soil type based on the trench box s tabulated data and that the trench box s tabulated data is on-site. Mark N/A if the excavation does not require a trench box. Answer must be YES or N/A in order to Cranes, Hoist, & Heavy Equipment Completion of this section is required if the task or job involves the use of cranes (including jib cranes), hoists, or heavy equipment such as (but not limited to) aerial lifts, dozers, side-booms, hoes, etc. 1. Answer each question within the section. All answers must be YES or N/A in order to 2. Ensure that daily pre-use equipment inspections are completed by the operator (typically accomplished by using inspection checklists provided by the vendor or by the contractor). Answer must be YES in order to Rev.3/ Company Safety Philosophy

18 3. As applicable, ensure that all rigging has been properly inspected by a qualified person prior to each use. Defective lifting devices shall be immediately removed from service. Mark N/A if the task or job does not require the use of lifting devices. Answer must be YES or N/A in order to 4. Ensure that all equipment appears to be in good working condition. Answer must be YES in order to 5. As applicable, ensure that proper clearance from overhead power lines is available. Mark N/A if the task or job does not involve potential exposures to overhead power line hazards. Answer must be YES or N/A in order to 6. As applicable, ensure a critical lift plan has been completed for lifts that either: (a) exceed 75% of the rated capacity of the crane or derrick; or (b) requires the use of more than one crane or derrick. Critical lift plans are typically provided by the vendor or contractor supplying the crane or derrick. Mark N/A if the task or job does not involve a critical lift. Answer must be YES or N/A in order to Abrasive Blasting (all) Completion of this section is required if the task or job involves abrasive blasting (including tank blasting). See the Abrasive Blasting safety practices for additional guidance. 1. Answer each question within the section. All answers must be YES or N/A in order to 2. As applicable, ensure that proper containment and other controls are in-place if lead is present (Blastox, etc.). Mark N/A if there are no potential exposures to lead. Answer must be YES or N/A in order to 3. As applicable, ensure that all areas where product/vapors could be trapped (false bottoms, pontoons, low piping, bell holes, trench bottoms, etc.) have been identified and de-gassed. Mark N/A if the task or job does not involve working on or near such areas. Answer must be YES or N/A in order to 4. Ensure that the blasting media to be used contains less than 2% silica. Answer must be YES in order to Rev.3/ Company Safety Philosophy

19 5. Ensure that atmospheric monitoring readings indicate safe work levels. Continuous air monitoring is required during all abrasive blasting activities. Answer must be YES in order to 6. Ensure that all blasting equipment, scaffolding, compressors, etc. are properly grounded in order to prevent static electricity. Answer must be YES in order to 7. Ensure that dead man controls are operational on all blasting nozzles. Answer must be YES in order to 8. Ensure that all supplied air to blasting hood(s) is equipped with carbon monoxide monitors and alarms. Answer must be YES in order to 9. Ensure that all airline couplings have safety clips and whip checks installed. Answer must be YES in order to Confined Space Entry Completion of this section is required if the task or job involves confined space entry permit or non-permit required. See the Confined Spaces safety practices for additional guidance. 1. Answer all of the first three questions in order to first determine if the space meets all characteristics of a confined space. If the answers to all of the first three questions are YES, proceed to the next part of this section. Answers to all of the first three questions must by YES in order to classify the space as a confined space. If any of the answers are NO, the space is not a confined space and the rest of the section is non-applicable 2. Verify whether or not the space is large enough for an employee to enter 3. Verify whether or not the space is designed for continuous human occupancy Rev.3/ Company Safety Philosophy

20 4. Verify whether or not the space has limited means of entry or exit 5. Answer all of the next four questions in order to determine if the space meets any of the characteristics of a permit-required confined space. If the answers to any of these four questions are YES, the space is initially considered a permit required confined space. Permit-required confined spaces may be reclassified as non-permit required confined spaces using the instructions listed below 6. Verify whether or not the space contains or has the potential to contain hazardous atmospheres 7. Verify whether or not the internal configuration is such that an entrant could be trapped 8. Verify whether or not there is a potential hazard of engulfing an entrant 9. Verify whether or not the space contains any serious safety or health hazards 10. Answer all of the next seven questions in order to verify that hazards have been mitigated or eliminated in order to reclassify the space to a non-permit-required confined space. Document all hazard control strategies on the JSA. If any of the answers are YES, consult the Confined Spaces safety practices for Permit-Required Confined Space Entry requirements; OR, answer the following questions in order to reclassify the space to a non-permit-required confined space. If all of the answers are NO, proceed to the next part of this section 11. Answers to all of the questions must be YES or N/A in order to re-classify the space 12. As applicable, ensure that all atmospheric hazards have been mitigated or eliminated; and that respirators are not required for entry. Mark N/A if the space never contained or had the potential to contain atmospheric hazards. Answer must be YES or N/A in order to 13. Ensure that continuous air monitoring is in place at all times during entries. Continuous air monitoring is required while working within all confined spaces. Answer must be YES in order to 14. As applicable, ensure that the space has been isolated from active piping/flow using blanks, blinds, etc. Mark N/A if isolation from active piping/flow is not required for the task or job. Answer must be YES or N/A in order to 15. As applicable, ensure that all potential energy sources are isolated and locked-out. Mark N/A if LOTO is not required for the task or job. Answer must be YES or N/A in order to Rev.3/ Company Safety Philosophy

21 16. Ensure that the space meets all CPC safety practices requirements to reclassify from permit-required to non-permit-required. See the Confined Spaces safety practices section for the requirements. Answer must be YES in order to 17. Ensure that all serious safety and health hazards have been controlled or eliminated as documented on the JSA. Answer must be YES in order to 18. Ensure that continuous air monitoring is in place at all times during entries. Continuous air monitoring is required while working within all confined spaces. Answer must be YES in order to 19. Document whether the space is a Non-Permit-Required Confined Space or a Permit- Required Confined Space Abrasive Blasting on Tanks Completion of this section is required if the task or job involves abrasive blasting of tanks. See the Abrasive Blasting and Safe Tank Work safety practices for additional guidance. Lead 1. Answer each question within the section. All answers must be YES or N/A in order to 2. As applicable, ensure that the tank is out-of-service and cleaned; OR is isolated, locked out, and filled to safe working capacity according to CPC safety practices guidelines. Mark N/A if not abrasive blasting on a tank. Answer must be YES or N/A in order to 3. As applicable, ensure that all tank vents in the work area are sealed off; OR that open vents are stacked a minimum of 8 feet high. Mark N/A if not abrasive blasting on a tank. Answer must be YES or N/A in order to 4. As applicable, ensure that tank valves are locked out during blasting operations. Mark N/A if not abrasive blasting on a tank. Answer must be YES or N/A in order to proceed with work 5. As applicable, ensure that all pontoon hatches are secured and other openings (such as legs) are adequately sealed. Mark N/A if not abrasive blasting on a tank. Answer must be YES or N/A in order to Rev.3/ Company Safety Philosophy

22 Completion of this section is required if the work to be performed will or may expose workers to lead. 1. Prior to cutting, abrasive blasting, grinding, pressure-washing, or hydro-blasting any painted surface, the paint/primer must be tested for lead content unless the surface has been previously tested and is known to not contain lead. If abrasive agents will not be used, the coating does not contain lead, and primer will not be disturbed (removing paint only), this section does not apply 2. Indicate the results to pre-work testing for lead content. If testing does indicate the presence of lead, proceed to next section of the permit 3. Answer each question within the section. All answers must be YES or N/A in order to 4. As applicable, indicate whether or not the contractor possesses the license(s) required by state/local agencies. Consult with District Environmental Team members or HSS Coordinator to determine applicable licensing requirements. Mark N/A if no licenses are required in your area. Answer must be YES or N/A in order to 5. Ensure the contractor possesses a site-specific lead abatement plan. The Colonial Representative should review the safety measures of the plan with the contractor prior to work beginning. Answer must be YES in order to 6. Ensure appropriate warning signs are placed at all entrances to the regulated area. Answer must be YES in order to Ladders, Fall Protection, Aerial Lifts, and Scaffolding Completion of this section is required if task or job involves potential falls from heights of four feet or higher, thus requiring personal fall protection; or if the task or job involves the use of aerial lifts or scaffolding. Rev.3/ Company Safety Philosophy

23 1. Answer each question within the section. All answers must be YES or N/A in order to 2. As applicable, ensure that all walking-working surfaces of four feet or higher are equipped with proper railing; OR that 100% tie-off policy is implemented. Mark N/A if there are no exposures to walking-working surfaces of four feet or higher. Answer must be YES or N/A in order to 3. As applicable, ensure that all open floor and/or wall holes are properly covered or barricaded. Mark N/A if the task or job does not involve exposures to open floor and/or wall holes. Answer must be YES or N/A in order to 4. As applicable, ensure that only extra-heavy-duty, industrial type 1A rated fiberglass ladders/step ladders are used. Wooden and metal ladders are, however, allowed for use in trenches for jobs on the Right of Way. Mark N/A if the task or job does not require the use of ladders. Answer must be YES or N/A in order to 5. As applicable, ensure that ladders are equipped with anti-slide shoe devices; and that ladders are properly positioned and secured. Step ladders shall only be used in their extended positions (not folded in). The tops of step ladders shall not be used as steps. Mark N/A if the task or job does not require the use of ladders. Answer must be YES or N/A in order to 6. As applicable, ensure that access to all ladders is unobstructed; and that all ladders extend at least three feet above the top edge of the platform or excavation surface. Mark N/A if the task or job does not require the use of ladders. Answer must be YES or N/A in order to 7. As applicable, ensure that all aerial lift controls, indicators, nameplates, and markings are in place and legible. Mark N/A if the task or job does not require the use of aerial lifts. Answer must be YES or N/A in order to Rev.3/ Company Safety Philosophy

24 8. As applicable, ensure that personal fall protection equipment properly inspected prior to donning. Mark N/A if fall protection equipment is not required. Answer must be YES or N/A in order to 9. As applicable, ensure that all aerial lift operators are properly trained. Mark N/A if the task or job does not require the use of aerial lifts. Answer must be YES or N/A in order to 10. As applicable, ensure that daily pre-use equipment inspections are completed by the aerial lift operator (typically accomplished by using inspection checklists provided by the vendor or by the contractor). Mark N/A if the task or job does not require the use of aerial lifts. Answer must be YES or N/A in order to 11. As applicable, ensure that 100% tie-off policy is implemented while in aerial lift baskets. Mark N/A if the task or job does not require the use of aerial lifts. Answer must be YES or N/A in order to 12. As applicable, ensure that all scaffolding is equipped with proper top-rails, mid-rails, and toe boards. Mark N/A if the task or job does not require the use of scaffolding. Answer must be YES or N/A in order to 13. As applicable, ensure that all scaffold planking is properly secured to prevent movement. Mark N/A if the task or job does not require the use of scaffolding. Answer must be YES or N/A in order to 14. As applicable, ensure that daily pre-use inspections are completed on all scaffolding (typically accomplished by using inspection checklists provided by the vendor or by the contractor). Mark N/A if the task or job does not require the use of scaffolding. Answer must be YES or N/A in order to 15. As applicable, ensure that all scaffolding is erected under the direction of a competent person. Mark N/A if the task or job does not require the use of scaffolding. Answer must be YES or N/A in order to Line Separation Completion of this section is required if the task or job requires the opening of the pipeline or any of its associated systems to the atmosphere. See the Static Electricity and Bonding safety practices for additional guidance. Rev.3/ Company Safety Philosophy

25 1. Ensure that a Colonial employee is present when a line is separated and/or open to the atmosphere. In the event of multiple locations on a single job, they may oversee several location with the aid of additional Colonial designated representatives 2. Answer each question within the section. All answers must be YES or N/A in order to 3. Ensure that all of the proper lines, valves, and or equipment are identified. Answer must be YES in order to 4. Ensure that bonding cable(s) are placed across the line separation in order to prevent the potential for static discharge. Answer must be YES in order to 5. Ensure that continuous air monitoring is in place at all times while the line or component is open to the atmosphere. Answer must be YES in order to proceed with work 6. Ensure that the drain-up/drain-down of the line or component is independently verified and that the line or component is empty. Answer must be YES in order to proceed with work 7. Ensure that adequate fire extinguisher(s) is/are on-site and dedicated fire watch personnel are assigned. Answer must be YES in order to 8. As applicable, ensure and verify that all vacuum trucks are properly grounded. Mark N/A if the task or job does not require the use of a vacuum truck. Answer must be YES or N/A in order to 9. As applicable, ensure that all rectifiers are turned OFF and locked out. Mark N/A if rectifiers are not associated with the line or component. Answer must be YES or N/A in order to 10. As applicable, ensure that the line or component is blinded or blanked as-necessary. Mark N/A if the task or job does not require blinding or blanking. Answer must be YES or N/A in order to Rev.3/ Company Safety Philosophy

26 11. Ensure that all drip/catch containers are made of metal. Plastic or rubber containers are prohibited. Ensure that all drip/catch containers are bonded to the pipe and are also grounded. Answer must be YES in order to 12. As applicable and if operationally possible, ensure that the line or component is isolated by double-blocking and that the valves are locked out both up- and down-stream. If not operationally possible, mark N/A and document hazard mitigation strategies on JSA. Answer must be YES or N/A in order to 13. As applicable and if operationally possible, ensure that the line has been purged with distillate and/or nitrogen. Mark N/A if the task or job does not require a line purge. If not operationally possible, mark N/A and document hazard mitigation strategies on JSA. Answer must be YES or N/A in order to Lockout/ Tagout Completion of this section is required if the task or job requires the de-energization and isolation of equipment, machinery, pipeline segments, or their associated systems. Refer to the Lockout/Tagout (LOTO) Program safety practices for additional information and instructions. 1. Answer each question within the section. All answers must be YES or N/A in order to 2. Ensure that all energy isolation devices are properly installed. Answer must be YES in order to 3. Ensure that all energy sources (primary and alternate) are identified and isolated. Answer must be YES in order to 4. As applicable, ensure the buddy system is used for the de-energization and isolation of electrical devices greater than 600 volts. Mark N/A if the task or job does not require work isolation of electrical devices greater than 600 volts. Answer must be YES or N/A in order to Rev.3/ Company Safety Philosophy

27 5. As applicable, ensure that only trained and qualified workers are within ten feet of exposed electrical circuits greater than 50 volts. Mark N/A if the task or job does not involve work within 10 feet of exposed electrical circuits greater than 50 volts. Answer must be YES or N/A in order to 6. As applicable, ensure that blanks and/or blinds are properly installed to isolate equipment or line segment from active systems. Mark N/A if blanks and/or blinds are not required for the task or job. Answer must be YES or N/A in order to proceed with work 7. Ensure that all crew members and Affected Employees are afforded the opportunity to affix their personal locks and/or tags to energy isolating devices. Answer must be YES in order to 8. As applicable, ensure that all applicable LOTO procedures will be followed for the task or job. Mark N/A if the task or job does not have associate LOTO procedures. If procedure needs to be developed, notify the Team Leader. Answer must be YES or N/A in order to 9. As applicable, walk down the LOTO with all contractor supervisors/foremen in order to provide verification of energy isolation to the contractor(s). Mark N/A if the task or job does not involve contractors. Answer must be YES or N/A in order to 10. As applicable, verify drain-up or drain-down by ensuring that equipment and piping is free of product. Mark N/A if the task or job does not require drain-up/down. Answer must be YES or N/A in order to 11. As applicable, ensure all affected employees are notified prior to completing LOTO. Mark N/A if no employees (other than the work crew) will be affected by the task or job. Answer must be YES or N/A in order to 12. As applicable, ensure all equipment and pipelines are properly shut down. Mark N/A if the task or job does not require the shutdown on any equipment or pipelines. Answer must be YES or N/A in order to 13. Test (attempt to energize) each piece of equipment or machinery in order to verify deenergization and isolation. Answer must be YES in order to 14. As applicable, ensure that any stored energy has been relieved. Mark N/A if the task or job does not involve potential exposure to stored energy. Answer must be YES or N/A in order to Lockout/ Tagout Isolation Process Completion of this section is required if the task or job requires the de-energization and isolation of equipment, machinery, pipeline segments, or their associated systems. Rev.3/ Company Safety Philosophy

28 If one or more equipment-specific LOTO procedures address the de-energization and isolation of all potentially hazardous energy sources of the task or job, the appropriate procedure(s) may be affixed to the permit in lieu of completing this section. For large or complex tasks or jobs, formal LOTO plans that contain the same information below may be created and used in lieu of completing this section 1. List the name and location of all valves, switches, breakers, and other equipment isolated during LOTO. Ensure proper position/condition before placing equipment back into service. Initial appropriately. All verifications must be separated by time and distance from the time the steps were completed. For work spanning multiple days, the initial permit may be used to document this information. In these cases, write SEE INITIAL PERMIT below. Formal LOTO plans containing the same information below may be affixed to the permit in lieu of this section. Use initials for completion and verification blocks 2. Signature of the Colonial representative verifying the work 3. Name and location of each valve, switch, breaker, and other equipment placed out-ofservice to complete energy isolation 4. Initials of the person performing each isolation during the process 5. Initials of the independent verifier of each isolation during the process. Independent verification must be separated by time and distance from the isolation 6. Initials of the person removing each isolation device during the process 7. Initials of the independent verifier of each removal of isolating devices during the process. Independent verification must be separated by time and distance from the removal Job Safety Analysis (JSA) Rev.3/ Company Safety Philosophy

29 Completion of this section is required if the risk assessment of the task or job indicates the need for a formal Job Safety Analysis. A JSA created using JSA Builder or other media may be attached to the permit in lieu of completing this section. See the Job Safety Analysis safety practices for additional guidance regarding work requiring written JSAs. During the pre-job briefing, the JSA shall be reviewed with all involved employees. All involved employees shall be encouraged to offer input on JSA content. Upon review of the JSA and agreement on content, all employees shall sign the Employee/Contractor Notification and Identification Roster of the permit indicating that they have reviewed the JSA and understand what is required of them to perform the job safely. Employees should review the JSA at the completion of the task or job for future improvements. The JSA is intended as a resource or guideline to help ensure safe work. Work shall stop if worksite or environmental conditions change that may affect the task or job, or if a deficiency in the current JSA is found. The JSA shall be modified (or new JSA created) to reflect changing conditions or to correct deficiencies. 1. Name of the task or job 2. Name or location of the work area 3. Project, job, or AFE number 4. Date the JSA is completed 5. Document each task or procedure step involved in the task or job. If possible, conduct a walk-thru survey of the work area, then list all existing or potential hazards and possible reactions to failure for each task or procedure step 6. Document the corrective/preventive actions associated with each hazard/reaction to failure 7. List the references, resources, safety equipment, or tools needed to perform the job safely 8. Signature of the individual that developed the JSA 9. Printed last name of the individual that developed the JSA 10. Signature of the individual that reviews the JSA will all involved employees 11. Printed last name of the individual performing the briefing Rev.3/ Company Safety Philosophy

30 12. Date the JSA is reviewed with all involved employees Additional Employee Signatures This section may be filled out to record large numbers of contractor employees and/ or to track their entry of the facility or jobsite. Rev.3/ Company Safety Philosophy