Joint Operations CHESM Interim Performance Review Form. Interim Performance Review Related Information

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1 Joint Operations CHESM Interim Performance Review Form Interim Performance Review Related Information Contractor Company Name: Contract Number: Contract Title: Location: Number of employees supporting the contract: Completed on (dd/mm/yyyy): J.O. Contract Owner: J.O. HES Representative: Company Director/Manager: Phone: /Fax: Contractor Representatives: Site Supervisor: Phone: /Fax: HES Representative: Phone: / Fax: Participant 4: Participant 5: J.O. HES Representative Contract Owner Contractor Representative J.O. Representative J.O. HES Representative Contract Owner Contractor Representative J.O. Representative Version 1.0. Revised 3 August Printed 22 February Uncontrolled when printed. JO_CHESM_Interim_Evaluation_2009.doc

2 Data Provide HES performance data specific to the Chevron project/contract, not to exceed 3 years Year Year Year Total number of employee hours worked Number of work-related fatalities Number of injuries that resulted in restricted work activity Number of injuries that resulted in one or more days away from work Number of injuries and illnesses involving medical treatment Number of motor vehicle accidents Number of oil and chemical spills Annual percent (%) employee turnover rate Have you received any regulatory citation or been involved in any court litigation in the last three years? N/A Corrective Active Required Target Date 1 Safety/Health Performance Acceptable or N/A Needs Improvement 2 Environmental Performance Acceptable or N/A Needs Improvement 3 Significant Events Acceptable or N/A Needs Improvement 4 Annual percent (%) employee turnover rate Acceptable or N/A Needs Improvement 5 Regulatory or court litigation Acceptable or N/A Needs Improvement Performance Indicators 6 Key Performance Indicators Defined Acceptable or N/A Needs Improvement 7 Key Performance Indicators Achieved Acceptable or N/A Needs Improvement 3.1 HES Organization: Does our organization have the following: 8 A director or senior manager responsible for HES

3 N/A Corrective Active Required Target Date 9 Does your organization have a part/full time position assigned HES responsibilities? 3.2 HES Benefits: Do you have or provide for your employees: 10 Do you have or provide for your employees Medical insurance? 11 Do you have or provide for your employees HES Training? 3.3 HES Targets: What are your company s annual HES targets in: 12 Safety: Determined or t Determined 13 Health: Determined or t Determined 14 Environment: Determined or t Determined 3.4 HES Written Plan: Plan include: Plan include HES policy and management commitment and expectations? Plan include Clearly defined HES responsibilities and accountabilities for managers, supervisors, and employees? Plan include Resources for meeting HES requirements?

4 N/A Corrective Active Required Target Date 18 Plan include periodic management system review of key processes, procedures, and standards to ensure compliance and performance? 19 Plan include Document control and record retention process? 20 Plan include Written safe work procedures specific for your work? 21 Plan include Written safe work procedures specific for your work? N/A 22 Plan include an Inspection / Audit program? 23 Plan include Hazard identification and risk control? 3.5 Employee Engagement: Periodic HES performance appraisals for all employees Do your employees participate in team activities to improve HES performance? Do your employees have the authority to stop work for safety reasons?

5 N/A Corrective Active Required Target Date 27 Are HES issues, inspection results, investigation results and learning communicated to employees? 3.6 HES Meetings: Do you hold periodic HES Meetings that include: 28 Do you hold daily toolbox safety meetings? 29 Do you hold periodic HES Meetings that include Field Supervisors? 30 Do you hold periodic HES Meetings that include Employees? 31 Do you hold periodic HES Meetings that include Subcontractors? Are the HES meetings documented with minutes and attendees list? Do Managers participate in safety meetings? (job titles?) 3.7 Sub-Contractors: 34 Does your company use sub-contractors? Is there a written Contractor Safety Management Process? (1. Pre qualification and/or selection; 2. Pre job activities and work in progress; 3. Final) Do you use HES performance criteria in selection of subcontractors? N/A N/A

6 N/A Corrective Active Required Target Date 37 Do you evaluate the ability of subcontractors to comply with applicable HES requirements as part of your selection process? N/A 3.8 Inspections and Audits: 38 Do you have a written inspection/audit procedure? Do you conduct selfinspection and audits and document them? Do you track/measure corrective actions to verify completion within assigned time? Describe the verification process. 3.9 Hazard Identification and Control: Do you have a documented process to identify work-related hazards including task, work location, natural conditions, and materials? Are procedures developed based on the hazards identified to mitigate the risk to employees? (Look for a what-if clause in procedures) 3.10 Incident Reporting, Investigation and Statistical Data: 43 Do you have a written process to report, investigate, and record incidents? 44 Does your process provide a technique for root cause analysis?

7 N/A Corrective Active Required Target Date Do you have a process in place to track recommendations and corrective actions to completion within the assigned time? Provide verification method. Does your company have a process to share lessons learned on incidents and near misses? 3.11 Behavior-Based Safety: 47 Do you have a behavior-based safety (BBS) process in place? 3.12 Personal Protective Equipment (PPE): 48 Do you have a written PPE program that includes 1. PPE use, 2. PPE care and maintenance, 3. PPE selection. 0 for ; 0.3 for 1 only; 0.7 for 1 a 49 Is the program communicated to all employees? Though: 1. HES Induction 2. Safety Meetings, 3. PPE Training. 0 for ; 0.3 for 1 program only; Do you provide the required PPE for the jobs that you perform? 0 for ; 0.3 for 33% of required PPE distributed; 0.7 for 67% of required PPE.

8 N/A Corrective Active Required Target Date 3.13 Regulatory Compliance: 51 Do you know the HES related government and local regulations pertaining to your work? If you do, please list titles of the regulations Pollution Prevention: Does your company have waste management plans? Have your waste streams been identified? 0 for ; 0.3 for only less than 33% plan implemented to identified waste; 0.7 for up-to 67%. Do you have a sitespecific spill prevention program? N/A N/A N/A 3.15 Emergency Preparedness and Response: 55 Do you have written site-specific emergency response plans? 56 Do you document emergency response training and drills? 0 for no; 0.3 for having training OR drills; 0.7 for having training & drills. 4.1 Short-Service Employee (SSE): employees new to your company or new in 57 Do you have documented SSE program? 0 for ; 0.3 for SSE procedure; 0.7 for induction; 1.0 for induction & mentoring.

9 N/A Corrective Active Required Target Date 4.2 Craft Training: Have employees been trained in appropriate job skills? 0 for ; 0.3 for training matrix; 0.7 for training matrix & record; 1.0 for training. Are employees job skills certified where required by regulatory or industry standards? 0 for ; 0.3 for training matrix; 0.7 for training plan. 4.3 Health, Environmental and Safety Orientation: 60 Do you have a HES orientation program for newly hired employees? 61 Does your orientation program include the requirements as agreed in the contract HES exhibit? 0 for ; 0.3 for 33% compliance; 0.7 for 67% compliance. 4.4 Health, Environmental and Safety Training Content: 62 Do you know the local regulatory & Chevron HES training requirements for your employees? 63 Have your employees received the required HES training & retraining? 0 for no; 0.3 for inconsistent implementation; 0.7 for consistent training.

10 N/A Corrective Active Required Target Date 64 Do you provide specific supervisory HES training for new supervisors and refresher training for existing supervisors? 0 for no; 0.3 for training program 65 General safe work practices? 66 Environmental protection? N/A 67 Hazard identification and control? Equipment lock-out and tag-out (LOTO)? Permit-to-work procedures? Fall protection? N/A N/A N/A

11 N/A Corrective Active Required Target Date 71 personal protective equipment? Vehicle/Driving safety Electrical equipment grounding? N/A N/A 74 Incident reporting and Investigation? 75 Emergency preparedness and response? 4.5 Training Records: 76 Do you have HES crafts training records for each individual employee that include employee identification, date of training and name of trainer? 5.1 Medical Services: 77 Do you have a process to provide medical treatment for your employees?

12 N/A Corrective Active Required Target Date 5.2 Medical Examination: 78 Do you conduct medical exams for employees for preplacement job capability? (1. General check-up, 2. Work specific check-up) N/A 5.3 Substance Abuse: 79 Do you have a substance abuse monitoring program? N/A 5.4 Industrial Hygiene (IH): 80 Do you perform IH monitoring on your employees? (1. Procedure available, 2. Inconsistent implementation, 3. Consistent implementation)? N/A 81 Do you a hearing conservation program with annual testing? N/A 6.1 General: Do you maintain updated and accessible MSDS for paints and chemicals? 0.3 for updated MSDS; 0.7 for uneasy to access updated MSDS. Does your company have a motor vehicle safety policy and process? For 6.1.b & 6.2.a & b. Type: X in the box. 0 for no; 0.3 for having procedure N/A

13 N/A Corrective Active Required Target Date 6.2 Equipment: Do you conduct, document and follow up inspections on operating equipment (e.g., cranes, forklifts) Do you maintain operating equipment in compliance with regulatory requirements including certification, calibration, maintenance system, etc. N/A N/A

14 J.O. Contract Owner: Date reviewed with Contract Owner: Corrective actions to be completed by: Dates mentioned above Contract firm informed of results? Name informed: Date: Contract firm to remain on re-selection bid list? Date: J.O. HES Representative J.O. Contract Owner Participant: 3 Participant: 4 Participant: 5

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