Project Name: Location of Work: Brief Description of Work: Subcontractor Name: Planned Start Date: Planned Completion Date: Date:

Plan Submitted By: David A Smith

Included N/A

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Project Key Personnel and Emergency Contact List Contractor's Basic Safety Information Page Competent Persons List Contractor's Summary Construction Schedule (One Page) Pre-Construction Jobsite Safety Inspection Form Construction Execution Plan Document Safety Procedures and Plans Safety & Reliability Plan for Working around Operating Equipment Request for Items Requiring Special Approval

Client : ______________________________________________________Date: ______________________

Berry Y&V Project Manager: ______________________________ Date: ____________________ Berry Y&V HSE&S Director: ______________________________________ Date: _____________ Project HSE: ________________________________________ Date: _____________________
After last person reviews and sign-offs on plan make copies and distribute to all signatories.


CONSTRUCTION SAFETY EXECUTION PLAN PROJECT KEY PERSONNEL AND EMERGENCY CONTACT LIST Contractor's Key Personnel Position/Title Project Manager Name Work Phone Home Phone Pager/Cell Fax Construction Manager Craft Superintendents HSE Manager Admin Assistant CLIENT Key Personnel Position/Title Project Manger Name Work Phone Home Phone Pager/Cell Fax Project Engineer Project HSE 2 .

shut down all equipment in an orderly manner. and report the information needed to be accounted for. All telephone contact will be kept to a minimum as to prevent interference with Emergency Responders. Once there they will make an effort to check-in with appropriate supervision. with keys remaining in the ignition and proceed to the assembly area to check in. report to the assembly areas and check in with their supervisor. Each supervisor will take a roll call and account for everyone on his or her crew. Each supervisor will report to BYV HSE or Project Management as to the accountability of his or her crew. BYV personnel will remain at the assembly area in an orderly fashion and wait for further instructions from BYV or Client HSE or Emergency Response representative.CONSTRUCTION SAFETY EXECUTION PLAN ______ ______ Project Name Contractor's Name EMERGENCY INFORMATION Resource Needed Name of Resource Telephone Number Medical Site Medical Facility Ambulance Designated Physician Address Hospital Address ______________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ Fire or Release Fire Department _________________________________________________________ HSE Incident Berry Y&V HSE Client Contact _________________________________________________________ _________________________________________________________ Evacuation Plan When an evacuation is necessary Berry Y&V will verify that all confined spaces are clear. 3 . All vehicles will pull over.

the Contractor has named the following personnel as the Competent Persons for this project. Cutting & Grinding Hot Taps Excavations Scaffolding Name Job Title Copies of this List will be posted at the worksite so all workers understand who the Competent Persons are. 4 . Expertise Cranes Fork Lifts Equipment Electrical X-Ray Ladders Fall Protection Rigging Steel Erection Welding.CONSTRUCTION SAFETY EXECUTION PLAN COMPETENT PERSONS LIST Project Name Contractor's Name After review of formal training received and on-the-job experience.

Bolts. y Develop a Logistics Plan for the Work Area. steam.CONSTRUCTION SAFETY EXECUTION PLAN PRE-CONSTRUCTION JOBSITE SAFETY INSPECTION FORM This form is used to walk down areas where Construction will be taking place in the near future. y Identify work areas hazards so they can be addressed in the Construction Execution Plan Document.etc) Temporary piping Electrical Cords Dismantled Equipment / Piping Tools and Equipment Old Scaffolding Trash Bins / Barrels Full Sheet Metal / Steel / Wire Boards and Nails Water and Algae Oil Leaks and Spills Discarded Nuts. Material Storage. etc. Project: Area Being Inspected: Jobsite Inspected by: HSE Manager Construction Manager Superintendent(s) Date Inspected: Projected Field Start Date: Potential Hazard Uneven/Slick Walking Surface Climbing Hazards (not Burns) Hoses (water. Gaskets Electrical Scrap Miscellaneous Trash Safety Showers in need of repair PASS FAIL Potential Hazard PASS FAIL Potential Falling Objects Unsecured Equipment / Piping Trash on Platforms / Structures General Appearance Valve Wrenches laying around Cut / Puncture Hazard Pinch Points Platform / Structure Damaged Lighting Inadequate Hot Lines / Equipment Uninsulated Loose Insulation Process Leak(steam. N2. Describe Problem(s) Found Action Req By 5 .product.etc) Broken Concrete Fire Fighting Equip Inoperable Access Road in need of repair Warning Signs in need of repair Eye Wash Stations need repair Other (Explain Below) † Any items marked in the FAIL column require an explanation below. air. The purpose of the walk down is to: y Identify any existing hazards so that they can be eliminated before the work crews move in. Fab Area.

Mobilize equipment and personnel to Facility Attend all required trainings Prepare for material arrivals and secure lay down areas Prepare for abatement of possible lead. 3. UT. pipe shall start erecting pipe spools. Logistics to site to be preplanned by rigging and subcontractor. and trash. firewatch. Equipment will be mobilized to the proper locations with haul trucks and use of flagman. to complete the project from start to finish. Plan to be agreed upon by HSE Manager and Construction Manager. staged neatly and barricaded. Schedule. off loaded and neatly stored at site. material inside the fireboxes. This section uses five (5) main key points to help you plan your work. Remove trailers. 2. Prepare system packages including all documentation for start-up and or turnover 2. pressure to the test pressure designed per system. pumps. steel and supports as defined by contract Install vessels. and horn. 6. Add additional lines/pages as required to fully explain work scope): Berry Y&V scope of work is as follows: 1. and Scope of Work. Personnel will park in area as directed. The use of flagman and qualified riggers will fly materials. HOW WILL THE JOB/TASK BE PERFORMED? How will the tasks detailed in #1 be performed? What procedures will be used? What applicable Client Safety Standards are applicable to these specific tasks? Add additional lines/pages as needed. 7. Areas will be cleaned daily. Materials will be unloaded with a forklift and pickers. 6 . Qualified and trained people will be used in this work. Lines will be signed off with pre-walked papers before hydros. vest. Once grouted. steel. Task Mobilize personnel and trailers Mobilize equipment and materials Materials to work locations (Steel or Pipe) Fireboxes Steel or Pipe Welding Hydro Equipment Setting Entering Equipment Demobilization How Performed Trailers will be mobilized to proper location with haul trucks and the use of flagman. Fill lines. as appropriate. drain line water to safe location at grade. Steel will be plumbed and level. Unit. WHAT IS THE WORK REQUIRED TO COMPLETE THIS PROJECT? Location of the Project (Site. Have power and water from trailers disconnected. Materials to be trailered from laydown area to work site. Hazards involved in the job and Mitigation Strategies for those hazards. 4. in sequential order. Work to be done inside equipment will be done according to applicable Regulations & BYV procedures. according to contract requirements Conduct all required testing such as hydro. Remove leftover pipe. 5. TSA or asbestos materials according toClient Specifications Install new foundations. miscellaneous piping and equipment. Will be put in place by the use of cranes and pickers. signed off by QA/QC before grouting. x-ray. Enclose hot work area with fire blanket to contain sparks as necessary. fire extinguisher. 8. in-service. 1. etc. Fireboxes will be complete. It encompasses Safety. etc): How long will it take to complete the Job? List the work scope that will be required to complete the Project (Include a list of tasks required. welding machines grounded.CONSTRUCTION SAFETY EXECUTION PLAN CONSTRUCTION EXECUTION PLAN DOCUMENT This section contains the detailed written plans of how the job will be completed.

Equipment Operators(certified). binder straps. Truck driver is the only one to remove chains. etc. WHAT WILL BE USED TO PERFORM THE JOB/TASK? List Tools. Barricade working area. Spotter will be needed to lay out timbers with a fork lift and on the trailer to ensure good point of contact with load and forks. Size crane to each mechanical item to be set. Stairs/handrails on truck ladder. Personnel on trailer to move out of swing path or descend trailer in a safe manner. Scaffold Builders(skill tested) What Materials will be needed at the jobsite? Pipe Valves Gaskets Studs & Nuts Structural Steel E&I Materials Scaffold Materials Paint Hilti Bolts Hilti Epoxy Pipe Cradles Blinds Welding Gases Welding Rods Concrete Materials Carpentry Materials Grout Insulation Materials Are any of the materials special orders or require a long lead time? What Tools will be needed at the jobsite? Fully Stocked Tool Trailer Misc. etc. Firewatch/Attendants (skill tested). Pick load up in a safe manner. Pipe fitters (skill tested). Concrete Workers. Survey load on trailer to ensure safe material handling. Attach predetermined sized slings and shackles at specified locations on equipment. Guide truck and trailer to unloading area. Remove crane. Welders (certified). Clear swing path. Prep ground (surface mat if needed). Line equipment up and lower load completely down. Pipe loads will be required to have standards on trailers to prevent pipe roll off.Unloading steel and piping Survey load on trailer to ensure safe material handling. binder straps. Pipe loads will be required to have standards on trailers to prevent pipe roll off. Personnel on trailer to move out of swing path or descend trailer in a safe manner. Clear swing path. Set crane up level and stable. Swing load to the intended location. Planner/Cost Tracker. Guide truck and trailer to unloading area. Designated flagman for fork lifts and cranes. Hand Tools Chain Falls Assorted Consumables Come-A-Longs 7 . Loading steel and piping Setting mechanical equipment 3. Spotter will be needed to lay out timbers with a fork lift and on the trailer to ensure good point of contact with load and forks. Clean up work area. Ironworkers (skill tested). Equipment. Unhook rigging. QA/QC. Attach tag lines. Stairs/handrails on truck ladder. Truck driver is the only one to remove chains. Materials and Personnel that will be required/used to complete the project How many personnel are needed to complete this project? _________________________ What skills / craft level must they have? Construction Manager. HSE Manager. Designated flagman for fork lifts and cranes. Lower load slowly onto the anchor bolts. Carpenters(skill tested).

suspended loads. equipment damage Securing material to crane Operator blind spot. improper rigging Swinging material from staging area to work area Working from Manlifts Improper Operation . excessive heat Cutting with torch Fire potential. arc flashes. electrical shock kick-backs. control of load. airborne particulates. excessive noise. line rupture. ruptured hoses. eye injury. pinch points. gasket failure High/Low Voltage Unanticipated contact. damaged Grinding wheels Damaged rigging. electrical shock. electrical shock. exceeding rigging capacity. falling objects Bolt ups Eye injury.What Equipment will be needed at the jobsite? Trucks Rigging Equipment Tool Trailers Cranes Forklifts Welding Machines Hydro Test Pumps Man-lifts Air Compressors Small Hand Tools Scaffolding Does any of the Equipment require special ordering or reserving to ensure availability? 4. WHAT COULD HAPPEN WHEN PERFORMING THE TASK AND WHY? Task Working from scaffolds What could happen to cause an incident or injury? Fall. ruptured air hose Grinding Excessive noise. exceed pressure test level. pinch points Fall hazard 8 . excessive heat Hydrostatic testing Lines not isolated. scaffold collapse. fall hazard. damaged leads. congested area Exiting and entering Manlift basket onto structure Welding Fire potential. pinch points.

Verify valves are seated completely closed. leather gloves. inspect tools prior to use. pinch points. electrical shock Damaged rigging. congested area Fall hazard Fire potential. pinch points. damaged leads. O2 and acetylene bottles away from falling sparks. falling objects What will be done to prevent it from happening Wear harnesses W/lifeline. WHAT WILL BE DONE TO PREVENT THE POTENTIAL INCIDENTS IDENTIFIED IN #4 ABOVE? Incident That Could Occur Fall. barricade under work area Two people will go up in Manlift. lines will be depressurized before any bolts. keep body parts from between structure and material Use qualified & competent operators. keep hands from between socket. line rupture Moving equipment Use certified operators. keep body parts inside Manlifts. airborne particulates. sealed eye wear with a faceshield. use competent riggers Stay in radio or visual communication with operator at all times. Eye injury.5. inspect all connections prior to pressuring. make sure power lines are shielded. if using ½´ drive impact or larger. assure rigging is rated for the weight of the load. or plugs will be tightened. wear burning goggles or shaded faceshield while cutting with torch. excessive noise. keep area free of combustible materials. 100% tie off to inside of basket. position welding machines & leads out of harms way. use spotters when in close proximity. inspect hoses prior to use. install barricade. use GFCI at the source of power Inspect chokers & shackles prior to use. eye injury Lines not isolated. exceed pressure test level. double hearing protection. position hoses. fall hazard. Employee will reverse action to get back to basket. barricade under work areas. communicate with all personnel in area when moving Manlifts. ensure equipment is grounded. pinch points Operating Manlifts. spotter 9 . use tag line of sufficient length to control load. ruptured air hose Excessive noise. verify pressure rating prior to test. Contain sparks. lift and swing path to be kept clear of all personnel. keep area free of combustible materials. Contain sparks. improper rigging Operator blind spot. flanges & structure. exceeding rigging capacity. operator to sound audible warning during lift and swing. use spotter if necessary. ruptured hoses. control of load. remove all non-essential personnel from area. keep hoses away from pinch points and sharp edges Proper hearing protection. inspect tools before each use. barricade around lift & swing area. suspended loads. use O2/LEL Meters and Firewatch as required by permits. operator will stay in basket. scaffold collapse. employee will tie off to a proper anchorage point outside of the basket before leaving basket then untie from basket. use proper size retaining rings. electrical shock Fire potential. scaffold will be erected and inspected by a competent person to applicable standards and inspection tag will be updated by a worker trained in scaffold user inspections on a per shift basis. ground as close to work as possible. secure tools or place in bolt bag when not in use Sealed eyewear and faceshield while using impact.

CONSTRUCTION SAFETY EXECUTION PLAN SAFETY PROCEDURES AND PLANS y Injury and Incident Reporting and Documentation .Describe our standard of housekeeping and how it will be managed on a continuous basis: 10 . Include procedures for when work will be stopped/resumed: y Heat and Cold Stress Plans .How Berry Y&V will train workers and implement the JSA Process : y y Safety Meeting Schedule . Include plans for mitigating both: JSA Process .Provide a job specific heat/cold stress plans.List the daily and scheduled safety meetings and times: y Housekeeping Plan .Ensure workers are not in danger due to weather conditions.Procedures that will be used to report injuries and non-injury incidents: y Severe Weather Plan .

A copy of the Job Safety Analysis (JSA) in use during the time of the incident will be attached to the incident investigation. The first aid attendant will fill out the ³Medical´ portion of the Safety Incident report. Minor Injury/Illness (On Site Treatment) The First Aid Facility will be used for all non-emergency treatments. 11 .Injury/Incident Reporting and Documentation: Non-Injury Incidents (Near Miss) Personnel will follow the procedures outlined in the reporting of any non-injury incidents that could occur while working is this facility. Craft Supervisor. should problems arise after hours. Within 24 hours Berry Y&V will provide copies of the Employer¶s First Report of Injury/Illness and other reports as required. should problems arise after hours. and generate site incident reports before end of shift. and generate site incident report within 24 hours. Craft Supervisor & Contract Safety will investigate the Injury/Illness. All personnel will notify Project Safety Specialists immediately. to initiate the Safety Incident report and to pick up a Contractor Personal Injury/Illness Report Form. Berry Y&V and appropriate Project Management personnel will be immediately notified. An HSE representative will accompany the injured/ill employee offsite. A Medical Status Report report will be completed by a physician. Berry Y&V will review and update the report and ensure employee affected has all after-hours contact numbers in his/her hand. Injury/Illness (Requiring Offsite Medical Treatment) Before leaving the site. and is refreshed on proper protocol before leaving for the day. the First Aid Facility should be visited for an initial assessment. and is refreshed on proper protocol before leaving for the day. Berry Y&V Management. and generate site incident report by the end of the shift on the day of the injury/illness. This also includes any of our sub-contractors. Berry Y&V or Contractor Safety Representative will always escort the injured/ill employee to the First Aid Facility for treatment. & Contract Safety will investigate Near Misses. Berry Y&V Management will investigate the Injury/Illness. The Berry Y&V HSE Manager. Berry Y&V will ensure affected employee has all contact numbers in his/her hand.

injure or damage. such as on structural steel members. 12 . limited visibility due to dust or particles in the air.) supervision will stop work activities. High Winds and Rain: When the winds or rain become a hazard to the work force or the work being performed. Berry Y&V Site Manager will make the call as to when all rain-outs are determined. wire. reassign work duties and/or areas. pipe-racks. poor visibility due to hazard. electrical discharge in the atmosphere. and equipment. and boards/plywood. Severe Weather Responsibilities Lighting y y y y y Avoid exposing personnel at high elevations. the visible flash of light accompanying such discharge. antennas. process columns. rope. high tension. and obtain further instructions from Project Management Appropriate material should be available and stored on the project to facilitate the securing of project property. re-assign work and area. roof tops. muddy and flooded work environments. and erection rigs unable to be boomed down must be grounded. lower/tie down crane booms and obtain further instruction from Site Management.g.. properly store and secure material which might blow away.27 Severe Weather) DEFINITIONS (SEVERE WEATHER) Lightning: All large-scale.SEVERE WEATHER PLAN (See Corporate Procedure 300. gin poles. etc. High Winds and/or Rain When high wind creates a hazard to craftsmen or work being performed (e.g.. e. RESPONSIBILITIES y y y Berry Y&V HSE Manager will keep Construction Manager updated as to location & intensity of storms. natural. Avoid a depression with standing or running water or a ditch. derricks. All cranes. instability in elevated areas. Wind approximately 30 mph and rain limiting visibility or footing. Make sure that personnel do not group together and/or huddle under or near tall structures. When rain creates a hazard to craftsman on work being performed (e. Have all crane booms lowered to the ground or retracted to the shortest boom length. materials. un-stable footing conditions due to slippery structural steel. etc. Berry Y&V will determine when lightning is threatening imminent danger. unmanageable materials.g. unstable trenches or excavations..

Berry Y&V Management is committed to making sure employees are trained to recognize the symptoms of Heat Stress and have knowledge on how to protect themselves from the hazards associated with the causes of High Heat Conditions that cause Heat Stress Disorders. See Corporate Procedure 300. See Corporate Procedure 300.22 Heat Stress. administrative and PPE controls. and they may be required to work for extended periods of time in the hot/cold environment. RESPONSIBILITIES Management of Berry Y&V will be responsible for providing information to all employees concerning their expectations on how to prevent Heat/Cold Stress Disorders and how our Project Management and our HSE Department will work together to provide means of eliminating as many heat/cold related hazards as possible through the use of appropriate Health Hazard control.23 Cold Stress.Heat Stress and Cold Stress Plans OVER VIEW Berry Y&V is concerned about the health and well being of all employees. We understand that employees will sometimes be exposed to working in a hot/cold environment. therefore we feel this policy is necessary to avoid hazards to their safety and health. 13 . PURPOSE The purpose of this plan is to assure that our employees are well informed about the hazard of High Heat/Cold conditions and to provide information and training on engineering.

This philosophy is known as the ³Brother¶s Keeper´ mentality.HAZARD CONTROLS A. Administrative Controls y y y y y Will provide heat/cold stress training to all employees Will provide an adequate and sanitary drinking facility and drinking apparatus Will provide a method to rotate employees frequently during extreme conditions Will base decisions on Heat/Cold Index NOT Ambient temperature Will utilize the ³Brother¶s Keeper´ mentality and watch for any signs or symptoms C. EMPLOYEE AWARENESS Berry Y&V feels that educating our employees about extreme environmental conditions is the key method of preventing Heat/Cold Stress Disorders. Time and consideration must be taken to recognize a safe and effective method to work under these conditions. Our Management and our Safety Representatives will continuously communicate the importance of using good safe techniques to prevent Heat/Cold Stress. We will also monitor and make special provisions for employees taking medications. The benefit of this will help to eliminate safety hazards associated with working in hot/cold areas. Engineering Controls y Will ensure that all areas have proper and adequate ventilation and or insulation y Will provide other sources of cooling/heating methods in extreme environments y Will make arrangements for frequent breaks B. We will also expect each employee to look out for others around them and communicate as soon as possible whenever signs of Heat or Cold Stress occur. Protective Equipment y y y Will provide appropriate PPE Will Provide frequent breaks Will provide ³Cool Down/Warm UP´ areas Safety Problems in Extreme Environments These are the things that could be the cause of an accident if proper preventive methods are not applied. We will continue to recommend to all employees that they absorb enough daily fluids (water or thirst quencher) to prevent dehydration. 14 .

other flammable materials such as oil soaked rags. Each foreman will be required to hold a daily safety meeting (toolbox). He will review the hazards that the employees might encounter during that shift and review the JSA for the tasks they are assigned to. An all hands Safety Meeting will be conducted by Berry Y&V on specified days at the start of the shift. The Berry Y&V HSE Manager shall prepare discussion outlines that are relevant to the work site. information reviewed. lacquers. oil. Housekeeping is everyone¶s responsibility. All crew members will then sign on the JSA only after becoming familiar of every aspect of the document. No rubbish or waste material may be burned in the facility. This will be conducted by Berry Y&V Management and/or Supervisors. Rubbish should be placed in a suitable container for waste disposal. Safety Meeting Schedule The need for regular safety meetings on the job cannot be stressed too highly. Paints. A competent member of a team working on a task will complete a JSA. Be sure that you are aware of the character of any waste material or rubbish and ensure that it is placed in the correct container for that particular type. waste and shavings. comments and attendees shall be maintained and provided to the Berry Y&V HSE Manager upon request. Berry Y&V HSE Personnel with members of the work force will conduct Daily Walks and they will be looking for deficiencies in this particular area as well as other hazards. buildings or other structures. paint thinners. must be kept in metal containers with self closing lids in an area far removed from any other flammable materials.JSA Process Explanation of the JSA Process will be communicated to all employees during site specific training. such as. The JSA will be maintained at the job site. and leads must be maintained as to prevent tripping hazards. cords. The meeting is opened to all employees for comments or concerns. work areas. exposures and occurrences for use by the presenters. The foreman will submit the JSA to the Berry Y&V HSE Manager for final review and storage. All solvents and flammable liquids must be kept in approved and properly labeled containers. Hoses. Housekeeping Plan Combustible materials. Documentation of the meeting agenda. 15 . Upon completion of task or end of shift the JSA will be returned to foreman for review and signed off. Paper and other combustible materials will not be allowed to accumulate. All work areas and walkways will be kept clear of tripping hazards at all times. Weeds and other vegetation should not be permitted to grow near and around Company property. All containers should be emptied as soon as possible.

Conexes All office trailers and temporary buildings must meet certain design. Do you plan on setting up office trailers or conexes in the plant? _________ How many? ____ What are you planning on setting up? What utilities do they need? What will they be used for? y Road Blockages or Closures Any road closures or blockages require review and approval from Berry Y&V and Client Supervision. Do you plan on bringing vehicles into the plant? _________ How many? _____ What will they be used for? ___________________________________________ y Office Trailers. Buildings. Completion of the questions and information below will enable your Berry Y&V construction contacts to provide you with specific forms. Approval from the Client is required. location and housing criteria. Do you plan on having to block any roads to complete the construction? Why does the road need to be blocked? Which roads? Starting approximately when? Lasting for how long? 16 . Your company logo must be displayed on both sides of the vehicle. To minimize delays to your construction crews this section highlights some of those items requiring approval and provides you with an opportunity to plan for them before construction starts.CONSTRUCTION SAFETY EXECUTION PLAN REQUEST FOR ITEMS REQUIRING SPECIAL APPROVAL Safety and security regulations at Client Sites require review and approval for certain items or actions. requirements and time needed to get approval for these items: y Vehicle Entry into Plants All sites require review and approval of cars and trucks that will be brought on site. The number of vehicles allowed in is limited and is based on business needs and use of the vehicle while in plant.

Do you plan on bringing in any cranes or lifts? List the type/make/description and when you plan to bring them onto the Site y MSDS¶ for Chemicals and Hazardous Materials MSDS sheets for all chemicals and hazardous materials must be reviewed and approved by Berry Y&V/Client Department before being brought into the Site. Do you plan on asking for any waivers or deviations? __________ if yes. rules and policies must be reviewed and approved before construction start. 17 . List them below and provide a copy of the MSDS sheets for review: Chemical What will it be used for? All chemicals are listed in binders kept in HSE Manager¶s Office y All pertinent chemicals as are necessary for a basic construction job. manlifts. provide details under separate cover. Manlifts. scissors lifts must be inspected by a competent person before they can be used on the Client Site. Deviations to Client Rules and Policies Any waivers or deviations to Berry Y&V and Client standards.CONSTRUCTION SAFETY EXECUTION PLAN REQUEST FOR ITEMS REQUIRING SPECIAL APPROVAL (CONTINUED) Cranes. Scissors Lifts All cranes.

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