Professional Documents
Culture Documents
BRRF
BRCP
BRFP
BRPO
BRPP
Existing Contractor
12/15/14
6/15/15
Pcla-3 2015 Ta
A
Provide a brief description of the type and scope of work to be performed:
Technical & installation services for Rapid Arc Welding for refractory anchor installation.
What is the Safety Risk Level for Contracting Company for this waiver?
Existing CSA
Spot Contract
SAP PO
Justification: Provide(Reason(s) supporting the safety waiver request and not using an ACL supplier (use additional
pages if needed):
If the job involves any type of electrical work to be performed by the contractor, the person(s) performing the work
must be electrical T1-BP certified. Contact Zone 27 (225-977-1358) for certification info . Note: Short Service Workers
(SSWs) should not be used during live electrical work. Contact Zone 27 (225-977-1358) for further guidance.
Attachment: Start of the Job Checklist (SOJC) Contractor/ExxonMobil Pre-Job Meeting Summary table 2 must be
completed at least annually table 1 can be used if table 2 has been completed within the last 12 months
Dan Songy
Requesters Title
11/20/14
Signature
Date
How long has your company provided the services described in section A?
22 Years
Is your company a member of the North American Substance Abuse Program ( NASAP ) program?
Yes, via ASAP Drug Solutions. We will switch to new membership in January
Is your company a member of the North American Background Screening Consortium ( NABSC ) program?
Yes
Is your company a member of the Houston Area Xnet?
No
Does your company have a Louisiana Contractors License?
No
If no, please explain?
Has your company ever worked in an ExxonMobil facility?
REQUIRED ATTACHMENTS:
Attachment: Contractor Risk Mitigation Plan - Actions are to address specific risks identified If deemed necessary by the
ExxonMobil Safety Department (for level 1 suppliers)
Attachment: Xnet participation. If not in Xnet provide specific procedures for the scope of services provided
Site Contractors are required to have an After-hours Offsite Occupational Health Care Provider:
CORE Occupational
Gulf Coast Occupational Medicine
Prime Occupational Medicine
Other**
Name of Facility or Doctor:
Address:
Phone:
Div. Mgr. Review
*Contract supervision understands that non-emergency injury evaluation and treatment shall be administered
by an occupational clinic and not a local hospital emergency room.
**Requires Division Manager review.
Safety Benchmarks:
YEAR
YTD
Year 1 data (most recent full year data)
Year 2 data
Year 3 data
3 year average
TRIR
LTIR
0
0
0
0
0
Fatality
(Number)
EMR
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Yes
No
Yes
No
Signature
Date
Requester's SLS
Signature
Date
Manager's Title
Denied Reason:
Signature
Date
The waiver requestor is to provide a brief description of the work that will be performed by the
contractor for which the exception is being requested. This will assist the ExxonMobil Safety
Facilitator in reviewing the contractor's mitigation plan (if required by Safety) for level 1 suppliers and
ExxonMobils SOJC to determine if it is adequate based on the level of risk associated with the work
to be performed. Also, the waiver requester will determine the safety risk level with assistance from
safety, contracts administration, and the OIMS 8.1 coordinator and determine how the onsite services
are being covered contractually.
Provide reason for needing to use this particular contractor even though they may present a higher
risk potential than another contractor currently on the ExxonMobil ACL. Note any other contractors
that can perform this type of work and why they are not being used.
The contractor for which the requestor is seeking a safety waiver is to complete the Contractor
Section of this form. Also, the Contractor will complete a Contractor Risk Mitigation Plan (if required
by Safety). This plan will be the primary basis for which a contractor is either granted or denied a
safety waiver. This is the plan the contractor will enact based on the deficiencies identified in the
screening process to ensure a safety incident does not occur on ExxonMobil projects or property. A
separate plan is to be completed for each risk factor identified. Some examples of risk mitigation
actions might include the following:
The ExxonMobil representative requesting the services of this contractor along with his/her
supervisor have agreed the need to use this contractor outweighs the safety risk and potential
exposure.
The completed plan is to be attached to the safety waiver form after it is reviewed by the requestor
for further processing.
This section is provided by the contracting company. In most cases an average of the TRIR will be
taken for the most recent three year period and used to compare with the screening requirement. If
three years are not available then the most recent information available will be used.
This section of the process requires the contractor to prepare documentation that discusses the
actual injuries/illnesses recorded on their OSHA log for the years being reviewed, the cause of the
injuries/illnesses for each of the years in question, any plans they have put into place to resolve the
reoccurrence of these injuries/illnesses and specific plans they have to mitigate similar risks on this
particular ExxonMobil project.
An approved safety waiver is only for a particular project or specified period of time. If the contractor
is to be used on another project or by a new requestor, a new safety waiver form must be approved.
The safety waiver may be granted for the length of the project, which may be more than one year, but
if the exception is only for a period of time the maximum is one year. At the end of the year new
safety statistics numbers will be reviewed to see if they meet ExxonMobil requirements for inclusion
on the ACL. If not, a new safety waiver form and mitigation plan must be submitted.
This section is to be reviewed and approved by the ExxonMobil Safety Facilitator. The safety waiver
requestor may be asked to provide additional information about the project name and or time period
for which the contractor will be used.
Signature sections of the form. Signatures needed from requestor, requestor's SLS, Safety Facilitator,
and requesters Department Head.
Waiver requester completes the electronic security waiver noting that the contractor safety waiver
request form and SOJC have been completed.
Note: Upon job completion, send completed SOJC and completed safety waiver form & risk
mitigation plan to the Contractor Safety Office at 165 EMPR
CONTRACTOR SAFETY LEVELS
The Safety Level is determined by the nature, location and duration of the work to be
performed. Careful consideration must be given to the potential for exposure to worksite
hazards and hazards of the work being performed, on the contractor and other individuals
when assigning the Safety Level. The Level is based on the highest risk work the contractors'
employees will perform while on site. If a contractor performs work under multiple contracts,
the same Level is assigned for each onsite contract.
Safety Risk Level 1 - High relative safety risk Contractors (Level of Compliance I)
are those who provide services essential to daily operations in all areas of the site
and have a direct impact on process safety or the health/safety of the
individual/others.
Examples: new construction, dismantling, electrical, water blasting, chemical
cleaning, insulation, process computer, instrumentation, pipefitting, welding,
millwrights, structural steel, painters, radiographers, asbestos & lead abatement,
leak repair, catalyst exchange, remediation, waste management, environmental
services, drafting and engineering on process units, any service that
connects/operates to process equipment
Safety Risk Level 2 - Medium relative safety risk Contractors (Level of
Compliance II) provides services essential to daily operations in all areas of the
site and has no impact on process safety and minimal impact on the health/safety
of the individual/others.
Examples: janitorial work, vehicle mechanics, building and grounds, telephone
repair, cafeteria, If level 2 contractors need to visit a Process area, they must be
accompanied at all times by ExxonMobil personnel or a safety level 1 contractor.