Broussard Brothers, Inc.

• Document Title

• Department Supervisor

EMPLOYEE INFORMATION

• Employee Name

• Last four digits of social security number

COMPANY INFORMATION

• Company

• Department

• Position

EVALUATION

• Date of Evaluation

  Date

• Evaluation conducted by:

RIGGING

• Does the employee perform overhead rigging duties

  Yes

  No

• Review rigger card to ensure it is current. If not current advise that rigger duties are suspended and contact supervisor immediately

• Can demonstrate a proper rigging inspection

  Yes

  No

  N/A

• Can demonstrate proper rigging of a load

  Yes

  No

  N/A

• Able to identify rigging gear by name

  Yes

  No

  N/A

• Is familiar with tag line use and restrictions

  Yes

  No

  N/A

WELDER HELPER DUTIES

• Does the employee perform welder helper duties as part of his regular duties

  Yes

  No

• Is familiar with PPE requirements associated with welder helper duties

  Yes

  No

  N/A

• Can demonstrate or describe hand tool inspection

  Yes

  No

  N/A

• Is employee aware of when a fire watch must be assigned

  Yes

  No

  N/A

HOT WORK AND FIRE WATCH

• Does employee perform hot work or fire watch duties as part of their regular duties

  Yes

  No

• Can describe when a hot work permit is required

  Yes

  No

  N/A

• Can explain when a fire watch is required

  Yes

  No

  N/A

• Is aware of how long a fire watch must remain on site following the completion of hot work

  Yes

  No

  N/A

• Can explain what safety equipment is required when a hot work permit is required

  Yes

  No

  N/A

• Is aware of special fire extinguisher requirement

  Yes

  No

  N/A

• Is aware of Chevron specific fire blanket requirements

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Was wearing PPE required for the task being performed upon arrival

  Yes

  No

  N/A

• Can demonstrate proper inspection of PPE

  Yes

  No

  N/A

• Understand the limitations of PPE

  Yes

  No

  N/A

• Is familiar with BBI PPE policies

  Yes

  No

  N/A

BEHAVIOR BASED SAFETY PROCESS

• Is there evidence that the employee is participating in the process

  Yes

  No

  N/A

• Understands proper completion of the Take 5 card

  Yes

  No

  N/A

• Familiar with stop work authority policy

  Yes

  No

  N/A

JSEA

• Was a JSEA prepared for the task being performed upon arrival

  Yes

  No

  N/A

• Aware of when a JSEA must be updated

  Yes

  No

  N/A

• Can the employee demonstrate proper completion of a JSEA

  Yes

  No

  N/A

ACCIDENT/NEAR MISS REPORTING

• Is familiar with reporting criteria and procedures

  Yes

  No

  N/A

• Can define near miss

  Yes

  No

  N/A

FUEL TRANSFER

• Can describe and/or demonstrate fuel transfer procedures

  Yes

  No

  N/A

• Is aware that all spills must be reported immediately

  Yes

  No

  N/A

SHORT SERVICE EMPLOYEES

• Able to describe how SSE's are identified

  Yes

  No

  N/A

SPUD UNIT OPERATION

• Does the employee operate a spud unit as part of their duties

  Yes

  No

• If possible, have a barge foreman or experienced boat captain familiar with proper spud operation available during review

• Can the employee demonstrate proper inspection procedures

  Yes

  No

  N/A

• Is the employee able to demonstrate raising the spud in a controlled manner

  Yes

  No

  N/A

• Can employee demonstrate lowering the spuds in a controlled manner

  Yes

  No

  N/A

• Does the employee lock the spud brake after each operation

  Yes

  No

  N/A

• Ask the employee about traveling and what requirement must be met to travel (spud pins). Are they aware of the policy

  Yes

  No

  N/A

CRANE OPERATION

• Does the employee operate a crane as part of their duties

  Yes

  No

• Ask to see crane operator card, is it current and appropriate for the crane operated

  Yes

  No

  N/A

• Can the operator demonstrate a proper crane inspection

  Yes

  No

  N/A

• Can the operator demonstrate knowledge of crane load chart

  Yes

  No

  N/A

• Does operator appear to have proper and reasonable control of the machine while operating

  Yes

  No

  N/A

• Give the operator some test hand signals, does he understand proper handsignals

  Yes

  No

  N/A

BOAT SPECIFIC

• Is the employee assigned to a boat

  Yes

  No

• Position

  Captain

  Wheelman

  Deck Hand

• Can describe emergency fire procedures

  Yes

  No

  N/A

• Can describe emergency man overboard procedures

  Yes

  No

  N/A

• Can describe emergency general alarm procedures

  Yes

  No

  N/A

• Able to identify rigging and towing gear and able to describe its required maintenance and inspection

  Yes

  No

  N/A

• Is employee familiar with proper engine and generator maintenance

  Yes

  No

  N/A

• Is proficient with wheelhouse electronics including communication and navigation equipment

  Yes

  No

  N/A

• Can describe emergency fire procedures

  Yes

  No

  N/A

• Can describe emergency man overboard procedures

  Yes

  No

  N/A

• Can describe emergency general alarm procedures

  Yes

  No

  N/A

• Able to identify rigging and towing gear and able to describe its required maintenance and inspection

  Yes

  No

  N/A

• Is employee familiar with proper engine and generator maintenance

  Yes

  No

  N/A

• Is proficient will wheelhouse electronics including communication and navigation equipment

  Yes

  No

  N/A

• Is familiar with the navigational "rules of the road"

  Yes

  No

  N/A

• Captain must be present during evaluation to ensure Deck Hand is providing honest answers

• Can describe role in an emergency fire on lard situation

  Yes

  No

  N/A

• Can describe role in an emergency man overboard situation

  Yes

  No

  N/A

• Can describe role in an emergency general alarm situation

  Yes

  No

  N/A

• Able to identify rigging and towing gear and able to describe its required maintenance and inspection

  Yes

  No

  N/A

• Is employee familiar with proper engine and generator maintenance

  Yes

  No

  N/A

• Is deck hand capable of throwing a rope

  Yes

  No

  N/A

• Is deck hand familiar with knots and rope handling

  Yes

  No

  N/A

CONCLUSION

• NOTES OR OBSERVATIONS:

• Is additional training required?

  Yes

  No

• Will the lack of training place the employee or personnel around him in danger?

  Yes

  No

• CONTACT DEPARTMENT MANAGER IMMEDIATELY

• ENSURE TRAINING IS SCHEDULED ASAP

ACKNOWLEDGEMENTS

• Evaluator Name

  Sign

• Employee Signature

  Sign