HEALTH, SAFETY & ENVIRONMENTAL (HSE) ORIENTATION
FORM SCO-4
PROGRAM SELF-CERTIFICATION WORKSHEET
(DO NOT MODIFY THIS FORM)

CONTENTS

PART 1 – PROGRAM SELF-STUDY
PART 2 – INSTRUCTIONAL MATERIALS
PART 3 – INSTRUCTORS/FACILITATORS
PART 4 – ATTESTATION & AGREEMENT
Name of Company or Institution: / ______

Form SCO-4

Revision 030506

Page 1

RIG PASS® HSE ORIENTATION

FORM SCO-4

PROGRAM SELF-CERTIFICATION WORKSHEET

PURPOSE

To expedite processing of an accreditation application, this form must be used by the applicant agency to describe the structure, format and administration of its orientation program. Please follow the instructions provided for each section.

Objective:

The key objective of RIGPASS is to provide new employees with a basic orientation of rig operations and safe work practices. Ideally, this should occur before the employee begins work at the rig. However, due to various logistical conditions in the drilling industry, this will not always be possible. Companies with in-house programs are encouraged to establish policies to ensure that their new employees complete the RIGPASS orientation as soon as it is practical.

PART 1: PROGRAM SELF-STUDY

To complete this section, the applicant agency must conduct a detailed self-study of its program curriculum compared to the Suggested Curriculum Outline of the IADC Rig Pass Service Contractor Orientation Program. Contents of this outline appear in the TOPICS column on the PROGRAM SELF-CERTIFICATION WORKSHEET below.

For each topic area in Part 1, the applicant agency must provide the following information:

Where Provided

This column pertains to the primary location where this topic is conveyed to the participant. Choose from the list below.

  • CLASSROOM (CLS) Provided in a dedicated facility (temporary or permanent) removed from the work site and intended for use by a group of persons. This may include a company training facility, a room at an educational institution, or a room used only on occasion, such as a meeting room at a hotel.
  • POINT OF HIRE (POH) Provided in an administrative office or other business facility where employees are regularly hired, either individually or in a small group.
  • POINT OF TRANSIT (POT) Provided at a heliport, boat dock, or other transportation-related facility regularly used for travel to the work site, either individually or in a small group.
  • WORK SITE (WST) Provided at the drilling location or on a platform or mobile offshore drilling unit, either individually or in a small group.
  • OTHER (OTH) Provided at any other location not fully described above.

How Instructed

This column pertains to the method, technique, or teaching aid used to convey this topic. Choose from the following list the primary means through which this topic is ordinarily conveyed to the participant during the orientation:

  • LECTURE/DISCUSSION (L/D) Instructed in a group setting (two or more participants) led by an instructor or facilitator.
  • AUDIOVISUAL (A/V) Instructed primarily through traditional audiovisual methods, such as slide/tape or videotape.
  • INDIVIDUAL (IND) Instructed on a one-on-one basis by a personnel or safety professional or other qualified person.
  • CBT (CBT) Computer -based training.
  • OTHER (OTH) Instructed by any other method that is not fully described above.

How Documented/Measured

Use this column to denote how a participant's involvement in the orientation is documented or measured. Choose from the list below.

  • CHECKLIST (CHK) The employee orientation is documented using a checklist initialed or signed by the participant and the instructor, supervisor, personnel or safety representative or other qualified person.
  • TEST (T) Participants are administered a written test to measure acquisition and retention of the topics presented in the orientation.
  • BOTH (B) Participant involvement's' are documented through both a checklist and test as described above.
  • OTHER (OTH) Any other method that is not fully described above, such as a test administered and recorded by a computer.

Time Allocated

In this column, indicate the approximate amount of time customarily allocated to the discussion or instruction on this subject, in hours and minutes (HH:MM, where 30 minutes would be expressed as 00:30).

COMPLETED WORKSHEET

All items listed above must be completed unless otherwise indicated. If an item is not applicable, it should be marked as "N/A."

RIGPASS Scheduling Policy - Time Frame For Newly Hired Employees / 30 Days

IADC RIG PASS® HSE ORIENTATION PROGRAM

PROGRAM SELF-CERTIFICATION WORKSHEET

PART 1: PROGRAM SELF STUDY

/ (Refer to instructions on preceding pages)
Topic / Where Provided / How Instructed / How Documented or Measured / Time Allocated
  1. General Safety

  1. Principles

  1. Employee safe work practices are a condition of employment
/ POH | WST / CLS / OTH | B
  1. Workplace Injuries are preventable
/ POH | WST / CLS / OTH | B
  1. Lead through example
/ POH | WST / CLS / OTH | B
  1. Safety is important both on and off the job
/ POH | WST / CLS / OTH | B
  1. Each individual's safety performance has a direct bearing on his/her employer's ability to work in the industry
/ POH | WST / CLS / OTH | B
  1. Workplace injuries are costly
/ POH | WST / CLS / OTH | B
  1. Attitude is contagious
/ POH | WST / CLS / OTH | B
  1. Alcohol and Drug Policies

  1. Defined/where posted

  1. Service Contractor
/ POH | WST / CLS / OTH | B
  1. E&P Operator (if different)
/ POH | WST / CLS / OTH | B
  1. Searches and seizures
/ POH | WST / CLS / OTH | B
  1. Testing
/ POH | WST / CLS / OTH | B
  1. Reporting of prescription medications
/ POH | WST / CLS / OTH | B
General Safety continued
Topic / Where Provided / How Instructed / How Documented or Measured / Time Allocated
  1. Firearms and Weapons Policy

  1. Personal Conduct

  1. No horseplay or practical jokes
/ POH | WST / CLS / OTH | B
  1. Observe smoking restrictions
/ POH | WST / CLS / OTH | B
  1. Practice respect for co-workers
/ POH | WST / CLS / OTH | B
  1. No ethnic, racial, religious or sexual harassment or jokes
/ POH | WST / CLS / OTH | B
  1. No profanity
/ POH | WST / CLS / OTH | B
  1. No excessive noise
/ POH | WST / CLS / OTH | B
  1. Proper dress on and off duty
/ POH | WST / CLS / OTH | B
  1. Attend to personal hygiene
/ POH | WST / CLS / OTH | B
  1. General Worksite Safety

  1. Pre-job planning meeting
/ POH | WST / CLS / OTH | B
  1. Site and unit specific orientation
/ POH | WST / CLS / OTH | B
  1. Signs and placards
/ POH | WST / CLS / OTH | B
General Safety continued
Topic / Where Provided / How Instructed / How Documented or Measured / Time Allocated
  1. Housekeeping

  1. Importance
/ POH | WST / CLS / OTH | B
  1. Proper storage
/ POH | WST / CLS / OTH | B
  1. Walkways and aisles
/ POH | WST / CLS / OTH | B
  1. Spills and trip hazards
/ POH | WST / CLS / OTH | B
  1. On the job
/ POH | WST / CLS / OTH | B
  1. Signs, cones, banners and barricades
/ POH | WST / CLS / OTH | B
  1. Communications, Chain of Command

  1. Service contractor supervisor
/ POH | WST / CLS / OTH | B
  1. Operator supervisor
/ POH | WST / CLS / OTH | B
  1. Reporting and Investigating Incidents

  1. General procedures

  1. Bodily injury and first aid
/ POH | WST / CLS / OTH | B
  1. Property damage
/ POH | WST / CLS / OTH | B
  1. Vehicle accidents
/ POH | WST / CLS / OTH | B
  1. Near miss events
/ POH | WST / CLS / OTH | B
  1. Uncontrolled and/or unauthorized release to the environment
/ POH | WST / CLS / OTH | B
  1. Potential hazardous conditions
/ POH | WST / CLS / OTH | B
  1. Purpose of incident investigation
/ POH | WST / CLS / OTH | B
General Safety continued
Topic / Where Provided / How Instructed / How Documented or Measured / Time Allocated
  1. Land Transportation (As Applicable)

  1. Vehicle condition
/ POH | WST / CLS / OTH | B
  1. Driving practices
/ POH | WST / CLS / OTH | B
  1. Motor vehicle laws
/ POH | WST / CLS / OTH | B
  1. Defensive driving
/ POH | WST / CLS / OTH | B
  1. Vehicle safety restraints
/ POH | WST / CLS / OTH | B
  1. Parking
/ POH | WST / CLS / OTH | B
Total Time Allocation – Section 1 / 1 Hour
  1. Personal Protective Equipment (PPE)

  1. Determining What PPE Is Needed

  1. Employee orientation
/ POH | WST / CLS / OTH | B
  1. Job planning orientation
/ POH | WST / CLS / OTH | B
  1. Site specific orientation
/ POH | WST / CLS / OTH | B
  1. Operator's and Contractor's safety policies
/ POH | WST / CLS / OTH | B
  1. Personal preferences
/ POH | WST / CLS / OTH | B
  1. Elimination of uncertainties – asking co-workers or supervisors
/ POH | WST / CLS / OTH | B
  1. Head Protection

  1. Types
/ POH | WST / CLS / OTH | B
  1. Inspection
/ POH | WST / CLS / OTH | B
  1. Care and use
/ POH | WST / CLS / OTH | B

Personal Protective Equipment continued

Topic / Where Provided / How Instructed / How Documented or Measured / Time Allocated
  1. Face and Eye Protection

  1. Types
/ POH | WST / CLS / OTH | B
  1. Protection
/ POH | WST / CLS / OTH | B
  1. Limitations
/ POH | WST / CLS / OTH | B
  1. Use in combination
/ POH | WST / CLS / OTH | B
  1. Inspection
/ POH | WST / CLS / OTH | B
  1. Care and use
/ POH | WST / CLS / OTH | B
  1. Hearing Protection

  1. Types
/ POH | WST / CLS / OTH | B
  1. Protection
/ POH | WST / CLS / OTH | B
  1. Limitations
/ POH | WST / CLS / OTH | B
  1. Use in combination
/ POH | WST / CLS / OTH | B
  1. Inspection
/ POH | WST / CLS / OTH | B
  1. Care and use
/ POH | WST / CLS / OTH | B
  1. Foot Protection

  1. Types
/ POH | WST / CLS / OTH | B
  1. Inspection
/ POH | WST / CLS / OTH | B
  1. Care and use
/ POH | WST / CLS / OTH | B
  1. Hand Protection

  1. Types
/ POH | WST / CLS / OTH | B
  1. Inspection
/ POH | WST / CLS / OTH | B
  1. Care and use
/ POH | WST / CLS / OTH | B

Personal Protective Equipment continued

Topic / Where Provided / How Instructed / How Documented or Measured / Time Allocated
  1. Respiratory Protection

  1. Medical Questionnaire/test
/ POH | WST / CLS / OTH | B
  1. Fit testing
/ POH | WST / CLS / OTH | B
  1. Types of respirators
/ POH | WST / CLS / OTH | B
  1. Types of canisters
/ POH | WST / CLS / OTH | B
  1. Inspections
/ POH | WST / CLS / OTH | B
  1. Care and use
/ POH | WST / CLS / OTH | B
  1. Fall Protection

  1. Types
/ POH | WST / CLS / OTH | B
  1. Inspection
/ POH | WST / CLS / OTH | B
  1. Care and use
/ POH | WST / CLS / OTH | B
  1. Other PPE

  1. Specialty clothing
/ POH | WST / CLS / OTH | B
  1. Care and use
/ POH | WST / CLS / OTH | B

Total Time Allocation – Section II

/ 1 Hour
Topic / Where Provided / How Instructed / How Documented or Measured / Time Allocated
  1. Hazard Communications and Materials Handling

  1. Types of Hazards

  1. Hazard communications
/ POH | WST / CLS / OTH | B
  1. Written plan
/ POH | WST / CLS / OTH | B
  1. Chemical inventory hazardous materials
/ POH | WST / CLS / OTH | B
  1. Container labeling
/ POH | WST / CLS / OTH | B
  1. Material safety data sheet

  1. Definition
/ POH | WST / CLS / OTH | B
  1. Location
/ POH | WST / CLS / OTH | B
  1. Safety equipment and employee responsibilities
/ POH | WST / CLS / OTH | B
  1. Transportation of Hazardous Materials

  1. Must be accompanied by material safety data sheet
/ POH | WST / CLS / OTH | B
  1. Container must be properly labeled
/ POH | WST / CLS / OTH | B
  1. Must be accompanied by a properly completed manifest
/ POH | WST / CLS / OTH | B
  1. Uncontrolled/Unauthorized Release of Hazardous Materials

  1. Report the incident to the person in charge
/ POH | WST / CLS / OTH | B
  1. Do not respond to the release unless properly trained
/ POH | WST / CLS / OTH | B

Total Time Allocation – Section III

/ 30 Minutes
Topic / Where Provided / How Instructed / How Documented or Measured / Time Allocated
  1. Occupational Health

  1. Employee's Responsibilities in Dealing With Industrial Hygiene Hazards

  1. Know the hazards
/ POH | WST / CLS / OTH | B
  1. Do not handle or dispose of health hazards unless specifically trained or certified
/ POH | WST / CLS / OTH | B
  1. Report any suspicion of a health hazard to the person in charge
/ POH | WST / CLS / OTH | B
  1. Potential hazards at the work site
/ POH | WST / CLS / OTH | B
  1. Hydrogen sulfide (H2S)
/ POH | WST / CLS / OTH | B
  1. Diesel mist (oil-based mud)
/ POH | WST / CLS / OTH | B
  1. Noise
/ POH | WST / CLS / OTH | B
  1. Others
/ POH | WST / CLS / OTH | B

Total Time Allocation – Section IV

/ 15 Minutes
Topic / Where Provided / How Instructed / How Documented or Measured / Time Allocated
  1. Specialized Work Procedures

  1. Hazardous Energy Control (Lock-out/Tag-out)

  1. Define
/ POH | WST / CLS / OTH | B
  1. Coordination with authorized persons
/ POH | WST / CLS / OTH | B
  1. Operator/contractor safety manual
/ POH | WST / CLS / OTH | B
  1. Job planning meeting
/ POH | WST / CLS / OTH | B
  1. Site and unit specific objectives
/ POH | WST / CLS / OTH | B
  1. Lock-out, tag-out, verify
/ POH | WST / CLS / OTH | B
  1. Work Permits (Confined Space and Hot Work)

  1. Define
/ POH | WST / CLS / OTH | B
  1. Types
/ POH | WST / CLS / OTH | B
  1. Confined space
/ POH | WST / CLS / OTH | B
  1. Hot work
/ POH | WST / CLS / OTH | B
  1. Other
/ POH | WST / CLS / OTH | B
  1. Employee responsibility
/ POH | WST / CLS / OTH | B

Total Time Allocation – Section V

/ 30 Minutes
Topic / Where Provided / How Instructed / How Documented or Measured / Time Allocated
  1. Fire Safety

  1. Prevention
/ POH | WST / CLS / OTH | B
  1. Employee Responsibilities

  1. Report all fires and fire hazards immediately
/ POH | WST / CLS / OTH | B
  1. Be familiar with onsite fire protection
/ POH | WST / CLS / OTH | B
  1. Don’t obstruct or block fire escape routes
/ POH | WST / CLS / OTH | B
  1. Don’t tamper with fire extinguisher/apparatus
/ POH | WST / CLS / OTH | B
  1. Use fire extinguisher only if trained and authorized to do so
/ POH | WST / CLS / OTH | B
  1. Observe all precautions and procedures
/ POH | WST / CLS / OTH | B
  1. Participate in site specific fire drills
/ POH | WST / CLS / OTH | B
  1. Be aware of location and position of exit routes
/ POH | WST / CLS / OTH | B
  1. Know your responsibilities, station bill (muster list) and/or emergency evacuation plan
/ POH | WST / CLS / OTH | B

Total Time Allocation – Section VI

/ 30 Minutes
Topic / Where Provided / How Instructed / How Documented or Measured / Time Allocated
  1. Materials Handling

  1. Mechanical Equipment
/ POH | WST / CLS / OTH | B
  1. Rules to follow when working around cranes/cherry pickers/forklifts
/ POH | WST / CLS / OTH | B
  1. Do not stand/walk under a suspended load
/ POH | WST / CLS / OTH | B
  1. Do not position yourself between a suspended load and an immovable object
/ POH | WST / CLS / OTH | B
  1. Always maintain communication with the operator
/ POH | WST / CLS / OTH | B
  1. Always stand clear of lines and rigging
/ POH | WST / CLS / OTH | B
  1. Never ride on a load
/ POH | WST / CLS / OTH | B
  1. Be aware of your surroundings and always have a way out
/ POH | WST / CLS / OTH | B
  1. Pay attention to backup/movement alarms
/ POH | WST / CLS / OTH | B
  1. Understand dangers associated with electrical lines in close proximity
/ POH | WST / CLS / OTH | B
  1. Never operate a crane or forklift unless you are certified and authorized to do so
/ POH | WST / CLS / OTH | B
  1. Always use tag lines
/ POH | WST / CLS / OTH | B
  1. Inspect slings & rigging before each use
/ POH | WST / CLS / OTH | B
  1. Personal Lifting Technique

  1. Review of lifting techniques
/ POH | WST / CLS / OTH | B

Total Time Allocation – Section VII

/ 30 Minutes
Topic / Where Provided / How Instructed / How Documented or Measured / Time Allocated
  1. First Aid

  1. General

  1. In the event of injury, call for help and report injury to the person in charge
/ POH | WST / CLS / OTH | B
  1. Be familiar with site specific first aid station locations
/ POH | WST / CLS / OTH | B
  1. Respond to the extent that you are trained
/ POH | WST / CLS / OTH | B
  1. Bloodborne Pathogens

  1. Definitions
/ POH | WST / CLS / OTH | B
  1. Precautions
/ POH | WST / CLS / OTH | B
  1. Avoid contact with blood or bodily fluids
/ POH | WST / CLS / OTH | B
  1. Use latex gloves or CPR barrier kits
/ POH | WST / CLS / OTH | B
  1. Use care when handling used razor blades, needles or other sharp objects
/ POH | WST / CLS / OTH | B
  1. Contaminated first aid materials (biohazards) must be properly handled in accordance with the site specific plan
/ POH | WST / CLS / OTH | B
  1. Report all exposures immediately
/ POH | WST / CLS / OTH | B

Total Time Allocation – Section VIII

/ 15 Minutes
Topic / Where Provided / How Instructed / How Documented or Measured / Time Allocated
  1. Rig/Platform Environment

  1. Platform or Location Arrival Procedures

  1. Use caution when using walkways (maintain good footing and balance)
/ POH | WST / CLS / OTH | B
  1. Keep one hand free to hold handrails
/ POH | WST / CLS / OTH | B
  1. Get help with baggage or make multiple trips
/ POH | WST / CLS / OTH | B
  1. Sign in at checkpoint with person in charge or dispatcher
/ POH | WST / CLS / OTH | B
  1. Home Away From Home

  1. Be prepared for unexpected extended stays
/ POH | WST / CLS / OTH | B
  1. Bring sufficient quantities of personal items
/ POH | WST / CLS / OTH | B
  1. Understand the Site-specific Orientation (Ask Questions If You Do Not Understand)
/ POH | WST / CLS / OTH | B

Total Time Allocation – Section IX

/ 2 Hours
Topic / Where Provided / How Instructed / How Documented or Measured / Time Allocated
  1. Emergency Response

  1. Alarms

  1. Types
/ POH | WST / CLS / OTH | B
  1. Fire
/ POH | WST / CLS / OTH | B
  1. Blowout
/ POH | WST / CLS / OTH | B
  1. Abandon rig
/ POH | WST / CLS / OTH | B
  1. H2S gas (if applicable)
/ POH | WST / CLS / OTH | B
  1. Combustible gas (if applicable)
/ POH | WST / CLS / OTH | B
  1. Man overboard (if applicable)
/ POH | WST / CLS / OTH | B
  1. All clear
/ POH | WST / CLS / OTH | B

Total Time Allocation – Section X

/ 30 Minutes

Total Time Allocation – Section I through X

/ 7 Hours

OFFSHORE ENDORSEMENT

NOTE: The program self-study for Sections XI and XII is required only

For those programs seeking to qualify for Offshore Endorsement.

Topic / Where Provided / How Instructed / How Documented or Measured / Time Allocated
  1. Transportation

  1. Arrival at Shorebase

  1. Check in with dispatcher or person in charge
/ POH | WST / CLS / OTH | B
  1. Inquire as to site specific orientation
/ POH | WST / CLS / OTH | B
  1. Identify carry-on baggage (weight, quantity, hazardous materials)
/ POH | WST / CLS / OTH | B
  1. Stand-by in designated waiting area until instructed to proceed by dispatcher or person in charge
/ POH | WST / CLS / OTH | B
  1. Helicopter Transportation

  1. The Pilot is in command and has complete authority
/ POH | WST / CLS / OTH | B
  1. Helicopter boarding and unboarding
/ POH | WST / CLS / OTH | B
  1. Board only when instructed to do so by pilot
/ POH | WST / CLS / OTH | B
  1. Avoid the main rotor and tail rotor
/ POH | WST / CLS / OTH | B
  1. Secure loose items and hats
/ POH | WST / CLS / OTH | B
  1. Keep all objects over 4 feet in the horizontal position
/ POH | WST / CLS / OTH | B
  1. Secure personal baggage in the baggage compartment. Never go aft of the baggage compartment.
/ POH | WST / CLS / OTH | B

Transportation continued