• Site Specific Simultaneous Operations Plan

Date of Plan: / Date of Activity / Plan #
Program: / Field / Location:

NEW PLAN AMMENDMENT EXTENSION Original Plan #______

This Document Is Valid For ______Hrs

This Site Specific Simultaneous Operation will utilize radio channel ______

Designated Person in Charge and Position: / Phone No.:
Scope of Work

Enter description & duration of specific work to be performed:

Work Space Area ( ie: radius, sq.kms, distance)______
List of Contractors Involved in Simultaneous Operation (contact information on page 4)
Company / Responsible Person / Description of Activity
Emergency Response Tools
What / Responsible Person / Phone No., Location, etc
Communications (alarms, radios, contact lists, etc.)
Emergency Drills
Emergency Response Plan activation (ERP)
Emergency Personnel (EMT / EMR)
Equipment (first aid kit, stokes litter, etc.)
Accounting for Workers on Site/Muster Lists
Notification of SimOps Coordinator
Risk Exposure Evaluation

Risk Exposure Assessment______ (High, Medium, or Low)

Significant Risk Assessment Items:

1.______

2.______

3.______

4.______

5.______

6.______

Additional Risk Exposure:

1.______

2.______

3.______

4.______

5.______

6.______

Mitigation Plan:

1.______

2.______

3.______

4.______

5.______

6.______

Is a more formal risk assessment required? YES NO

Hazard Identification & Evaluation (continued)
Review OE Tenets of Operation / Review Use of Stop Work Authority
Review Other Applicable Safe Work Practices

S.O.P’s and J.S.A.’s to be reviewed

Is any type of work permit required? Yes No

(fall prevention, hot work, cold work, confined space)

Does security gate require notification of this SimOp? Yes No

Are there any third party operator concerns? Yes No
If yes, what are they?

Will a stop work “period” be required to avoid conflict? Yes No

Details:
Will risk level change as job progresses? Yes No

If yes, how?

Can weather affect this plan? Yes No

Number of Personnel on site ______(note: increased personnel may raise risk ranking)

Any work-alone activity? Yes No

Will there be a shift change during the course of this plan? Yes No

Is an Emergency Contact List attached? Yes No

Has this Site Specific SimOps Plan been acknowledged on the SimOps Daily Log? Yes No

Additional Precautions / Procedures or Concerns:

In addition to the Risk Exposure Evaluation, the following precautions /procedures and concerns shall be followed:

1.______

2.______

3.______

4.______

5.______

6.______

Communication

The key element during simultaneous operations is communication. It is imperative that clear and effective communications be maintained between company personnel, contractors and service partners on location.

COMPANY / CONTACT / PHONE #

This communication shall be established at the outset of simultaneous operations and maintained daily through both normal and abnormal conditions and documented on the Daily Simultaneous Operations Log.

Does this Site Specific Simultaneous Operation Plan:

·  Operate within design or environmental limits? Yes No

·  Operate in a safe and controlled manner? Yes No

·  Ensure that safety devices are in place and functioning? Yes No

·  Follow safe work practices and procedures? Yes No

·  Meet or exceed customer’s requirements? Yes No

·  Maintain integrity of dedicated systems? Yes No

·  Comply with all applicable rules and regulations? Yes No

·  Address abnormal conditions? Yes No

·  Follow written procedures for high risk or unusual situations? Yes No

·  Involve the right people in decisions that affect procedures and equipment? Yes No

Reviewed by:

Position / Name & Phone No.
(note N/A if Not Applicable) / Signature
SimOps Coordinator

Date:______

Time:______

POST ACTIVITY

Was Any Stop Work Authorities Used? Yes No

Were There Any Spills/Incidents? Yes No

Were There Any Conflicting Operations? Yes No

Was There Any Variance From This Plan? Yes No

Were There Any Issues Not Covered By This Plan? Yes No

Details:

______

______

______

Work Permit(s) Issued? Yes No

Permit type
Permit #

Are copies of safety meetings / work permits attached? Yes No

Is an extension of this plan required? Yes No

IS THIS SIMULTANEOUS OPERATION ACTIVITY COMPLETED? Yes No

Comments:______

______

______

______

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