F12254-Cdb-W01-Hse-Pro-00116 - 02 Inspections & Monitoring

PERU LNG EXPORT PROJECT
MARINE FACILITIES EPC CONTRACT

________________
CONTRACT NUMBER LNG-P/05-0005
02 21-Ago-08 Approved for Construction JPX MCZ TAC

HSE periodical review
01 25-Sep-07 Approved for Construction CPM MCZ RCA
0A 30-Jul-07 Issued for Review GSE MCZ TAC
Rev. Date Description of revision Prepared by Checked by Approved by

DD-MM-YY Visa Visa Visa
OWNER: CONTRACTOR:
This document is CDB Melchorita property. It cannot be copied or transmitted to third parties without prior authorization.
Type of documents :
PROCEDURE
Contractor's document identification: Rev. Status :

F 1 2 2 5 4 C D B W 0 1 H S E P R O 0 0 1 1 6 0 2 AFC
Document title:
INSPECTIONS & MONITORING
Owner’s or other entities documents No.: Sheet:
1 / 19
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PERU LNG EXPORT PROJECT F12254-CDB-W01-HSE-PRO-00116
Rev.: 02 Date: 21-Ago-08

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REVISION SHEET
Rev. N° Status Description of Revision
0A IFR Issued for Review
01 AFC Approved for Construction
02 AFC Approved for Construction. HSE periodical review

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TABLE OF CONTENTS
1. SCOPE AND PURPOSE ............................................................................................................................................... 4
2. REFERENCE DOCUMENTS......................................................................................................................................... 4
3. DEFINITIONS................................................................................................................................................................. 4
4. ACTIVITIES DESCRIPTION.......................................................................................................................................... 5
4.1 RESPONSIBILITIES.................................................................................................................................................. 5
4.1.1 Project Director..................................................................................................................................... 5
4.1.2 Deputy Project Director & Construction Manager................................................................................ 5
4.1.3 HSES Manager .................................................................................................................................... 5
4.1.4 Supervisor ............................................................................................................................................ 5
4.1.5 Employee.............................................................................................................................................. 5
4.2 PERFORMANCE EVALUATION FOR CONSTRUCTION ................................................................................................... 6
4.2.1 Measurement categories...................................................................................................................... 6
4.2.2 Sub construction Equipment ................................................................................................................ 6
4.2.3 Housekeeping ...................................................................................................................................... 6
4.2.4 Environmental ...................................................................................................................................... 6
4.2.5 Subcontractor Management................................................................................................................. 6
4.2.6 HSE Representatives ........................................................................................................................... 7
4.2.7 Communication .................................................................................................................................... 7
4.2.8 Risk management ................................................................................................................................ 7
4.2.9 Training................................................................................................................................................. 7
4.2.10 Health ................................................................................................................................................... 7
4.2.11 Emergency Preparedness (medical/fire/spill prevention) .................................................................... 7
4.2.12 Field ...................................................................................................................................................... 7
4.2.13 Inspections/assessments and surveys ................................................................................................ 7
4.2.14 HSE First Compliance .......................................................................................................................... 7
4.2.15 Reporting .............................................................................................................................................. 8
4.2.16 Safety Statistics.................................................................................................................................... 8
APPENDIX A – PRELIMINARY INCIDENT INVESTIGATION REPORT............................................................................. 9
APPENDIX B – FINAL INCIDENT INVESTIGATION REPORT ......................................................................................... 10
APPENDIX C – GENERAL HSES INSPECTION................................................................................................................ 11
APPENDIX D – SCAFFOLDING CHECKLIST.................................................................................................................... 12
APPENDIX E – LIFELINE INSPECTION............................................................................................................................. 13
APPENDIX F – HARNESS INSPECTION ........................................................................................................................... 14
APPENDIX G – INSPECCIÓN DE LÍNEA DE VIDA ........................................................................................................... 15
APPENDIX H – INSPECCIÓN DE ARNÉS ......................................................................................................................... 16
APPENDIX I – OCCUPATIONAL NOISE MONITORING ................................................................................................... 17
APPENDIX J – HSE SCORE CARD.................................................................................................................................... 18
APPENDIX K – EXPLOSIVES MAGAZINE INSPECTION ................................................................................................. 19

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1. SCOPE AND PURPOSE
This Procedure describes the Inspection & Monitoring Procedure compliance activities performed by
CONTRACTOR, during the Marine Facilities Project and Quarry activities.
This procedure addresses field implementation and controls for Inspection & Monitoring Procedure
management during construction and commissioning as well as the processes for monitoring and
mitigation of construction activities that could potentially impact the environment.
This procedure will be updated if conditions or Inspection & Monitoring Procedure requirements change.
2. REFERENCE DOCUMENTS
CONTRACT LNG-P/05-0005 Peru LNG Export Project / Marine Facilities EPC Contract
F12254-CDB-W01-PMT-PLA-00001 Project Execution Plan

F12254-CDB-W01-HSE-PLA-00100 Health & Safety Plan
F12254-CDB-W01-HSE-PRO-00115 Hazard Identification and Risk Assessment
F12254-CDB-W01-HSE-PLA-00131 HSES Training
F12254-CDB-W01-HSE-PRO-00134 HSE Safety Task Analysis Risk Reduction Talk (STARRT)
F12254-CDB-W01-HSE-PRO-00136 Housekeeping, Fire Prevention and Protection
3. DEFINITIONS
PROJECT: PERU LNG Export Project Marine Facilities EPC Contract

OWNER: PERU LNG S.R.L.
CONTRACTOR: CDB Melchorita
PROJECT common definitions are listed in the F12254-CDB-W01-PMT-PLA-00001 - Project Execution

Plan.
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4. ACTIVITIES DESCRIPTION
4.1 RESPONSIBILITIES
When an activity is defined for a certain position in this procedure, the responsibility remains with
that person although a designee may perform the implementation of that activity. The appointed
designee must report directly to the assigned individual
4.1.1 Project Director

Project Director has the overall responsibility for this procedure and is responsible for
supporting it and for ensuring that all entities at the jobsite actively participate.
Project Director is responsible for providing the personnel, facilities, and other resources
necessary to effectively implement this procedure.
Project Manager and management team will lead by example, modeling the behavior
expected from all personnel performing work at the jobsite.
4.1.2 Deputy Project Director & Construction Manager

Deputy Project Director & Construction Manager has the responsibility for compliance
with this PROCEDURE and shall provide the personnel, facilities, and other resources
necessary to effectively implement, administer and enforce this procedure.
Deputy Project Director & Construction Manager is responsible for the effective
dissemination and education of the requirements throughout the Subcontractor’s and its
Subcontractor’s organizations. The Subcontractor Construction Manager shall ensure
that all Subcontractor employees and all Lower tier Subcontractors comply and actively
participate with its requirements.
4.1.3 HSES Manager

HSES Manager shall be responsible for the continuous monitoring of the implementation
of this procedure.
HSES Manager will provide feedback on performance and assist Subcontractor
Supervision to proceed and coordinate the work to effectively implement the requirements
of the procedure.
4.1.4 Supervisor
Supervisor shall be thoroughly familiar with this procedure and with their individual
responsibilities regarding its implementation and enforcement.
Supervisor shall ensure that only competent persons are assigned work tasks. This
includes ensuring the worker has the skills, physique and knowledge to safely execute
the work task.
4.1.5 Employee
Employees must know, understand and comply with the health, safety and environmental
requirements of this procedure as applicable to the work they perform.
Employees must report to their Supervisor any equipment malfunction that may effect the
safe operation of the equipment.
Employee must advise their immediate Supervisor whenever unsure of the instructions
for a task or where concerned about the safety status of any task.
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4.2 PERFORMANCE EVALUATION FOR CONSTRUCTION
4.2.1 Measurement categories

Sub construction Equipment 10%
Housekeeping 15%
Lower Tier Subcontractor Management 5%
HSE Staffing 5%
Communication 5%
Risk Management 5%
Training 5%
HSE
Health 4%
Performance
Environmental 10%
Emergency 4%
Field 5%
Inspections 5%
HSE First Implementation 2%
Reports 2%
Lost time incidents 15%
4.2.2 Sub construction Equipment

Monthly scoring will be determined by physical inspections and reviews of the
Subcontractor’s equipment brought to the project and existing equipment used and
maintained for the period. The Subcontractor will be requested to participate in these
reviews. Inspection/maintenance of tools and equipment, procedure provides the
evaluation forms.
4.2.3 Housekeeping
Weekly scoring will be determined by physical inspections and reviews of the
CONTRACTOR´S work and storage areas.
The CONTRACTOR will be requested to participate in these reviews.
4.2.4 Environmental
Monthly scoring will be determined by physical inspections and reviews of the
CONTRACTOR’S work and storage areas using the form contained in Attachment D,
Subcontractor Environmental Report.
The Subcontractor will be requested to participate in these reviews.
4.2.5 Subcontractor Management

Monthly scoring will be determined by reviewing the Subcontractor’s management in
accordance to this Procedure and the categories as specified on Appendix C. Weighting
will be as indicated on full compliance.
Before mobilizing to the Project, CONTRACTOR shall require all Subcontractors to
submit a written HSE-MS specific to their scope of work. CONTRACTOR shall review
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and accept all such procedures for compliance with OWNER and regulatory
requirements.
4.2.6 HSE Representatives

CONTRACTOR HSE Representative(s) shall be resident on the Project for all work
activities.
CONTRACTOR HSE Representative(s) and staff shall have sufficient authority and
control to ensure effectiveness of the HSE process and hold them accountable for
facilitating its implementation.
4.2.7 Communication
Attendance and or effectively conducting the following meetings, maintaining bulletin
boards and HSE Entrance Boards.
• Daily STARRT CARD
• HSE Toolboxes
• Weekly inspections
• Daily HSE Coordination
4.2.8 Risk management

CONTRACTOR shall be scored on implementation and conducting the JSA reviews in
accordance with F12254-CDB-W01-HSE-PRO-00115, Hazard Identification and Risk
Assessment.
Conducting STARRT meetings and displaying STARRT cards in accordance with
F12254-CDB-W01-HSE-PRO-00134, HSE Safety Task Analysis Risk Reduction Talk
(STARRT). The Subcontractors will be requested to participate in these reviews.
4.2.9 Training
CONTRACTOR shall be scored on implementation and submitting HSE training matrices
and ensuring employees attend required sessions in accordance with F12254-CDB-W01-
HSE-PLA-00131, HSES Training.
4.2.10 Health
CONTRACTOR shall be scored on implementation and submitting HSE Health / Medical
Procedure’s.
4.2.11 Emergency Preparedness (medical/fire/spill prevention)

CONTRACTOR shall be scored on implementation with the following criteria field
evaluations using the emergency drill reports.
4.2.12 Field
CONTRACTOR shall be scored on implementation according to field evaluations.
4.2.13 Inspections/assessments and surveys

CONTRACTOR shall be scored on implementation with the following criteria field
evaluations utilizing the checklists contained in this document.
4.2.14 HSE First Compliance

CONTRACTOR will be provided with periodic reports to the OWNER of their performance
in relationship to the established targets.
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4.2.15 Reporting
CONTRACTOR shall be scored on compliance with the submittal of reports and other
records in accordance with the requirements established in this procedure
4.2.16 Safety Statistics

CONTRACTOR weekly and monthly reports will be used to establish current safety
statistics to the OWNER and posted on the HSE Boards based on site.
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APPENDIX A – PRELIMINARY INCIDENT INVESTIGATION REPORT

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Appendix A
Preliminary Incident Investigation Report
For:
Insert Title
Date of incident:
Insert Date
This document was printed on 16-Sep-08.

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GENERAL INFORMATION
INCIDENT CLASSIFICATION: _______________ OTHER (SPECIFY):
LOCATION: TASK BEING CONDUCTED:
DEPARTMENT: _________________ PROJECT SPECIFIC: _________
REPORTED BY: PHONE # :
DATE OF INCIDENT: TIME: DATE REPORTED:
INCIDENT: CDB SUBCONTRACTOR SUBCONTRACTOR:
IDENTIFY INCIDENT
INJURY: PROPERTY DAMAGE: ENVIRONMENTAL:
Injured Party: ______________ Fire Equipment Failure Spill Volume ___
Injury Type: _______________ Security Equipment Damage Spill Recovered ___
Lost Days (if applicable) Theft Vehicle Accident - Water
Date Returned to Work (if applicable) Vandalism Chargeable Hydrocarbon
Violation Vehicle Accident - Emulsion
PROCESS LOSS: _______________
Non-Chargeable
Other (Specify) Gas
Gas Leak Volume ___
Total Estimated CDB Cost: Public Impact / Complaint
Total Estimated Total Cost: Regulatory Action
TERRAIN AFFECTED: ______________
CLIENT PERSONNEL NOTIFIED (IF MORE SPACE REQUIRED, PLEASE LIST ON SEPARATE SHEET)
DATE NOTIFIED: CONTACT PERSON: CONTACT PHONE #: DEPARTMENT:
_____________
_____________
_____________
PRELIMINARY DESCRIPTION OF INCIDENT
ANALYSIS: RISK ASSESSMENT (of actual events)

Catastrophic Mid Risk High Risk High Risk High Risk
(4) (8) (12) (16)
Consequence
Critical Mid Risk Mid Risk High Risk High Risk

(3) (6) (9) (12)
Severity Probability Risk Ranked Moderate Low Risk Mid Risk Mid Risk High Risk
(2) (4) (6) (8)
---------------------- ---------------------- ---------------------- Minor Low Risk Low Risk Mid Risk Mid Risk
(1) (2) (3) (4)
Improbable Remote Occasional Frequently
Probability
DIRECT CAUSE The actual hazardous or unsafe action or condition. (the point of energy)
INDIRECT CAUSE The situation that perpetuated the hazardous or unsafe actions of people, or that created the hazardous/unsafe condition.
Act of Others Housekeeping Material Specs Inadequate Training Inadequate
Animal Presence Human Factor Modifications Inadequate Weather Extremes
Corrosion Inspection Inadequate Orientation Inadequate Work Planning Inadequate
Design Inadequate Lack of Procedure Procedure Inadequate
Excessive Wear and Tear Maintenance Inadequate Procedure Not Used
ROOT CAUSE The breakdown of a management system that, if left uncorrected, may allow the hazardous condition or situation to continue.
Hazard Assessment & Risk Management Competency Training Communications
Legal and Other Requirements Document Control Operational Control
Incident Investigation and Analysis Objectives, Targets Emergency Readiness
REMEDIAL ACTION SECTION
Remedial Action Item: Target Date: Completed Date: Action By:
1.
2.
3.
4.
5.
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SIGNATORIES
Title NAME SIGNATURE DATE
CDB Representative:
HSES Representative:
HSES Manager:
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APPENDIX B – FINAL INCIDENT INVESTIGATION REPORT

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Appendix B
Final Incident Investigation Report
For:
Insert Title
Date of incident:
Insert Date

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GENERAL INFORMATION
INCIDENT CLASSIFICATION: _______________ OTHER (SPECIFY):
LOCATION: TASK BEING CONDUCTED:
DEPARTMENT: _________________ PROJECT SPECIFIC: _________
REPORTED BY: PHONE # :
DATE OF INCIDENT: TIME: DATE REPORTED:
INCIDENT: CDB SUBCONTRACTOR SUBCONTRACTOR:
IDENTIFY INCIDENT
INJURY: PROPERTY DAMAGE: ENVIRONMENTAL:
Injured Party: ______________ Fire Equipment Failure Spill Volume ___
Injury Type: _______________ Security Equipment Damage Spill Recovered ___
Lost Days (if applicable) Theft Vehicle Accident - Water
Date Returned to Work (if applicable) Vandalism Chargeable Hydrocarbon
Violation Vehicle Accident - Emulsion
PROCESS LOSS: _______________
Non-Chargeable
Other (Specify) Gas
Gas Leak Volume ___
Total Estimated CDB Cost: Public Impact / Complaint
Total Estimated Total Cost: Regulatory Action
TERRAIN AFFECTED: ______________
CLIENT PERSONNEL NOTIFIED (IF MORE SPACE REQUIRED, PLEASE LIST ON SEPARATE SHEET)
DATE NOTIFIED: CONTACT PERSON: CONTACT PHONE #: DEPARTMENT:
_____________
_____________
_____________
DETAILED DESCRIPTION OF INCIDENT
Clearly describe how the incident occurred (ex: who, what, when, where, why and how). Include all relevant information
immediately prior to, during, after the incident, and all remedial actions taken in chronological order. Address all items checked
above. Include recent trends based on risk assessments and observations. Update this section as information becomes
available. Attach separate sheet if necessary:
KEY FINDINGS
1.
2.
3.
4.
5.
ANALYSIS: RISK ASSESSMENT (of actual events)
RISK ASSESSMENT (of actual events) Catastrophic Mid Risk High Risk High Risk High Risk
(4) (8) (12) (16)
Consequence
Severity Probability Risk Ranked Critical Mid Risk Mid Risk High Risk High Risk
(3) (6) (9) (12)
------------------- ---------------------- ---------------------- Moderate Low Risk Mid Risk Mid Risk High Risk
(2) (4) (6) (8)
RISK ASSESSMENT (of what could have happened) Minor Low Risk Low Risk Mid Risk Mid Risk
(1) (2) (3) (4)
Severity Probability Risk Ranked Improbable Remote Occasional Frequently
------------------- ---------------------- ---------------------- Probability
DIRECT CAUSE The actual hazardous or unsafe action or condition. (the point of energy)
1.
2.
3.
4.
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5.
INDIRECT CAUSE The situation that perpetuated the hazardous or unsafe actions of people, or that created the hazardous/unsafe condition.
Act of Others Housekeeping Material Specs Inadequate Training Inadequate
Animal Presence Human Factor Modifications Inadequate Weather Extremes
Corrosion Inspection Inadequate Orientation Inadequate Work Planning Inadequate
Design Inadequate Lack of Procedure Procedure Inadequate
Excessive Wear and Tear Maintenance Inadequate Procedure Not Used
Description
1.
2.
3.
4.
5.
ROOT CAUSE The breakdown of a management system that, if left uncorrected, may allow the hazardous condition or situation to continue.
Hazard Assessment & Risk Management Competency Training Communications
Legal and Other Requirements Document Control Operational Control
Incident Investigation and Analysis Objectives, Targets Emergency Readiness
Description
1.
2.
3.
REMEDIAL ACTION SECTION
Remedial Action Item: Target Date: Completed Date: Action By:
1.
2.
3.
4.
5.
SIGNATORIES
Investigation Team Leader:
HSES Manager:
Project Director:
Investigation Team Members:
Not Applicable

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APPENDIX C – GENERAL HSES INSPECTION

Health, Safety, Environment and Security (HSES)
HSE Inspection
CDB
Date ( )

HSES Inspection
HSES Inspection
General Data
Company Inspected: Date/Time: / /

Participants:
Company Name Position Signature
Type of Risk
TYPE OF RISK
H High Noncompliance posing imminent risk for personal injury / exposure or property damage / loss if uncorrected
M Medium Noncompliance posing moderate risk for personal injury / exposure or property damage / loss if uncorrected
L Low Noncompliance posing occasional risk for personal injury / exposure or property damage / loss if uncorrected
Observations Report
Print Date; 16-Sep-08 Page 2 of 3

HSES Inspection
Final
Type of
No Photo Description Corrective Actions Target Date Resp. Status/
Risk
Date
Print Date; 16-Sep-08 Page 3 of 3

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APPENDIX D – SCAFFOLDING CHECKLIST

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APPENDIX D - Scaffolding Checklist

Location:
Date:
YES NO Corrective actions made

1. Basis and surrounding Conditions of the Scaffolds
1.1. Is scaffold tag installed?
1.2. Is STARRT card being conducted and present on site?
1.3. Are there any ditches for the scaffolding drainage?
1.4. s there any stagnant water around the scaffolds?
1.5. If the ground is firm and level enough to support the scaffolds.
1.6. Is there any excavation close the scaffolding base?
1.7. Are there any blocks on the access to the scaffolding area?
1.8. Are there any heavy equipments or high electrical lines near the scaffold
area?
2. Scaffolds building and maintenance
2.1. Erected under proper supervision
2.2. Is there any signs to show the status of scaffolds, such as “Non-use” or “Can
be used” or under construction”
2.3. Passersby and overhead protection in place
2.4. Guard rails, mid rail, toe boards; full planks, brace installed, access, etc are
secured.
2.5. Are there any loose, or useless objects, or blocks put on scaffolding and/or
housekeeping is being done?
2.6. Scaffolds or platform is under good conditions? Are there overload or slope?
2.7. Are gin wheels or pulley qualified for works?
2.8. Are lifting ropes are in good condition?
2.9. Are materials being lifted according to the Max Load (max. 50 kilos)?
2.10. Is erection area being barricaded?
3. Dismantling of scaffolds
3.1. Are there any warning tapes around the dismantling area?
3.2. Is there any watch man to control people getting into the area?
3.3. If dismantling works includes high risk; is there a JSA for the job?
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Observations for unsafe acts and unsafe conditions Corrective actions made
1. 1.
2. 2.
3. 3.
4. 4.
5 5
Inspector
Noted by:
HSE ENGINEER
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APPENDIX E – LIFELINE INSPECTION

Lifeline Inspection/Audit From
Contractor Date Inspected:

Inspected By Area Inspected:
Action Required
Item Description of issues Compliance Details
Yes No
1 Any areas where lifeline is required,but missing ?
2 Are lifeline inspection tags correctly color coded?
3 Are lifeline tags signed by non-authorised person?
4 proper access to lifeline?
Is the wire rope sized to support 2270kg/worker/(12mm

5 minimum)?
Is the wire rope in th good condition?(e.g.,no

6 kinks,broken wire)
Are both ends of the .lifeline attached to structure that is

7 capable of supporrting 2270kg/worker?
Are lifelines secured on each end by at least three cable

8 clip and proper cable clip used and properly lused?
Are lifeline softeners placed where lifelines contact

9 sharp edges of beams to prevent damage to lifeline?
Maximum number of worker permitted to tied off lifeline

10 stated on tag?
Date Action Action closeout

Item Action Required Action by Action date
signature
Close
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APPENDIX F – HARNESS INSPECTION

Safety Harness Inspection Form
Checking by: Location: Company: Date:
Safety Harness serial No: Lanyard Nº:

Component Condition/Fault to be cheecked Pass Fail
Cuts or tears
Abrasion damage especially where there is contact with hardware.
Excessive streching
Webbing
Damage due to contact with heat,corrosive or solvent substance
Deteriioration due to rotting,mildew or ultraviolet exposure
Distortion of hooks or latch
Cracks heat damage
Snap Hooks Wear at swivels and latch
Broken ,weak or misplaced latch springs.(if possible ,compare with new snap hook)
Free of distorted or other physical damage
Miss distorted or other physical damage

Buckles and Cracks and forging laps where applicable
Adjusters Bent tongues
Open rollers
Excessive streching
Excessive vertical movements of the staright portion of the D-ring at its attctchment point
on the harness,so the corners between the straight and curved sections of yhe D become
completely exposes .NOTE:excessive vertical movement of the D -ring in its mointing
can allow the nose of larger snap hooks to become lodged behind the staight portion of
the D,inn which case the snap hook can accidentally "rool out"of the D under load.
D-rings
Cracks ,especially at the intersection of the straight and curved portions
Distortionor or other physical damage of the D-ring
Excessive loss of cross section due to wear.

Broken ,cut or worn threads
Stitching
Damage or weakening of threads due to contact with heat ,corrosives or mildew
Cuts
Abrasion or fraying
Lanyard Stretching
Damage due to rotting ,mildew or ultraviolet exposure
Deterioration due to rotting ,mildew or ultraviolet exposure
check for indication of overload
Shock Absorber
Is shock absorber casing in good order
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APPENDIX G – INSPECCIÓN DE LÍNEA DE VIDA

Formulario de Inspección de Líneas de Vida
Contratista Fecha de Inspección

Inspeccionado por Area inspeccionada
Acción requerida
Item Descripcción Detalles sobre cumplimiento
Sí No
¿Existen áreas donde las líneas de vida son requeridas
1 pero no están instaladas?
¿Están las líneas de vida inspeccionadas e

2 identificadas?
¿Las inspecciones de las líneas de vida han sido

3 ejecutadas por una persona autorizada?
4 Hay un acceso apropiado a las líneas de vida?
El cable de las líneas de vida está calculado para

5 soportar 2270 kg/persona (12 mm mínimo)
¿Está el cable en buenas condiciones? (no presenta

6 rizos, roturas, etc)
¿Los extremos de la línea de vida son capaces de

7 soportar 2270 kg/persona?
¿Están las líneas de vida aseguradas en sus extremos

8 con por lo menos tres grapas? ¿Son las grapas
apropiadas?
¿Existen dispositivos a fin de prevenir que las líneas de

9 vida hagan contacto con puntos afilados que puedan
deteriorarla?
¿Se han colocado señalización para indicar el número

10 de personas que pueden estar atadas a las líneas de
vida?
Fecha
Item Acción requerida Responsable Fecha de cierre Firma de cierre
prevista
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APPENDIX H – INSPECCIÓN DE ARNÉS

Formato de Inspección de Arneses y Lanyards
Revisado por: Ubicación: Compañía: Fecha:
Serie del Arnés: Serie de Lanyard Nº:

Componente Condición / Falta a ser revisada Pasa No Pasa
Cortes o desgarros
Abrasión especialmente en zonas de contacto con accesorios
Cintas del arnés Estiramiento excesivo
Daños por contacto con calor, sustancias corrosivas o solventes
Deterioro por podredumbre, enmohecimiento o exposición ultravioleta
Deterioro del gancho o seguro
Daño por calor
Ganchos Desgaste en pivotes o seguros

Resortes rotos, desgastados o fuera de lugar (si fuera posible compare con un
gancho nuevo)
Libre de deformación o daño físico
Deterioro o daño físico
Roturas o labios deformados

Hebillas
Lenguetas deformadas
Falta de ajuste
Estiramiento excesivo
Movimiento vertical excesivo en la parte recta del D-ring y en su punto de sujeción

con el arnés lo que provoca que las esquinas entre la parte recta y curva del D-ring
esté completamente expuesta.
NOTA: Excesivos movimientos verticales del D-ring puede permitir que ganchos
D-rings grandes se coloquen en la parte recta del mismo provocando un deslizamiento del
gancho bajo carga..
Roturas, especialmente en la intersección de la parte recta y curva
Deterioro o cualquier daño físico en el D-ring
Excesivo desgaste de la sección por uso.
Costuras rotas, cortadas o desgastadas

Costuras Daño o debilitamiento de costuras debido a contacto con el calor, elementos
corrosivos o enmohecimiento
Cortes
Abrasión o deshilachado
Lanyard Estiramiento
Daño por podredumbre, enmohecimiento o exposición ultravioleta
Deterioro por podredumbre, enmohecimiento o exposición ultravioleta
Amortiguador de Verificar indicaciones de sobrecargas

impactos Protector del amortiguador de impactos en buen estado
Nombre y firma del Nombre y firma de persona

inspector con cargo del arnés
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APPENDIX I – OCCUPATIONAL NOISE MONITORING

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APPENDIX I - Occupational noise monitoring
Reading
Date Time Location Observations
Max Min
Monitoring by: ________________ Signature: _______________

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APPENDIX J – HSE SCORE CARD

HSE Score Card
Working area: Date
Subcontractors:
Inspected by: Title
Housekeeping Good Poor N/A

1. Regular disposal of waste, debris & surplus soils
2. Construction & Domestic waste receptacles in place
3. Clear Access to work areas
4. Free of tripping hazards and obstructions
5. Materials properly stacked, piled & arranged
6. Cylinders stored vertical, secured with caps ,and free of chemical reaction between each
other
7. Cords & leads elevated or protected
8. Storage cabinets for workers personal tools and items
9. Drains are clear and free of obstructions
10. Lighting/emergency lighting is adequate
11. Materials are adequately secured
NOT APPLICABLE 0 0 0
Personal Protective Equipment Good Poor N/A

1. Wearing suitable Safety shoes which were in compliance with requirementson site
2. Wearing suitable hard cap which were in compliance with requirements on site.
3. Wearing suitable safety harness which were in compliance with requirements on site.
4. Wearing suitable eye protection which were in compliance with requirements on site.
5. Wearing suitable earing plug at environment where noise was over 85 db.
6. Wearing suitable respirator in environment required by related procedures.
7. Wearing suitable gloves in compliance with requirements.
Ladders Good Poor N/A
1. Broken or damaged ladders tagged ”Do Not Use”
2. Ladders lashed at the top/tied off
3. Step Ladder fully opened to permit spreader lock
4. Medal ladders not used for electrical work
5. Correct operation with ladder required by procedures.(firm base,correctly stand on
ladder,etc)
Scaffolding Plans Good Poor N/A

1. Is scaffolding plans developed ,appropriate for tasks, implemented?
2. If the material of scaffold can procedure's requirement
3. Scaffolding Installation
a. Erected under proper supervision
b. All structural members adequate for intended use
c. If the base were firm enough
d. Proper footings provided sound ,rigid and secure
e. If all elements were completed or installed in correct methods.
f. Defective and damaged parts, planks, etc, removed and tagged “Do Not Use”
g. Passerby and overhead protection in place
h. Adequate guard Rails ,mid rails foot board and toe boards installed.
i. Safe means of access
Electrical Installations Good Poor N/A

1. Appropriate insulated extension cords,cables
2. Electrical equipment with plug and in good condition
3. Danger signs and inspection signs posted
4. Appropriate earthing /grounding
5. Exposed electrical equipment free of corrosion and watertight. Correct fitting, leads
protected, waterproof plugs.
6. Cables were elevated or underground at the access.
Material Handling Good Poor N/A

1. Satisfactory plan/layout for Material Storage Facilities
2. Proper/Safe storage cabinets, pallets
3. Fire protection/prevention plan and systems in place
4. Safe access and walkways and elevated work platforms
5. Entrance/Exits and Emergency Exits
6. appropriate spillage prevention facility for hazardous material.
7. Proper Rigging/Craneage Equipment
8. Material were stacked or placed in order.
9. Fall Protection/prevention addressed
Rigging Good Poor N/A

1. Free from defects (frayed/kinked/damaged/visible damage)
2. Minimum size complied (12 mm. And above)
3. Softeners when in contact with sharp edges.
4. Color-coded and/or SWL tagged./
5. Inspected and color coded.
6. Rigging Equipment (proper storage, left laying on ground, housekeeping)
Tools and small equipment Good Poor N/A

1. Proper Protective equipment/shields provided and used
2. Damaged or defective tools tagged, and taken out of service for repair
3. Tools kept free from splinters or cracks
4. Safety Check valves at manifold outlet of supply link
5. All pneumatic hose connections fastened securely
6. Pressure hoses inspected and in good condition
7. electrical cords in good condition
8. Inspection signs on tools and small equipment
Construction Waste Management Good Poor N/A

1. Adequate number of waste bins
2. Waste bins properly labeled
3. Wastes properly segregated (i.e., hazardous/non-hazardous, recyclable)
4. Measures implemented to keep waste from being wind blown
5. Adequate number of portable toilets in clean condition with sufficient water for flushing
and hand washing
6. Waste effluent being properly managed (e.g., sewage being disposed at STP).
7. Waste log being maintained
8. Waste has been correctly separately
Construction Environmental Control Good Poor N/A

1. Adequate noise Control measures implemented where exceedances identified or
expected
2. Adequate dust Control measure implement
3. Environmental inspections being conducted and documented
4. Environmental training being conducted
5. Concrete batch plant being managed in accordance with requirements (i.e., sediment
basin for rinse water sized for rinse water and 50 mm storm event)
6. suitable drainage system for surface water and sewages.
Risk Management Good Poor N/A

1. STARRT
a. Correctly fill the starrt card for different work in timeSTARRT
b. Tool box meeting were held in time.
c. Subcontractor's safety or supervisor were full time on site.
2. Job Safety Analysis (JSA)
a. Number of compliance vs. those Observed per the progress schedule
Training Good Poor N/A

1. Actual attendance of training measured actual vs. planned per monthly schedule
Health Good Poor N/A

1. There are adequate First Aid box and medicines
2. Adequate clean drinking water.
Note: the score card is based on daily inspection(70%) on site of the safety personnel
and management joint inspection(30%).
Doc. N°:

Page: 19/19
APPENDIX K – EXPLOSIVES MAGAZINE INSPECTION

Explosives Magazine Inspection
Date: 03-Jun-08
Area: Quarry Magazine Inspector: J. Pasco
1.0 Magazine area Good Bad N/A

1.1 Security in place
1.2 Perimeter barricade
1.3 Signage on place
Sub-Total 0 0 0
Average score #DIV/0!
2.0 Fire systems Good Bad N/A

2.1 Water tank filled
2.2 Fire extinguishers on place
2.3 Extinguisher placed without obstacles
Sub-Total 0 0 0
3.0 Structures Good Bad N/A

3.1 Integrity of the structures
3.2 Protective system on the windows
3.3 The windows provide enough ventilation
There is a structure to able people to discharge static
3.4
electricity
Sub-Total 0 0 0
4.0 Storage Good Bad N/A

4.1 Explosives are stored only in the magazines
Different kind of materials (explosive, cords, etc) are
4.2
stored separately
4.3 Explosive are stored over pallets
4.4 Storage height don't exceed 2 meters
4.5 Space between storage piles is at least 5 cm.
Storaged materials cant be supported on the walls
4.6
and must have at least 1 meters from them
There is forbidden to storage materials different from
4.7
explosives
Sub-Total 0 0 0
Total 0 0 0
Overall score #DIV/0!
Inspector Signature

F12254-Cdb-W01-Hse-Pro-00116 - 02 Inspections & Monitoring

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PERU LNG EXPORT PROJECT

MARINE FACILITIES EPC CONTRACT

CONTRACT NUMBER LNG-P/05-0005

02 21-Ago-08 Approved for Construction JPX MCZ TAC

0A 30-Jul-07 Issued for Review GSE MCZ TAC

Rev. Date Description of revision Prepared by Checked by Approved by

Contractor's document identification: Rev. Status :

INSPECTIONS & MONITORING

Owner’s or other entities documents No.: Sheet:

INSPECTIONS & MONITORING

Rev. N° Status Description of Revision

0A IFR Issued for Review

01 AFC Approved for Construction

02 AFC Approved for Construction. HSE periodical review

INSPECTIONS & MONITORING

1. SCOPE AND PURPOSE ............................................................................................................................................... 4

APPENDIX A – PRELIMINARY INCIDENT INVESTIGATION REPORT............................................................................. 9

APPENDIX B – FINAL INCIDENT INVESTIGATION REPORT ......................................................................................... 10

APPENDIX C – GENERAL HSES INSPECTION................................................................................................................ 11

APPENDIX D – SCAFFOLDING CHECKLIST.................................................................................................................... 12

APPENDIX E – LIFELINE INSPECTION............................................................................................................................. 13

APPENDIX F – HARNESS INSPECTION ........................................................................................................................... 14

APPENDIX G – INSPECCIÓN DE LÍNEA DE VIDA ........................................................................................................... 15

APPENDIX H – INSPECCIÓN DE ARNÉS ......................................................................................................................... 16

APPENDIX I – OCCUPATIONAL NOISE MONITORING ................................................................................................... 17

APPENDIX J – HSE SCORE CARD.................................................................................................................................... 18

APPENDIX K – EXPLOSIVES MAGAZINE INSPECTION ................................................................................................. 19

INSPECTIONS & MONITORING

1. SCOPE AND PURPOSE

F12254-CDB-W01-PMT-PLA-00001 Project Execution Plan

PROJECT: PERU LNG Export Project Marine Facilities EPC Contract

PROJECT common definitions are listed in the F12254-CDB-W01-PMT-PLA-00001 - Project Execution

INSPECTIONS & MONITORING

4.1.1 Project Director

4.1.2 Deputy Project Director & Construction Manager

4.1.3 HSES Manager

INSPECTIONS & MONITORING

4.2 PERFORMANCE EVALUATION FOR CONSTRUCTION

4.2.1 Measurement categories

4.2.2 Sub construction Equipment

4.2.5 Subcontractor Management

INSPECTIONS & MONITORING

4.2.6 HSE Representatives

4.2.8 Risk management

4.2.11 Emergency Preparedness (medical/fire/spill prevention)

4.2.13 Inspections/assessments and surveys

4.2.14 HSE First Compliance

INSPECTIONS & MONITORING

4.2.16 Safety Statistics

INSPECTIONS & MONITORING

APPENDIX A – PRELIMINARY INCIDENT INVESTIGATION REPORT

INSPECTIONS & MONITORING

Preliminary Incident Investigation Report

This document was printed on 16-Sep-08.

INSPECTIONS & MONITORING

ANALYSIS: RISK ASSESSMENT (of actual events)

Critical Mid Risk Mid Risk High Risk High Risk

INSPECTIONS & MONITORING

INSPECTIONS & MONITORING