CHESM Performance Review

Chevron CHESM Performance Review

1. General Information

Contractor Company Name:

Contract/Project Name or Number:

CHESM Contract Owner:

Contractor Management Representative:

Attendees:      

Number of employees supporting the contract/operations:

Date of Review:

Date of Last Performance Review:

Scoring Guidelines* Results will be captured in the CHESM database

The following table summarizes points available in each section with a total of 100 points. Award range of
points in accordance with the level of performance.

Enter point totals for each category in the Score column:

Section Questions/Points Available Score

1 HES Performance Management 2questions /12 points available for distribution

7questions / 28 points available for distribution

2 HES Management
No points assigned to N/As

1/10 points
3 Action Item Management
If N/A, deduct from total points available

4 Verification and Validation Score 1/40 points

5 Local Focus 1/10points

Total points available: *if no N/A = 100 points 100 pts.

Total N/A (deduct from 100):       pts.

Revised total points available:       pts.

Final score (total/total available):

CHESM Performance Review

HES Performance Data

HES performance data specific to work
Year Year Current Year 2019
performed within Chevron OE Reporting
2017 2018 Q1 Q2 Q3 Q4
Boundaries, not to exceed 3 years.
Total number of employee hours worked
Number of work-related fatalities 0 0 0 0
Number of injuries that resulted in one or more
0 0 0 0
days away from work
Number of injuries that resulted in restricted 0 0
0 0
work activity
Number of injuries and illnesses involving 0 0
0 0
medical treatment
Number of motor vehicle crashes
0 0 0 0
(C, M, S, L)

Number of CVX regulatory violations 0 0 0 0

Number of oil and chemical spills 0 0 0 0

1. HES Performance Management Acceptable Needs Imp Unacceptable

HES KPI performance vs. targets Acceptable if : (6)
(e.g. –TRIR, DAFWR, MVCR) HES KPI performance meet
KPI : Leading & Lagging with the target
Indicators Need Improvement : (3)
Lagging meet KPI, Leading
not meet KPI
Unacceptable if : (0)
Lagging not meet with KPI
Tracking and reporting Acceptable if : (6)
(e.g. - timeliness and accuracy of All report submitted timely
reporting hours and incidents) and accurate
Reporting : Need Improvement : (3)
 Man hours 5 out of 6 report submitted
timely and accurate
 Miles Driven
Unacceptable if : (0)
 DIMS
4 or less report submitted
 KPI timely and accurate
 MSW roles
 Incident &Nearmiss
SCORE: _____of _12_ pts

2
CHESM Performance Review

2. HES Management N/A Acceptable Needs Imp Unacceptable

Subcontractor management No 1 is
(e.g. – selection process, mandatory
orientations, safety meetings)
This item is acceptable, if :
1. Subcontractor procedure is
available and contained with
1 Not available
HES aspect
1 ,2 available or
2. The subcontractor
All available or 1 available but 2
management procedure
(4) 1.3 available &3 not available
implemented consistently to all
subcontractor (starting from (2) (0)
selection process, pre job
meeting, periodical evaluation)
3. All subcont employee receive
induction & training and
included in safety meeting

SSE program management *Field

(e.g. – identification, mentoring, Verificatio
documentation) n
Refer to guideline and
CHESM/MSW field verification :
1. All SSE participant are
documented within the SSE
list
2. All SSE implementation are
consistently documented using
SSE form
3. SSE participant limited under All requirements Any violation
20% unless managed under are met or
(0)
approved variance form mitigated by
4. SSE participant is visually variance form
identified (obtain from field (4)
inspection and MSW
leadership engagement
5. Mentor on site
6. Mentor duration 6 months
7. SSE participant are aware of
the program and mentors
(obtain from field inspection
and MSW leadership
engagement)
8. Subcontractor well managed
under the same requirement
CHESM Performance Review

Mitigation Plans No 1 & 3

(e.g. – progress, communication, are
completion) mandatory
1. Mitigation plan developed by 1, 2, 3
CMR based on CHESM review
(i.e. PQ, IR)within 14days 1, 2, 3, 4 or Either 1 or 3 not
available 1, 3, 4 available
2. Mitigation plan is tracked
(4) (2) (0)
3. Mitigation plan is completed
by due date
4. Mitigation plan completion is
communicated to contract owner
Behavior Based Safety No 1 is
(e.g. – tracking, trending, mandatory
communication/participation)
1. Updated procedure is available
with expected items 1 available
2. BBS are implemented and 1 not available
consistently aligned with 1, 2, 3, 4 inconsistent Or
procedure, KPI, HES program, available implementatio
contract clause Only no 1
n (2,3,4)
3. BBS analysis conducted for all (4) available
(2)
observation result for continual (0)
improvement
4. BBS analysis result is
communicatedml to all
workforces

4
CHESM Performance Review

Incident Investigation and No 1 & 2

Reporting program are
management mandatory
(e.g. – reporting, *including
near misses, investigation,
corrective actions)
1.An updated written procedure is
available with expected content
: Incident terminology &
definition, Incident
classification, Investigator team
including investigator leader or
RCA facilitator (refer to HES Only 1 not
Exhibit 14.7), Root Cause available
Analysis method/technique, 1, 2 available
(if there is no
and 3,4,5,6 incident/nearmiss)
Tracking system to track
inconsistent
corrective action completion, All available implementatio 1 & 2 not
Process share lesson learned (4) n available
(if there is any
(2)
2.All incident within the review incident/nearmiss)
timeline is reported and
investigated aligned with (0)
procedure
3.Investigation result are well
documented
4.All action items are tracked
completed with PIC, due date
and status
5.Recommendation are closed
within assigned timeline
6.Workers are well informed with
learnings of current incident and
nearmiss (obtain from field
inspection and MSW leadership
engagement)
CHESM Performance Review

2. HES Management Continued N/A Acceptable Needs Imp Unacceptable

Hazard Identification *Field Verification
(e.g. – JSA, Hazard Analysis,
safety meetings)
1. List of PPHA & PPHA
evidence
2. Onsite JSA evidence 3
(Availability of JSA's specific inconsistent
to scope of work, JSA's implementat 1,2,3
1, 2, 3
reviewed at Pre Job Meeting's, ion (poor Not
available
Personnel attending Post award quality of available
kick off meting’s either sign (4) PPHA/JSA) (0)
the JSA or a post award kick (2)
off meeting form if the
contractor uses one, Review
process for pre-typed JSA's)
3. PPHA and onsite JSA
implemented consistently
aligned with MSW
requirement
Stop Work Authority No 1 is mandatory
(e.g. – support, application, Only 1
documentation/reporting) available
1. SWA policy signed by top Or
management & communicated 2,3
to all workforces inconsistent
2. Evidence of implementation 1,2,3
implementa
3. Documentation of follow up 1, 2, 3 Not
tion
action for the SWA case available available
Or
(4) (0)
SWA
implementa
tion get
indetified
in RCA
(2)

SCORE: _____of _28_ pts

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CHESM Performance Review

3. Action Item Management N/A Acceptable Needs Imp Unacceptable

Evaluate contractor-specific
action items from Action Item V&V :
report in the CHESM IT Tool. Need to re-
Acceptable performance confirm to
indicates assigned ownership, V&V team to
timely management, completion ensure data
& validation of identified validity of
actions. contractor
1. Inspection (contractor)
2. Audit (contractor internal
audit)
7.5 :91% - 99% Under
3. Management review 100%
5 :71% - 90% 50%
(contractor) completed
2.5 :51% - 70% completed
4. Incident investigation timely
(0)
corrective action (10)
(contractor)
5. CHESM Field Inspection
for MVS& MSW (CVX)
6. Post award kick off meeting
(CVX)
7. CHESM/MSW Field
verification (CVX)
8. Last Interim Review (CVX)
9. Mitigation plan (CVX)

_____of _10_
SCORE:
pts

4. Field Verification (V&V score)Acceptable Needs Imp Unacceptable

Review the V&V score from FV : V&V score; if V&V

SIFP team; if no V&V score score not available, use FV
available, use average (max 5) Average score from CHESM IT tool
from field verification found in V&V score score (Average last 5 assessment
CHESM IT tool V&V score between 41 below that will be used)
is 100% to 99% 40%
(40) (0)

SCORE: _____of _40_ pts

CHESM Performance Review

5. Local Focus Acceptable Needs Imp Unacceptable

Component based on 1. Forum engagement &

demonstrated support of local participation(1)
programs / processes: Contractor 2. HES organization(1)
Leadership engagement, 3. Employee Benefit
commitment to CHESM Process (i.e. medical services,
improvement, etc. craft & HES training
1. Forum engagement & and its record) (2)
participation 4. Employee
2. HES organization Engagement (i.e.
3. Employee Benefit (i.e. employee
medical services, performance
craft&HES training and appraisal)(1)
its record) 5. Regulatory
4. Employee Engagement Compliance (i.e. but
(i.e. employee not limited to
performance appraisal) Pollution prevention,
5. Regulatory Compliance Medical examination,
(i.e. but not limited to PPE, P2K3,
Pollution prevention, Substance abuse,
Medical examination, Certification, MSDS,
PPE, P2K3, Substance Industrial Hygiene)
abuse, Certification, (4)
MSDS, Industrial 6. ERP(1)
Hygiene)
6. ERP

SCORE: _____of _10_ pts

6. Engagement / Open Discussion: (No score)

1. Best Practices, Sharing opportunities (internal / external)
2. Emerging Issues / challenges (e.g. - SSE’s, regulatory, incident trends, Process Safety, Operational
Discipline, Human Performance)
3. Feedback for Chevron
4. Other (e.g. – areas where support requested)

Total Points ______

7. Action Items from Performance Review

Target Completion
Section # / Action Item Description Owner
Date Date

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CHESM Performance Review

7. Action Items from Performance Review

Target Completion
Section # / Action Item Description Owner
Date Date

Attach additional documentation if needed.

CHESM Contract Owner: Date: