JSA Samples for Steel Energy Services

JOB SAFETY ANALYSIS (JSA)

This document is designed to Eliminate, Control, or Protect (ECP)against the hazards intrinsic to the job/task at hand.

Division: BHES North BHES ND Email: tyler.noah@steelteams.com;jeff.peterson@steelteams.com;gerardo.borja@steelteams.com; NDSuperintendents@steelteams.com;jon.matson@steelteams.com Rig Number 305 Location Name: LBJ 24-14HU

Page 1

Date:

Time (24hrs):

05/01/2023

07:23

Client:

Shift: Day

Chord

Night

If more than one shift,additional JSA is required Rig Manager:

Company Man / Consultant

Dan Adkins If hot work is planned, permit is required, or there is a planned lift over 200 lbs use drop down.

Required Personal Protective Equipment (PPE) Hard Hat FR Clothing

Safety Toe Boots Goggles

Chemical Apron Respirator

Impact Gloves Face Shield

Hearing Protection H2S/4-Gas Monitor

Lifting over 200 lbs

Safety Glasses

Chemical Gloves

Chemical Boots

Fall Protection (Inc SRL) Extreme Heat/Cold Prep

Chemical Goggles

PPE OTHER: PPE assessment conducted by (initial):

Page 2

Chemical Face Mask

Other:

Pre-Lift Check

Yes/NA

Personnel Responsible

Payload-Equipment Weight Verified

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

If lifting with Loader - Rating of Loader verified

Yes

Pusher

N/A

Superintendant

If lifting with Loader - Backup Alarm Functioning

Yes

Pusher

N/A

Superintendant

If lifting with a Loader -Is the horn functional?

Yes

Pusher

N/A

Superintendant

If lifting with Loader - Seatbelt functioning?

Yes

Pusher

N/A

Superintendant

If lifting with Loader - Tires in Good condition?

Yes

Pusher

N/A

Superintendant

If lifting with Loader - Fire Extinguisher functional?

Yes

Pusher

N/A

Superintendant

Lifting Equipment in Good Condition YT & MYT Slip Grip Elevators Size & Function SIM OPS JSA for task completed and signed Approval/Permit given Weather/Wind Conditions Good Lift area barricaded no entry Contingency Plan in place Emergency Plan if Needed.

Page 3

Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator

Rigging Check

Yes/NA

Personnel Responsible

Lifting Equipment Inspections/Tags Current

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Rating of Sling or Lifting Chain EXCEEDS Item being Lifted?

Yes

Pusher

N/A

Superintendant

Using Correct Lifting Equipment

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Rating of Sling or Lifting Chain Verified

Lifting Equipment Inspected Prior to Use Sling Angle/Placement/Weight Acceptable Lift points/Fixings Inspected and Approved Tag Lines attached

Operator Operator Operator Operator Operator Operator Operator Operator

I Confirm that the lift plan has been explained to me, that we have discussed it and I understand the operation and my role and responsibility as it pertains to the Lifting Plan Name

Signature

Date

Eric Davis

05/01/2023

Xavier waggoner

05/01/2023

Sergio oliveros

05/01/2023

James Myers

05/01/2023

Angel castrellon

05/01/2023

Enter each time the Posi-Stop was set Enter N/A if Posi-Stop was not used

Was the Posi-Stop Set

Bottom Number Reading

Top Number Reading

Yes

No

100

0

Yes

No

100

0

Yes

No

100

0

Signature

IS YOUR RIG EQUIPPED WITH A ROD TRANSFER SAFETY SYSTEM (RTSS)?

IS YOUR RIG EQUIPPED WITH A ROD TRANSFER SAFETY SYSTEM (RTSS)?

Yes No HAS YOUR ROD TRANSFER SAFETY SYSTEM (RTSS) BEEN TESTED AND IS IT FUNCTIONING "PRIOR" TO TRIPPING RODS "TO OR FROM" THE DERRICK? If "NO" is selected YOU MUST not PROCEED with the JOB - STOP WORK IMMEDIATELY!!!

Yes No

Page 4

IS YOUR RIG EQUIPPED WITH AN ORANGE CONE TO BE PLACED ON THE OPERATOR'S STAND ALONG WITH A PLACARD ON A CHAIN TO BE PLACED ON THE OPERATOR'S CLUTCH VALVE HANDLE AS A REMINDER IF THE BOP RAMS (PIPE OR BLINDS) ARE OPEN OR CLOSED PRIOR TO RESUMING OPERATIONS??? - MUST BE CONFIRMED EACH AND EVERY TIME!!!!

On Off IS YOUR RIG EQUIPPED WITH A BOP SAVER SAFETY SYSTEM ???

IS YOUR RIG EQUIPPED WITH A BOP SAVER SAFETY SYSTEM ??? HESS RIGS PAY ATTENTION Yes No HAS YOUR BOP SAVER SAFETY SYSTEM (BSSS) BEEN TESTED AND IS IT FUNCTIONING "PRIOR" TO "MOVING PIPE - AGAIN, DO NOT MOVE PIPE UNTIL THIS IS CONFIRMED EACH AND EVERY TIME - LOOK AT THE LIGHTS ON THE DISPLAY PANEL! If "NO" is selected YOU MUST not PROCEED with the JOB - STOP WORK IMMEDIATELY!!!

Yes No SAFETY ALERTS CONFIRMATION CONFIRM YOU HAVE READ THE LATEST SAFETY ALERTS ON THE TABLET BY PRINTING YOUR NAME AND SIGNING BELOW Print Name

Signature

Eric Davis Xavier Waggoner Sergio oliveros James Myers Angel castrellon

Page 5

Step 1

2

3

Task Crew Travel

Nipple Down BOP

Rig Down Rig

Hazard(s)

(Eliminate, Control, or Protect ECP) Controls (who,what,when)

Crew Travel Hazards

Crew Travel Mitigations

Hitting wildlife, falling asleep while driving, popping tires, truck breaking down, accidents with other drivers

Defensive driving, pay attention, make sure the driver is fit for duty, make sure whole crew is awake in truck

Nippling Down Hazards

Nipple Down Mitigations

Parted pipe while pulling over, parted drill line while pulling over, dropped blocks, hands caught in between slips, struck by BOP, BOP falling to the ground, struck by loader, loader hitting equipment, tripping on ice/scoria, h2s hazard

Stand back while pulling over, complete brake inspection, complete drill line inspection, watch your hands when bringing in slips, wear impact gloves, inspect lifting equipment, make sure lifting equipments ratings exceed the load being lifted, dont stand between BOP and wellhead, 100% spotters during loader ops, qualified driver in the loader, wear ice cleats, clear the area of any large chunks of scoria, make sure crew are wearing h2s monitors and SCBA's are in a good location, know the wind direction

Rig Down Hazards

Rig Down Mitigations

Struck by basebeam, struck by rig, hands crushed by derrick, caught lines, struck by loader, loader hitting equipment, falling from heights, hands crushed by levelng jacks, rig falling over, equipment crushed in fall path of rig

Dont stand between basebeam and wellhead, dont stand between rig and wellhead, watch hand placement and use good communication while leveling out, watch your lines and use SWA if anything gets caught up, check wind direction before rigging up, domt spot equipment within fall zones, 100% spotters while using loaders, qualified drivers only using loader, three points of contact while working at heights, 100% tie off while working at heights

Page 6

SSE (Short Service Employees) or ARE (At Risk Employees) Employees Present?

Yes

SSE/ARE understand process?

(Select No if no SSE/ARE are present)

No

Yes

No

Mentor Name:

SSE or ARE Name:

Xavier Waggoner

Sergio Oliveros

Job Involvement by any Third Party companies or employees?

Yes

No

Drops Log Book - Tool tracking for items taken into the Derrick Yes

No

Crew Members On Duty Number of Crew Members

5

Crew Members Employee:

Position:

Years of Experience:

Days on Hitch:

Eric Davis

Operator

5

10

Xavier Waggoner

Hamd

1

11

Sergio oliveros

Fh

5m

1

James Myers

Derrickhand

15

1

Angel castrellon

Op

16

1

Sign:

By signing this JSA you are acknowledging, understand the tasks laid out above and that you're fit for duty. By your signature you also indicate that you did not sustain any injuries!

Visitor Log

Page 7

Name

Sign

Company

Reason for Visit?

Time In

Dan Adkins

Steel

Supervisor

07:39 AM

Daniel

Summit

ESP Tech

08:25 AM

Nearest Hospital and Directions: Stanley. North on hwy 8 Rig Location

Emergency Response/Evacuation Plan (Direction of Travel, Muster Point,etc):

Cross wind and upwind. Doghouse or entrance to location Other Safety Concerns/Topics Discussed: (Direction of Travel, Muster Point,etc):

Post Job/Task Summary Incidents/Near Misses occured during shift? (require additional documentation)

Yes

No Did you initiate an SWA (Stop Work Authority) today?

Yes

No

Powered by www.doForms.com

Page 8

Time Out

JOB SAFETY ANALYSIS (JSA)

This document is designed to Eliminate, Control, or Protect (ECP)against the hazards intrinsic to the job/task at hand.

Division: SWS SWS Email: jeff.peterson@steelteams.com;tyler.noah@steelteams.com;gerardo.borja@steelteams.com; NDSuperintendents@steelteams.com;jon.matson@steelteams.com Rig Number 20 Location Name: Blessings 11-36H

Page 1

Date:

Time (24hrs):

05/01/2023

07:36

Client:

Shift: Day

Cord

Night

If more than one shift,additional JSA is required Rig Manager:

Company Man / Consultant

Vincent O'Donnell

Peter Horvath

FIRE RISK ASSESSMENT - API RF54 If hot work is planned, permit is required, or there is a planned lift over 200 lbs use drop down.

Required Personal Protective Equipment (PPE) Hard Hat FR Clothing

Safety Toe Boots Goggles

Chemical Apron Respirator

Impact Gloves Face Shield

Hearing Protection H2S/4-Gas Monitor

Lifting over 200 lbs

Safety Glasses

Chemical Gloves

Chemical Boots

Fall Protection (Inc SRL) Extreme Heat/Cold Prep

Chemical Goggles

PPE OTHER: PPE assessment conducted by (initial):

Page 2

Chemical Face Mask

Other:

Pre-Lift Check

Yes/NA

Personnel Responsible

Payload-Equipment Weight Verified

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

If lifting with Loader - Rating of Loader verified

Yes

Pusher

N/A

Superintendant

If lifting with Loader - Backup Alarm Functioning

Yes

Pusher

N/A

Superintendant

If lifting with a Loader -Is the horn functional?

Yes

Pusher

N/A

Superintendant

If lifting with Loader - Seatbelt functioning?

Yes

Pusher

N/A

Superintendant

If lifting with Loader - Tires in Good condition?

Yes

Pusher

N/A

Superintendant

If lifting with Loader - Fire Extinguisher functional?

Yes

Pusher

N/A

Superintendant

Lifting Equipment in Good Condition YT & MYT Slip Grip Elevators Size & Function SIM OPS JSA for task completed and signed Approval/Permit given Weather/Wind Conditions Good Lift area barricaded no entry Contingency Plan in place Emergency Plan if Needed.

Page 3

Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator

Rigging Check

Yes/NA

Personnel Responsible

Lifting Equipment Inspections/Tags Current

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Rating of Sling or Lifting Chain EXCEEDS Item being Lifted?

Yes

Pusher

N/A

Superintendant

Using Correct Lifting Equipment

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Rating of Sling or Lifting Chain Verified

Lifting Equipment Inspected Prior to Use Sling Angle/Placement/Weight Acceptable Lift points/Fixings Inspected and Approved Tag Lines attached

Operator Operator Operator Operator Operator Operator Operator Operator

I Confirm that the lift plan has been explained to me, that we have discussed it and I understand the operation and my role and responsibility as it pertains to the Lifting Plan Name

Signature

Date

Dane Reing

05/01/2023

Saul Gutierrez flores

05/01/2023

Jose Rodriguez

05/01/2023

Jose Camacho

05/01/2023

Enter each time the Posi-Stop was set Enter N/A if Posi-Stop was not used

Was the Posi-Stop Set

Bottom Number Reading

Top Number Reading

Yes

No

100

0

Yes

No

100

0

Yes

No

100

0

Signature

IS YOUR RIG EQUIPPED WITH A ROD TRANSFER SAFETY SYSTEM (RTSS)?

IS YOUR RIG EQUIPPED WITH A ROD TRANSFER SAFETY SYSTEM (RTSS)?

Yes No HAS YOUR ROD TRANSFER SAFETY SYSTEM (RTSS) BEEN TESTED AND IS IT FUNCTIONING "PRIOR" TO TRIPPING RODS "TO OR FROM" THE DERRICK? If "NO" is selected YOU MUST not PROCEED with the JOB - STOP WORK IMMEDIATELY!!!

Yes No

Page 4

IS YOUR RIG EQUIPPED WITH AN ORANGE CONE TO BE PLACED ON THE OPERATOR'S STAND ALONG WITH A PLACARD ON A CHAIN TO BE PLACED ON THE OPERATOR'S CLUTCH VALVE HANDLE AS A REMINDER IF THE BOP RAMS (PIPE OR BLINDS) ARE OPEN OR CLOSED PRIOR TO RESUMING OPERATIONS??? - MUST BE CONFIRMED EACH AND EVERY TIME!!!!

On Off IS YOUR RIG EQUIPPED WITH A BOP SAVER SAFETY SYSTEM ???

IS YOUR RIG EQUIPPED WITH A BOP SAVER SAFETY SYSTEM ??? HESS RIGS PAY ATTENTION Yes No HAS YOUR BOP SAVER SAFETY SYSTEM (BSSS) BEEN TESTED AND IS IT FUNCTIONING "PRIOR" TO "MOVING PIPE - AGAIN, DO NOT MOVE PIPE UNTIL THIS IS CONFIRMED EACH AND EVERY TIME - LOOK AT THE LIGHTS ON THE DISPLAY PANEL! If "NO" is selected YOU MUST not PROCEED with the JOB - STOP WORK IMMEDIATELY!!!

Yes No SAFETY ALERTS CONFIRMATION CONFIRM YOU HAVE READ THE LATEST SAFETY ALERTS ON THE TABLET BY PRINTING YOUR NAME AND SIGNING BELOW Print Name

Signature

Dane Reing Saul Gutierrez flores Jose Rodriguez Jose Camacho

Page 5

Step

Task

Hazard(s)

(Eliminate, Control, or Protect ECP) Controls (who,what,when)

1

Crew travel

Hitting wildlife, falling sleep while driving popping tires truck breaking down accidents with others drivers,

Adjust speed due to the road conditions watch for wildlife check oil before driving do a walk around vehicle before

2

Rods

Motion Rods swinging in hitting floor hand, rods not latching properly, slipping or tripping on something tailing rods in, blocks hitting rod hangs, derrick hand getting hand caught on transfer when making up rod, rods not making up properly.

Motion Always have a chain tied to the unit and the rig with a sleeve or cover on it at a level above or at the rod table to avoid rods swinging in and hitting floor hand, sleeve to prevent metal to metal contact, Inspect transfer bottle before sending it up, derrick hand never place hand on transfer bottle while making up rods, place hands above the swivel, always check torque on first rod of every taper to ensure rods are not over or under torqued

Mechanical Rod tongs breaking, rod tongs malfunctioning, blocks not stopping in time and hitting floor hand, backup pin breaking, elevators not latching properly and rods falling out of elevators Gravity Rods falling out of elevators, falling while tailing in rods, falling off floor transfer bottle falling out of derrick when sending it up, rods falling out of derrick, rods rolling or falling off trailer, hand tripping and falling off trailer

Page 6

Mechanical Inspect tongs thoroughly before use for any cracks, wears, or and malfunctions, check brakes and adjustment of brake handle to ensure blocks are stopping properly, check the backup pin for any cracks or wearing and do not pull out backups while pin is still in, inspect elevators thoroughly before use and function test before sending rod up Gravity Never stand under rod as it is being tailed in, keep a clear and level walking path at all times while tailing rods in to avoid any trip hazards or falling with the rods, install transfer cable properly onto rod hook to avoid the transfer falling out and dropping, secure rods properly in derrick ro avoid rods falling out of derrick, ensure rods do not get too close to the edge of the trailer so they do not fall off trailer, try to work on top of trailer as little as possible, but if necessary never walk ot stand near the edge of the trailer to avoid falling off, never jump off trailer while getting off to avoid any injuries

SSE (Short Service Employees) or ARE (At Risk Employees) Employees Present?

Yes

SSE/ARE understand process?

(Select No if no SSE/ARE are present)

No

Yes

Mentor Name:

No

SSE or ARE Name:

Job Involvement by any Third Party companies or employees?

Yes

No

Drops Log Book - Tool tracking for items taken into the Derrick Yes

No

Crew Members On Duty Number of Crew Members

4

Crew Members Employee:

Position:

Years of Experience:

Days on Hitch:

Dane Reing

Dh

5

1

Saul Gutierrez flores

Rm/Op

9

1

Jose Rodriguez

Fh

8

2

Jose Camacho

Op

20

2

Sign:

By signing this JSA you are acknowledging, understand the tasks laid out above and that you're fit for duty. By your signature you also indicate that you did not sustain any injuries!

Visitor Log

Page 7

Name

Sign

Company

Peter Horvath

Chord Energy

Reason for Visit?

WSS

Time In 07:00 AM

Nearest Hospital and Directions: Trinity community clinis new town Rig Location

Emergency Response/Evacuation Plan (Direction of Travel, Muster Point,etc):

Entrance of location up wind. CRoss wind Other Safety Concerns/Topics Discussed: (Direction of Travel, Muster Point,etc):

Post Job/Task Summary Incidents/Near Misses occured during shift? (require additional documentation)

Yes

No Did you initiate an SWA (Stop Work Authority) today?

Yes

No

Reason for initiating SWA? Held a secondary tailgate. Meeting discussing procedure of stripping over bops

Page 8

Time Out

Powered by www.doForms.com

Page 9

JOB SAFETY ANALYSIS (JSA)

This document is designed to Eliminate, Control, or Protect (ECP)against the hazards intrinsic to the job/task at hand.

Division: BHES North BHES ND Email: tyler.noah@steelteams.com;jeff.peterson@steelteams.com;gerardo.borja@steelteams.com; NDSuperintendents@steelteams.com;jon.matson@steelteams.com Rig Number 307 Location Name: Ma

Page 1

Date:

Time (24hrs):

05/01/2023

07:09

Client:

Shift: Day

Oasis

Night

If more than one shift,additional JSA is required Rig Manager:

Company Man / Consultant

Mike Pantoja

Mike Pantoja

FIRE RISK ASSESSMENT - API RF54 If hot work is planned, permit is required, or there is a planned lift over 200 lbs use drop down.

Required Personal Protective Equipment (PPE) Hard Hat FR Clothing

Safety Toe Boots Goggles

Chemical Apron Respirator

Impact Gloves Face Shield

Hearing Protection H2S/4-Gas Monitor

Lifting over 200 lbs

Safety Glasses

Chemical Gloves

Chemical Boots

Fall Protection (Inc SRL) Extreme Heat/Cold Prep

Chemical Goggles

PPE OTHER: PPE assessment conducted by (initial):

Page 2

Chemical Face Mask

Other:

Pre-Lift Check

Yes/NA

Personnel Responsible

Payload-Equipment Weight Verified

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

If lifting with Loader - Rating of Loader verified

Yes

Pusher

N/A

Superintendant

If lifting with Loader - Backup Alarm Functioning

Yes

Pusher

N/A

Superintendant

If lifting with a Loader -Is the horn functional?

Yes

Pusher

N/A

Superintendant

If lifting with Loader - Seatbelt functioning?

Yes

Pusher

N/A

Superintendant

If lifting with Loader - Tires in Good condition?

Yes

Pusher

N/A

Superintendant

If lifting with Loader - Fire Extinguisher functional?

Yes

Pusher

N/A

Superintendant

Lifting Equipment in Good Condition YT & MYT Slip Grip Elevators Size & Function SIM OPS JSA for task completed and signed Approval/Permit given Weather/Wind Conditions Good Lift area barricaded no entry Contingency Plan in place Emergency Plan if Needed.

Page 3

Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator Operator

Rigging Check

Yes/NA

Personnel Responsible

Lifting Equipment Inspections/Tags Current

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Rating of Sling or Lifting Chain EXCEEDS Item being Lifted?

Yes

Pusher

N/A

Superintendant

Using Correct Lifting Equipment

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Yes

Pusher

N/A

Superintendant

Rating of Sling or Lifting Chain Verified

Lifting Equipment Inspected Prior to Use Sling Angle/Placement/Weight Acceptable Lift points/Fixings Inspected and Approved Tag Lines attached

Operator Operator Operator Operator Operator Operator Operator Operator

I Confirm that the lift plan has been explained to me, that we have discussed it and I understand the operation and my role and responsibility as it pertains to the Lifting Plan Name

Signature

Date

Jesus bencomo

05/01/2023

Abimael Lozano

05/01/2023

Francisco ochoa

05/01/2023

Joel retana

05/01/2023

Mike Pantoja

Enter each time the Posi-Stop was set Enter N/A if Posi-Stop was not used

Was the Posi-Stop Set

Bottom Number Reading

Top Number Reading

Yes

No

156

0

Yes

No

145

0

Yes

No

145

0

Signature

IS YOUR RIG EQUIPPED WITH A ROD TRANSFER SAFETY SYSTEM (RTSS)?

IS YOUR RIG EQUIPPED WITH A ROD TRANSFER SAFETY SYSTEM (RTSS)?

Yes No HAS YOUR ROD TRANSFER SAFETY SYSTEM (RTSS) BEEN TESTED AND IS IT FUNCTIONING "PRIOR" TO TRIPPING RODS "TO OR FROM" THE DERRICK? If "NO" is selected YOU MUST not PROCEED with the JOB - STOP WORK IMMEDIATELY!!!

Yes No

Page 4

IS YOUR RIG EQUIPPED WITH AN ORANGE CONE TO BE PLACED ON THE OPERATOR'S STAND ALONG WITH A PLACARD ON A CHAIN TO BE PLACED ON THE OPERATOR'S CLUTCH VALVE HANDLE AS A REMINDER IF THE BOP RAMS (PIPE OR BLINDS) ARE OPEN OR CLOSED PRIOR TO RESUMING OPERATIONS??? - MUST BE CONFIRMED EACH AND EVERY TIME!!!!

On Off IS YOUR RIG EQUIPPED WITH A BOP SAVER SAFETY SYSTEM ???

IS YOUR RIG EQUIPPED WITH A BOP SAVER SAFETY SYSTEM ??? HESS RIGS PAY ATTENTION Yes No HAS YOUR BOP SAVER SAFETY SYSTEM (BSSS) BEEN TESTED AND IS IT FUNCTIONING "PRIOR" TO "MOVING PIPE - AGAIN, DO NOT MOVE PIPE UNTIL THIS IS CONFIRMED EACH AND EVERY TIME - LOOK AT THE LIGHTS ON THE DISPLAY PANEL! If "NO" is selected YOU MUST not PROCEED with the JOB - STOP WORK IMMEDIATELY!!!

Yes No SAFETY ALERTS CONFIRMATION CONFIRM YOU HAVE READ THE LATEST SAFETY ALERTS ON THE TABLET BY PRINTING YOUR NAME AND SIGNING BELOW Print Name

Signature

Jesus bencomo Abimael Lozano Francisco ochoa Joel retana Mike Pantoja

Page 5

Step

Task

Hazard(s)

(Eliminate, Control, or Protect ECP) Controls (who,what,when)

1

LSR

Driving

Driving

2

Rig up

1a) Cable could get caught and break or break what it gets caught on. MOTION 1b) Strained back when lifting jack stands and boards. GRAVITY 1c) Slick and muddy surfaces around rig and location. Buried objects in the snow

1a) Have everyone in there spot, watching all cables, keep good communication with each other and with operator. PROTECT 1b) Use proper lifting, get help if needed. Use loader for all heavy objects. ELIMINATE 1c) Watch footing, walk slower if needed. Get help carring boards and jack stands

3

Trip out of hole with rods Trip Rods

4

Loader operations

1a) Operator could crown out or drop blocks. MOTION 1b) Pinch points with tongs, rod hook, elevators, rod elevators setting on rod table.

MECHANICAL 1c) operator could part transfer line when tripping rods. MOTION

1a) Operator must set POSI STOP and test it, before tripping any rods. ELIMINATE 1b) know where all pinch points are at. Keep hands and body position clear at all times. Wear Impact Gloves and all PPE at all times. PROTECT 1c) Set RTSS and test it. Derrick hand needs to flag transfer line so it's visible to the operator.

Floorhand needs to keep rod elevator on until Derrick hand removes transfer bottle.

1a) loader attachment may not be locked in properly and could fall off with the load.

GRAVITY 2a) Backing into or running over something with loader. MOTION 3a) load could fall off forks when moving the load. MOTION

1a) ensure loader attachment is on and 100 percent locked in and secured before picking up any load. ELIMINATE 2a) Have a spotter at all times when moving loader. Have clean widows and mirrors on loader.

ELIMINATE 3a) Secure load on the forks before moving, 5 MPH on location with loader. PROTECT

Page 6

SSE (Short Service Employees) or ARE (At Risk Employees) Employees Present?

Yes

SSE/ARE understand process?

(Select No if no SSE/ARE are present)

No

Yes

Mentor Name:

No

SSE or ARE Name:

Job Involvement by any Third Party companies or employees?

Yes

No

Drops Log Book - Tool tracking for items taken into the Derrick Yes

No

Crew Members On Duty Number of Crew Members

5

Crew Members Employee:

Position:

Years of Experience:

Days on Hitch:

Jesus bencomo

Ro

3

1

Abimael Lozano

Operator

10

1

Francisco ochoa

Dh

3

11

Joel retana

Op

7

11

Mike Pantoja

RM

22

11

Sign:

By signing this JSA you are acknowledging, understand the tasks laid out above and that you're fit for duty. By your signature you also indicate that you did not sustain any injuries!

Visitor Log Name

Sign

Company

Reason for Visit?

Trevor Hall Tomas Martinez

Chord energy

Safety visit q

Page 7

Time In

Time Out

Nearest Hospital and Directions: Tioga ND Rig Location

Emergency Response/Evacuation Plan (Direction of Travel, Muster Point,etc):

Entrance to location Other Safety Concerns/Topics Discussed: (Direction of Travel, Muster Point,etc):

Post Job/Task Summary Incidents/Near Misses occured during shift? (require additional documentation)

Yes

No Did you initiate an SWA (Stop Work Authority) today?

Yes

No

Powered by www.doForms.com

Page 8

JOB SAFETY ANALYSIS (JSA)

This document is designed to Eliminate, Control, or Protect (ECP)against the hazards intrinsic to the job/task at hand.

Division: BHES North BHES ND Email: tyler.noah@steelteams.com;jeff.peterson@steelteams.com;gerardo.borja@steelteams.com; NDSuperintendents@steelteams.com;jon.matson@steelteams.com Rig Number 309-1 Location Name: Hansen

Page 1

Date:

Time (24hrs):

05/01/2023

18:25

Client:

Shift: Day

Whiting

Night

If more than one shift,additional JSA is required Rig Manager:

Company Man / Consultant

Richard carrasco

David Pittman

FIRE RISK ASSESSMENT - API RF54 If hot work is planned, permit is required, or there is a planned lift over 200 lbs use drop down.

Required Personal Protective Equipment (PPE) Hard Hat

Safety Toe Boots

FR Clothing

Goggles

Chemical Apron Respirator

Impact Gloves Face Shield

Chemical Gloves

Hearing Protection H2S/4-Gas Monitor

Lifting over 200 lbs

Safety Glasses Chemical Boots

Fall Protection (Inc SRL) Extreme Heat/Cold Prep

Chemical Goggles

Chemical Face Mask

Other:

PPE OTHER: PPE assessment conducted by (initial):

Enter each time the Posi-Stop was set Enter N/A if Posi-Stop was not used

Was the Posi-Stop Set

Bottom Number Reading

Top Number Reading

Yes

No

101

0

Yes

No

101

0

Yes

No

101

0

Signature

IS YOUR RIG EQUIPPED WITH A ROD TRANSFER SAFETY SYSTEM (RTSS)?

IS YOUR RIG EQUIPPED WITH A ROD TRANSFER SAFETY SYSTEM (RTSS)?

Yes No HAS YOUR ROD TRANSFER SAFETY SYSTEM (RTSS) BEEN TESTED AND IS IT FUNCTIONING "PRIOR" TO TRIPPING RODS "TO OR FROM" THE DERRICK? If "NO" is selected YOU MUST not PROCEED with the JOB - STOP WORK IMMEDIATELY!!!

Yes No IS YOUR RIG EQUIPPED WITH AN ORANGE CONE TO BE PLACED ON THE OPERATOR'S STAND ALONG WITH A PLACARD ON A CHAIN TO BE PLACED ON THE OPERATOR'S CLUTCH VALVE HANDLE AS A REMINDER IF THE BOP RAMS (PIPE OR BLINDS) ARE OPEN OR CLOSED PRIOR TO RESUMING OPERATIONS??? - MUST BE CONFIRMED EACH AND EVERY TIME!!!!

On Off IS YOUR RIG EQUIPPED WITH A BOP SAVER SAFETY SYSTEM ???

Page 2

IS YOUR RIG EQUIPPED WITH A BOP SAVER SAFETY SYSTEM ??? HESS RIGS PAY ATTENTION Yes No HAS YOUR BOP SAVER SAFETY SYSTEM (BSSS) BEEN TESTED AND IS IT FUNCTIONING "PRIOR" TO "MOVING PIPE - AGAIN, DO NOT MOVE PIPE UNTIL THIS IS CONFIRMED EACH AND EVERY TIME - LOOK AT THE LIGHTS ON THE DISPLAY PANEL! If "NO" is selected YOU MUST not PROCEED with the JOB - STOP WORK IMMEDIATELY!!!

Yes No SAFETY ALERTS CONFIRMATION

Page 3

Step 1

Task Lsr

Hazard(s) Line of fire

(Eliminate, Control, or Protect ECP) Controls (who,what,when) Keep yourself and others Out of the line of fire I position myself to avoid moving objects Vechicles Pressure releases Dropped objects I established and obey barriers and exclusion zones I take action to secure loose objects and report potential dropped objects

2

Lsr

Working at heights

Protect yourself against a fall when working at heights I inspect my fall protection equipment before use I secure tools and work materials to prevent dropped objects I tie off 100% to approved Anchore points while outside a protected area

3

Inspections

BRAKE/DRILL LINE HAZARDS Failure to inspect brakes and drill line prior to starting work.

Failure to test posi stop.

Dropping blocks.

BRAKE/DRILL LINE Always do a good brake and and drill line inspection prior to starting work.

Set and test posi stop.

If anything feels or looks wrong stop the job.

4

Loader ops

LOADER HAZARD Speeding on location.

Failure to use spotter.

Failure to inspect loader or perform walk around prior to using.

Failure to inspect lifting equipment.

LOADER No speeding on location. 5mph speed limit.

Always use spotter.

Always check fluids and perform a walk around loader prior to moving.

Always inspect lifting equipment before using.

No piggy riding loader.

Check pins and inspect different loader attachments.

Page 4

5

Wrangler ops

Wrangler operations.

Miscommunication with wrangler operator.

Inadequate hand signals.

Pipe falling off racks.

Personnel walking underneath wrangler.

WRANGLER OPERATIONS always keep good communication with wrangler operator.

Use adequate hand signals when communicating.

Always have safety stoppers on pipe racks to avoid pipe rolling off.

Inspect wrangler prior to using.

Flag off non walking areas around wrangler.

6

Laying down tubing

No communication with each other Slips not set right Elevators not latched right Pose-stop not set Torque not set right Pinch points Strike zones Bad hand signals Not looking up up Suspended loads Hydraulic leaks Not locking slips when pipe light Weather conditions

Have good communication with each other always make sure slips set good before before unlatching elevators always double check elevators make sure they are latched up good always make sure pose-stop is set before starting work Make sure your torque is set right watch were you place your hands an fingers so don't pinch them between or smash smash them between pipe an tongs or elevators an tongs Use good hand signals with wrangler operator Never stand underneath the pipe when it is getting picked up Always look up so you don't hit the tubing board When you are pipe light make sure you are locking the slips Be awear of the weather conditions if it is to windy stop so you don't damge the pipe an so no one gets hurt

7

TOH

Tripping pipe.

Working in heights.

Falling from heights.

Failure to inspect falling protection.

Slipping or tripping in derrick.

Failure to rig up escape device.

Failure to inspect elevators and equipment.

Pinch points

TRIPPING PIPE derrick hand always inspect falling protection prior to using.

Check SRL, harness, and lanyards.

Watch your footing, always 3 points of contact.

100 percent tie off above 4ft.

Inspect Geronimo cart and cable.

Good communication within operator and Derrick hand.

Slowdown and latch/unlatch will be practiced.

Always inspect elevators, slips, and blocks.

Watch hand placement when operating tong machinery and when latching or unlatching tbg

Page 5

8

Go double fast

No communication Suspended load Winch an chain not hooked up correctly Drill line hung up Drill line not wrapped right on deadline anchore Strike zones Pinch points Drill line not wrapped right on drum

Have good communication with each other make sure you dont get under the blocks or between the blocks or anything make sure your Winch an chain are hooked up correctly Watch were you are placing your hands an fingers so you dont smash or pinch them between the drill line itself on drum or dead line anchor always make sure you hold on good to line when wrapping it on deadline anchore so doesn't hit you always look around an watch your drill line so its not hung up anywhere

9

Make up tools

No communication with each other Strike zones Pinch points Wedding band clamp not on right Torque not set right Getting hit by a hammer Slips not set right

Have good communication with each other watch were you place your hands an fingers so you dont smash between tongs an collars or tools an tongs or between the elevators an stump always make sure make sure weddings band clamp on right an tight An slips are set good before unlatching elevators Make sure elevators are latched good latched before picking up out the slips or picking up anything off the wrangler Always make sure lifting subs get tighten properly and marked always look when making up or breaking out collars an tools that way you lifting subs aren't losing up make sure are slacked off enough on the elevators Beaware of your strick zones especial when swinging a hammer look before swinging an be alert of hammers being swung

Page 6

10

TIH

Tripping pipe.

Working in heights.

Falling from heights.

Failure to inspect falling protection.

Slipping or tripping in derrick.

Failure to rig up escape device.

Hitting rod basket with blocks.

Failure to inspect elevators and equipment.

Pinch points operating tong machinery.

SSE (Short Service Employees) or ARE (At Risk Employees) Employees Present?

Yes

SSE/ARE understand process?

(Select No if no SSE/ARE are present)

No

Mentor Name:

TRIPPING PIPE derrick hand always inspect falling protection prior to using.

Check SRL, harness, and lanyards.

Watch your footing, always 3 points of contact.

100 percent tie off above 4ft.

Inspect Geronimo cart and cable.

Good communication within operator and Derrick hand.

Slowdown and latch/unlatch Always inspect elevators, slips, and blocks.

Watch hand placement when operating tong machinery and when latching

Yes

No

SSE or ARE Name:

Job Involvement by any Third Party companies or employees?

Yes

No

Drops Log Book - Tool tracking for items taken into the Derrick Yes

No

Crew Members On Duty Number of Crew Members

6

Crew Members

Page 7

Employee:

Position:

Years of Experience:

Days on Hitch:

Richard carrasco

Rm

19

1

Leonel

Op

11

1

Marco a cardenas

Ro

8

1

Juan Favela

Dh

8

1

Joel waldner

Dh

2

1

Brandon Rodriguez

Fh

4

1

Sign:

By signing this JSA you are acknowledging, understand the tasks laid out above and that you're fit for duty. By your signature you also indicate that you did not sustain any injuries!

Visitor Log Name

Sign

Company

Reason for Visit?

Time In

JC Wehmeyer

LES

Flowback

06:32 PM

Wal Khat

LES

Flowback

06:32 PM

Johnnie Sanders

LES

Flowback

06:32 PM

Michael Forest

LES

Flowback

06:32 PM

David Pittman

Chord

Company man

06:33 PM

Page 8

Time Out

Nearest Hospital and Directions: Stanley Rig Location

Emergency Response/Evacuation Plan (Direction of Travel, Muster Point,etc):

Location entrance Other Safety Concerns/Topics Discussed: (Direction of Travel, Muster Point,etc):

Have good communication with each other Post Job/Task Summary Incidents/Near Misses occured during shift? (require additional documentation)

Yes

No Did you initiate an SWA (Stop Work Authority) today?

Yes

No

Powered by www.doForms.com

Page 9