Gulf of Mexico Contractors: Contacts: Confidential Feedback Submittal


	GOM Contacts
		Contractor Safety Leadership Team

Confidential Feedback Submittal
We want to hear from you immediately if you have any feedback.

You are encouraged to contact your Chevron representative first whenever there is an issue that needs to be resolved. If this is not an option, please bring the issue up to the next level of management.

Use this form to send your feedback to the GOM Health, Environment & Safety Department.

Please be complete and accurate in the information you provide so that your feedback may be addressed appropriately.

The Contractor Safety Specialist coordinates the collection and distribution of feedback from this site to the appropriate party or parties in Chevron. While every effort will be made to maintain confidentiality, please be aware that information or feedback provided by you through this web site will be handled according to relevant Chevron Policies. There is no guarantee that action will be taken or that any action taken will be visible to the person(s) submitting the information.

Job # / Name:
Location:			Date:

Safety:
	1. How would you rate the Pre-Job meeting, done prior to going offshore? Did it describe the scope of work and safety expectations for this job?
	Excellent	Good	Fair	Not Done

	2. Did the Chevron Project Engineer visit the job site?
	Yes	No

	3. Were you given a site specific orientation by a Chevron representative when arriving on the platform?
	Yes	No

	4. Did the Chevron personnel fully participate in the daily safety meetings?
	Yes	No	Meetings Not Held

	5. Did the Chevron personnel review and/or participate in the JSA Process?
	Reviewed	Participated		Neither

	6. Was there an emergency evacuation drill conducted while on this job?
	Yes	No

	7. Did you participate in the Observation program (G.A.T.O.R. or Your company specific)?
	Yes	No

	8. Did you participate in or write a JSA for each task you performed?
	Yes	No

	9. Was a JSA reviewed for the tasks you performed?
	Yes	No

	10. If Stop Work Authority was needed on this project was it utilized?
	Yes	No	Not Needed

	11. Do you feel like you could have stopped the job no matter how big or small the project was?
	Yes	No

	12. Did you get support from the Chevron Representative when it came to safety related issues? (such as stop work authority, etc)
	Yes	No

	13. Did you feel pressured by a Chevron Representative to take a risk in order to get the job completed sooner?
	Yes	No

	14. Were any safety processes or policies bypassed to get the job completed?
	Yes	No

Productivity:

	15. How would you rate the efficiency of the job?
	Excellent	Good	Fair	Poor

	16. Were there a lot of changes to the scope of the work?
	Yes	No

	17. Do you know if the job was ahead or behind schedule?
	Ahead	Behind	Not Sure

	18. Were your job assignments clear & accurate from your supervisor or the Chevron Representative?
	Yes	No

	19. Were you or your crew waiting for long periods of time for material or equipment?
	Yes	No

	20. Were you or your crew waiting for a long periods of time for transportation from one location to another?
	Yes	No

	21. Did you have the proper tool/equipment to perform your job safely and efficiently?
	Yes	No

	22. How were the general living accommodations?
	Good	Fair	Poor

	23. How was the food?
	Good	Fair	Poor

	24. How were the sleeping accommodations?
	Good	Fair	Poor

	25. How would you rate this job?
	Excellent	Good	Fair	Poor

If you have any additional feedback, please contact your project manager or Contractor Safety Specialist, Lane Blanchard at 985-773-6171, LaneBlanchard@chevron.com


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