PSMS Critical Tools can help Manage Day-to-Day Field Work Risks

Pre-Mobilization Reviews and Prep-Job Briefs as additional Layers of Protection

The PSMS Mains and Services Construction Tactical Guide features a section on PSMS Critical Tools that include Pre-Mobilization Reviews (PMRs) and Pre-job Briefs (PJBs). PMRs and PJBs function as additional Layers of Protection when assessing and managing risks associated with the work we are preparing to perform in the field. The purpose of PMR is to ensure that responsible personnel review and understand all aspects of the work package as designed. In addition, the purpose of the PJB is to ensure that the supervisor, crew leaders and field personnel discuss and understand the tasks that are going to be performed, including procedures necessary, energy controls to be used, as well as any potential task specific AOCs and associated mitigation measures. These activities are also part of the “Plan” section of the Plan-Do-Check-Act tables associated with PSMS Mains and Services Construction within the Tactical Guide

Description of Event:

During the execution of a System Operating Procedure (SOP), a planned cut and cap was performed in the wrong location. Personnel were referencing a “red line” sketch from a prior revision of the project and did not compare this sketch against the revised SOP Sketch. Gas Control coordinated with Operations Engineering and Dispatch to ensure that there was no immediate negative impact to the system. The main was reconnected to ensure system integrity was maintained.

Key Causal Factors/Root Causes:

Primary Causal Factor: Personnel on site did not compare “red line” sketch to latest SOP (Rev. 2 Sketch) prior to performing cut & cap.

• Root Cause: Procedures – Wrong – Wrong revision used.
• Root Cause: Management System – Standards Policies Admin Controls (SPAC) Needs Improvement (NI) – Drawings/prints NI.

Causal Factor: Printed SOP Rev. 2 was not on site, and no onsite revision meeting was held.

• Root Cause: Management System – SPAC Not Used – Communication of SPAC NI
• Root Cause: Work Direction – Preparation – Work Package/Permit NI.Key Corrective Actions:

Key Corrective Actions:

Engineering to review internal process for scaled drawings associated with work package.

• Contractor Oversight to meet with work force to reinforce verification of SOP work package.

• Contractor Oversight, Contractor, and Engineering to review work package management.

• Contractor Oversight, Engineering and Gas Control to review scope change hold point process.

Key Lessons Learned:

It is important to review the SOP in its entirety, including the sketch(es), to ensure all changes are understood prior to commencing work.

• Red line (scaled drawing) are a good reference document for dimensions and location of underground facilities; however, the SOP sketch must be reviewed for location of main connections/ cut and caps.

Walk the Job Down ! Don’t underestimate the safety value opportunity in walking the job down with the field crew as a component of the pre-job brief. This time allows for crew engagement in the work to be performed, allows individuals to spot potential inconsistencies with the work package, drawings and actual field conditions. Questions naturally emerge from this PSMS engagement opportunity !