Form BSEE-0131 Performance Measures Data

30 CFR Part 250, Subpart S, Safety and Environmental Management Systems (SEMS)

Form 0131

30 CFR 250.1914(e); 1928(d), (e); 1929 - Form BSEE-0131; maintain contractor employee injury/illness log retain for 2 yrs, make available to BSEE; inform re hazards;

OMB: 1014-0017

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U.S. Department of the Interior OMB Control Number 1014-0017

Bureau of Safety and Environmental Enforcement (BSEE) OMB Approval Expires xx/xx/xxxx


PERFORMANCE MEASURES DATA

Provide Data on an Annual Basis for the Previous Calendar Year by March 31 of Each Year


Company Name(s)                             BSEE Region                       
Operator Code(s)*                     Calendar Year ____________
Contact Name Email Address                                                     

Telephone Fax Date                                   


PRODUCTION DRILLING** CONSTRUCTION

SAFETY OPERATIONS OPERATIONS OPERATIONS

A. No. of Company Employee 1st Qtr ___________                                 

Recordable Injuries/Illnesses

2nd Qtr ___________ _____________ ______________


3rd Qtr ___________ _____________ _______________

4th Qtr ___________ ______________ _______________

B. No. of Contract Employee 1st Qtr ___________                                 

Recordable Injuries/Illnesses

2nd Qtr ___________ _____________ ______________


3rd Qtr ___________ _____________ _______________

4th Qtr ___________ ______________ _______________



C. No. of Company Employee 1st Qtr ___________                                

DART Injuries/Illnesses***

2nd Qtr ___________ _____________ ______________

3rd Qtr ___________ _____________ _______________

4th Qtr ___________ ______________ _______________


D. No. of Contract Employee 1st Qtr ___________                                 

DART Injuries/Illnesses***

2nd Qtr ___________ _____________ ______________

3rd Qtr ___________ _____________ _______________

4th Qtr___________ ______________ _______________


BSEE Form BSEE-0131 (Mo/Year - Replaces all previous versions of this form that may not be used.) Page 1 of 2


PRODUCTION DRILLING** CONSTRUCTION

SAFETY OPERATIONS OPERATIONS OPERATIONS


E. Company Employee 1st Qtr                               

Hours Worked

2nd Qtr _____________ ____________ ________________


3rd Qtr _____________ _____________ ________________


4th Qtr _____________ _____________ ________________



F. Contract Employee 1st Qtr                               

Hours Worked

2nd Qtr ___________ ___________ _______________


3rd Qtr ____________ ____________ _______________

4th Qtr ____________ _____________ _______________



ENVIRONMENT


G. No. of EPA NPDES Noncompliances                               

H. For Oil Spills < 1 bbl


1. No. of Spills                             


2. Total Volume for Spills bbl


* Please list all operator codes that these data represent.

** Drilling Operations include Drilling, Workover, and Allied Services.

*** Formerly Lost Time Cases that include Days Away from work, Restricted duty, and Transfer situations.


Paperwork Reduction Act of 1995 (PRA): The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that BSEE collects this information to carry out its responsibilities under the OCS Lands Act, as amended. BSEE will use the information to evaluate the effectiveness of industry’s continued improvement of safety and environmental management in the OCS. Responses are mandatory (43 U.S.C. 1334). No proprietary data are collected. We estimate the public reporting burden, including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the information to average 15 hours per response. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid Office of Management and Budget (OMB) control number. The OMB has approved this collection of information and assigned OMB Control Number 1014-0017. You may direct comments regarding the burden estimate or any other aspect of this collection of information to the Information Collection Clearance Officer, Bureau of Safety and Environmental Enforcement, 45600 Woodland Road, Sterling, VA 20166.


COMPANY-SPECIFIC DATA COLLECTED UNDER THIS REQUEST IS INTENDED FOR GOVERNMENT USE ONLY


BSEE Form BSEE-0131 (Mo/Year - Replaces all previous versions of this form that may not be used.) Page 2 of 2


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