Form BSEE-0131 PERFORMANCE MEASURES DATA

U.S. Department of the Interior
Bureau of Safety and Environmental Enforcement (BSEE)

OMB Control Number 1014-0017
OMB Approval Expires 11/30/2021

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
Telephone

SAFETY
A. No. of Company Employee
Non-DART Recordable
Injuries/Illnesses***

B. No. of Contract Employee
Non-DART Recordable
Injuries/Illnesses***

Email Address
Fax

Date
PRODUCTION
OPERATIONS

DRILLING**
OPERATIONS

CONSTRUCTION
OPERATIONS

1st Qtr ___________
2nd Qtr ___________

_____________

______________

3rd Qtr ___________

_____________

_______________

4th Qtr ___________

______________

_______________

1st Qtr ___________
2nd Qtr ___________

_____________

______________

3rd Qtr ___________

_____________

_______________

4th Qtr ___________

______________

_______________

2nd Qtr ___________

_____________

______________

3rd Qtr ___________

_____________

_______________

4th Qtr ___________

______________

_______________

D. No. of Contract Employee
1st Qtr ___________
DART Injuries/Illnesses****
2nd Qtr ___________

_____________

______________

3rd Qtr ___________

_____________

_______________

4th Qtr___________

______________

_______________

C. No. of Company Employee
DART Injuries/Illnesses****

1st Qtr ___________

BSEE Form BSEE-0131 (Nov, 2018 - Replaces all previous versions of this form that may not be used.)

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PRODUCTION
OPERATIONS

SAFETY
E. Company Employee
Hours Worked

F.

Contract Employee
Hours Worked

DRILLING**
OPERATIONS

CONSTRUCTION
OPERATIONS

1st Qtr
2nd Qtr

_____________

____________

________________

3rd Qtr

_____________

_____________

________________

4th Qtr

_____________

_____________

________________

2nd Qtr

___________

___________

_______________

3rd Qtr

____________

____________

_______________

4th Qtr

____________

_____________

_______________

1st Qtr

ENVIRONMENT
G. 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.
*** Recordable injuries/illnesses that required medical treatment beyond first aid, but did not result in
days away from work, restricted work, or transfer to another job (DART)
**** 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 (Nov, 2018 - Replaces all previous versions of this form that may not be used.)

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