Form BSEE-0131 Performance Measures Data

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 1^st Qtr ___________                                 

Recordable Injuries/Illnesses

2^nd Qtr ___________ _____________ ______________

3^rd Qtr ___________ _____________ _______________

4^th Qtr ___________ ______________ _______________

B. No. of Contract Employee 1^st Qtr ___________                                 

Recordable Injuries/Illnesses

2^nd Qtr ___________ _____________ ______________

3^rd Qtr ___________ _____________ _______________

4^th Qtr ___________ ______________ _______________

C. No. of Company Employee 1^st Qtr ___________                                

DART Injuries/Illnesses***

2^nd Qtr ___________ _____________ ______________

3^rd Qtr ___________ _____________ _______________

4^th Qtr ___________ ______________ _______________

D. No. of Contract Employee 1^st Qtr ___________                                 

DART Injuries/Illnesses***

2^nd Qtr ___________ _____________ ______________

3^rd Qtr ___________ _____________ _______________

4^th 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 1^st Qtr                               

Hours Worked

2^nd Qtr _____________ ____________ ________________

3^rd Qtr _____________ _____________ ________________

4^th Qtr _____________ _____________ ________________

F. Contract Employee 1^st Qtr                               

Hours Worked

2^nd Qtr ___________ ___________ _______________

3^rd Qtr ____________ ____________ _______________

4^th 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