Personnel Record and Application

Personnel Record & Application (Korpal Enterprises)

Note: Answering yes to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.

Employment History

Please provide the following information for your previous three employers, beginning with the most recent: (Please attach an additional page if necessary, do not use "see attached resume".)

---Employment History 1---

Dates Employed:

Weekly Pay:

---Employment History 2---

Dates Employed:

Weekly Pay:

---Employment History 3---

Dates Employed:

Weekly Pay:

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigation and inquiries of my personal, employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools, or individuals from all liability when responding to inquiries in connection with my application. In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

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Employee Information for Direct Deposit

Employee Information for Direct Deposit (Korpal Enterprises)

What portion of Net Pay Would You Like Deposited?

You may have all or part of your paycheck deposited directly to your bank account(s).

Select one of the following options to indicate the portion of your total paycheck you want deposited.


How Do You Want The Direct Deposit Made?

Please identify up to four bank accounts where you want your check deposited, and indicate the amount or percentage of your paycheck you want  deposited in each account.

Account #1 for the Balance of the Direct Deposit Amount

Account #2 for the Balance of the Direct Deposit Amount


Account #3 for the Balance of the Direct Deposit Amount


Account #4 for the Balance of the Direct Deposit Amount

Workforce Confidentiality Agreement (Korpal Enterprises)


I understand that J Solutions has a legal and ethical responsibility to maintain privacy, including obligations to protect the confidentiality of clients' information and to safeguard the privacy of client information.

In addition, I understand that during the course of my employment/assignment/affiliation at J Solutions, I may see or hear other Confidential Information such as financial data and operational information pertaining to the business that J Solutions is obligated to maintain as confidential.

As a condition of my employment/assignment/affiliation with J Solutions I understand that I must sign and comply with this agreement. By signing this document I understand and agree that:

I will disclose Information and/or Confidential Information only if such disclosure complies with J Solutions policies, and is required for the performance of my job.

My personal access code(s), user ID(s), access key(s) and Password(s) used to access computer systems or other equipment are to be kept confidential at all times.

I will not access or view any information other than what is required to do my job. If I have any question about whether access to certain information is required for me to do my job, I will immediately ask my supervisor for clarification.

I will not discuss any information pertaining to the practice in an area where unauthorized individuals may hear such information (for example, in hallways, on elevators, in the cafeteria, on public transportation, at restaurants, and at social events).

I understand that it is not acceptable to discuss any business information in public areas.

I will not make inquiries about any business information for any individual or party who does not have proper authorization to access such information.

I will not make any unauthorized transmissions, copies, disclosures, inquiries, modifications, or purging of Business -Information or Confidential Information. Such unauthorized transmissions include, but are not limited to, removing and/or transferring Business Information or Confidential Information from J Solutions' computer system to unauthorized locations (for instance, home).

Upon termination of my employment/assignment/affiliation with J Solutions, I will immediately return all property (e.g. Keys, documents, ID badges, etc.) to J Solutions.

I agree that my obligations under this agreement regarding Business Information will continue after the termination of my employment/assignment/affiliation with J Solutions.

I understand that violation of this Agreement may result in disciplinary action, up to and including termination of my employment/assignment/affiliation with J Solutions and/or suspension, restriction or loss of privileges, in accordance with J Solutions' policies, as well as potential personal civil and criminal legal penalties.

I understand that any Confidential Information or Business Information that I access or view at J Solutions does not belong to me.

I have read the above agreement and agree to comply with all its terms as a condition of confirming employment.

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Payroll Deduction Authorization (Korpal Enterprises)


I authorize PEO Company, to deduct from my wages the following: local, state, and federal taxes; any court ordered payments; any deductions required by state or federal law; deductions for loss or damage to any uniforms, machinery, merchandise, equipment, tools, vehicles, or other property provided by PEO Company which I do not return or which are not returned in good condition; any unpaid loans or advances which I owe to PEO Company and, any personal expenses or charges owed by me to PEO Company.

In addition, I authorize the full unpaid amount of any such charges or expenses to be deducted from my final paycheck on the termination of my employment with PEO Company.

I acknowledge that I have received, read, and understand the contents of this PEO Company policies and safety program. If unable to read, the contents of the safety program have been read and explained to me by my supervisor. I understand that my compliance with all stated PEO Company policies, including safety, is a condition of continued employment with this PEO Company.

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48 Hour Rule (Korpal Enterprises)


Any occupational injury not reported within 48 hours will be considered non-occupational injury and therefore may result in loss of occupational injury benefits.

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Drug Testing Policy and Consent to Drug Testing (Korpal Enterprises)


It is the policy of the Client Company that the use of alcohol, illegal drugs or inhalants will not be tolerated. Although the Client Company recognizes that many such products have legitimate uses, it is the policy of the Client Company not to tolerate misuse or abuse of industrial solvents, aerosol propellants, paint thinners, lacquer thinners, paints, lacquers, dopes, or any other similar product which could be used to produce an intoxicated state by inhalation of its vapors or gases (which will be called "inhalants" in this document). The Client Company maintains a list of all such substances which may be used, or with which its workers or contractors may come in contact in the course of their work. The presence of detectable residues to off other industrial solvents, aerosol propellants, paint thinners, lacquer thinners, paints, lacquers, dopes (this list is by way of example only, and does not constitute a complete statement of all products or substances which may be abused by inhalation) is cause for immediate dismissal without notice. Consumption of alcohol or use of illegal drugs during working hours or in such a way as to leave a detectable trace of alcohol or illegal drugs in the body is cause for immediate dismissal without notice.

I understand that the Client Company policy prohibits any Employee from engaging in work or being on Client Company premises or the premises of any Client with a detectable level of alcohol, any illegal or controlled drug, drug by-product or drug metabolite or inhalant or by¬product of metabolite of an inhalant in the body, including in the breath, blood, urine or hair. This policy does not apply to the proper use of medication prescribed for me by a physician.

I understand that it is a condition of, but not a guarantee or promise of, employment, continued employment, advancement or promotion that I follow the Client Company's policies on drugs, alcohol and inhalants, and the policies of any Client Client Company where I may be assigned. I understand that I may be asked to participate in drug, alcohol and inhalant testing ("Testing") to determine whether I comply with such policies.

I understand that I may refuse to participate in any Testing required by the Client Company or the Client Client Company, but I understand and agree that my failure to participate in testing will be cause of immediate termination, and that I will not be eligible to be re-hired. If I participate in Testing, my signature or mark below indicates my consent to the taking of samples of my breath, hair, blood, urine or other bodily fluids and the analysis of such samples by a laboratory selected by the Client Company, without charge to me. I consent to the disclosure of all negative and confirmed positive test results to the Client Company and any Client Client Company where I may be assigned.

I agree that I will disclose the names of any prescription or over-the-counter medications which I may be taking at the time of testing or may have taken within the thirty (30) days immediately prior to Testing. If my failure to disclose such medications causes positive results which must be confirmed and if the Client Company elects to have the results confirmed by further and more specific laboratory tests, I agree that I will furnish any further samples which may be required in order to perform the confirmatory test and reimburse the Client Company for the actual costs of such screening test and confirmation. I understand that I may refuse to participate in further Testing and/or refuse to reimburse the Client Company for expenses incurred in confirmatory analysis, but I understand and agree that my failure to participate in Testing or to agree to reimburse the Client Company will be cause for immediate termination, and that I will not be eligible to be re-hired.

I understand that I may be required to participate in Testing, after the occurrence of any on-the-job event that did or could have resulted in personal injury or property damage, or for any other reasonable cause. I understand that a confirmed positive test for the presence of drugs or alcohol is grounds for the immediate termination of my employment for cause.

As a consideration of my employment, continued employment, advancement or promotion with the Client Company, I waive, and agree to release and hold harmless both the Client Company and any Client Client Company, and any testing laboratory along with their agents and employees from any claim or cause of action arising out of the taking of a sample of my breath, blood, urine, hair or other bodily fluids, arising out of the test, or arising out of the disclosure of negative and confirmed positive test results.

DEFINITION: The following definition applies to this and all other Client Company policies unless another definition is expressly indicated in the policy.

Premises means, except as otherwise limited in this definition or applicable law, ALL PLACES AND VEHICLES owned, leased, used, controlled by, or otherwise under the dominion of the Client Company, or where Employees are engaged in work on behalf of, or service to, the Client Company. Premises specifically include parking lots and sidewalks and other surrounding areas in the vicinity of any Client Company Premises. A personal vehicle used on Client Company Business is subject to this policy and to inspection, search or testing for the enforcement of this policy while the vehicle is in use on Client Company Business. Where a person to be searched is not an employee of the Client Company, this definition shall be limited to the real estate, improvements, vehicles and trailers actually owned, possessed, or otherwise under the dominion of the Client Company, not including any public roads, parking areas, sidewalks or other such areas surrounding such real estate and improvements.

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Employment Separation Acknowledgement (Korpal Enterprises)


Regardless of the type of separation, it is the employee's responsibility to report to the PEO Company in order to conduct a complete exit interview. This interview must take place within three (3) calendar days from the last paid day of employment. During this interview the employee will return all files, documents, equipment, keys, or other property belonging to the client company. The employee will be interviewed and a complete review of the departing assignment will be conducted by the PEO Company for any possible reassignment of employment. All final paychecks for hours worked will be paid on the pay day following the separation date. Accrued unused paid leave will be included in the final paycheck.

Any employee who separates in good standing may re-employ provided they are qualified for the position they are applying for. Any person re-employed with at least one-year time & service and who is re-employed within three months of separation will keep all accumulated time & service.

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Acknowledgment (Korpal Enterprises)


I acknowledge that I have read and understand the contents of this policy. If I am unable to read, I acknowledge that the contents have been read and explained to me. I understand there is a copy of the Employee Manual available for further review located at the Client Company office and the PEO Company office. The Client Company may change or withdraw any of the policies at its sole discretion, at any time and without advance notice. I understand that compliance with all Client Company policies is a condition of, but not a guarantee or promise of my employment and continued employment with the Client Company. I further understand that my failure to comply immediately and fully with Client Company policies will result in disciplinary action, which may include immediate termination for cause.

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Company Rules and Guidelines (Korpal Enterprises)

Company Rules and Guidelines

1. I will not use any profane or foul language while on duty.

2. I will give full cooperation to all managers and other employees.

3. I will not argue with other employees or customers and treat them with respect.

4. I understand that weapons are not allowed on the property.

5. I understand that stealing of any kind is prohibited.

6. I will not work under the influence of any substance while on the clock.

7. I will arrive 5 minutes before the beginning of my shift.

8. I will complete all duties listed on the shift duties (AM and PM Duties) sign before I clock-

9. I will not come behind the counter unless I am in full uniform AND on the clock.

10. I am not allowed to make or receive personal phone calls on the business phone. I understand that the any long distance charges will be deducted from my next paycheck.

11. I am not allowed to have visitors loiter in the store or come behind the counter while on duty.

12. If I am unable to attend a scheduled shift, it is my responsibility to call and inform the manager no less than two hours prior to the beginning of the scheduled shift. I understand that I am under no circumstances allowed to miss a shift without informing the manager.

13. If I am unable to attend a shift due to medical reasons, I will not be allowed to return to work without a valid doctor’s excuse note dated for the missed day. I understand that call-ins for non-valid reasons are not acceptable.

14. I will not clock-in early or stay longer than my scheduled shift unless told to do so by the

15. I understand that it is everybody’s responsibility to keep the store clean, which includes me. If I see something dirty, I will clean it.

16. I will clock-out for my meal and all smoke breaks. However, I will not take any breaks if there is any outstanding tasks needed to be completed.

17. I am required to show up to work clean and in full uniform, and understand that I will be sent home if I do not meet these standards. A full uniform includes the following items:

a. Current Subway shirt
b. Subway hat or visor
c. Subway waist apron
d. Black/khaki pants or jeans (no holes)
e. Slip-free shoes
f. Name tag

18. I will not chew gum, eat, drink, or smoke behind the counter.

19. I will never give free food, drink, or other items to any customer, friend, or family member.

20. I am only allowed 1 6-inch sub, salad, or pizza and 1 cookie during the shift I worked. I understand that I will have to pay for anything extra that I eat, and cannot use a free meal for a later time.

21. I understand the write-up policy.

a. Write-ups will occur when found in violation to any rules or policies listed above or for any other infractions deemed necessary by the managers. The first two write-ups will serve as a warning and termination will occur after the third write-up. However, termination can occur any time prior to the issuance of a third write-up if deemed necessary.

I have read, understood, and agree to follow these rules and guidelines and understand the consequences I will
face if they are violated.

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Employee Uniform Deduction Form (Korpal Enterprises)



This is to authorize a deduction of $10.00 per pay period, until a total of $10.00 is collected.

Explanation of Deduction: Uniform Shirt

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Direct Deposit Instructions (Korpal Enterprises) Subway


Any employees that would like to enroll in the payroll direct deposit option would need to submit the direct deposit form and one of the following items:

  1. Letter from their financial institution on their letterhead with the employee's name, account number and routing number.
  2. Copy of a voided check.
  3. An employee currently using a debit card for their direct deposit will need to submit a form from the issuing institution with the employee's name, account number and routing number. These forms normally come with the debit card that the employee would like their payroll checks loaded to.
Our direct deposit process for the employee's first check is one penny is deposited into the employee's account and the remainder of their wages is paid via live paper check. Once the employee's penny is credited to their account, they will need to notify J Solutions and their next check will go 100% direct deposit.


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Handbook Receipt (LA Crazy Cajun)


This Employee Handbook does not constitute a contract of employment either in whole or in part. The Company, reserves the right to add, delete, or change any portion of the Employee Handbook with or without notice.


I acknowledge receipt of, and have read, the Employee Handbook that outlines my benefits and obligations as an employee of Crazy Cajun. I understand the Standards of Conduct and each of the rules and regulations which I am expected to follow, as well as the additional policies. I agree to abide by all of them.

All employees are expected to conform their conduct to the rules and regulations as set out in this handbook, and understand that they are at-will employees. The contents of any Employee Handbook, including this one, that may be distributed during the course of their employment shall not be construed to be a contract or in any way binding. The Company reserves the right to change, at its discretion, the contents of this handbook.



This handbook is a general guide and provisions of this handbook do not constitute an employment agreement (contract) or a guarantee of continued employment. It is simply intended to outline the benefits and work requirements for all employees. It is further understood that the Company reserves the right to change the provisions in this handbook at any time. It is policy of the Company that employment and compensation of any employee is at will and can be terminated with or without cause, at any time, at the option of the employee or at the option of the Company.

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Employee Handbook Update (LA Crazy Cajun)


Employee Handbook Update: April 26, 2018

Employee Meals
Employees may purchase any menu items at a 50% discount up to $7.00 on days they work. The discount may be applied before or after shift (within 30 minutes). Employees may also receive their discount during a regularly authorized break.
Employees may NOT purchase or consume any alcoholic beverages before or during their shift. If a guest offers any employee an alcoholic beverage while that employee is
on the clock or about to be on the clock, that employee must kindly decline the offer. Bartenders are only allowed to consume alcohol if it is to “check for quality” and is a “taste”.
Uniform Policies
All – Per city and state health codes, no facial jewelry, no artificial nails or polish and all earrings must be studs only. All-natural nails must be kept clean and neat and should not pass the tip of the finger. All long hair, must be pulled back and up, so that it does not reach shoulder length.

FOH – All shoes MUST be approved for restaurant use with proper non-slip sole. Shoes must be maintained and replaced when necessary. If the company uses a vendor for shoes, all employees must purchase shoes through
company (at a discount). All pants must be of the “blue jean” variety and shorts may be blue denim or khaki. No other colors or material can be worn. Pants must not
drag the floor and must sit properly so that no undergarments or skin shows. No stretch or legging type denim. Shirts must be uniform and clean. Shirts must be tucked in or an apron must be worn.

BOH – Shirts must be uniform and clean covered by an apron while on the clock and working. No jewelry other than wedding band can be worn in the back of house. Same shoe policy as FOH. Any questions, please get with management.
Drug policy Crazy Cajun reserves the right to have any local law enforcement bring a drug sniffing dog on the premises at any given time to perform sweep of property. Any employee found to be violating company policy may be terminated immediately.

*By signing this document, I am acknowledging that all the above updates to the Crazy Cajun Handbook have been explained to me and I accept and understand. I also understand that the previous complete handbook is still in effect unless the
modification is mentioned above.
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Social Media Policy (LA Crazy Cajun)

LA Crazy Cajun

Social Media Policy

The purpose of this policy is to outline the guidelines and principles for employees of LA Crazy Cajun, to follow when communicating via social media sites. Social media sites are an excellent way to share one's life and opinions with family, friends and co-workers without any geographical barriers. It also is an advantageous form of marketing and communication for businesses. This policy will clearly define what LA Crazy Cajun deems as acceptable and unacceptable use of social media sites. Management reserves the right to amend this policy at its discretion. Social media guidelines will be outlined for both forms of social media usage: Employee Personal Usage and Business Usage.


Social media is any form of electronic communication through the Internet, This can include, but is not limited to, traditional social media sites, personal web site/blog, someone else's web site/blog, journal, bulletin board or chat room. Traditional social media sites provide online environments, which allow users to join virtual communities to share information, ideas, personal message and other content (images, audio, video, etc.). Users set up "profiles" to interact with both personal and business contacts via chat, email, video chat, private messaging, voice chat, blogging, file sharing, discussion groups, multimedia sharing, etc. These web sites are available to the public and access to view profiles varies depending on the provider. Popular social media web sites, include but are not limited to Facebook, Google Plus+, MyLife, Yelp, LiveJournal, MySpace, Twitter, LinkedIn, ClassMates, Blogger, YouTube, Instagram and Pinterest,


As with any form of technology, several risks exist and new risks will continue to surface. The primary objective of this policy is to mitigate the following risks that exist with social media use:

  • Risk of LA Crazy Cajun's reputation
  • Disclosure of LA Crazy Cajun's trade secrets, private information and confidential customer information
  • Intra-company slander (employees/supervisors)
  • Malware infection (spyware, botnets, keyloggers, etc.)
  • Workplace productivity
  • Inaccurate/outdated information
  • Convenient portal for disgruntled former and current customers, vendors and employees
  • Information disclosed on social media sites utilized for social engineering attacks against the Restaurant

Employee Personal Usage

There exists a tremendous risk for individual employees to inadvertently put LA Crazy Cajun at one of the aforementioned risks utilizing profiles created for personal use on any of the social media sites. When posting to social media web sites, ensure that content is consistent with this policy and the other policies defining appropriate employee behavior.

Inappropriate postings that may include discriminatory remarks, harassment and threats of violence or similar inappropriate or unlawful conduct will not be tolerated and may subject you to disciplinary action up to and including termination.

In posting online, be respectful to your coworkers, customers, members, vendors and any individual working on behalf of the Restaurant.

Avoid using statements, photographs, video or audio that reasonably could be viewed as malicious, obscene, threatening or intimidating, that disparage customers, members, associates or suppliers or that might constitute harassment or bullying.

Ensure that all content posted is honest and accurate; if a mistake is made, correct it immediately. Do not disclose LA Crazy Cajun's trade secrets, private or confidential information.

Do not post non-public information, such as internal reports, policies, procedures or other internal business-related confidential information.

Do not misrepresent yourself as a spokesperson of LA Crazy Cajun.

Restaurant Usage

Employees with access to post as LA Crazy Cajun must first have all intended posts approved by management.

Social Media Use During Work Hours

Social Media web sites have the ability to install malicious programs, such as spyware and adware on users' computers. Social Media can also lead to a sharp decrease in employee productivity. For these reasons, LA Crazy Cajun employees are banned from accessing social media web sites while, on the Bank's network unless specific permission is given by management.

Statement of Understanding for Social Media

Employees are allowed to maintain "profiles" on social media web sites; however, any content deemed inappropriate as defined in this policy can result in disciplinary action up to and including termination.

Social media web sites lack privacy, regardless of advertised security features. Any post an employee posts is permanently released and cannot be retrieved. Employees must remember to be smart about what they publish. Due to Internet archiving, once something is published, the damage is done and it can be virtually impossible to retract.

Employees should report any security violations immediately to management.


I understand and will abide by LA Crazy Cajun's Social Media Policy, while employed by LA Crazy Cajun, and thereafter.

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Corporate Credit/Debit Purchasing Card Policy (LA Crazy Cajun)


Each entity, restaurant has a debit/credit card that has been assigned to that specific business.

This corporate card CANNOT be used to obtain cash advances, bank checks, traveler's checks, or electronic cash transfers for expenses other than those incurred by the assigned employee that is ultimately responsible for the card, as well as any employees whom are given use of card for business purchases. Misuses of the card will result in cancellation of the card and withdrawal of corporate credit/debit card privileges, as well as termination. If the card is used for any personal expenses, the employer reserves the right to recover these monies from the employee. Card users will be required to sign a declaration authorizing the company to recover, from their pay checks, any amount incorrectly claimed. Additionally, the employer reserves the right to terminate employee for use of corporate card that do not comply with the uses incorporated herein.

Corporate credit/debit card expenditures must be reconciled on a weekly basis, from Monday — Sunday of prior week and due no Later than Monday of the following week and is the responsibility of General Managers. All receipts MUST accompany the weekly expense report. These expenses along with copy of receipts can be scanned and emailed to and copy Cardholders who have not reconciled and submitted weekly expenditures within this period will be asked to reconcile and submit their weekly expenditures immediately. Continued or repeated non-conformance to this policy will result in cancelation of this card and the employee responsible for this card will be reprimanded for not following procedures and policies.


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Declaration Credit/Debit Card (LA Crazy Cajun)


I understand and agree to the following:

  • I bear ultimate responsibility for the card when in my possession
  • I will NOT use the corporate card to withdraw cash, bank checks, traveler's checks, or electronic cash transfers or allow all other employee to do so as well
  • I will NOT use the corporate card for personal expenses and will use it only for official business on behalf of company
  • If I misuse the card (i.e. use it other than in accordance with the instructions given to me in the agreement or related policies) or otherwise fail to reconcile expenditures within the prescribed procedures and timeframe, I authorize the company to recover the funds through payroll deductions for any amounts incorrectly claimed or for reconciliations that are 2 days in arrears of the due date, (the Monday which follows as stated, week will consist of prior Monday —Sunday)
  • If the card is lost or stolen I will report it immediately to corporate headquarters.
  • If I resign from company, I will return card to management in corporate office with a final reconciliation of all expenditures prior to departure
  • ANY charges OVER $150.00, need to have prior approval from Upper Management
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Fit for Duty Annual Physical Consent Form (Economy Industrial Services)

Economy Industrial Services
J Solutions, Inc.

Fit for Duty Annual Physical Consent Form

One (1) of the following courses will be required annually-

Fit for Duty Office —

This Exam is intended for those employees that will not be performing any work in the field. These employees may include, but are not limited to human resources, accountants, administration, and secretaries. This level will require the individual to complete a basic physical examination only. The exams will be administered by BHP (Baytown & Beaumont).

Fit for Duty Level 1 —

This exam is intended for those employees performing light to medium duty work. These employees may include, but are not limited to inspectors, planners, engineers, safety, supervisors, instrumentation, security, and equipment operators. This level will require the individual to complete a basic physical examination and a level 1 functional capacity exam. The exams will be administered by BHP (Baytown & Beaumont).

Fit for Duty Level 2 —

This exam is intended for those employees performing medium to heavy duty work. These employees may include, but are not limited to welders, insulators, attendants/firewatch, railcar workers, electricians, painters, HVAC workers, blasters, vacuum truck operators, scaffold builders, laborers, boilermakers, riggers and pipefitters. This level will require the individual to complete a basic physical examination and a level 2 functional capacity exam. The exams will be administered by BHP (Baytown & Beaumont).

As a condition of employment and continued employment with Economy Industrial Services, Inc. and J Solutions Inc. , I agree to annual fit for duty testing.

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P.O. Box 88
Bridge City, Texas 77611
Telephone (409) 999-6091
Fax (409) 999-6093

Certified Woman-Owned Business Enterprise

Employee Accident/Incident Policy (Economy Industrial Services)

Economy Industrial Services
J Solutions, Inc.


In the event that you have an accident/incident while on the job, you are to immediately report this to your supervisor. If an accident requires medical attention of first aid, the accident will be investigated and a report will be completed as soon as practical following the accident.

If you have an injury that doesn't require outside medical attention, you may apply whatever minor treatment is necessary. Your supervisor has a first aid kit available.

If you get a foreign body in your eye, these can usually be washed out with eye wash. Do not stick objects into your eyes in an effort to remove objects. This may further complicate the injury. In the event the foreign body remains or is embedded in the eye, you will be sent for medical attention.

If you have an injury that requires outside medical attention, depending upon the extent of the injury, you will be transported either by company vehicle or ambulance to a medical facility.

Near miss accidents/incidents should also be reported to your supervisor. These can be investigated and the findings can be used as material for the next safety meeting.

In the event you have an accident requiring outside medical attention of any sort, you will be referred for a drug screen.

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P.O. Box 88
Bridge City, Texas 77611
Telephone (409) 999-6091
Fax (409) 735-5675

Certified Woman-Owned Business Enterprise

Wage Deduction Authorization Agreement (Economy Industrial Services)

Economy Industrial Services
J Solutions, Inc.


I understand and agree that my employer, Economy Industrial Services, Inc. and J Solutions, Inc. may deduct from my paycheck the following:

  • Drug Test Charge - $25.00
  • H2S Monitor - $125.00
  • ISTC Charges — (Vary per job)

A deduction will be made on your payroll check for the Drug test Charge of $25.00 if you fail to pass the drug screen, if you quit or are fired before the job is complete.

In the event that your H2S Monitor is lost or not returned upon discharge, a deduction of $125.00 will be deducted from your payroll check.

All ISTC charges paid by Economy Industrial Services, Inc. will be payroll deducted in the event that you quit or are fired before the job is complete or before 30 days of employment.

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P.O. Box 88
Bridge City, Texas 77611
Telephone (409) 999-6091
Fax (409) 999-6093

Certified Woman-Owned Business Enterprise

Lion Elastomers - Emergency Alarms & Initial Response for Contractors (W.I.T. Development)

Lion Elastomers



All contractors should be aware of their location in the Plant at all times. When the Emergency Alarm System is sounded, all Contractors should stop and divert their attention to the verbal instructions that will follow.

  1. Alert Tone: Continuous, fast alternating, high-low sound followed by a verbal Announcement i.e., "Fire in 6D Process" or "Gas Escape at 8D Reactor"
  2. Plant Evacuation: Prolonged, continuous air horn blast followed by verbal announcement. Follow any special instructions for evacuation routes and assembly points that may be announced. If no special instructions for your location are announced, follow evacuation routes and assembly points indicated on the Plant map. If the evacuation route is blocked, proceed cross wind or upwind from point of emergency to an alternate assembly point.
  3. All Clear: Continuous siren followed by verbal announcement.


W.I.T. Development and Contracting

It is the intent of W.I.T. Development and Contracting and It's employees to comply with all laws as well as safety and environmental policies within the Lion Elastomer's Facility. To do this,we must constantly be aware of conditions in all work area's that could potentially produce an injury .No employee is required to work at a job they know is unsafe. Your co­operation in detecting hazards, and in turn controlling them, is a condition of your employment. Inform your supervisor immediately of any situation beyond your ability or authority to correct.

I have received and reviewed the Port Neches Elastomers Facilities Safety/Security Requirements for Contractors and we will abide by all of the policies and procedures contained therein.

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Responsibilities (W.I.T. Development)

W.I.T. Development and Contracting

This program outlines the minimum requirements that will be met by W.I.T. Development and Contracting,Ine when performing high-pressure water cleaning (HPWC).




  • Provide proper equipment and procedures

Provide safety training for all operators of HP Water systems

  • Perform periodic inspections and audits


  • Oversee all operations involving use of high pressure water
  • Ensure equipment is safe prior to use
  • Allow only qualified employees to operate equipment
  • Ensure areas are safe for passers by
  • Ensure all equipment meets the requirements of this program
  • Provide employees with on-job training
  • Maintain records of maintenance and training
  • Provide safety controls at all work sites


High-pressure water cleaning: The use of high-pressure water, with or without the addition of other liquids or solid particles, to remove unwanted matter from various surfaces.

High-pressure water cleaning systems: Water delivery systems, which have nozzles or other openings whose function is to increase the speed of liquids. Solid particles or additional chemicals may also be introduced, but the exit in all cases will be a free stream. The system includes pumps (pressure reducing devices) and the hoses, lances, nozzles, valves and safety devices as well as any heating elements or injection systems attached thereto.

High-pressure water cutting: The use of high-pressure water, with or without the addition of other liquids or solid particles, to penetrate into surfaces of a material for the purpose of cutting that material.

Dump valve: A device that immediately shuts down the high-pressure water stream if the operator loses control.


High-pressure water cleaning is normally performed using jet streams that can have a velocity greater than that of a 45-caliber bullet, and do as much damage. Therefore, extreme caution and strict compliance with procedures must be used to prevent the jet stream from striking the operator, other employees or delicate equipment. No portion of the body must ever be placed in front of the water jet. These jets of water can easily puncture and tear the skin or penetrate deeper causing infection or serious internal damage. Horseplay with such equipment is strictly forbidden. Violators will be disciplined and subject to immediate termination.



Personnel performing high-pressure water cleaning that are exposed to water spray or reflected material will wear a raincoat, rain pants, safety glasses, hardhat with face shield, rubber boots and gloves. Hearing protection will also be worn. These do NOT provide protection from the jet but do protect against hazards encountered while performing the work.

The following identifies at a minimum the personal protective equipment that will be issued to employees performing high-pressure water cleaning outside of the required hardhat and safety glasses with side shields:

Face shields — Clear shield nine inches deep by fifteen and one-half inches wide by 0.60 thick (ANSI Z87.1-1979 or equivalent).

Rain Suit — Standard vinyl rain suit

Gloves — Made of Neoprene, rubber and PVC with rough wet grip finish.

Rubber steel-toed boots — Knee length with ribbed steel shanks and heavy tread soles for nonslip traction (ANSI Z41.1-1967 or equivalent).

Metatarsal Guards — Designed to be worn with lace-type steel toe boots.

When cleaning equipment which could possible be contaminated with hazardous chemicals, appropriate additional protection specified by the project management/safety will be worn by the operator as well as other employees who may be affected.

When tube lancing or "shotgunning", boots provided with steel toecaps and metatarsal protection will be worn.



The High-Pressure Water Cleaning Job Qualification form (see focus section) must be completed prior to performing any high-pressure water cleaning to deteirmine if there are alternate methods for performing the task that are less hazardous.

The HPWC system will be depressurized when: Not in use.

  • Unauthorized or inadequately protected personnel enter the barricaded area.
  • Replacement or repairs are made to the system.

Recommended practices are violated.

Any incident, near miss or abnormal occurrence will be immediately reported to the responsible supervisor and an investigation conducted.

A cleaning crew will be composed of at least two operators. Each crew member will be in view of another crew member at all times.

Operators will not operate equipment for more than eight (8) consecutive hours in any sixteen (16) hour period. The team members should. rotate their duties during the job to minimize fatigue to the operator holding the tools.

The equipment operator nearest the high-pressure nozzle must always have a means of immediately reducing pressure or interrupting the flow to the nozzle.

When the hose drop exceeds ten (10) feet, the hose will be securely tied off to a rigid support with a fiber rope to limit the pull due to hose weight. Bend radius limits (as identified by the manufacturer) must be maintained.

At least one control valve or switch will control each high-pressure tool. An employee will operate only one high-pressure lance or shotgun at one time.

The area around the job, pump and hoses will be barricaded a minimum of fifteen (15) feet and signs stating "D.AiNGER IIIGH-PRESSURE WATER CLEANING" must be placed at the perimeters. Barricades may be of rope, tape, barrels, etc. as long as they give an effective warning and are highly visible.

If the job is above ground level, barricades may be required below. Warning signs should be placed along those portions of the high-pressure water hose, which are outside the barricades.

High-pressure cleaning hose will be positioned and handled to minimize bends and turns. Sharp bends and turns can result in hose failure.

High-pressure hose connections will have safety cables, chains or the equivalent bridging at each joint.

High-pressure water cleaning equipment must be designed and maintained to achieve a minimum safety factor of three to one (3:1) against maximum allowable working pressure.

The operator responsible for the job will fill out the High-Pressure Water Cleaning Equipment Checklist form before starting each job.

The pressure must be removed from the system before tightening or loosening fittings.

When the hose is pressurized, personnel must not handle the hose within one foot of the hose-to­hose connections.



Reactive back thrust forces from the high-pressure water jets physically stress the operator and affects operator control. Sound footing conditions must be established and maintained during cleaning.

Back thrust forces results from water leaving the nozzle at a high velocity. During manual shotgun cleaning operations, back thrust can be calculated from the equation below.

Back Thrust (lb) — 0.052 Q I P

Where: Q-Flow Rate in U.S. gallons/minute P — Jet Pressure Measured in PSI

For determining GPM, use the equation: Q-{29.9(K) D2) (tP)}

Where K — 0.09 constant

Operators of the shotgun-type equipment will not be required to withstand a back thrust of more than one-third (1/3) of their body weight.

If the area to be blasted is in a cozened space or the operator must climb to an elevated position such as on a ladder or scaffolding, it is required that a safety harness be used. Railings or other protection should be provided.

DO wear protective clothing.
DO stop unit to change nozzle, hose assemblies and other parts.
DO stop unit in case of a leak.
DO wear a safety harness when in an elevated position.
DO use only the manufacturer's recommended chemicals.
DO use sediment — free water.

DON'T tie gun lever or trigger down.
DON'T start the unit with the gun engaged.
DON'T aim the gun at people, light unsecured objects or other potential hazards.
DON'T engage gun unless it is properly connected and held.
DON'T lay the gun in mud, dirt or sand.



An automatic relief device will be installed on the high-pressure side of the pump set to relieve at not higher than the maximum allowable working pressure of the lowest rated component in the high-pressure system.(Rupture Disc Provided By Lion Elastomers)

Prior to starting the job, a visual inspection of the high-pressure components (including rupture disk pressure rating) should be performed. Hose with exposed or damaged wire braid will be removed from high-pressure service. The assembled high-pressure water cleaning components will be SLOWLY pressurized to the maximum operating pressure to verify integrity of the system.

A hose inspection and testing program (per manufacturer's guidelines) will be conducted at least quarterly. The inspection test will be conducted at 1 '/2 times the maximum operating pressure and will be observed by supervision.

Hose failures usually occur near fittings due to bending stresses during use and handling. Pressurized hoses will NOT be handled within one foot of hose-to-hose connections. Hose-to­tool connections, which are in frequent contact with the operator, must be shielded by a shroud to protect the operator. These shrouds must have sufficient rigidity to resist bending to radius smaller than those recommended by the hose manufacturers.



The following items will be overhauled and inspected for proper functioning at the manufacturer's recommended intervals (All EQUIPMENT PROVIDED BY Lion Elastomers)

  • Pressure relief valve
  • Bursting discs (if used)
  • Pressure control valves Hand or foot operated dump control valve or dry shut-off valve
  • Dry shut-off valve or dump systems
  • Changeover valve



When maintaining or assembling high-pressure water cleaning systems, the correct size tool MUST be used. The use of adjustable tools having serrated gripping jaws (i.e. pipe wrenches), which can damage equipment, will NOT be used.

NOTE: Only manufacturer's parts may be used for repairs to equipment. Manufacturer's equipment will not be altered or modified under any circumstances. (all parts provided by Lion Elastomers)



Shot gunning is our preferred basic high-pressure water cleaning method. Different variations of
each method are available and increasing with new technology. Rotating nozzle assemblies,
rotating lances and orbital nozzles are some variations available at this time.

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