1. Gajeske OQ Services Operator Qualification
Program
Gajeske OQ Services
www.gajeskeoqservices.com
Contact Information
Corporate Office
Bob Gajeske
2929 Antoine Dr
Houston, TX 77092
Office: 713-688-2728
Email: 8173347@gajeske.com
Dallas/Ft Worth
(OQ Services)
James West
1314 W. Oakdale Rd
Grand Prairie, TX 75050
Office: 972-314-8100
Email: jwest@gajeske.com
Additional Locations
Austin San Antonio
Todd White Mike Seitze
14300 Gregg Manor Rd 13406 Western Oaks
Manor, TX 78653 Helotes, TX 78023
Office: 512-278-1557 Office: 210-695-4440
Email: twhite@gajeske.com Email: mikes@gajeske.com
Tulsa
Manny Parker
2723 E. Hwy 117
Sapulpa, OK 74066
Office: 918-227-3408
Email: mparker@gajeske.com
Page 1 of 35

2. Gajeske OQ Services Operator Qualification
Program
Gajeske specifically targets the qualifications needed to fulfill the requirements of
the Department of Transportation Operator Qualification Rule. The DOT Operator
Qualification Rule requires pipeline operators to develop and maintain a written
qualification program for individuals performing covered tasks on pipeline
facilities. The DOT also requires that pipeline operators qualify their work force
on covered tasks. The Operator Qualification Rule includes Subpart N in 49 CFR
Part 192 and Subpart G in 49 CFR Part 195.
Gajeske delivers a complete qualification and documentation system. Gajeske
has a library of Operator Qualification courses for natural gas distribution
developed and ready to present to your employees. These courses are designed
to meet the requirements of the DOT Operator Qualification Rule.
The Gajeske OQ Program consists of 3rd party administered knowledge test and
client administered performance based evaluations. This program was
specifically designed with the contractor in mind. There are no required computer
based training modules or electronic tests. We at Gajeske have asked and
listened to the request and recommendations of hundreds of contract companies
throughout the US.
Our program allows the flexibility for you to schedule and administer performance
evaluations on your schedule and not that of when a computer or third party
program is available.
Other programs contract their technical advice or obtain consultation through
associations that meet on a quarterly basis. Gajeske has well over 100 years
combined experience in the natural gas distribution industry. We are not just
another qualification program; we are your one-stop-shop for compliance with the
Operator Qualification Rule.
The following will describe the Gajeske process from establishing an evaluator,
evaluating and verifying individual’s knowledge and performance of covered task,
to record keeping and auditing for compliance with the Operator Qualification
Rule.
Page 2 of 35

3. Gajeske OQ Services Operator Qualification
Program
Evaluator Program
To meet the ever rising need to conduct ethical and accurate evaluations,
Gajeske has developed an Evaluator training program.
Once your designated Evaluators have completed Gajeske’s mandatory
Evaluator training, the rest is like clockwork.
The Train the Evaluator session is tailored to meet the needs of the operators of
natural gas pipelines who must comply with the federally mandated operator
qualification program. This training provides information on the theory of
evaluation, but its strength is in providing useful information and hands-on
practice for conducting credible performance evaluations.
Train the Evaluator “One-Day” training sessions include:
• Reliability and Validity
• Using Observation Skills
• Using Listening Skills
• Tips for Handling Problem Situations
• Tips for Evaluator Response to Evaluatee Questions
• Evaluation Exercise
• Various Practice Exercises
Additional Topics covered:
• Preparing yourself
• Preparing the Individual for Evaluation
• Starting an Evaluation
• Stopping an Evaluation
• Determining Qualified vs Non-Qualified
Optional Discussions: Test Question Administration; Work Performance; History
Review; and the OQ Rule
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4. Gajeske OQ Services Operator Qualification
Program
Evaluator Authorization
Gajeske conducts a background check of each Evaluator applicant to determine
technical competence prior to being authorized. Each Evaluator is authorized to
evaluate personnel only for those covered tasks for which technical competence
can be verified and documented. Gajeske tracks/reports Evaluators by employer
and can transfer applicable records when an Evaluator changes employers.
Evaluation by Authorized Contractor Evaluator
Gajeske will develop authorized evaluators within a contractor's organization to
enable them to evaluate/qualify their own personnel. To become an authorized
evaluator, the individual must be approved by Gajeske in terms of "technical
competence" AND must successfully complete the Gajeske Evaluator Training
Program. Gajeske will monitor (through random observations and audits)
Contractor evaluators at a rate of frequency to be determined by Operator to
ensure consistency with Operator's written plan and Gajeske procedures.
Page 4 of 35

5. Gajeske OQ Services Operator Qualification
Program
Record Keeping Procedures
Operators must keep records for the personnel who perform covered tasks for
their company. The OQ Rule states that an operator must maintain records for
personnel that perform covered tasks for the operator for a minimum of 5 years
from their date of qualification or 5 years from the last date that the individual
performed a covered task.
Many large operators have intricate record keeping solutions that already track
large amounts of information regarding qualifications for a multitude of regulatory
actions. Mid-to-small-sized operators and contractors will be the hardest hit by
this requirement.
Operators will be requesting qualified personnel and will, in all likelihood, be
requesting that contractors provide the information in an electronic format for
easy import into the operator's record keeping database. It will be beneficial for
contractors to be proactive and have quick access to a database of their
employees that are able to perform covered tasks.
With Gajeske’s OQ Program, records are retained in a secure manner with
reports available 24 hours a day. Gajeske is also an Approved data provider to
ISNetworld which supplies access to records for hundreds of Operators across
the United States.
Gajeske offers training for your OQ Administrator at no charge so record
retention is quick and effortless.
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6. Gajeske OQ Services Operator Qualification
Program
Audit Program
Quality Assurance
Gajeske rigorously reviews all records submitted by Evaluators, contractors,
Operators, and others to assure accuracy and consistency. Incomplete or
inaccurate records are refused and returned to the originator.
Gajeske personnel monitor data within the OQ Services database from these
records. For data to be entered within OQ Services, we require a full audit trail
and any necessary records to support that data. Assuring the quality of those
records and, subsequently, the data entered into OQ Services gives our clients
confidence in the integrity and availability of our records and reporting
processes.
For each “Record of Evaluation” submitted, Gajeske ensures that the Evaluator of
record has been authorized for the applicable covered task covered during the
evaluation.
Monitoring/Auditing
Evaluators – Gajeske routinely monitors Evaluator performance to ensure that
evaluations are conducted in accordance with the Operator’s OQ program and
Gajeske procedures. Evaluators are randomly selected for audit, but may also be
audited on a “for cause” basis when there is evidence to suggest questions.
Qualified Personnel - Random and “for cause” audits are conducted of previously
qualified individuals to ensure they have not contributed to an incident/accident
while performing a covered task(s) to ensure there is no other reason to suspect
the individual may no longer be qualified. All personnel audits are conducted
relative to all applicable Operator clients to promote economies of scale.
Records – As the last step in concluding an Evaluator or qualified personnel
audit, all internal records are audited for completeness/accuracy and to assure
that electronic records within OQ Services are consistent with submitted records.
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7. Gajeske OQ Services Operator Qualification
Program
What's more, Gajeske can get your company started
TODAY, fully equipped to satisfy your company's
needs for: Training Delivery, Testing, Records
Documentation, and Performance Evaluations
With the click of a mouse or a simple phone call, Gajeske’s
OQ Program is instantly available to your employees.
Your employees will be able to complete their training at
your location or ours complete with on hands verification of
knowledge retention.
The same "engine" that is used to deliver Gajeske’s OQ
Program is currently being used by over 5000 users.
Finally, Gajeske is available to answer your questions and for
technical support around the clock. You will find our support
is unequal to any other program available to you.
Page 7 of 35

8. Gajeske OQ Services Operator Qualification
Program
Step by Step Qualification Process:
1. Becoming a member of Gajeske OQ Services
a. Go to www.gajeskeoqservices.com and click on OQ Application.
b. Print application
c. Complete application
d. Fax to the number printed at the top of the application
2. Once the application has been processed, you will be contacted by one of
our representatives
a. Application information will be verified
b. Client OQ Administrator should be determined at this time
c. Training for OQ Administrator will be scheduled
3. The Gajeske OQ Program consists of client administered performance
based evaluations. Once your designated Evaluators have completed
Gajeske’s mandatory Evaluator training, the process of qualifying can
begin.
a. Determine which individuals who will be your Performance Evaluators
b. Complete Evaluator Application process
c. Schedule and complete training for Proctors and Evaluators
d. Begin the qualifying process
(KNOWLEDGE TESTS)
4. This program requires both a knowledge assessment and performance
evaluation be taken and passed to become OQ Qualified.
a. Schedule a testing date with your local Gajeske representative
b. Tests will be administered in a controlled environment
c. ALL KNOWLEDGE BASED ASSESSMENTS WILL BE GRADED BY GAJESKE,
INC
d. Feedback will be conducted on an individual basis
e. Knowledge base evaluation results will be entered into the Gajeske database
PASS or FAIL
(PERFORMANCE EVALUATIONS)
5. This program requires both a knowledge test and performance evaluation
be taken and passed to become OQ Qualified.
a. Download and print appropriate Performance checklist from
www.gajeskeoqservices.com
b. Administer evaluation via qualified Evaluator
c. Enter Evaluation and date into Gajeske database
d. Complete appropriate report forms and fax evaluation and report forms to
Gajeske, Inc
Page 8 of 35

9. Gajeske OQ Services Operator Qualification
Program
USERS GUIDE:
1. Go to www.gajeskeoqservices.com
2. Log in with user name and password.
Page 9 of 35

10. Gajeske OQ Services Operator Qualification
Program
3. Your Company’s information page will load. Please input, verify and or
make any changes to your company’s contact information. When
completed click on the Submit button at the bottom of the page.
(If information is correct, no submission is required)
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11. Gajeske OQ Services Operator Qualification
Program
4. If adding an employee to the database, click on “Add a New Employee
Record”, wait for page to load and input employee’s information and
correct social security in the appropriate boxes. Scroll to the bottom of the
page and click on “Update Employee”.
Page 11 of 35

12. Gajeske OQ Services Operator Qualification
Program
5. If editing an employee, click on “Edit / View / Delete an Existing Record”
then type the last name or OQ number of that individual you want to edit
and then click on Search.
TIP: To view your entire employee list, leave the search boxes blank and click
the Search button.
Page 12 of 35

13. Gajeske OQ Services Operator Qualification
Program
6. Once you have selected the individual that you wish to edit, select the
correct link at the top of the page for the qualifications and dates that you
wish to enter. (Examples below)
GOQ-100 -- GOQ-200 GOQ-01 -- GOQ-12 Third Party Tasks
Page 13 of 35

14. Gajeske OQ Services Operator Qualification
Program
7. Once you have selected the correct page you may begin entering required
information. Click on the drop down box for the appropriate qualification
and select the qualifying company. The Assessment Required box will
autofill and you will then enter the “Qualifying Date”. NOTE: You must tab
out of the four digit year box for the database to capture the expiration
date.
Page 14 of 35

15. Gajeske OQ Services Operator Qualification
Program
8. When you have completed entering all required information, scroll to the
bottom of the page and click on “Update Tasks”. All recorded information
will be released only after the required information has been entered into
the database and Gajeske has received all completed documentation.
Page 15 of 35

16. Gajeske OQ Services Operator Qualification
Program
Third Party Qualifications (Poly Fusion, Slip Fit, Welding, X-Ray)
1. After having your employees tested or re-qualified, your administrator will
need to go to www.gajeskeoqservices.com , log in and enter the required
information for that employee's qualification and “SUBMIT” the
information.
2. The approved third party provider will be required to send Gajeske a
certificate of qualification before the record can be released.
Page 16 of 35

17. Gajeske OQ Services Operator Qualification
Program
Operators Using and or accepting Gajeske OQ
Atmos Energy
Center Point Energy
City of Brenham
City of Hempsted
City Public Service (CPS)
City of Onalaska
City of Splendora
Ferrell Gas
San Antonio Housing Authority
Texas Gas Services
Page 17 of 35

18. Gajeske OQ Services Operator Qualification
Program
Contractors Using Gajeske OQ
A & L Underground Flowers Construction
Austin Engineering Fuquay
Battson Contracting G & H Inspections
BJC Mgt G & Y Construction
Caliber GB & G Construction
Carlton Contracting Griffin Boring & Construction
CB Construction H & T Utilities
CCB & Associates Holloman Corp.
Chaparral Housley Communications
Circle J Boring Infrasource Utility
Conatser Construction Infrastrux Energy Services
C.S. Electric JC Evans
CS Utilities Jet Underground
Darnell & Dickson Joe Bland Construction
Developers Construction LI Tex
Driver Pipeline Llano Utility Services
Dry Utilities of Texas Lowes Construction
Eakin Pipeline Mastec
EP Seal Rite Mastec Pipeline
ForceCon Matcor
Flournoy Service Center
Page 18 of 35

19. Gajeske OQ Services Operator Qualification
Program
Contractors Using Gajeske OQ
Miller Pipeline Texcon
MJ Sheridan TJ Inspection, Inc.
Murray Construction Tri - Dal
Northern Pipeline Turn Key Construction
OK TEX Watkins Construction
Pedro SS Services Guy Willis Inspection
Planetary Utilities
Quanta Utility Services
Rodgers Construction
Rodman Companies
Ross Construction
Schieffer Corp.
SL Sibert
Smetana & Associates
Standard Utility
Superior Pipeline Services
Texas State Utilities
Tech Serv
Texas Electric Utility Contractors
Page 19 of 35

20. Gajeske OQ Services Operator Qualification
Program
GAJESKE OQ TASK LIST
Task # Task Description Pri Atmos Task #
G101 Operating Propane Air Systems A01
G201 Welding in a fixed Position / Manual Metal Arc Weld E01
G202 Welding Branch Connections / Manual Metal Arc Weld E02
G203 Welding Metal in the fixed position / Oxy-Acetylene E03
G204 Welding Metal on Steel Branch Connection / Oxy-Acetylene E04
G205 Perform Non- Destructive Tests on Steel Welds E05
G301 Joining of Polyethylene Pipe / Electrofusion (Coupling fusion) F01
G302 Joining of Polyethylene Pipe / Electrofusion (Saddle fusion) F02
G303 Joining of Polyethylene Pipe / Heat Fusion (Butt Fusion) F03
G304 Joining of Polyethylene Pipe / Heat Fusion (Sidewall Fusion) F04
G305 Joining of Polyethylene Pipe / Heat Fusion (Socket) F05
Joining of Polyethylene Pipe / Mechanical Coupling (1/2" CTS
G306 through 1" IPS F06
G307 Joining of Polyethylene Pipe / Mechanical Coupling (1 1/4" and 2") F07
Joining of Polyethylene Pipe / Mechanical Tapping Tee (1 1/4" and
G308 above) F08
G309 Joining of Polyethylene Pipe / Mechanical Coupling (Bolt Type) F09
G310 Joining of Polyethylene / Compression Type Coupling F10
G311 Repairing Non PE Plastic Pipe F11
G312 Joining Dissimilar Pipe Types F12
G401 Repairing Steel Pipe - Distribution G01
G402 Installing Underground Casing G02
G403 Installation / Excavation of Pipeline G03
G501 Installing / Replacing Meters H01
G502 Installing Regulators H02
G503 Installing Service Lines H03
G504 Installing / Replacing Service Valves H04
G601 Conducting Pipe to Soil Measurement I01
G602 Monitoring Rectifiers I02
G603 Monitoring Interference Bonds I03
G604 Installing or Repairing Corrosion Control Devises I04
G605 Installing / Replacing CP Test leads to Pipe I05
G606 Installing Anodes and Insulating Devices I06
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21. Gajeske OQ Services Operator Qualification
Program
Task # Task Description Atmos Task #
G607 Inspecting for External Corrosion and Repairing Pipe Coating I07
G608 Installing, Inspecting and testing Electrical Isolation Devices I08
G609 Internal Corrosion Control I09
G610 Atmospheric Corrosion I10
G701 Tapping Steel Pipelines Under Pressure L01
G702 Activating and Purging Pipelines L02
G703 Perform Odorization Test L03
G704 Tapping Pipelines (Self Tapping Tee) L04
G801 Surveying Leaks M01
G802 Conducting Pipeline Patrolling Surveys M02
G803 Locating and Marking Lines M03
G804 Testing Service Lines (New and Reinstating) M04
G805 Testing Mains and Transmission Lines M05
Inspecting and Testing Pressure limiting, telemetering or recording
G806 gauges and relief valves M06
G807 Performing Valve Inspection and Maintenance M07
G200 Preventing Accidental Ignition M08
G809 Making Permanent Repairs On Transmission lines M09
G810 Inspect, Repair, Tap and Protect Cast Iron Pipe M10
G811 Abandoning / Deactivation or Shutting Down Gas Pipelines M11
Monitor and Regulate the flow and Pressure of Gas from Remote
G812 Locations M12
G813 Emergency Response M13
G814 Damage Prevention during Excavation or Encroachment M14
G815 Leak Classification M15
G100 Recognize and React to Generate Abnormal Operating Conditions M16
G817 Installing / Maintaining Pipeline Markers M17
G818 Inspecting Vault Conditions M18
G819 Inspect & Test Relief Devices at Compressor Stations M19
G820 Operating within Established MAOP M20
G901 Conducting Indirect Inspection O01
G902 External Pipe Inspection for Anomalies O02
G903 Internal Corrosion Inspection (Non-destructive) O03
Page 21 of 35

22. EVALUATOR APPLICATION
Directions:
Anyone desiring to become an Authorized Evaluator must submit an application to Gajeske, Inc.
The application consists of 1) this cover page detailing your contact information and 2) Evaluator
Reference Forms that you must complete and send directly to at least three individuals who can
substantiate technical competence. Below are step-by-step instructions.
1. Complete ALL SECTIONS of this application sheet sign, date, and fax to Gajeske at
972-314-8105. No cover page is necessary. As soon as your application is processed,
Gajeske will email you when the verification process is complete.
2. Indicate on the attached Evaluator Reference Forms which category(s) of tasks you are
requesting, fill-in the appropriate reference contact information and send directly to at
least three different references that can substantiate your technical competence.
YOUR ARE RESPONSIBLE FOR ENSURING THAT THE REFERENCES RESPOND
TO GAJESKE.
3. Your references will then complete their part of the form sign, date and SEND DIRECTLY
TO GAJESKE. Gajeske may contact references directly to substantiate information
submitted. Gajeske will send email updates as your references respond. When your
final reference responds, you will be notified of dates and locations available to attend
Gajeske’s Evaluator Training Program.
4. Schedule and complete the Evaluator Training Program.
You will NOT become authorized until 3 references have validated your technical competence in each
category AND you have successfully completed the Gajeske Evaluator Training Program.
Prospective Evaluator Data (complete all)
Are you a brand new applicant NOT currently in the Gajeske database (YES / NO)?
If an existing evaluator, are you requesting ADDITIONAL CATEGORIES of tasks (YES / NO)?
Name Date of Birth (MM/DD/YYYY)
Email Address Contact Phone
Company Name Company Address
City State Zip Code
Gajeske expects Evaluators to be responsible, safety conscious, objective, and have integrity and good
judgment. By signing below, I am confirming my understanding of these obligations and agree to comply with
all Gajeske procedures. I certify that the information that I have provided in this application is true and correct.
Print Name Signature Date
Page 22 of 35
Gajeske Evaluator Application Date.-02/01/08
Copyright © 2008-2014 Gajeske, Inc. All rights reserved.

23. EVALUATOR REFERENCE FORM
Applicant Instructions: Applicant Name:
Mark an “X” IN THE LEFT MOST COLUMN LABELED “EVALUATOR” next to the categories where you feel you have
technical competence sufficient to objectively conduct evaluations. Then, fill in your name and the name and other
contact information for your reference below and email, fax, or mail this form to your reference. YOUR REFERENCE
WILL THEN COMPLETE AND RETURN THIS FORM DIRECTLY TO GAJESKE. REFERENCE FORMS WITHOUT
VALID CONTACT INFORMATION FOR YOUR REFERENCE WILL NOT BE ACCEPTED.
Reference Name Email Address Phone
Reference Instructions:
Applicant Name: ______________________has applied to become a Gajeske Evaluator. Below is a list of
categories that the prospective Evaluator could be authorized for. The prospective Evaluator must be
technically competent in areas for which he/she will evaluate others. He/she must possess the knowledge
necessary to competently and objectively evaluate an individual’s qualifications to perform a covered task(s).
With that in mind, please fill out the form by marking the appropriate boxes in the right-hand column next to
the categories that the evaluator has marked if you feel they are technically competent is that area. When
complete, please sign, date and fax this form directly to Gajeske at 972-314-8105.
Evaluator Reference
(Evaluator) Task Category: Is the prospective Evaluator technically competent in the (Reference)
Indicate Indicate
requested following category(s)? validation by
categories. marking the
box.
Operating Propane Air Systems
Welding in a fixed Position / Manual Metal Arc Weld
Welding Branch Connections / Manual Metal Arc Weld
Welding Metal in the fixed position / Oxy-Acetylene
Welding Metal on Steel Branch Connection / Oxy-Acetylene
Perform Non- Destructive Tests on Steel Welds
Joining of Polyethylene Pipe / Electrofusion (Coupling fusion)
Joining of Polyethylene Pipe / Electrofusion (Saddle fusion)
Joining of Polyethylene Pipe / Heat Fusion (Butt Fusion)
Joining of Polyethylene Pipe / Heat Fusion (Sidewall Fusion)
Joining of Polyethylene Pipe / Heat Fusion (Socket)
Joining of Polyethylene Pipe / Mechanical Coupling (1/2" CTS through 1" IPS
Joining of Polyethylene Pipe / Mechanical Coupling (1 1/4" and 2")
Joining of Polyethylene Pipe / Mechanical Tapping Tee (1 1/4" and above)
Joining of Polyethylene Pipe / Mechanical Coupling (Bolt Type)
Joining of Polyethylene / Compression Type Coupling
Repairing Non PE Plastic Pipe
Joining Dissimilar Pipe Types
Repairing Steel Pipe - Distribution
Installing Underground Casing
Reference Initials: ___________
Page 23 of 35
Gajeske Evaluator Application Date.-02/01/08
Copyright © 2008-2014 Gajeske, Inc. All rights reserved.

24. EVALUATOR REFERENCE FORM
(Evaluator) Task Category: Is the prospective Evaluator technically competent in the (Reference)
Indicate Indicate
requested following category(s)? validation by
categories. marking the
box.
Installation / Excavation of Pipeline
Installing / Replacing Meters
Installing Regulators
Installing Service Lines
Installing / Replacing Service Valves
Conducting Pipe to Soil Measurement
Monitoring Rectifiers
Monitoring Interference Bonds
Installing or Repairing Corrosion Control Devises
Installing / Replacing CP Test leads to Pipe
Installing Anodes and Insulating Devices
Inspecting for External Corrosion and Repairing Pipe Coating
Installing, Inspecting and testing Electrical Isolation Devices
Internal Corrosion Control
Atmospheric Corrosion
Tapping Steel Pipelines Under Pressure (TDW or Equivalent)
Activating and Purging Pipelines
Perform Odorization Test
Tapping Pipelines (Self Tapping Tee)
Surveying Leaks
Conducting Pipeline Patrolling Surveys
Locating and Marking Lines
Testing Service Lines (New and Reinstating)
Testing Mains and Transmission Lines
Inspecting and Testing Pressure limiting, telemetering or recording gauges and relief
valves
Performing Valve Inspection and Maintenance
Preventing Accidential Ignition
Making Permanent Repairs On Transmission lines
Inspect, Repair, Tap and Protect Cast Iron Pipe
Abandoning / Deactivation or Shutting Down Gas Pipelines
Monitor and Regulate the flow and Pressure of Gas from Remote Locations
Emergency Response
Damage Prevention during Excavation or Encroachment
Reference Initials: ___________
Page 24 of 35
Gajeske Evaluator Application Date.-02/01/08
Copyright © 2008-2014 Gajeske, Inc. All rights reserved.

25. EVALUATOR REFERENCE FORM
(Evaluator) Task Category: Is the prospective Evaluator technically competent in the (Reference)
Indicate Indicate
requested following category(s)? validation by
categories. marking the
box.
Leak Classification
Recognize and React to Generate Abnormal Operating Conditions
Installing / Maintaining Pipeline Markers
Inspecting Vault Conditions
Inspect & Test Relief Devices at Compressior Stations
Operating within Established MAOP
Conducting Indirect Inspection
External Pipe Inspection for Anomalies
Internal Corrosion Inspection (Non-destructive)
Reference Acknowledgement
I acknowledge that I am the individual listed as Reference on this form and that, in my opinion, the prospective Evaluator listed above
is technically competent in the categories that I have marked on this form. Furthermore, I believe that the prospective Evaluator is
responsible, safety conscious, objective, and has integrity and good judgment such that he/she can objectively evaluate an
individual’s knowledge, skills, and ability to perform a Covered Task.
Print Name Contact Phone Number Signature Date
Reference: After you have completed this form, print your name and
phone number, sign, date, and fax to Gajeske at 972-314-8105.
Reference Initials: ___________
Page 25 of 35
Gajeske Evaluator Application Date.-02/01/08
Copyright © 2008-2014 Gajeske, Inc. All rights reserved.

26. Prior to an evaluation session you should:
Prepare yourself:
• Contact individual’s supervisor / OQ Administrator and schedule a time and location for the
evaluation
• Collect material and review procedures related to the task being evaluated
• Prepare the assessment location
• Obtain a Gajeske Knowledge and Performance Evaluation Form
• Ensure that the individual has completed the required testing or training for the covered task
prior to the performance evaluation
Prepare Individual:
• Explain the evaluation process
• Offer the Gajeske Knowledge and Performance Evaluation Form to the individual for review
prior to the start of the evaluation
• Advise individual that this is the time to ask any questions
NOTES:
• Other individuals who may be evaluated on the same task / day should not be present or
observe another individuals evaluation
• Individual’s supervisor / OQ Administrator should not be present during the evaluation
unless the supervisor / OQ Administrator is performing the evaluation
Reference Initials: ___________
Page 26 of 35
Gajeske Evaluator Application Date.-02/01/08
Copyright © 2008-2014 Gajeske, Inc. All rights reserved.

27. During an evaluation you should:
An evaluation cannot commence without a Gajeske Knowledge and Performance Evaluation Form
in the evaluators possession
Starting the evaluation:
• Questions asked should be the same questions for every individual being evaluated. If needed
develop a script of standard questions.
• Advise individual when the evaluation has begun
Ask questions only for clarification and verification:
i.e. What brand is that fitting? Or Are those glasses rated ANSI Z87?
Avoid:
• Asking leading questions
• Making assumptions / snap judgments
• Anticipating mistakes
• Giving feedback during the evaluation
Observe individual for:
• Abilty to recognize and react to abnormal operating conditions
• Safety / PPE
• Correct tools and procedures
• Performance
Advise individual when the evaluation is complete:
Stopping an evaluation:
• Evaluator may stop the evaluation for safety or operation concerns
Reference Initials: ___________
Page 27 of 35
Gajeske Evaluator Application Date.-02/01/08
Copyright © 2008-2014 Gajeske, Inc. All rights reserved.

28. • The individual may request that the evaluation be stopped
• If an evaluation is stopped, it cannot be restarted; the individual is considered non-qualified
and must wait 5 working days before scheduling another evaluation
• The evaluator or individual may suspend the evaluation by calling a time out; a time out is
not considered stopping the evaluation
After the evaluation is completed or stopped:
When the evaluation is completed or stopped, provide feedback and coaching to the individual
concerning their performance
Declare the individual is:
• Qualified
• Non-Qualified
No comments should be written on the Gajeske Knowledge and Performance Evaluation Form
Communicate results to the individual’s OQ Adminisrator
Non Qualified results:
• Select proper notation on the Gajeske Knowledge and Performance Evaluation Form and
provide a copy to the individual’s OQ Administrator
• Inform individual of specifics, errors made, etc.
• Respect the individual’s feelings
Qualified results:
• Evaluator signs Gajeske Knowledge and Performance Evaluation Form and provides a copy
to the individual’s OQ Administrator
• Record / submit qualified covered task(s) in the record keeping system
Reference Initials: ___________
Page 28 of 35
Gajeske Evaluator Application Date.-02/01/08
Copyright © 2008-2014 Gajeske, Inc. All rights reserved.

29. Gajeske OQ Services
OQ Field Audit Documentation
General On-Site Audit Information
Section 1
Project Name:
Job Site Location:
Assessment Date:
ISN Job Site Number:
On-Site Supervision
Name:
Employee ID (ISN # If available):
Job Title:
Company:
Company Employee Responsible for Project Oversight
Name:
Employee ID:
Job Title:
Verification of Qualifications
Section 2
Was the Job Site set-up in ISN and the qualification documentation readily available? Yes No
If no explain:
How was documentation provided?
Computer CD/Disk/Hardrive Internet/Intranet Hardcopy
Is the documentation presented current and up to date? (Auditor should check the Yes No
If no, explain and record action taken:
Are the employees working at the job site the same employees assigned to the job in Yes No
If no, explain and record action taken (Contractor must be notifed to assign correct employees to the job in
Reference Initials: ___________
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30. Qualified Individuals' Information
Section 3
Responsibility of Qualified Individual(s):
Are qualified individuals “Directing and Observing” (span-of-control)
a non-qualified individual while performing a Covered Task? (If YES ,
auditor must complete Section 5 )
Yes No
Are qualified individual(s) performing the Covered Tasks? (If YES ,
auditor must complete the "Qualified Employees Section" below)
Yes No
Qualified Employee Information:
Auditor should list all of the qualified employees present on the job site
Name Company ISN or other ID#
Reference Initials: ___________
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Gajeske Evaluator Application Date.-02/01/08
Copyright © 2008-2014 Gajeske, Inc. All rights reserved.

31. Covered Task Information
Section 4
Job Site Covered Task Overview
Are the covered task assigned to the job site in ISNetworld the same
covered tasks being performed on the job site?(Auditor should observe job
tasks being performed and compare to job site task list)
Yes No
If no, explain and record action taken:
Job Site Covered Task List (List
the tasks individually below or attach the job site task requirements from ISNetworld)
Covered Task Name Covered Task Number
Reference Initials: ___________
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32. Directing and Observing Non Qualified Individuals
(To Be Completed if Being Used at the Site)
Section 5
Does the contractor supervisor and/or inspector understand the
company requirements for utilizing an employee to “Direct and
Observe” non-qualified personnel (span of control)? Yes No
If no explain:
Is the qualified individual “Directing” the work being performed? (Auditor
should observe qualified individual watching the non-qualified individuals
perform the work) Yes No
If no explain and record action taken:
Employee (s) being Directed & Observed
Name Contractor ISN # if available
Covered Tasks that are being "Directed and Observed"
Task Name and Number
Is the qualified individual in close enough proximity to “Observe” work
being performed and be able to take immediate corrective action when
necessary? Yes No
If no explain and record action taken:
Have environmental or location specific issues that may hamper
“Directing and Observing” non-qualified individuals been taken
into consideration (i.e. weather, equipment, terrain)? Yes No
If no explain and record action taken:
Reference Initials: ___________
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33. List any other notable conditions or observations during the assessment:
Section 5 "cont"
Observe qualified employees as they “direct and observe” . Are the
qualified individuals capable of “Reacting and Responding” to
Abnormal Operating Conditions? Yes No
If no explain and record action taken:
Reference Initials: ___________
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Gajeske Evaluator Application Date.-02/01/08
Copyright © 2008-2014 Gajeske, Inc. All rights reserved.

34. Section 6
Auditor should observe covered task performance. Is the Covered Task
work being performed to company standards? Yes No
If no explain and record action taken:
.Task Name and Number
Please list the covered task (s) that were observed during this field audit..
Covered Task Name Covered Task
Are there any other notable findings (Positives and Negatives)? Yes No
Provide explanation and description of findings (Record any actions taken):
Other Comments:
Reference Initials: ___________
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Gajeske Evaluator Application Date.-02/01/08
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35. Important: All work deemed as a Covered Task must be performed by a qualified person or
be directed and observed by a qualified person. If a violation to the OQ program is found,
Covered Task work being performed must stop immediately until appropriate action can be
taken and the situation remedied. The company employee responsible for the oversight of the
project must be contacted to ensure that appropriate action has been taken before covered
task works resumes.
Contractor Employee Project Supervisor
Printed Name:
Company:
Signature: Date
Company On-Site Representative (if applicable)
Printed Name:
Company:
Signature: Date
Individual Performing OQ Filed Audit
Printed Name:
Company:
Signature: Date
Reference Initials: ___________
Page 35 of 35
Gajeske Evaluator Application Date.-02/01/08
Copyright © 2008-2014 Gajeske, Inc. All rights reserved.