CSMS Rev5 PHE ONWJ Forms Checklist Final 2011 (Bag 2)

New Contracts Qulification Phase: Select A Qualified Contractor

Pre-Qualification Selection

Risk Assessment

CSMS

Contract Award

Data Bank Contract Implementation Phase: Ensure Field Safe Work

Pre-Job Activity

Work In Progress

Final Evaluation

CSMS Forms and Checklists Rev-5: 2011

Contractor Health, Safety, and Environmental Management System

INDEX Appendix I. Risk Assessment Forms ....................................................................................... 35 APPENDIX I.1. FORM CSMS/RA/01 ......................................................................................... 36 APPENDIX I.2. FORM CSMS/RA/02 ......................................................................................... 42

Appendix II. Pre-Qualification Forms .................................................................................... 43 APPENDIX II.1. FORM CSMS/PQ/01: ....................................................................................... 43 APPENDIX II.2. FORM CSMS/PQ/02: ...................................................................................... 44 APPENDIX II.3. FORM CSMS/PQ/03: ....................................................................................... 53 APPENDIX II.4. FORM CSMS/PQ/04: ....................................................................................... 54 APPENDIX II.5. FORM CSMS/PQ/05: ....................................................................................... 62

Appendix III. Selection Forms ............................................................................................... 65 APPENDIX III.1. FORM CSMS/SL/01: ....................................................................................... 65 APPENDIX III.3. FORM CSMS/SL/03: ....................................................................................... 69 APPENDIX III.4. FORM CSMS/SL/04: ....................................................................................... 83

Appendix IV. Pre-Job Activity Form ....................................................................................... 81 APPENDIX IV.1. FORM CSMS/PJA/01: ..................................................................................... 84 APPENDIX IV.2. FORM CSMS/PJA/02: ..................................................................................... 85

Appendix V. Work In Progress (WIP) Forms ........................................................................... 81 APPENDIX V.1. FORM CSMS/WIP/01: ...................................................................................... 89 APPENDIX V.2. FORM CSMS/WIP/02: ...................................................................................... 95 APPENDIX V.3. FORM CSMS/WIP/03: ...................................................................................... 97 APPENDIX V.4. FORM CSMS/WIP/04: .................................................................................... 101 APPENDIX V.5. FORM CSMS/WIP/05: .................................................................................... 103

Appendix VI. Final Evaluation Form ...................................................................................... 93 APPENDIX VI.1. FORM CSMS/FE/01: ..................................................................................... 104 APPENDIX VI.2. FORM CSMS/FE/02: ..................................................................................... 105 APPENDIX VI.3. FORM CSMS/FE/03: ..................................................................................... 111 APPENDIX VI.4. FORM CSMS/FE/04: ..................................................................................... 113

Appendix I. Risk Assessment Forms

Risk Assessment New Contracts Qulification Phase: Select A Qualified Contractor

Pre-Qualification Selection

Risk Assessment

CSMS

Contract Award

Contract Implementation Phase: Ensure Field Safe Work

Pre-Job Activity

Work In Progress

Final Evaluation

Data Bank

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

Appendix I.1. Form CSMS/RA/01

No

Risk Area

Risk Exposure

What

(Impact Severity x Likelihood) L/M/H People

1

Nature of work

2

Work location

3

Materials/equipm ent used

4

Potential for exposure to work site hazards

5

Potential exposure to hazards for all personnel

6

Simultaneous work by different contractors

7

Work duration

8

Potential incident consequences

9

Contractor experience

10

Exposure to negative publicity

Assets

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Environment

Reputation

Remarks

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines DEFINITION OF CONSEQUENCES – SEVERITY OF IMPACT Consequences HEALTH AND SAFETY

Severity Level F

E

LOW

MEDIUM

D

C

B

A

HIGH

Potential Severity Impact Slight Injury or Health Effect

Definition - First aid - No effect on work performance

Minor Injury or Health Effect

- Medical treatment case - Restricted work case - LTI (a few days) - Agents capable of minor health effects which are reversible (No hospitalization)

Major Injury or Health Effect

- Prolonged LTI - Agents capable of moderate health effects which are reversible but with hospitalization

Permanent Disability

- Accident/ illness resulting permanent disability - Agents capable of irreversible effects without loss of life but with serious disability and prolonged hospitalization

1-2 Fatalities

- Accident/ illness resulting up to 2 fatalities - Outbreak within facility leading to potential shutdown of facility - Agents capable of irreversible effects leading to death

≥ 3 Fatalities

- Accident / illness resulting more than 3 fatalities - Outbreak to neighbourhood - Agents with the potential to cause multiple fatalities eg. chemicals with acute toxic effects

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines DEFINITION OF CONSEQUENCES – SEVERITY OF IMPACT

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

DEFINITION OF CONSEQUENCES – SEVERITY OF IMPACT

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

DEFINITION OF CONSEQUENCES – SEVERITY OF IMPACT

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

DEFINITION OF LIKELIHOOD

LIKELIHOOD

DEFINITION

Quantifification

Rare or never heard of in the industry

1 per year

Almost Impossible (AI) Very Low (VL)

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

RULE OF THUMB IN DEFINING THE RISK EXPOSURE

LIKELIHOOD

Almost Impossible

Very Low

Low

Medium

High

A

M

H

H

H

H

B

M

M

H

H

H

C

L

M

M

H

H

D

L

L

M

M

H

E

L

L

L

M

M

F

L

L

L

L

M

IMPACT SEVERITY

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

Appendix I.2. Form CSMS/RA/02

RISK ASSESSMENT RESUME

Date

:

Project Period : Job Title

:

Contract No

:

Work Location

:

Risk Category

:

Explanation

:

L (Low)

M (Medium)

H (High)

Assessed by:

Approved by:

(Contract Originator)

(Team Leader)

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Contractor Safety, Health and Environmental Management System (CSMS) Guidelines

Appendix II. Pre-Qualification Forms

Pre-Qualification New Contracts Qualification Phase: Select A Qualified Contractor

Pre-Qualification Selection

Risk Assessment

Contract Award

Data Bank

Contract Implementation Phase: Ensure Field Safe Work

Pre-Job Activity

Work In Progress

CSMS

Final Evaluation

Contractor Safety, Health and Environmental Management System (CSMS) Guidelines

Appendix II.1. Form CSMS/PQ/01

PRE-QUALIFICATION

Date

:

Project Period

:

Job Title

:

Contract No

:

Work Location

:

Contractor Name

:

Address

:

Assessed by:

Approved by:

(Contract Originator)

(Team Leader)

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Contractor Safety, Health and Environmental Management System (CSMS) Guidelines Appendix II.2. Form CSMS/PQ/02: Contractor HSE MS Questionnaires

Company Name: Work Subject:

SECTION 1 – LEADERSHIP AND TOP MANAGEMENT COMMITMENT 1. Commitment to HSE through leadership

a) How are senior managers is top management personally involved in HSE management?

b) Provide evidence of commitment at all levels of the organization by:· (i) Stating this year's company targets for HSE performance·

(ii) Describing how you ensure that your organization understands and is committed to deliver your company HSE targets

c) How do you promote a positive culture towards HSE matters?

d) Provide your current Organization chart

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Contractor Safety, Health and Environmental Management System (CSMS) Guidelines

SECTION 2 – POLICY AND STRATEGIC OBJECTIVES 2.1. HSE Policy & Documents

a) Does your company have an HSE policy document that is applied? (Yes/No) If yes, please attach.

b) Who has overall and final responsibility for HSE in your organization?

c) How do you ensure HSE Policy compliance and communication at site?

2.2. Availability of Policy Statements to Employees

How do you communicate your company's policy to your employees including any changes?

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Contractor Safety, Health and Environmental Management System (CSMS) Guidelines

SECTION 3: ORGANIZATION, RESPONSIBILITY, RESOURCES, STANDARDS AND DOCUMENTATION 3.1. Organizations - Commitment and Communication

a) How is management involved in HSE activities, objective setting and monitoring?

b) What provision does your company make for HSE communication and meetings?

3.2. Competence and Training of Manager/Supervisors/Senior Site Staff/HSE Advisor

Have the managers and supervisors at all levels that will plan, monitor, oversee and carry out the work received formal HSE training in their responsibilities with respect to conducting work to HSE requirements? (Yes/No) If yes, please attach the training matrix.

3.3. Competence and General HSE Training

a) What arrangements does your company have to ensure employees have knowledge of basic industrial HSE, and to keep this knowledge up to date?

b) What arrangements does your company have to ensure ALL employees, including sub contractors, also have knowledge of your HSE policies and practices?

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Contractor Safety, Health and Environmental Management System (CSMS) Guidelines

SECTION 3: ORGANIZATION, RESPONSIBILITY, RESOURCES, STANDARDS AND DOCUMENTATION 3.4. Specialized Training

Have you identified areas of your company's operations where specialized training is required to deal with potential hazards? (Yes/No) If Yes, please provide the list (e.g. radioactive, asbestos, explosive, diving, etc).

3.5. HSE Qualified Staff - Additional Training

Does your company have HSE specialist (related to your company's services) who can provide training for other employees? (Yes/No)

If Yes, please attach the curriculum vitae 3.6. Assessment of Suitability of Subcontractors

a) Do you employ sub-contractor(s) for the intended service? (Yes/No) If No, please go to the question 3.7. Do you have sub-contractor(s) selection procedure in term of HSE? b) How do you assess your sub-contractor(s) to ensure they comply with your company's HSE policy and standards?

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Contractor Safety, Health and Environmental Management System (CSMS) Guidelines

SECTION 3: ORGANIZATION, RESPONSIBILITY, RESOURCES, STANDARDS AND DOCUMENTATION 3.7. Standards

a) What kind of HSE regulatory or industrial standards that your company refer to for the intended service?

b) How do you ensure these are met and verified?

SECTION 4: HAZARDS AND EFFECT MANAGEMENT 4.1. Hazards and Effect Management

Does your company have procedure for the identification, assessment, control and mitigation of hazards and effects? (Yes/No) If Yes, please attach the index/table of content including the sub-index. 4.2. Exposures of the Workforce

What systems are in place to monitor the hazard's exposure of your workforce e.g. chemical or physical agents?

4.3. Handling of Potential Hazards

How is your workforce advised on potential hazards, e.g. chemicals, noise, radiation, etc., encountered in the course of their work?

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Contractor Safety, Health and Environmental Management System (CSMS) Guidelines

SECTION 4 : HAZARDS AND EFFECT MANAGEMENT 4.4. Personnel Protective Equipment

a) What arrangements does your company have for provision and unkeep of protective equipment and clothing, both standards issue, and that required for specialized activities?

b) Do you provide appropriate personal protective equipment (PPE) for your employees? (Yes/No) Please provide a listing of the PPE for the scope of this work. c) Do you provide training on how to use PPE? (Yes/No) Explain the content of the training and any follow-up d) Do you have a program to ensure that PPE is impacted and maintained? 4.5. Waste Management

a) What systems are place for identification, classification, minimization and management of waste? b) Please provide the number of accidents resulting in environmental damage in the amount greater than $50,000 for the last 24 months. Attach copies of any governmental reports submitted. c) Do you have procedures for waste disposal? (Yes/No) d) Do you have procedures for spill reporting? (Yes/No) e) Do you have procedures for spill clean up?(Yes/No) f) Please provide details at any of your equipment related to environmental matters.

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Contractor Safety, Health and Environmental Management System (CSMS) Guidelines

SECTION 4 : HAZARDS AND EFFECT MANAGEMENT 4.6. Industrial Hygiene

Do you have an industrial hygiene program? (Yes/No)

Please describe this process. If Yes, please provide the list. 4.7. Drugs and Alcohol

Do you have a drugs and alcohol policy in your organization? (Yes/No) If yes, please attach

SECTION 5: PLANNING AND PROCEDURES 5.1. HSE or Operations Manuals

a) Do you have HSE procedures? (Yes/No) If Yes, please attach the list of content

b) How do you ensure that the working practices and procedures used by your employees on-site are consistently in accordance with your HSE policy objectives and arrangements? 5.2. Equipment Control and Maintenance

How do you ensure that plant and equipment used within your work environment, on-site, or at other locations by your employees are correctly registered, certified with regulatory requirement, inspected, controlled and maintained in a safe working condition? 5.3. Transport Safety Management and Maintenance

What arrangement does your company have for vehicle incidents prevention? 5.4. Lifting Operation Procedure (if applicable)

Do you have any procedures to control the work involved in lifting operation? 5.5. Maintenance Schedule of Lifting Operation Equipments (if applicable)

Do you have any inspection, testing, maintenance and certification programs and schedule for lifting equipments e.g. crane, forklift and rigging equipment? 5.6. Competency of Lifting Operation Personnel (if applicable)

Do you have any system to ensure that the lifting teams e.g. lifting equipment operators, signalmen and rigging personnel are competent?

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Contractor Safety, Health and Environmental Management System (CSMS) Guidelines

SECTION 6: IMPLEMENTATION AND PERFORMANCE MONITORING 6.1. HSE Management and Performance Monitoring of Work Activities

a) What arrangement(s) does your company have for supervision and monitoring of HSE performance?

b) What arrangements does your company have for passing on any results and findings of this supervision and monitoring to your: (i) Top/Base management (ii) Site employees c) Has your company received any award for HSE performance achievement? (Yes/No) 6.2. Statutory Notifiable Incidents/Dangerous Occurrences, Improvement Requirement and Prohibition Notices

Has your company suffered any improvement requirement or prohibition notices on statutory notifiable incidents/dangerous occurrences by the relevant national body, regulatory body for HSE or other enforcing authority or been prosecuted under any HSE legislation in the last five years? (Yes/No) If yes, please give the number of occurrences and its short description. 6.3. HSE Performance Records

a) Please provide statistical details of your HSE performance over the past 3 years (if not recorded/applicable please mark N/R or N/A) Total Number Frequency (incl. All contract & sub contract personnel) (based on OSHA)   

Fatalities Loss Time Incidents (LTI) Total Recordable Cases (e.g. Medical Treatment, Restricted Work, Transfer to Another Job, Unconsciousness)

b) How is health performance recorded? c) How is environmental performance recorded?

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Contractor Safety, Health and Environmental Management System (CSMS) Guidelines

SECTION 6: IMPLEMENTATION AND PERFORMANCE MONITORING 6.4. Incident Investigation and Reporting

a) Do you have a procedure for the investigation, reporting and follow-up of accidents, dangerous occurrences or occupational illnesses? (Yes/No) If yes, please attach

b) How are the findings following an investigation, or a relevant incident occurring elsewhere, communicated to your employees? Please attach an example of investigation reports during the last 12 months.

SECTION 7: AUDIT AND REVIEW a) Do you have a written procedure on HSE auditing? (Yes/No) b) How does this procedure specify the standards for auditing, including schedule, coverage and the qualifications for auditors?

c) How is the effectiveness of audit verified and how does management report and follow up audits?

SECTION 8: EMERGENCY RESPONSE PROCEDURE Do you have an emergency response plan? (Yes/No) If yes, please attach

SECTION 9: HSE MANAGEMENT - ADDITIONAL FEATURES Does your company hold association(s) membership? (Yes/No) If yes, please provide the list

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Contractor Safety, Health and Environmental Management System (CSMS) Guidelines Form CSMS/PQ/02 Appendix II.3. Form CSMS/PQ/03

PRE-QUALIFICATION TABLE TOP EVALUATION (PRIOR SITE VISIT) Company

: ___________________________

Evaluator

: ___________________________

Date

: ___________________________

Item Number

Item Description

Verification

Positive Practices

Evaluated by: …………………………… Page 53 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT

Gaps

Score Before

After

Site Visit Remarks

Contractor Safety, Health and Environmental Management System (CSMS) Guidelines

Appendix II.4. Form CSMS/PQ/04:

PRE-QUALIFICATION EVALUATION CRITERIA A

B

C

D

Section 1: Leadership and Commitment Commitment to HSE through leadership: Item 1 (a - d). No commitment from senior management

HSE disciplines delegated to line managers – no direct involvement by senior management

Evidence of active senior management involvement in HSE aspects

Evidence of a positive HSE culture in senior management and at all levels

Section 2: Policy and Strategic Objectives HSE policy documents and availability: Items 2.1 and 2.2. Policy statements exist but responsibility for HSE is unclear.

A policy statement exists with clear responsibility for HSE but not in a widely distributed document

HSE policy establishes responsibility for HSE in languages easily understood, but not widely distributed

Policy with clearly established responsibility and accountability; is distributed to all employees; and is visible on notice boards

Section 3: Organization, Responsibilities, Resources, Standards and Documentation HSE communication and meeting programmes: Item 3.1 (a - b). No management involvement or commitment toward HSE activity

Management involvement and commitment toward HSE in special occasion only, likewise for periodic HSE meetings.

Regular management involvement and commitment toward HSE. HSE meetings performed on a regular basis at management and supervisor level

Regular management involvement and commitment toward HSE. Regular HSE meetings performed and employees are assigned topics to discuss on a rotational basis

HSE training established and implemented but only to a limited staff only.

HSE training established and fully implemented to all staff related to the work.

Staff HSE training: Item 3.2. No HSE training established

HSE training established but not implemented.

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Contractor Safety, Health and Environmental Management System (CSMS) Guidelines PRE-QUALIFICATION EVALUATION CRITERIA A

B

C

D

Section 3: Organization, Responsibilities, Resources, Standards and Documentation (cont‟d) Employee competency and HSE training: Item 3.3. (a - b). No formal programme

Formal program established to update employee knowledge on HSE.Verbal instructions on company procedures only for new employee. Orientation booklet provided for new employees but no onthe- job orientation by supervisor

Formal program established and implemented for employee and new employee on HSE. Update employee knowledge on HSE. Employee handbook provided and supervisor outlines, explains and demonstrates new employee's job

Formal program established and implemented for employee and new employee on HSE. Update employee knowledge on HSE. Employee handbook provided and supervisor outlines, explains and demonstrates new employee's job. With: follow-up observation of the new employee's work is also included. Supervisor has explained to him safe practices and emergency duties

Specialized HSE training established and implemented.

Specialized HSE training established and implemented on a regular basis. Retraining periods are established. Qualified HSE professional are employed.

Assessment program and standards for subcontractor are established and implemented.

Assessment program and standards for subcontractor are established and fully implemented. Quality assurance for compliance in place.

HSE performance standards established and in compliance with local industry regulatory standards.

HSE performance standards established and in compliance with local and global industry regulatory standards.

Specialized training: Items 3.4 and 3.5. No specialized HSE training established

Specialized HSE training established but not implemented.

Subcontractors: Item 3.6 (a - b). No assessment program for subcontractor established.

Assessment program and standards for subcontractor are established, covering limited area only but not implemented yet,

HSE Performance Standards: Items 3.7 (a - b). No HSE performance standards available

HSE performance standards established for limited purposes only or partial and in compliance with local industry regulatory standards only.

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Contractor Safety, Health and Environmental Management System (CSMS) Guidelines PRE-QUALIFICATION EVALUATION CRITERIA A

B

C

D

Company's HSE system includes methods for the assessment of major hazards and effects

Company's HSE system has a comprehensive set of methods for the assessment of all HSE hazards and effects and applies them to all of its contracts with documentation

Company has formal methods for monitoring exposure to the major hazards

Company has a set of formal methods for monitoring exposure to all foreseeable hazards (linked to its hazards and effects assessment method) and applies them to all contracts

Section 4: Hazards and Effects Management Hazards and Effects Assessment: Item 4.1. Company's HSE system does not include hazards and effects assessment

Company's HSE system makes reference to the need to assess hazards and effects but has no comprehensive structure to carry this out

Exposure of the workforce: Item 4.2. Company does not actively advise the workforce nor monitor exposure

Company advises the workforce of the major hazards that they are likely to be exposed to but only monitors exposure randomly

Potential Hazards (chemical, physical and biological hazards such as noise, radiation, vapors, fumes, temperature extremes etc.): Item 4.3. Company makes no special provision for advising the workforce about properties of potential hazards

Company provides information to workforce in the workplace on properties of potential hazards but has no active follow-up

Company distributes information to individuals in the workforce at start of their involvement on-site

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Company maintains a database of the properties of all potential hazards encountered in its contracts and has formal methods of information distribution to all personnel and trains its workforce in handling, etc.

Contractor Safety, Health and Environmental Management System (CSMS) Guidelines PRE-QUALIFICATION EVALUATION CRITERIA A

B

C

D

Section 4: Hazards and Effects Management (cont‟d) Personal protective equipment: Item 4.4 (a – d) Basic PPE provided to personnel but no corporate procedure for assessing individual needs

PPE requirements formally assessed but little effort made to ensure correct usage

PPE requirements formally assessed with spot checks on usage

Procedures in place to assess all PPE requirements monitor and enforce usage and replacement needs. Stock inventories monitored, kept above demand levels. Training in use provided where needed

Company has procedures for the disposal of each of the main categories of site wastes but makes no provision for minimizing environmental impact

Company has a formal system for waste management (including identification, minimization and classification), which actively seeks to minimize environmental impact

A procedure exists and recognizes hazards but is not followed up.

A procedure exists which manages operations to minimize human health impacts providing a workplace free of recognized health

An alcohol and drugs procedure includes establishing responsibility and accountability, and widely distributed

Drugs procedure with clearly established responsibility, accountability, and disciplinary clause is distributed to all employees; and is visible on notice boards

Waste management: Item 4.5 (a – f) Company has no formal methods for the control of waste

Company has general procedures for waste disposal

Industrial Hygiene Items 4.6 No Industrial Hygiene procedure exists.

Basic procedure exists but is not enforced.

Alcohol and Drugs Items 4 .7 No alcohol and drugs procedure written

An alcohol and drugs procedure statement exists but not in a widely distributed document

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Contractor Safety, Health and Environmental Management System (CSMS) Guidelines PRE-QUALIFICATION EVALUATION CRITERIA A

B

C

D

Contractor has written HSE procedures/manual to cover all hazardous operations

Contractor has procedures to cover all HSE precautions/manual, typical contractor HSE Plan requirements with a system of updating and dissemination to employees

A written programme outlining supervisory guidelines, responsibilities, frequency and follow-up is in effect

In addition to C, periodic inspections conducted by top management or by teams of specialists

Company has a general management strategy with some procedures for its component issues

Company has a complete strategy and set of plans and procedures covering vehicles, drivers and operations management

Section 5: Planning and Procedures HSE or operations manuals: Item 5.1 (a – b) No HSE procedures / manual is available

Basic HSE procedures/manual exist

Equipment control and maintenance: Item 5.2 No defined programme to ensure control and maintenance of plant and / or equipment

Program relies on outside sources, i.e. company inspections. Supervisory inspection of equipment confined to worksite personnel only

Transport Safety Management: Item 5.3 No special attention paid to transport safety as an area of hazardous activities

Importance of transport safety acknowledged but left to core business managers/supervisors to enact individually

Lifting Operation Procedure: Item 5.4, (if applicable) No manual/procedures/ guidelines/instructions for work control of lifting operations are available

Basic procedures for work control of lifting operations exist

Standard written procedures for lifting operations are available and implemented

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A comprehensive system for work controls, including lifting operations is available and continually maintained to comply with local regulations and related international industrial standards.

Contractor Safety, Health and Environmental Management System (CSMS) Guidelines PRE-QUALIFICATION EVALUATION CRITERIA A

B

C

D

Maintenance Schedule of Lifting Operation Equipments: Item 5.5, (if applicable) No inspection, testing, maintenance or certification programs for lifting equipment are available

Basic programs for inspection, testing, maintenance and certifications for lifting equipment exist

Standard programs for inspection, testing, maintenance and certifications for lifting equipment are available including color coding is implemented

A comprehensive system and organization is available to ensure that the program for inspection, testing, maintenance and certifications of lifting operation equipments is properly implemented in accordance with the local regulations and related industrial standards.

Competency of Lifting Operation Personnel: Item 5.6, (if applicable) The lifting team displays no evidence of clear assignments, training or competency assessments

Basic assignments, training, and competency assessments for the lifting team exist

Roles and responsibilities of involved parties in lifting operations are clear. Formal training and certifications for key persons and competency assessment are available and implemented

In addition to C, the formal training and certifications for al related persons comply with the local regulations;related industrial standards are maintained.

Section 6: Implementation and Performance Monitoring Management and performance monitoring of work activities: Items 6.1 (a – c) No system for formally monitoring HSE performance at all

Informal/incidental monitoring HSE performance only

Company has a system for monitoring HSE performance in key areas

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Company has a comprehensive system for monitoring performance in all areas with feedback to employers for improvement and has received awards for achievement

Contractor Safety, Health and Environmental Management System (CSMS) Guidelines PRE-QUALIFICATION EVALUATION CRITERIA A

B

C

D

Section 6: Implementation and Performance Monitoring (cont‟d) Statutory notifiable incidents, dangerous occurrences, improvement requirements and prohibition notices: Items 6.2 More than one occurrence of major incident in last five years

One occurrence of a major incident in the last five years

Occurrences relate to minor incident(s) only

No occurrences in the last five years

HSE Performance records (Latest year injury rate comparison to contractor‟s three preceding years average): Item 6.3 (a - c) Contractor supplied insufficient information to establish rate or rate increases

Rate is not improving

Shows only minor rate improvement

Rate steadily improving by more than 20 per cent per year

Incident Investigation and reporting: Item 6.4 (a - b) Procedure are available but Findings not generally communicated

Procedure are available and Findings communicated to key personnel only via limited company internal memo or similar media

Procedure are available and Findings communicated to all employees via specific company notice

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As in C but with the addition of details of implication for improving HSE performance

Contractor Safety, Health and Environmental Management System (CSMS) Guidelines PRE-QUALIFICATION EVALUATION CRITERIA A

B

C

D

Company HSE documents include details of how auditing is to be implemented with schedules/coverage for the key areas

As in C but additionally specifies management's role in audit and followup on action items

Emergency procedures written for major scenarios, e.g. fires/explosions, H2S, evacuation, release of toxic or flammable materials and medical emergencies. No requirements established for drill frequencies.

Emergency procedures written for major scenarios, e.g. fires/explosions, H2S, evacuation, release of toxic or flammable materials and medical emergencies. Procedures documented in an Emergency Procedures Manual, which is widely distributed. Frequency of conducting drills established.

Company is a member of at least one HSE association

Company is an active participant in at least one HSE association

Section 7: Auditing and Review Auditing: Item 7 (a - c) Audit process is cursory only - HSE documents are not explicit about auditing

Company HSE documents include reference to auditing but there are no specific details about scheduling and coverage Section 8: Emergency Response Procedure Emergency Response Procedure : Item 8 No written Emergency Basic procedures only. Response.

Section 9: HSE Management - Additional Features Membership of Associations: Item 9 No memberships Company has Membership of at least one association but with no prominence given to HSE

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Contractor Safety, Health and Environmental Management System (CSMS) Guidelines

Appendix II.5. Form CSMS/PQ/05:

PRE-QUALIFICATION SCORING SHEET Contractor Address Date Contractor Safety Contract Phone

: ______________________________________________ : ______________________________________________ : ______________________________________________ : ______________________________________________________

: ______________________________________________

Circle the number, which best represents this evaluation based on the criteria for rating purposes attached.

SECTION 1 – LEADERSHIP AND COMMITMENT

A

B

C

D

0

4

8

12

SUBTOTAL SECTION 2 – POLICY AND STRATEGIC OBJECTIVES SECTION2 – ITEM 2 .1 SECTION2 – ITEM 2 .2

Subtotal

Factor

X1 0

4

8

12

0

4

8

12

Subtotal SECTION 3 – ORGANIZATION, RESPONSIBILITY, RESOURCES, STANDARDS AND DOCUMENTATION

X1/2

SECTION 3 – ITEM 3 .1 (A – B)

0

4

8

12

SECTION 3 – ITEM 3 .2

0

4

8

12

SECTION 3 – ITEM 3 .3 (A - B)

0

4

8

12

SECTION 3 – ITEM 3 .4

0

4

8

12

SECTION 3 – ITEM 3.5

0

4

8

12

SECTION 3 – ITEM 3 .6 (A – B)

0

4

8

12

SECTION 3 – ITEM 3 .7 (A – B)

0

4

8

12

Subtotal SECTION 4 – HAZARDS AND EFFECT MANAGEMENT

X1/7

SECTION 4 – ITEM 4 .1

0

4

8

12

SECTION 4 – ITEM 4 .2

0

4

8

12

SECTION 4 – ITEM 4 .3

0

4

8

12

SECTION 4 – ITEM 4 .4 (A – D)

0

4

8

12

SECTION 4 – ITEM 4 .5 (A – F)

0

4

8

12

SECTION 4 – ITEM 4 .6

0

4

8

12

SECTION 4 – ITEM 4 .7

0

4

8

12

SUBTOTAL TOTAL (SECT 1-SECT 4)

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X1/7

Total

Contractor Safety, Health and Environmental Management System (CSMS) Guidelines

SUBTOTAL (SECT 1 – SECT 4) A

B

C

D

SECTION 5 – ITEM 5 .1) (A - B)

0

4

8

12

SECTION 5 – ITEM 5 .2

0

4

8

12

SECTION 5 – ITEM 5 .3

0

4

8

12

SECTION 5 – ITEM 5 .4, (IF APPLICABLE)

0

4

8

12

SECTION 5 – ITEM 5 .5, (IF APPLICABLE)

0

4

8

12

SECTION 5 – ITEM 5 .6, (IF APPLICABLE)

0

4

8

12

Subtotal

Factor

SECTION 5 – PLANNING AND PROCEDURE

SUBTOTAL IF LIFTING OPERATION IS NOT APPLICABLE

X1/3

SUBTOTAL IF LIFTING OPERATION IS APPLICABLE

X1/6

SECTION 6 – IMPLEMENTATION AND PERFORMANCE MONITORING SECTION 6 – ITEM 6 .1 (A – C)

0

4

8

12

SECTION 6 – ITEM 6 .2

0

4

8

12

SECTION 6 – ITEM 6 3 (A – C)

0

4

8

12

SECTION 6 – ITEM 6 .4 (A – B)

0

4

8

12

SUBTOTAL SECTION 7 – AUDIT AND REVIEW

X1/4 0

3

7

10

SUBTOTAL SECTION 8 – EMERGENCY RESPONSE PROCEDURE

X1 0

3

7

10

SUBTOTAL SECTION 9 – HSE MANAGEMENT – ADDITIONAL FEATURES

X1 0

SUBTOTAL TOTAL RATING (SECT 1 – SECT 9)

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2

5

8 X1

Total

Contractor Safety, Health and Environmental Management System (CSMS) Guidelines

SUMMARY The numerical values below are the weighted ratings calculated above. The total represents the overall score for the Contractor. TOTAL RATING

_____________*)

EVALUATED BY:

NAME TITLE DATE

NAME TITLE DATE

*) FOR A BIDDER TO QUALIFY AS ACCEPTABLE, THE TOTAL RATING MUST BE EQUAL OR MORE THAN 64.0 IF INSUFFICIENT NUMBERS OF BIDDERs ARE QUALIFIED, SELECTION SHALL BE MADE FROM THE FIVE BIDDERS HAVING THE HIGHEST TOTAL RATING, PROVIDED THAT THE PRIMARY FACTORS THEREOF MUST BE THE HIGHEST RELATIVE TO THE OTHER BIDDERS‟ PRIMARY FACTORS.

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines Appendix III. Selection Forms

Selection New Contracts Qualification Phase: Select A Qualified Contractor

Pre-Qualification Selection

Risk Assessment

Contract Award

Data Bank

Contract Implementation Phase: Ensure Field Safe Work

Pre-Job Activity

Work In Progress

CSMS

Final Evaluation

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

Appendix III.1. Form CSMS/SL/01

SELECTION

Date

:

Project Period

:

Job Title

:

Contract No Work Location

: :

Contractor Name : Address

:

Assessed by:

Approved by:

(Contract Originator)

(Team Leader)

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines Appendix III.2. Form CSMS/SL/02: EXAMPLE OF EXHIBIT H HEALTH, SAFETY, AND ENVIRONMENT (Attached and part of Contract No.______________) 1.

COMPANY‟S COMMITMENT TO HSE PERFORMANCE COMPANY's policy is to manage all operations in a manner that protects the environment and the health and safety of employees, customers, contractors, and the public. Our goal is simply stated – no incident. To accomplish this, CONTRACTOR shall take all necessary precautions for the safety and health of all personnel and environmental protection at the Worksite. All activities must comply with COMPANY‟s applicable HSE Policies and Standards as listed in Attachment No.1 to Exhibit H and all applicable Government laws, rules and regulations while working at any COMPANY's premises. CONTRACTOR shall ensure that its subcontractors also comply with the abovementioned HSE requirements.

2.

CONTRACTOR‟S HEALTH, SAFETY AND ENVIRONMENTAL (HSE) PLAN CONTRACTOR shall establish and implement a HSE Plan designed to minimize the risk of injury or illness to CONTRACTOR's Personnel from any physical, chemical, biological, ergonomics, psychosocial and other hazards present at any COMPANY‟s premises, and to minimize the potential of loss of or damage to the environment and any property. HSE Plan shall be submitted within 14 days after Contract‟s Effective Date or refer to Performance Schedule Exhibit. CONTRACTOR's HSE Plan shall, where applicable, be based on COMPANY's HSE policies, rules and procedures and include, at a minimum: 2.1.

Leadership and commitment This describes a commitment to HSE issues through senior management personal style of leadership and employees at all levels in the organization.

2.2.

Policy and strategic objectives This describes a confirmation of the existence of a formalized policy that has reference to importance of HSE.

2.3.

Organization, responsibilities, resources, standards and documentation

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines This describes an organizational system explaining the set of practices in addressing HSE issues. 2.4.

Hazard and Effect management This describes an established scheme to clearly address hazard and effect management.

2.5.

Planning and procedures This describes an existence of, documented, review and updated plan and procedures that covers HSE issues within business.

2.6.

Implementation and performance monitoring This describes a procedure established for HSE system implementation and performance measure.

2.7.

Auditing and review This describes an existence of methodology for audit of HSE contract operations.

Detailed CONTRACTOR‟s HSE Plan shall refer to:  PHE ONWJ HSSE Plan Minimum Requirements Guideline Note for User: User should ensure the above attachments are provided to CONTRACTOR as part of Exhibit H. Those attachments can be obtained from HSE Department. 3.

CONTRACTOR SAFETY, HEALTH AND ENVIRONMENTAL MANAGEMENT SYSTEM (CSMS) REQUIREMENT In line with the Contractor Safety, Health and Environmental Management System (CSMS) Guidelines, CONTRACTOR shall understand, comply with and implement all procedures during period of the Contract. This CSMS Guidelines is a control mechanism and summarized in checklist format as attached in this exhibit. CONTRACTOR must complete all checklists in parallel with the relevant stages in the Work. As of effective date of this Contract and during the Contract Implementation in the Field, CONTRACTOR shall constitute the following steps: 3.1.

Pre-Job Activity Prior to mobilization personnel and/or equipment, CONTRACTOR‟s and COMPANY‟s Representatives and other related parties shall conduct a meeting to communicate work implementation including but not limited to review the COMPANY‟s and Contractor HSEMS, HSE Plan, risk assessment, interface plan, KPI‟s, emergency procedure, accident & incident reporting, people‟s competencies, readiness of equipment and tools, pre-job inspection and audit requirement and review the Conditional Acceptance, if any, that was obtained during the Pre-Qualification and/or Selection Process. The similar meeting shall also be conducted upon CONTRACTOR‟s arrival at the worksite. CONTRACTOR‟s and COMPANY‟s Representatives must complete the Pre Job Activity Checklist.

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines 3.2.

Work In Progress CONTRACTOR‟s and COMPANY‟s Representatives shall conduct Interim Evaluation on a regular basis to closely monitor and evaluate the Work In Progress. The schedule of this Interim Evaluation shall be determined and agreed upon by CONTRACTOR‟s and COMPANY‟s Representatives considering the Work time period and the risks associated with the Work. COMPANY has the right to inspect and review progress of the Work at any time. During the interim evaluation CONTRACTOR‟s and COMPANY‟s Representative must complete the checklist which consists of HSE Inspection, HSE Program and Interim Evaluation Checklists.

3.3.

Final Evaluation At the end of the Work, a Final Evaluation Checklist as the attachment in the Exhibit H: Health, Safety and Environment, shall be filled out. The Final Evaluation shall be based on HSE contractual obligations, Pre Job Activities Reports, Interim Evaluation Reports, corrective action during interim evaluations and final KPI‟s figures. This Checklist shall be communicated and agreed on. The Final Evaluation Reports will be used for future Pre Qualification and Selection Process. COMPANY shall have the right to suspend or terminate the Contract if in COMPANY‟s opinion CONTRACTOR do not comply with the above steps including, but not limited to, follow-up to Conditional Acceptance and/or complete the specific requirements which was obtained during Pre-Qualification and/or Selection Process, do not follow-up corrective actions required during interim evaluation. In the event of suspension of the Contract, penalty as set forth in Exhibit D, “Performance Schedule”, will be applied and will be continued until CONTRACTOR fulfill all requirements needed. CONTRACTOR may develop an additional checklist to fit a specific requirement if such requirement is not included in the guidelines and this additional checklist is subject to COMPANY‟s approval.

4.

HSE SPECIFICATION REQUIREMENT CONTRACTOR shall refer to Exhibit B: Scope of Work for detail HSE Specification Requirement such as Personal Protective Equipment (PPE), Medical Check-Up Standard, CONTRACTOR‟s OnSite Safety Officer, etc. in accordance to, including but not limited to PPE Specification List. Note for User: User should consult to HSE Department in developing this HSE Specification requirement.

5.

HSE PERFORMANCE INDICATOR HSE Performance indicator shall refer to Exhibit of Contractor Performance Management. The HSE performance indicator should include provision for COMPANY to suspend the work if the CONTRACTOR does not observe the HSE criteria spelled out in the contract HSE Plan, and in particular at mobilization, to withhold permission to start execution and hold payments until a satisfactory pre-job audit has been achieved.

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

Appendix III.3. Form CSMS/SL/03: HSE Plan Guideline for Major and Small Work

HSE Plan Guideline for Small Contracts HSE Plan Definition Guideline When the contracted activities are covered by a contractor HSE Management System (e.g. in line with the E&P Forum or other guidelines on HSE Management System), including HSE Cases for contracted installations, the HSE Plan should only address those issues that are unique for the contract under consideration. It shall focus on contract specific risks and the management of controls to eliminate reduces or mitigates these risks. Other contract-specific issues that may be addressed in the Plan are:  organisation and personnel for the project  project specific procedures  project audit and review Plan  compliance with local rules and legislation  etc.

Table 1. Checklist for HSE Plan Checklist items Leadership and commitment

Senior management should reinforce the importance of HSE at all levels in the organisation and should be seen to be setting a personal example.

Policy and Strategic Objectives

Contractor has a policy that makes reference to the importance of HSE. It is formalised by the Chief Executive‟s or the Manager‟s signature.

Organisation, Responsibilities, Resources, Standards and Documentation

A focal point in the organisation for HSE. Simple procedure for distributing information on HSE issues to the workforce. A procedure for determining/enacting HSE training. Provision for obtaining HSE advice should this be outside the capability of the contractor‟s personnel. A procedure for ensuring any subcontractor adheres to same HSE standards. Simple advice on the importance of the links with client (or third party) emergency services on contracts. Typical agenda for any HSE items in meetings and how to ensure they are covered effectively. A statement of how HSE competence is assessed for personnel with HSE-critical activities to perform. Statement of requirements for employees to indicate that they have the necessary appreciation of the HSE issues in the contractor‟s business activities. This should include reference to potential client HSE introduction sessions and HSE training. Such training could include items from the following list (as relevant to the contract):  Hazards identification  Road safety  First-aid  Permit to work  Risk assessment  Security  Basic HSE rules  Occupational health  Environmental protection

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Checked

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines Table 1 Checklist for HSE Plan (cont.) Checklist items Hazards and Effects Management

 HSE targets set in clear quantifiable terms.  A system in place to assess workplace hazards.

Planning and Procedures

Contractor has a document with procedures/rules covering the HSE issues in his business activities with a method for review and update.  Basic HSE precautions to be observed in the workplace  HSE hazards of equipment used, tasks and operations encountered in his business  PTW system  Communications with supervisory personnel on site  outlines the activities of his business  identifies those areas that are HSE-critical  finds a method how individual contract scopes can be simply appraised to determine where the attention to HSE issues need to be focused  identifies how to determine PPE requirements  identifies a simple set of steps for road transport management

Implementatio n and Performance Monitoring

 Contractor has a procedure for recording incident, for advising legislative bodies where necessary and for making annual reviews of performance.

Auditing and Review

Contractor has a method for the management to carry out audits of his contract operations.

 Contractor has a procedure for investigating incidents.

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Checked

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines Small Contract Typical HSE Plan Performance This provides guidance for a set of headings for a typical HSE Plan for use on small contracts. The list of headings should be determined individually for the contract concerned.

Table. 2 Small contract typical HSE Plan Performance Item General Company Project Contract Title/Number Contractor details Site location Company Contract Holder/Representative(s) Company Representative(s) Contract Manager/contractor Representative(s) Hazard assessment Contract scope description Expected hazards identified (including adjacent operations, etc.) Procedures to be followed for hazard control (list documents or describe details here) Access/escape provisions (alarms, muster stations, etc.) Emergency service provisions (including first-aid, nearest medical treatment, emergency phone numbers, etc.) Competence standards for contractor‟s personnel Standards for contractor‟s equipment Training requirements (including site HSE induction) Job/services description Contractor‟s personnel assigned Contractor‟s equipment/consumables/services assigned Company‟s personnel assigned Company‟s equipment/consumables/services assigned Subcontractor‟s details Responsibilities/interfaces defined PPE and any special HSE equipment to be used Working hours/job duration Site description/limits PTW provisions applicable Conditions for suspending work (e.g. weather, adjacent site operations, etc.)

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Details

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines HSE Plan Guideline for Major Contract HSE Plan Definition Guideline

When the contracted activities are covered by a contractor HSE Management System (e.g. in line with the E&P Forum or other similar guidelines on HSE Management System), including HSE Cases for contracted installations, the HSE Plan should only address those issues that are unique for the contract under consideration. It should focus on contract specific risks and the management of controls to eliminate, reduce or mitigate these risks. Other contract specific issues that may be addressed in the Plan are:  organisation and personnel for the project  project specific procedures  project audit and review Plan  compliance with local rules and legislation The checklist in Section 1 to 7 can be used to check the HSE plans for the project specific issues, but can also be used to assess the HSE Management System if this has not been certified or assessed in any other manner. When the contractor does not have an HSE Management System, the HSE Plan should be developed in line with the principles of the E&P Forum guidelines for HSE Management System or other comparable guidelines. The HSE Plan should follow principal headings with an expansion into key checklist items given on the following pages under respective headings. The detail included in the tender should be in keeping with the complexity of the contract and should additionally include prompts for specific action plans, target dates and action parties.

HSE Management System Section 1 Leadership and commitment  Leadership and Commitment Section 2 Policy and strategic objectives  HSE Policy Statement Section 3 Organisation, responsibilities, resources, standards and documentation  HSE Organisation  HSE Professionals resources.  Subcontractors  HSE Communications  HSE meeting programme  HSE promotion and awareness  HSE competence requirements  Employee orientation programme  HSE training  HSE legislation  HSE standard Section 4 Evaluation and risk management  Methods and procedures for hazards and effects management  Assessment of exposure of the workforce to hazards, effects and PPE requirements  Material and data sheets for safe handling of chemicals  Methods and procedures for waste management Section 5 Planning and procedures  HSE procedures  Emergency response procedures  HSE equipment and inspection  Occupational health  Environmental  Road safety Section 6 Implementation and performance monitoring  HSE performance – general  Incident reporting and investigation Section 7 Auditing and review  HSE auditing Page 72 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

Section 1 Leadership and Commitment Checklist items Leadership and Commitment Commitment to Senior management should engender commitment to HSE issues at all levels HSE aspects through their personal style of leadership and management. Key elements through include: leadership  Visible expressions of commitment by senior people  HSE matters should be placed high on personal and collective.  All senior managers should set a personal example to others.

Checked

They should be, and seen to be actively involved in HSE matters, e.g. attendance at HSE meetings, investigation of HSE, audits and reviews, etc.  A feedback system should be established to encourage and facilitate employee feedback on HSE matters  A positive culture should be promoted at all levels  Procedures and standards should be endorsed and implemented at the local level.

Section 2 Policy and Strategic Objectives Checklist items HSE Policy Statement General

Content



Written HSE policy



Dated and signed by Chief Executive



Policy statements:  specific to individual parts of the contract (e.g. locations/sites/plants)  consistent with company guidelines  clear, concise and motivating

 Importance of HSE as a contract objective.  Incidents and injuries are unacceptable.  HSE established as a line management responsibility.  Everyone is responsible for their own and their colleagues‟ HSE at work.

Distribution/ availability

HSE policy distributed to all concerned, i.e.  handed to each employee by their line manager when issued  all new employees handed a copy by their line manager  displayed on notice boards at each company on the contract (including subcontractors, suppliers and agents)  available to company and contractor employees in their working languages)

Familirization

Policy and its implementation when issued discussed by line managers with each employee.

Section 3 Organisation, Responsibilities, Resources, Standards and Documentation HSE Organisation Key personnel

 Personnel responsible for the implementation of HSE objectives clearly identified in an organisation chart.  Responsibility adequately covered during all phases of the contract.  Job descriptions in place showing each team member‟s HSE competencies, responsibilities and function.  Organisation clearly shows position of HSE professionals

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Checked

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

HSE Organisation (cont‟d) Contract objectives/ accountability

 Defined to meet health, safety and environmental objectives as well as those of time, cost and quality.  Accountability for HSE success and equally of any failure clearly stated.  Focal point within the team structure ensuring that all HSE matters have been identified.  Designated team leader to produce HSE objectives, tasks and targets for the contract.  Targets, etc. to be realistic and consistent .  Establish procedures for distribution, reporting and reviewing HSE issues.

Manning/ communication s

 Manpower level to be defined correctly so as not to compromise HSE .  Effective means to communicate HSE issues to the company, contractor and subcontractors.  Organisation staffed by competent personnel with sufficient appreciation of HSE where necessary with specific training in the issues involved.  Establish procedures for distribution, reporting and reviewing HSE issues involved.

Corporate structure/ responsibility

 Company‟s expectations on HSE management to be communicated in depth.  Access of contractor‟s line management to their corporate management structure on HSE issues to be defined.  Level of handling project HSE issues by the contractor corporate structure (middle or senior management or board level).  In the contractor‟s corporate organisation, individuals charged with responsibility for HSE at middle senior manager or board member level  Access to specialist HSE advice for line management e.g.  Provision and employement of HSE documentation for small contracts.  Employment of HSE specialist for large contracts.

HSE Professionals Job definition Reporting/ follow-up



Role of the contractor‟s HSE advisers well defined



Job definition drafted.

 Reporting relationship with line management.  Direct access to the Chief Executive.  Does line management follow-up on advice offered.

HSE department

Contractor‟s HSE department involved in:  preparing and monitoring departmental action plans  formulation and suitability of HSE rules  planned inspections and audits together with line management  promotional material  HSE training  subcontractor assessment  training and auditing  health risk assessment, health performance monitoring and health surveillance  environmental monitoring  supporting incident investigation by line management Guidance given by the contractor‟s HSE management in preparing and implementing:  operating and emergency plans manuals

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines  Training for fire fighting teams, first-aiders etc.  emergency drills and exercises  protective equipment and rescue maintained contact and liaison with government departments

Subcontractor Management

Identification

Coverage/ awareness

   

To be well integrated and identified in contract HSE Plans. Have own plans if carrying out a large portion of the work. HSE Plans to be vetted for suitability by main contractor. Main contractor to communicate that subcontractor subject to the same rigorous HSE standards as main contractor.  Subcontractors to be identified at this stage of the project.  Maintenance of approved subcontractor lists where HSE has been considered.  Set up appropriate lines of communication to handle HSE issues, e.g. such items as:  direct access to emergency services  nearest hospital  helicopter availability  air ambulance, etc.  Authorisation and implementation procedures fully understood  Emergency services: those organisations that would be expected to provide support in a major incident aware of requirements briefed as to their likely role.

Emergency communication



Appropriate for incidents envisaged.



Strengthened, duplicated or backed up by other means.

HSE Meeting Programme Scheduling



Contractor to establish a regular schedule for HSE meetings.



Define responsible management person for scheduling such meetings.



Procedure to maintain records of personnel attendance of personnel attendance.

Management participation

Managers seen to be involved by employees in:  HSE activities, objective setting and monitoring  taking action and providing resources to support their stated policies and objectives

Follow-up actions

 Where action is agreed, is it seen to be carried out?

Communication



Results of HSE activities, both successful and less successful, openly communicated to all employees.



Meeting programme consistent with the rest of the management structure to communicate effectively HSE issues.



Meetings recorded clearly and consistently.



Structured to include health, safety and environment items.

 Where action is not agreed, is it explained why?

HSE Promotion and Awareness Techniques

 

Appropriate communications techniques used to make the personnel aware of HSE issues. How this is to be implemented, e.g.  personal contact  interactive video  notice-boards  newsletters (suitable for large sites)

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines  

bulletins posters, etc.

Performance

HSE performance boards (e.g. at worksite gates).

Promotional methods

Possibilities include:

Part of business

HSE activities seen as an intrinsic part or running an efficient business rather than a costly and time-consuming „extra‟.

 small „give-aways‟ with the HSE message  competitions  suggestion schemes

HSE Competence Requirements Fitness for work

Confirmation of medical fitness from a recognised and approved medical facility of all proposed employees for contract.

HSE Orientation Programme Approach

New employees Accountability

 On-the-job orientation for supervisory staff.  Established procedure in relation to follow-up of all new employees at the worksite.  Adequately trained and confident of their own abilities.  Coached to improve their work practices rather than blamed for mistakes.  Employees know they are accountable for HSE performance.  Aware that their HSE performances part of the contractor‟s appraisal and reward system.  Know that flagrant or frequent breaks of published HSE rules will result in disciplinary action.

Procedures

Required for new employee orientation consistent with existing company guidelines.

Re-appraisal

Programme subject to appraisal and review.

HSE Training Contract standards

Statement on the current standard of workforce and training requirements to meet contract standard.

Established training programme

Including:  HSE management  Job procedures  Road safety  Health (first-aid health hazards, medical services, alcohol and drugs, health promotion, use of PPE)  Auditing  Incident investigation and reporting  Supervisory development  Environmental protection

Supervisory training

Supervisory development training promotes man-management skills and communication skills.

Formalised programme

   

Course content

Specialised

Records kept of employees who have been through the programme. Employees trained before starting work. Training covers those joining as a contract is being implemented. Effective system for establishing the need for and the content of training courses.  Determining course effectiveness and relevance of training assessed.  Relevant training given to personnel prior to the execution or hazardous

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines training  

operations. Training gained through course attendance supplemented by on-the-job training as necessary. Records kept of attendees of the training courses and qualifications gained by employees.

Emergency training

Training covers the actions to be implemented and the employees‟ responsibilities in an emergency.

HSE content in other courses

HSE included in:  induction courses  craft training  supervisory training  line management training  auditing techniques

HSE Legislation Coverage

 HSE Plan to include:  a comprehensive list of applicable legislation  government, national and international codes  company regulations, codes and standards  contractor‟s identification of regulations, codes and standards  Definition of the legislation, codes, standards, etc. reflecting the company‟s previous experience.  For contracts carried out i separate countries:  different legislation requirements  company assistance for foreign contractors

HSE Standards Availability

Control/ authorisation

Coverage

 Contractor in possession of HSE manual/set of standards.  Identifying minimum criteria for achievement during contract implementation.  Available in writing to all users in consistent, concise and clear form.  Users involved in the development.  Standards in line with company requirements.  Controlled documents  Updated regularly  Approval level indicated  Procedure for obtaining deviations from standards  Responsibility for authorization  Standards in line with company requirements  Clear reference to national and international standards.  Setting minimum requirements on health, safety and environmental issues.

Section 4 Evaluation and Risk Management Checklist items Methods and Procedures for Hazards and Effects Management Coverage  Company assessment used as a starting point with additional hazards identified by the contractor.  Contractor‟s assessment carried out in accordance with his formal methods and procedures.  Analysis techniques used in preliminary form where appropriate.  Contract covers all parts of the contract with assessments for the specific scope and location of the contract. Experience and Contractor able to use material from previous similar projects and awareness demonstrate awareness from past experience. Coverage Contractor develops assessment of the scope and degree of exposure of Page 77 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT

Checked

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines workforce to hazards from the hazards and effects management process. Handling of Chemicals Coverage

Contractor demonstrates availability and distribution of guidance/information on the safe handling of chemicals, likely to be encountered in the contract, and proposals for confirming adherence to guidance during contract.

Hazards and Effects Management and The Assessment of PPE Requirements Hazard assessment/PPE requirements

PPE instruction/ training

 All processes identified that PPE requirement.  Procedure in place for recording, follow-up inspection and replacement/re-certification of PPE and ensuring adequacy of stock.  Schedule and criteria for renewing PPE.  Responsibility for payment.  Requirements identified for all personnel.  Instruction and training in its use provided where needed .  Procedure for checking its use specified. 

Section 5 Planning and Procedures Checklist items HSE Procedures Availability/ control

      

Deviations

Omissions

   

Permit to work (PTW).

  

Training/ qualification

Training standards and qualifications set for personnel allowed to implement procedures.

Written procedures available to cover hazardous operations on HSE. Include HSE precautions to be taken. Consistent with company guidelines. Controlled documents. Appropriate level. Coverage: include health and environment. Written procedures:  familiar to all employees including subcontractors  available in their working language  contents related to individual job descriptions Procedure for obtaining. Responsibility and level. Recording of authorised deviations. Identify whether there are any areas where procedures for hazardous operations are not drafted. Commitment to prepare. System in place. If the contractor‟s own system is utilised, is it consistent with industry norms and in line with company guidelines?

Emergency Response Procedures Coverage



Identification of potential major emergency scenarios, and procedures to use in such scenarios, e.g.         

fire abandon rig/location storm oil/chemical, spill aircraft incident emergency communications Medevac blow-out diving emergency

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines         Awareness

Potential use of company guidelines

By employees of procedures       

Plans

search and rescue (SAR) explosions H2S well control man overboard evacuation terrorism

Orientation Schedule of drills and testing Medical contingency Plan included Review frequency Responsibility of employees for own and colleagues‟ HSE Monitoring mechanism Drills to be carried out without warning

 Contingency plans allowed for in emergency situations.  Recovery procedures in place to be activated in event of emergency scenarios.  Drills to be held to demonstrate preparedness for response.

HSE Equipment and Inspection HSE equipment



List drawn up of all HSE equipment to be used on the project.



Identified by type, capacity and reference to standards.



Requirements identified for each item of HSE equipment, including:     

Critical items for HSE inspection

Schedule

registry classification licensing survey test certification

 List drawn up of critical items of equipment that must be the subject of an HSE inspection.  Procedure established for carrying out HSE inspection of equipment (covering health, safety and environmental aspects to be reviewed).  Procedure established for checking standards where tools have been provided personally by tradesmen.  HSE equipment inspection schedule established for the duration of the project.  Inspection frequency clearly identified for critical items of plant.

Occupational Health Facilities available

 Facilities defined as part of contract  identify health hazards  assess health hazards  Control hazards, e.g. engineering controls, procedural controls, PPE, vaccinations, etc.  maintain emergency procedures  Appropriate for the site conditions.  Welfare programme meets the needs of isolated sites.  Local medical facilities evaluated in detail to assess:  range and quality of equipment and supplies  hygiene standards  administration procedures and standards  transportation and communication

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

Staffing

 Sufficient for day-to-day needs and consistent with relevant health programmes.  Adequate provision for supply of drugs, antidotes, etc.  Availability of adequately trained, experienced staff.  Access to medical treatment facilities (if external).

Contingency, plans

Defined for possible incidents beyond capability of site facilities.

Accommodatio n and catering facilities

 Where provided, facilities to meet normally accepted standards of hygiene at site location.  Facilities to be operated in line with government hygiene regulations and to meet company guidelines.  Rules in force to maintain cleanliness of site and other facilities.  Promotional material available to assist in maintaining standards.  Appropriate for the contractor‟s workforce in terms of:  Language.  clarity, etc.

Promotion

Hygiene and housekeeping

Procedures on on-site cleanliness and maintenance.

Environmental Awareness

Workforce aware of requirement to protect the environment whilst executing contract

Control

 

Aims

    

Monitoring/ restoration Audits

    

Identify potential environmental hazards. Develop procedures for handling materials and performing operations that may damage the environment. Contingency plans. Focus for the environmental protection team. At what level Line management responsibility for environmental protection defined as well as other job objectives. Development and enhancement of environmental impact statements for the contract. Environmental monitoring to gauge the impact of operations. Plans appropriate and sufficiently detailed. Recovery and restoration of site after contract completion. Environmental audits of operations during the contract. Carried out by experienced individuals or companies.

Road Safety Drivers: Competence and selection

 Assess physical, mental and psychological capability  Character and background  Qualities and experience, medical examination, document checks, driving tests  Special skills such as terrain and climatic experience and first-aid knowledge

Driving Permits

 Should record personal and employment details, types of vehicle licensed to drive and types of cargo licensed to carry.

Driver induction

 Local area characteristics and regulations

Driver training

 This should test vehicle operation and use, operating conditions (terrain, climate), off-loading and positioning, emergency situations, and vehicle inspection.

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

Driver Improvement

 Techniques should identify deficiencies; analyses cause and select appropriate retraining.

Selection

 Ensure correct type, capacity and size for facilities  Good manoeuvrabiliy and serviceability

Vehicle specification

 The job description should be clearly defined before the vehicle is chosen, to ensure work operations do not exceed the manufacturer‟s specifications

Passenger

 Is the vehicle designed to carry passengers?  Design of vehicle and load limits

Freight Vehicle maintenance

 Segregation, positioning and securing of freight Conducted on a regular basis

Procedures

 Ensure procedures are in place for all transport operations.  Monitor and review mechanisms in place.

Emergency service

In place and tested

Section 6 Implementation and Performance Monitoring Checklist items HSE Performance – General Measurement

Proposed plan to measure performance, i.e.       

performance indicators progress against targets, HSE initiatives/incentive schemes, achievement of milestones, numbers and types of training courses numbers and results of audits clearance of action items

Use will be made of reactive statistical indicators, e.g.  Lost Time Injury Frequency/Total Recordable Incident Rate  Numbers of first-aid and minor injuries.  material losses  vehicle incidents  spillages  occupational illnesses  sickness absenteeism Feedback/ analysis Comparison of performance

 Availability and use of performance records.  Feedback/review/discussion at HSE meetings.  Presentation and distribution to employees. Comparison of performance:  With other similar contrack work  Frequency specified  Involvement of company personnel

Incident Investigation Coverage

 Reporting procedure for the contract  Covering not only injuries to and time lost by personnel but also:  Health incidents (diseases, exposures to hazardous substances, near

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

Methods

misses, etc.)  environmental incidents (spilages, releases, contamination, etc.)  other safety incidents (safety equipment failures, loss of capital equipment)  material loss  Incident investigation method established to determine and correct causes.  Incidents first reported to the direct supervisor.  Methods to be used for collecting incident statistics.

Section 7 Audit and Review Checklist items HSE Auditing Availability

Established HSE procedure outlining responsibilities, frequency, methods and follow-up.

Scope

Compliance with the HSE Plan including:        

Coverage

Effectiveness

Follow-up

HSE Manajement technical personnel HSE subcontractor occupational health unsafe acts audit training environmental own activities and those of his subcontractors

 Schedule for full contract duration.  Involvement of personnel in audit teams from outside the location.  Carried out by a wide cross-section of the workforce including company and subcontractor personnel.  Involvement of the contractor‟s corporate management in review of findings.  Intention to publish findings.  Discussion with personnel on contract and HSE meetings,  Lessons used to improve operations across the contract.  Any numerical treatment made of findings.  Frequency of review of implementation progress.  Rejections of audit findings properly authorised and documented.

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

Appendix III.4. Form CSMS/SL/04: Site Verification Result

Date: Inspector: Contract No: Contract Title: VERIFICATION RESULT Evaluated Items

Min. Req. as in the selection criteria

Verification Result

SUMMARY & RECOMMENDATION

Verified by:

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Remarks

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

Appendix IV. Pre-Job Activity Form

Pre-Job Activity

New Contracts

Qualification Phase: Select A Qualified Contractor

Pre-Qualification Selection

Risk Assessment

Contract Award

Data Bank

Contract Implementation Phase: Ensure Field Safe Work

Pre-Job Activity

Work In Progress

CSMS

Final Evaluation

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

Appendix IV.1. Form CSMS/PJA/01

COMPANY ACCEPTANCE PRE-JOB ACTIVITY

Date

:

Project Period : Job Title

:

Contract No

:

Work Location

:

Contractor Name

:

Address

:

Recommendation

:

GO/NO GO *to Mobilization Phase.

Contractor Reps: _________________ PHE ONWJ Reps: ___________________ (Name/Date) (Name/Date) *): Select based on assessment Page 84 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines Appendix IV.2. Form CSMS/PJA/02

PRE-JOB ACTIVITY CHECKLIST No

ITEM

YES

NO

PREMOBILIZATION I. Work Plan 1.1

Has the HSE KPI been set up and agreed by PHE ONWJ and Contractors (such as safety observation, management visit, audit, reward and diciplinary action)

1.2

Has the contractor's equipment, related to the job to be performed and pass inspected? (Evident of readiness the equipment, tools and its safety devices attached, verification by certificate, maintenance history, functional check and test).

1.3

Are safe execution procedures for critical activities are written, reviewed approved and familirization with the contractor workforce before the work begins?

1.4

Is he/she contractor's competent person as the HSE representative available?

1.5

Is contractor‟s designated person for HSE inspector and auditor?

1.6

Minimum requirement to work at site full filled (evident of the workforce fitness for work by appropriate medical check up record and mandatory applicable HSE training – sea survival, etc).

1.7

Has the HSE plan been developed, approved and include in the execution program (or project schedule), following minimum contain: 1.7.1. HSE Induction of new employees? 1.7.2. HSE meetings, promotion and communication?

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N/A

REMARKS

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

1.7.3. Risk Assessment? 1.7.4. Safe work execution procedures? 1.7.5. HSE inspections and audit? 1.7.6. Control of Work and or Permit to Work System? 1.7.7. Supervisor and employees‟ safety behavior observation? 1.7.8. Emergency drills? 1.7.9. Accident reporting and Investigation? 1.8

Does the Contractor have rewards programs for an effort to reduce occupational injuries, illnesses and environmental damages?

1.9

Does the Contractor have disciplinary action programs in case of noncompliance?

II. Potential Hazards 2.1

Does the Contractor provide a system for potential hazard identification and control or mitigation and verify their implementation

2.2

Does this contracted work have writen risk assessment in place and tracking the control measure action closure status?

III.

Emergency Response Plans and Procedures

3.1

Do they have emergency respon procedure specific to the scope of contracted work?

3.2

Are the Contractor's employees aware of their role in an emergency?

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

3.3

Is Contractor‟s Contact Person and telephone numbers available during emergency? posted through the site and communication tested?

IV

HSE Training

4.1

Does the contractor's having evidence that all the workers are competence to perform the work (CV, Training, Certification, etc.)?

4.2

Is there any a HSE training plan for contractor‟s employees and management relevant with scope of work?

V 5.1

Contractor‟s Management Commitment Have all HSE issues been communicated to the Contractor‟s upper management (example: approval Risk Assessment, HSE plan, Audit status, closure action progress, etc)

Mobilization 6.1 6.2 6.3

Do you have tools/check list to measure your readiness progress before mobilization staff and equipment? Do you consider that they are ready to execute the work (evidence contractor‟s management approval) Did you conduct HSE site orientation program and scope induction to all involved personil before mobilization to site?.

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

Appendix V. Work In Progress (WIP) Forms

Work In Progress New Contracts Qualification Phase: Select A Qualified Contractor

Pre-Qualification Selection

Risk Assessment

Contract Award

Data Bank

Contract Implementation Phase: Ensure Field Safe Work

Pre-Job Activity

Work In Progress

CSMS

Final Evaluation

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

COMPANY ACCEPTANCE WORK IN PROGRESS

Date

:

Project Period : Job Title

:

Contract No

:

Work Location

:

Contractor Name

:

Address

:

Contractor Reps: _________________ PHE ONWJ Reps: _________________ (Name/Date) (Name/Date)

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

Appendix V.1. Form CSMS/WIP/01:

OFFICE AND FIELD WORK IN PROGRESS EVALUATION CRITERIA A

B

C

D

SECTION 1- PEOPLE 1

How does the standard of competence and completeness certification/documents required from the supervisor/leader on location. Incompetent and incomplete documents

2

All competent and complete documents

Work plan and scope of work available but not aligned.

Work plan provided but not agreed with scope of work.

Provided work plan agreeable with scope of work.

HSSE KPI not updated and not agreed by contractor

HSSE KPI agreed by owner company and Contractor‟s but not updated.

Has been update and agreed by Owner Company and Contractor‟s

Less than 50% skilled to do their work

An average skilled to perform the work.

It‟s all very skilled at doing the work.

How does the skills of crew /technician in performing work on location. Unskilled

7

competent to do the job and document completeness > 50%

How does the skills of supervisor /leader in performing work on location. Unskilled

6

competent to do the job and document completeness < 50%

Has the HSSE KPI been update and agreed by Owner Company and Contractor‟s They haven‟t HSSE KPI

5

All competent and complete documents

Has the Contractor‟s provide the work plan agreeable with scope of work Not Provided work plan and scope of work

4

competent to do the job and document completeness > 50%

How does the standards of competence and completeness certification/documents required from the crew/technician on location. Incompetent and incomplete documents

3

competent to do the job and document completeness < 50%

Less than 50% skilled to do their work

An average skilled to perform the work.

It‟s all very skilled at doing the work.

How does the HSSE behavior of all Contractors‟ personnel. Always repeat the mistakes

Often must be reminded and sometimes repeat a mistake.

Sometimes need to be reminded and not repeat the mistake.

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Always show the habit of safe behavior.

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

8

Have minimum requirement work force fitness for work at site full filled Not document supported (medical checkup and Mandatory HSSE Training)

9

Active, meet as KPI

Very active more than KPI per person.

Occasional

Active, every morning in general but not prior job execution.

Very active, tool box talk performed prior job execution

Occasional cannot be contacted/communicate d.

Communication with the field / IOM is fluently and easily accessible, but still often not responsive to follow up action.

Very responsive to followup action and coordinate at site.

Is number and competency of Crew complying with the work required on site? Number and competency of crew not sufficient.

13

Occasional, less than target in KPI

How does responsive the Project Management Team (PMT)/Contractor Project Manager. Difficult to contact/to communicate

12

Full filled with document by appropriate medical checkup record and mandatory applicable HSE training (Sea Survival, etc)

How does the participation of all personnel in implementing Safety meeting (tool box talk). Not active

11

Full filled but not documented.

How does the participation of all personnel in implementing STOP (Safety Observation Program). Not active

10

Support document only Sea survival training.

Number of crew sufficient but not competent.

Competence of Crew comply with work but the number of crew not enough.

Number and competence of crew always comply and consistent with work required.

Have all HSSE issues been communicated to the contractor‟s upper management Never

HSSE issues communicated only management at site verbally.

HSSE issues communicated only middle management at site and written to upper management without approval upper management.

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Contractor‟s upper management communicated and coordinates all HSSE issues, such as: approve risk assessment and mitigation, HSSE plan, follow up recommendation.

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

SECTION 2- PLANT 14

How is the completeness PPE for personnel Most of the personnel have not received a complete PPE.

15

18

19

Each personnel already get a complete PPE follow a standard including stock availability guarantee the back up and can be replaced.

Occasional borrow a standard equipment

Complete accordance with the required service, no mitigation the backup / backup equipment

Always a complete accordance with the required services, including mitigation the backup equipment

How to order equipment from site if any defective equipment for replacement unsatisfied

17

All personnel receive a complete PPE follow a standard but there is no guarantee of availability of back up, or be Replaced.

How is the availability of standard equipment / regular tool Never used a standard equipment

16

Some personnel have not received a complete PPE (less than 10%).

Often not satisfied

Occasional there is a discrepancy of required.

Always arrived on time as required at site.

How does maintenance of equipment implementation. Visually not feasible, not perform maintenance and data is not available

Visually good, there was no maintenance and inspection, including no pre-use check list.

Visually good, performed Visually good, performed maintenance and routine maintenance and inspection, but the inspection, completed documents are document use pre-use incomplete. check list Accommodation, Kitchen, Sanitary System, and Food Material storage appropriate Uncontrolled all accommodation, kitchen and food material store.

All accommodation, kitchen and food material storage not clean, sanitary system uncontrolled.

All accommodation, kitchen and food material storage keep clean, sanitary system uncontrolled.

All accommodation, kitchen and food material storage keep clean and tidy, sanitary system keep appropriate control.

The contractors have housekeeping program verbally without procedure or guideline

The contractors have housekeeping program such as: procedure familiarization, implementation and assessment.

Has the Contractor‟s Housekeeping Program The contractor‟s haven‟t housekeeping program.

The contractors have housekeeping program but not implemented.

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

SECTION 3 - PROCESS 20

How does the implementation of Standard Operating Procedure (SOP). There is no procedure on site and not implemented

21

23

All leader/supervisor already training SSOW (PA) but the certification is invalid and covered with a dispensation.

All leader/supervisor already trained SSOW (PA) with valid certificate.

Training matrix available Training matrix available Training matrix not by contractor‟s, but not by contractor‟s, but not implemented and implemented and available and not documented documented to documented management. How does the implementation of Control Of Work (COW) procedure.

Training matrix available by contractor‟s, implemented and documented to all level

Procedure implemented including competency personal, but audit and analyst not performed.

Procedure implemented including competency personal, audit and analyst.

Procedure approve but not implemented

How does the Risk Assessment process and its implementation. Risk assessment occasional implemented including competency of personal, and no assesment. How does the Permit To Work process and its implementation No method of risk assessment.

25

Some of leader/supervisor trained SSOW (PA)

Is there any a HSE training plan implemented for contractor‟s employees, include provide training for its managers and supervisor to ensure that they are capable?

No procedure available 24

There is Procedure on site, approve by management familiarization to work force and implement by all crew.

How is the Training Safe System Of Work (SOW) performed All leader/supervisor not train SSOW (PA)

22

There is procedure on There is procedure on site site but not implemented. but implementation not consistently

No procedure or method available

Risk assessment method available but not implemented.

Procedure approve but not implemented

Procedure implemented including competency personal, but audit and analyst not performed.

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Risk assessment implemented including competency of personal, and assessment.

Procedure implemented including competency personal, audit and analyst.

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

26

How does the HSE induction for new employees No plan to induction program

27

The program perform by Company and Contractor‟s on periodic basis, recommendations not follow up by contractor‟s

The program perform by Company and Contractor‟s on periodic basis, recommendations follow up by Contractor‟s and documented

Contractors have program reward and consequences, but not implemented.

Contractor‟s implement consequences (Punishment) programs without reward to reduce injuries, illnesses and environmental damage.

Contractor‟s implement rewards and consequences programs for an effort to reduce occupational injuries, illnesses and environmental damage

Have safe execution procedures for critical activities relevant scope of works been written, reviewed, approved and familiarized to contractors‟ workforce. Safe execution procedure not provided by contractor‟s

30

The program performs by Company and Contractor‟s occasionally.

Does the contractor‟s implement rewards and consequences programs for an effort to reduce occupational injuries, illnesses and environmental damage No program reward and consequences.

29

Perform with appropriate material to all new employee coverage all hazard and activities

Does the contractor conduct HSE inspections and audits together on periodic basis No program inspections and audit.

28

Perform with verbally

Perform with appropriate material to all new employee but not inform all hazard and activities

Contractors provide safe execution procedures for critical activities relevant scope of works been written, but not reviewed and approved by management.

Contractors provide safe execution procedures for critical activities relevant scope of works been written, reviewed, approved, but not familiarized to Contractors workforce.

Contractors provide safe execution procedures for critical activities relevant scope of works been written, reviewed, approved and familiarized to Contractors workforce.

Has the HSE plan been implemented in the execution phase (or project schedule) Contractors haven‟t HSE plan.

contractors have HSE plan during PJA only not in execution phase

Contractors have HSE plan in the execution phase.

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Contractor‟s implemented HSE plan in the execution phase.

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

31

Is the contractor has Emergency Respond Plan. Contractor‟s not provided Emergency Respond Plan Procedure.

32

Contractor has Emergency Respond Plan not approved procedure.

Contractor has Emergency Respond Plan Approved Procedure, review and familiarization to ERT, but never exercise/tested

Contractor has Emergency Respond Plan Approved Procedure, review and familiarization to ERT including exercise/tested

Are Contractor‟s Emergency telephone numbers posted throughout the site and tested. No Contractor Emergency telephone numbers.

Contractor Emergency telephone numbers not posted.

Contractor Emergency telephone numbers posted throughout the site, but not tested

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Contractor Emergency telephone numbers posted throughout the site and tested

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

Appendix V.2. Form CSMS/WIP/02:

OFFICE AND FIELD WORK IN PROGRESS SCORING SHEET Contractor

: ______________________________________________

Address

: ______________________________________________

Date

: ______________________________________________

Circle the number, which best represents this evaluation based on the criteria for rating purposes attached. A

B

C

D

SECTION 1 – ITEM 1

0

4

8

12

SECTION 1 – ITEM 2

0

4

8

12

SECTION 1 – ITEM 3

0

4

8

12

SECTION 1 – ITEM 4

0

4

8

12

SECTION 1 – ITEM 5

0

4

8

12

SECTION 1 – ITEM 6

0

4

8

12

SECTION 1 – ITEM 7

0

4

8

12

SECTION 1 – ITEM 8

0

4

8

12

SECTION 1 – ITEM 9

0

4

8

12

SECTION 1 – ITEM 10

0

4

8

12

SECTION 1 – ITEM 11

0

4

8

12

SECTION 1 – ITEM 12

0

4

8

12

SECTION 1 – ITEM 13 Subtotal

0

4

8

12

Subtotal

Factor

SECTION 1 – PEOPLE

X1/13

SECTION 2 – PLANT SECTION 2 – ITEM 14

0

4

8

12

SECTION 2 – ITEM 15

0

4

8

12

SECTION 2 – ITEM 16

0

4

8

12

SECTION 2 – ITEM 17

0

4

8

12

SECTION 2 – ITEM 18

0

4

8

12

SECTION 2 – ITEM 19 SUBTOTAL

0

4

8

12

Page 95 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT

X1/6

Total

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

SECTION 3 – PROCESS SECTION 3 – ITEM 20

0

4

8

12

SECTION 3 – ITEM 21

0

4

8

12

SECTION 3 – ITEM 22

0

4

8

12

SECTION 3 – ITEM 23

0

4

8

12

SECTION 3 – ITEM 24

0

4

8

12

SECTION 3 – ITEM 25

0

4

8

12

SECTION 3 – ITEM 26

0

4

8

12

SECTION 3 – ITEM 27

0

4

8

12

SECTION 3 – ITEM 28

0

4

8

12

SECTION 3 – ITEM 29

0

4

8

12

SECTION 3 – ITEM 30

0

4

8

12

SECTION 3 – ITEM 31

0

4

8

12

SECTION 3 – ITEM 32 Subtotal

0

4

8

12 X1/13

TOTAL RATING (SECT 1 – SECT 3)

SUMMARY The numerical values below are the weighted ratings calculated above including contribute from field values. The total represents the overall score for the Contractor. This score only for performance control of Contractor field and office implementation.

TOTAL RATING

_____________*)

EVALUATED BY:

NAME TITLE DATE

NAME TITLE DATE

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

Appendix V.3. Form CSMS/WIP/03:

FIELD WORK IN PROGRESS EVALUATION CRITERIA A

B

C

D

SECTION 1 PEOPLE 1

How does the standard of competence and completeness certification/documents required from the supervisor/leader on location. Incompetent and incomplete documents

2

Work plan and scope of work available but not aligned.

Work plan provided but not agreed with scope of work.

Provided work plan agreeable with scope of work.

Less than 50% skilled to do their work

An average skilled to perform the work.

It‟s all very skilled at doing the work.

Less than 50% skilled to do their work

An average skilled to perform the work.

It‟s all very skilled at doing the work.

Often must be reminded and sometimes repeat a mistake.

Sometimes need to be reminded and not repeat the mistake.

Always show the habit of safe behavior.

How does the participation of all personnel in implementing STOP (Safety Observation Program). Not active

8

All competent and complete documents

How does the HSSE behavior of all Contractors‟ personnel. Always repeat the mistakes

7

competent to do the job and document completeness > 50%

How does the skills of crew /technician in performing work on location. Unskilled

6

competent to do the job and document completeness < 50%

How does the skills of supervisor /leader in performing work on location. Unskilled

5

All competent and complete documents

Has the Contractor‟s provide the work plan agreeable with scope of work Not Provided work plan and scope of work

4

competent to do the job and document completeness > 50%

How does the standards of competence and completeness certification/documents required from the crew/technician on location. Incompetent and incomplete documents

3

competent to do the job and document completeness < 50%

Occasional, less than target in KPI

Active, meet as KPI

Very active more than KPI per person.

How does the participation of all personnel in implementing Safety meeting (tool box talk). Page 97 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

Not active

9

Occasional

Active, every morning in general but not prior job execution.

Very active, tool box talk performed prior job execution

Is number and competency of Crew complying with the work required on site Number and competency of crew not sufficient.

Number of crew sufficient but not competent.

Competence of Crew comply with work but the number of crew not enough.

Number and competence of crew always comply and consistent with work required.

All personnel receive a complete PPE follow a standard but there is no guarantee of availability of back up, or be Replaced.

Each personnel already get a complete PPE follow a standard including stock availability guarantee the back up and can be replaced.

SECTION 2 - PLANT 10

How is the completeness PPE for personnel Most of the personnel have not received a complete PPE.

11

How is the availability of standard equipment / regular tool Never used standard equipment.

12

13

14

Some personnel have not received a complete PPE (less than 10%).

Occasional borrow standard equipment.

Complete accordance with the required service, no mitigation the back up / backup equipment.

Always a complete accordance with the required services, including mitigation the backup equipment.

How does maintenance of equipment implementation. Visually not feasible, not perform maintenance and data is not available

Visually good, there was no maintenance and inspection, including no pre-use check list.

Visually good, performed Visually good, performed maintenance and routine maintenance and inspection, but the inspection, completed documents are document use pre-use incomplete. check list Accommodation, Kitchen, Sanitary System, and Food Material storage appropriate Uncontrolled all accommodation, kitchen and food material store.

All accommodation, kitchen and food material storage not clean, sanitary system uncontrolled.

All accommodation, kitchen and food material storage keep clean, sanitary system uncontrolled.

Has the Contractor‟s House keeping Program

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All accommodation, kitchen and food material storage keep clean and tidy, sanitary system keep appropriate control.

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

The contractor‟s haven‟t house keeping program.

The contractor‟s have house keeping program but not implemented.

The contractor‟s have house keeping program verbally without procedure or guideline

The contractor‟s have house keeping program such as: procedure familiarization, implementation and assessment.

SECTION 3 - PROCESS 15

How does the implementation of Standard Operating Procedure (SOP). There is no procedure on site and not implemented

16

Procedure approve but not implemented

All leader/supervisor already trained SSOW (PA) with valid certificate.

Procedure implemented including competency personal, but audit and analyst not performed.

Risk assessment occasional implemented including competency of personal, and no assesment. How does the Permit To Work process and its implementation No procedure or method available

20

All leader/supervisor already training SSOW (PA) but the certification is invalid and covered with a dispensation.

Procedure implemented including competency personal, audit and analyst.

How does the Risk Assessment process and its implementation. No method of risk assessment.

19

Some of leader/supervisor trained SSOW (PA)

How does the implementation of Control Of Work (COW) procedure. No procedure available

18

There is Procedure on site, approve by management familiarization to work force and implement by all crew.

How is the Training Safe System Of Work (SOW) performed All leader/supervisor not train SSOW (PA)

17

There is procedure on There is procedure on site site but not implemented. but implementation not consistently

Risk assessment method available but not implemented.

Procedure approve but not implemented

Procedure implemented including competency personal, but audit and analyst not performed.

Risk assessment implemented including competency of personal, and assessment. Procedure implemented including competency personal, audit and analyst.

Does the contractor conduct HSE inspections and audits together on periodic basis

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

No program inspections and audit.

21

The program perform by Company and Contractor‟s on periodic basis, recommendations follow up by Contractor‟s and documented

contractor‟s have HSE plan during PJA only not in execution phase

Contractor‟s have HSE plan in the execution phase.

Contractor‟s implemented HSE plan in the execution phase.

Contractor has Emergency Respond Plan Approved Procedure, review and familiarization to ERT, but never exercise/tested

Contractor has Emergency Respond Plan Approved Procedure, review and familiarization to ERT including exercise/tested.

Is the contractor has Emergency Respond Plan. Contractor‟s not provided Emergency Respond Plan Procedure.

23

The program perform by Company and Contractor‟s on periodic basis, recommendations not follow up by contractor‟s

Has the HSE plan been implemented in the execution phase (or project schedule) Contractors haven‟t HSE plan.

22

The program performs by Company and Contractor‟s occasionally.

Contractor has Emergency Respond Plan not approved procedure.

Are Contractor‟s Emergency telephone numbers posted throughout the site and tested. No Contractor Emergency telephone numbers.

Contractor Emergency telephone numbers not posted.

Contractor Emergency telephone numbers posted throughout the site, but not tested

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Contractor Emergency telephone numbers posted throughout the site and tested

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines Appendix V.4. Form CSMS/WIP/04:

FIELD WORK IN PROGRESS SCORING SHEET Contractor

: ______________________________________________

Address

: ______________________________________________

Date

: ______________________________________________

Circle the number, which best represents this evaluation based on the criteria for rating purposes attached.

A

B

C

D

SECTION 1 – ITEM 1

0

4

8

12

SECTION 1 – ITEM 2

0

4

8

12

SECTION 1 – ITEM 3

0

4

8

12

SECTION 1 – ITEM 4

0

4

8

12

SECTION 1 – ITEM 5

0

4

8

12

SECTION 1 – ITEM 6

0

4

8

12

SECTION 1 – ITEM 7

0

4

8

12

SECTION 1 – ITEM 8

0

4

8

12

SECTION 1 – ITEM 9

0

4

8

12

Subtotal

Factor

SECTION 1 – PEOPLE

Subtotal

X1/9

SECTION 2 – PLANT SECTION 2 – ITEM 10

0

4

8

12

SECTION 2 – ITEM 11

0

4

8

12

SECTION 2 – ITEM 12

0

4

8

12

SECTION 2 – ITEM 13

0

4

8

12

SECTION 2 – ITEM 14

0

4

8

12

SUBTOTAL

X1/5

SECTION 3 – PROCESS SECTION 3 – ITEM 15

0

4

8

12

SECTION 3 – ITEM 16

0

4

8

12

SECTION 3 – ITEM 17

0

4

8

12

Page 101 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT

Total

Contractor Health, Safety and Environmental Management System (CSMS) Guidelines

SECTION 3 – ITEM 18

0

4

8

12

SECTION 3 – ITEM 19

0

4

8

12

SECTION 3 – ITEM 20

0

4

8

12

SECTION 3 – ITEM 21

0

4

8

12

SECTION 3 – ITEM 22

0

4

8

12

SECTION 3 – ITEM 23

0

4

8

12 X1/9

Subtotal TOTAL RATING (SECT 1 – SECT 3)

SUMMARY The numerical values below are the weighted ratings calculated from field only. This score only for performance control of Contractor field implementation as contribute data to Form CSMS/WIP/01: The contract holder should compile the Field and Office score.

TOTAL RATING

_____________*)

EVALUATED BY:

NAME TITLE DATE

NAME TITLE DATE

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Contractor Health, Safety and Environmental Management System (CSMS) Guidelines Appendix V.5. Form CSMS/WIP/05:

WORK IN PROGRESS INTERIM REPORT (Office and Field) No.

Descriptions

Improvement needed

COMMENTS

Section 1 - People

1. 2. 3. Section 2 - Plant

1. 2. 3. Section 3 - Process

1. 2. 3. Contractor Reps: ___________________________ Name/Title

HSE PERFORMANCE 1. No of First Aids :_______ 2. No of Recordable Cases

:____

3. No of Lost Workday Cases

:_____

4. No of Equipment Damage Incidents :______ 5. No of Spills / non-Compliance Cases

:_____

___________________________ Signature/Date PHE ONWJ Reps: ___________________________ Name/Title ___________________________ Signature/Date

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Contractor Health, Safety, and Environmental Management System (CSMS) Guidelines

Appendix VI. Final Evaluation Form

Final Evaluation

New Contracts

Qualification Phase: Select A Qualified Contractor

Pre-Qualification Selection

Risk Assessment

Contract Award

Data Bank

Contract Implementation Phase: Ensure Field Safe Work

Pre-Job Activity

Work In Progress

CSMS

Final Evaluation

Contractor Health, Safety, and Environmental Management System (CSMS) Guidelines

Appendix VI.1. Form CSMS/FE/01:

FINAL EVALUATION

Date

:

Project Period : Job Title

:

Contract No

:

Work Location

:

Contractor Name

:

Address

:

Contractor Reps: _________________ PHE ONWJ Reps: ___________________ (Name/Date) (Name/Date)

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Contractor Health, Safety, and Environmental Management System (CSMS) Guidelines Appendix VI.2. Form CSMS/FE/02:

FINAL EVALUATION CRITERIA A

B

C

D

SECTION 1- PEOPLE 1

How does the standard of competence and completeness certification/documents required from the supervisor/leader on location. Incompetent and incomplete documents

2

All competent and complete documents

Work plan and scope of work available but not aligned.

Work plan provided but not agreed with scope of work.

Provided work plan agreeable with scope of work.

HSSE KPI not updated and not agreed by contractor

HSSE KPI agreed by owner company and Contractor‟s but not updated.

Has been update and agreed by Owner Company and Contractor‟s

Less than 50% skilled to do their work

An average skilled to perform the work.

It‟s all very skilled at doing the work.

How does the skills of crew /technician in performing work on location. Unskilled

7

competent to do the job and document completeness > 50%

How does the skills of supervisor /leader in performing work on location. Unskilled

6

competent to do the job and document completeness < 50%

Has the HSSE KPI been update and agreed by Owner Company and Contractor‟s They haven‟t HSSE KPI

5

All competent and complete documents

Has the Contractor‟s provide the work plan agreeable with scope of work Not Provided work plan and scope of work

4

competent to do the job and document completeness > 50%

How does the standards of competence and completeness certification/documents required from the crew/technician on location. Incompetent and incomplete documents

3

competent to do the job and document completeness < 50%

Less than 50% skilled to do their work

An average skilled to perform the work.

How does the HSSE behavior of all Contractors‟ personnel.

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It‟s all very skilled at doing the work.

Contractor Health, Safety, and Environmental Management System (CSMS) Guidelines

Always repeat the mistakes 8

Full filled with document by appropriate medical checkup record and mandatory applicable HSE training (Sea Survival, etc)

Occasional, less than target in KPI

Active, meet as KPI

Very active more than KPI per person.

Occasional

Active, every morning in general but not prior job execution.

Very active, tool box talk performed prior job execution

Occasional cannot be contacted/communicate

Communication with the field / IOM is fluently and easily accessible, but still often not responsive to follow up action.

Very responsive to followup action and coordinate at site.

Is number and competency of Crew complying with the work required on site? Number and competency of crew not sufficient.

13

Full filled but not documented.

How does responsive the Project Management Team (PMT)/Contractor Project Manager. Difficult to contact/to communicate

12

Support document only Sea survival training.

How does the participation of all personnel in implementing Safety meeting (tool box talk). Not active

11

Always show the habit of safe behavior.

How does the participation of all personnel in implementing STOP (Safety Observation Program). Not active

10

Sometimes need to be reminded and not repeat the mistake.

Have minimum requirement work force fitness for work at site full filled Not document supported (medical checkup and Mandatory HSSE Training)

9

Often must be reminded and sometimes repeat a mistake.

Number of crew sufficient but not competent.

Competence of Crew comply with work but the number of crew not enough.

Have all HSSE issues been communicated to the contractor‟s upper management

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Number and competence of crew always comply and consistent with work required.

Contractor Health, Safety, and Environmental Management System (CSMS) Guidelines

Never

HSSE issues communicated only management at site verbally.

HSSE issues communicated only middle management at site and written to upper management without approval upper management.

Contractor‟s upper management communicated and coordinates all HSSE issues, such as: approve risk assessment and mitigation, HSSE plan, follow up recommendation.

All personnel receive a complete PPE follow a standard but there is no guarantee of availability of back up, or be Replaced.

Each personnel already get a complete PPE follow a standard including stock availability guarantee the back up and can be replaced.

SECTION 2- PLANT 14

How is the completeness PPE for personnel Most of the personnel have not received a complete PPE.

15

How is the availability of standard equipment / regular tool Never used a standard equipment

16

Complete accordance with the required service, no mitigation the backup / backup equipment

Often not satisfied

Occasional there is a discrepancy of required.

Always a complete accordance with the required services, including mitigation the backup equipment Always arrived on time as required at site.

How does maintenance of equipment implementation. Visually not feasible, not perform maintenance and data is not available

18

Occasional borrow a standard equipment

How to order equipment from site if any defective equipment for replacement unsatisfied

17

Some personnel have not received a complete PPE (less than 10%).

Visually good, there was no maintenance and inspection, including no pre-use check list.

Visually good, performed Visually good, performed maintenance and routine maintenance and inspection, but the inspection, completed documents are document use pre-use incomplete. check list Accommodation, Kitchen, Sanitary System, and Food Material storage appropriate

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Contractor Health, Safety, and Environmental Management System (CSMS) Guidelines

Uncontrolled all accommodation, kitchen and food material store.

19

All accommodation, kitchen and food material storage not clean, sanitary system uncontrolled.

All accommodation, kitchen and food material storage keep clean, sanitary system uncontrolled.

All accommodation, kitchen and food material storage keep clean and tidy, sanitary system keep appropriate control.

The contractors have housekeeping program verbally without procedure or guideline

The contractors have housekeeping program such as: procedure familiarization, implementation and assessment.

Has the Contractor‟s Housekeeping Program The contractor‟s haven‟t housekeeping program.

The contractors have housekeeping program but not implemented.

SECTION 3 - PROCESS 20

How does the implementation of Standard Operating Procedure (SOP). There is no procedure on site and not implemented

21

There is Procedure on site, approve by management familiarization to work force and implement by all crew.

Some of leader/supervisor trained SSOW (PA)

All leader/supervisor already training SSOW (PA) but the certification is invalid and covered with a dispensation.

All leader/supervisor already trained SSOW (PA) with valid certificate.

Is there any a HSE training plan implemented for contractor‟s employees, include provide training for its managers and supervisor to ensure that they are capable? Training matrix available by contractor‟s, but not implemented and documented to management. How does the implementation of Control Of Work (COW) procedure.

Training matrix available by contractor‟s, implemented and documented to all level

Procedure implemented including competency personal, but audit and analyst not performed.

Procedure implemented including competency personal, audit and analyst.

Training matrix not available and not documented

23

There is procedure on site but implementation not consistently

How is the Training Safe System Of Work (SOW) performed All leader/supervisor not train SSOW (PA)

22

There is procedure on site but not implemented.

No procedure available

Training matrix available by contractor‟s, but not implemented and documented

Procedure approve but not implemented

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Contractor Health, Safety, and Environmental Management System (CSMS) Guidelines

24

How does the Risk Assessment process and its implementation. Risk assessment occasional implemented including competency of personal, and no assesment. How does the Permit To Work process and its implementation No method of risk assessment.

25

No procedure or method available 26

Procedure implemented including competency personal, audit and analyst.

Perform with appropriate material to all new employee but not inform all hazard and activities

Perform with appropriate material to all new employee coverage all hazard and activities

Perform with verbally

The program performs by Company and Contractor‟s occasionally.

The program perform by Company and Contractor‟s on periodic basis, recommendations not follow up by contractor‟s

The program perform by Company and Contractor‟s on periodic basis, recommendations follow up by Contractor‟s and documented

Does the contractor‟s implement rewards and consequences programs for an effort to reduce occupational injuries, illnesses and environmental damage No program reward and consequences.

29

Procedure implemented including competency personal, but audit and analyst not performed.

Does the contractor conduct HSE inspections and audits together on periodic basis No program inspections and audit.

28

Procedure approve but not implemented

Risk assessment implemented including competency of personal, and assessment.

How does the HSE induction for new employees No plan to induction program

27

Risk assessment method available but not implemented.

Contractors have program reward and consequences, but not implemented.

Contractor‟s implement consequences (Punishment) programs without reward to reduce injuries, illnesses and environmental damage.

Contractor‟s implement rewards and consequences programs for an effort to reduce occupational injuries, illnesses and environmental damage

Have safe execution procedures for critical activities relevant scope of works been written, reviewed, approved and familiarized to contractors‟ workforce.

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Contractor Health, Safety, and Environmental Management System (CSMS) Guidelines

Safe execution procedure not provided by contractor‟s

30

31

32

Contractors provide safe execution procedures for critical activities relevant scope of works been written, but not reviewed and approved by management.

Contractors provide safe execution procedures for critical activities relevant scope of works been written, reviewed, approved, but not familiarized to Contractors Has the HSE plan been implemented in the execution workforce. phase (or project schedule)

Contractors provide safe execution procedures for critical activities relevant scope of works been written, reviewed, approved and familiarized to Contractors workforce.

Contractors haven‟t HSE plan.

contractors have HSE plan during PJA only not in execution phase Is the contractor has Emergency Respond Plan.

Contractors have HSE plan in the execution phase.

Contractor‟s implemented HSE plan in the execution phase.

Contractor‟s not provided Emergency Respond Plan Procedure.

Contractor has Emergency Respond Plan Approved Procedure, review and familiarization to ERT, but never exercise/tested

Contractor has Emergency Respond Plan Approved Procedure, review and familiarization to ERT including exercise/tested

Contractor has Emergency Respond Plan not approved procedure.

Are Contractor‟s Emergency telephone numbers posted throughout the site and tested. No Contractor Emergency telephone numbers.

Contractor Emergency telephone numbers not posted.

Contractor Emergency telephone numbers posted throughout the site, but not tested

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Contractor Emergency telephone numbers posted throughout the site and tested

Contractor Health, Safety, and Environmental Management System (CSMS) Guidelines Appendix VI.3. Form CSMS/FE/03:

FINAL EVALUATION SCORING SHEET Contractor

: ______________________________________________

Address

: ______________________________________________

Date

: ______________________________________________

Circle the number, which best represents this evaluation based on the criteria for rating purposes attached. A

B

C

D

SECTION 1 – ITEM 1

0

4

8

12

SECTION 1 – ITEM 2

0

4

8

12

SECTION 1 – ITEM 3

0

4

8

12

SECTION 1 – ITEM 4

0

4

8

12

SECTION 1 – ITEM 5

0

4

8

12

SECTION 1 – ITEM 6

0

4

8

12

SECTION 1 – ITEM 7

0

4

8

12

SECTION 1 – ITEM 8

0

4

8

12

SECTION 1 – ITEM 9

0

4

8

12

SECTION 1 – ITEM 10

0

4

8

12

SECTION 1 – ITEM 11

0

4

8

12

SECTION 1 – ITEM 12

0

4

8

12

SECTION 1 – ITEM 13

0

4

8

12

Subtotal

Factor

SECTION 1 – PEOPLE

Subtotal

X1/13

SECTION 2 – PLANT SECTION 2 – ITEM 14

0

4

8

12

SECTION 2 – ITEM 15

0

4

8

12

SECTION 2 – ITEM 16

0

4

8

12

SECTION 2 – ITEM 17

0

4

8

12

SECTION 2 – ITEM 18

0

4

8

12

SECTION 2 – ITEM 19

0

4

8

12

SUBTOTAL SECTION 3 – PROCESS Page 111 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT

X1/6

Total

Contractor Health, Safety, and Environmental Management System (CSMS) Guidelines

SECTION 3 – ITEM 20

0

4

8

12

SECTION 3 – ITEM 21

0

4

8

12

SECTION 3 – ITEM 22

0

4

8

12

SECTION 3 – ITEM 23

0

4

8

12

SECTION 3 – ITEM 24

0

4

8

12

SECTION 3 – ITEM 25

0

4

8

12

SECTION 3 – ITEM 26

0

4

8

12

SECTION 3 – ITEM 27

0

4

8

12

SECTION 3 – ITEM 28

0

4

8

12

SECTION 3 – ITEM 29

0

4

8

12

SECTION 3 – ITEM 30

0

4

8

12

SECTION 3 – ITEM 31

0

4

8

12

SECTION 3 – ITEM 32

0

4

8

12

Subtotal

X1/13

TOTAL RATING (SECT 1 – SECT 3)

SUMMARY The numerical values below are the weighted ratings calculated above. The total represents the overall score for the Contractor.

TOTAL RATING

_____________*)

EVALUATED BY:

NAME TITLE DATE

NAME TITLE DATE

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Contractor Health, Safety, and Environmental Management System (CSMS) Guidelines Appendix VI.4. Form CSMS/FE/04:

FINAL EVALUATION RESULT SHEET No.

ITEM

Improvement needed

COMMENTS

Section 1 - People 1. 2. 3.

Section 2 - Plant 1. 2. 3.

Section 3 - Process 1. 2. 3. Contractor Reps: ___________________________ Name/Title

HSE PERFORMANCE 1. No of First Aids :_______ 2. No of Recordable Cases

:____

3. No of Lost Time Incident Cases

:_____

4. No of Equipment Damage Incidents :______ 5. No of Spills / non-Compliance Cases

:_____

___________________________ Signature/Date PHE ONWJ Reps: ___________________________ Name/Title ___________________________ Signature/Date

Page 113 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT