Contractor Safety Questionnaire LAST THREE YEARS OF PERFORMANCE BELOW TRIR 0 YEAR 2018 TRIR 0 LTIR 0 YEAR 2018 LTIR 0 EMR 1.0 YEAR 2018 EMR 1.0 Number of full t1me safety professionals Number of Employees 3 Total Yearly Hours ---- 51 Question 1) Workers Experience Modifier Rate (EMR) 2) Received a citation from a US Regulator Agency? (last 3 years) 2.1) If regulatory citation(s) have been issued, have all issues been resolved with the regulatory agency and put in place? 3) Had a fatality in the past three years? 4) Had a recordable while working for Eni? 5) Total Lost time case rate in the last three years 6) Total Recordable Incident Rate in the last three years. 7) Does your company have an internal audit program? 7.1) If non conformity's were issued, have all issues been resolved? 8.1) Has your company reported any spills or releases in the last three years? 8.2) Has your company reported any spills or releases in sufficient quantity to require notification to the National Response Center (NRC) or regulatory agency? 8.3) Has your company received any environmental charges and/or fines within the last three years? 8.4) Does your company have an Environmental Management policy endorsed by upper management? 8.5) Does your company br ing chemicals onto Owner Client sites? 8.6) Does your company have a written environmental program? 8.7) Does your company's pre-job planning process include environmental concerns? (Waste, Release, Permit violation) 8.8) Does your company have the correct spill kits and cleanup supplies to contain any spills that may be reasonably anticipated? 9.1) Does your company have an Sfety Managemetn program? 9.2) Does your company provide HSE and/or technical training to your workers? 9.3) Does your company have written safety procedures specific to the type of work your company performs? YEAR 2017 TRIR 0 YEAR 2017 LTIR 0 YEAR 2017 EMR 1.0 102,000 please explain your answer NO NOT APPLICABLE NO NO NO 0.00 0.00 YES NOT APPLICABLE NO NO NO YES NO YES YES YES YES YES YES YEAR 2016 YEAR 2016 YEAR 2016
Transcript
Contractor Safety Questionnaire
LAST THREE YEARS OF PERFORMANCE BELOW
TRIR 0 YEAR 2018 TRIR 0 LTIR 0 YEAR 2018 LTIR 0 EMR 1.0 YEAR 2018 EMR 1.0
Number of full t1me safety professionals
Number of Employees
3 Total Yearly Hours ----51
Question
1) Workers Experience Modifier Rate (EMR)
2) Received a citation from a US Regulator Agency? (last 3 years)
2.1) If regulatory citation(s) have been issued, have all issues been resolved
with the regulatory agency and put in place?
3) Had a fatality in the past three years?
4) Had a recordable while working for Eni?
5) Total Lost time case rate in the last three years
6) Total Recordable Incident Rate in the last three years.
7) Does your company have an internal audit program?
7.1) If non conformity's were issued, have all issues been resolved?
8.1) Has your company reported any spills or releases in the last three
years?
8.2) Has your company reported any spills or releases in sufficient quantity
to require notification to the National Response Center (NRC) or regulatory
agency?
8.3) Has your company received any environmental charges and/or fines
within the last three years?
8.4) Does your company have an Environmental Management policy
endorsed by upper management?
8.5) Does your company bring chemicals onto Owner Client sites?
8.6) Does your company have a written environmental program?
8.7) Does your company's pre-job planning process include environmental
concerns? (Waste, Release, Permit violation)
8.8) Does your company have the correct spill kits and cleanup supplies to contain any spills that may be reasonably anticipated?
9.1) Does your company have an Sfety Managemetn program?
9.2) Does your company provide HSE and/or technical training to your
workers?
9.3) Does your company have written safety procedures specific to the type of work your company performs?
YEAR 2017 TRIR 0 YEAR 2017 LTIR 0 YEAR 2017 EMR 1.0
102,000
please explain your answer
NO
NOT APPLICABLE
NO
NO
NO
0.00
0.00
YES
NOT APPLICABLE
NO
NO
NO
YES
NO
YES
YES
YES
YES
YES
YES
YEAR 2016 YEAR 2016 YEAR 2016
HSE Technical Evaluation Questionnaire for Tender Process
1. General
Tenderer Company Name
Materials and Services Provided
Operator Requester
Number of Employees Supporting Operations
Contractor Key Personnel
Contractor Key Personnel
Technical Industries, Inc. a subsidiary of Energy & Technology, Corp. Group of Companies. Stock Market Trading Symbol ENGT
Contractor Management Representative: Edmund Baudoin Jr. Administrator
Phone: 337 984 2000 x 14 Fax: 337 988 1777 email: techn icalin d ustries@tec hnjcalind us tries.co m
1. General
Please provide a copy of your Company HSE Management System do~ument structure inc.luding i.oformatioo on it's content, distribution, ~view and update mechanisms Attached
Please provide a copy of your Company Environmental Policy, including the site specific Environmental Plan and Waste Management Plan. Artacbed
Please provide an organiza tion chart for key leadership positions of responsibility for BSE within your organization identifying the most senior person responsible for compUance with company snd s ite specific HSE Potic.y. Attached
2. Health, Enviroamental and Safety Performance
Are key erement records listed in 2.1 - · 2.10 Yes No available for the last three years? XX 0
Comments
Provide compaoywide (aU customers) information for worldwide operations
2.1 Total number of employee hours worked
Ve.ar 2010
Year 2009
Year 2008
13959 19785 15502 2 1 0
Specify the basis for exposure or employee hours: 8 Hr. Shifts XXO 12 Hr. Sbiftx D Other: 0
2.2
2.3
2.4
2.5
Number ofwork-related fatalities
Nomber of injuries resu lting in days away from work (see attached defioirion)
Number of recordable jojuries (see attached d efiilition)
Nutnber of motor vehicle accidents (see attached defuJjtion)
Provide compaoywide (all customers) information for U.S. GoM operations
2.6 Total number of employee boors worked
Specify the basis for exposure or employee hours: 8 Hr. Shifts 0 Other~[]
0 0 0
0 0 0
0 3 1
0 0 0
Year Year Year 2008 2007 2006
0 0 0
l2 Hr. Shifts 0
2. Health, Environmental and Safety Performance
2 .. 7 Number of work-related fatalities 0 0 0
2.8 Number of injuries resulting in days away from work (see attached 0 00 0
dermition}
2.9 Number of recordable injuries (see attached definition) 0 0 0
2.10 Number of motor vehicle accidents (see attached defmition) 0 0 0
Rave you received a.ny regulatory citations or been involved in any court 0 .x No 2.11 litigation related to HSE incidents or noncompliance within tbe U.S . in tbe Yes
last three years?
2.12 Have you received any regulatory awards within the U.S. in rbe last three 0 x No years? Yes
3. Health. Environmental and Safety Management
Key Elements Yes No N/A Comments
3.1 HES Organization : Does your orgahlzation have the following:
A director or senior manager responsible x O for HES?
Does your organization have a part/full- Our company maintains in house HES and time position assigned HES Contracts Advance Safety periodic safety responsibilities? (Please describe.) inspection and Safety Training Classes.
3 .2 HES Benefits: Do you have or provide for your employees:
Medical insurance?
HES training?
XX 0
XX 0
0
0
3.3 HES Targets: What are your company's annual HES 1argets in :
a) Safety Zero recordable accidents
J. Health, Enviroomeotal aod Safety Management
Key Elements Yes No N/A Comments
b) Health Zero health exposures
c) Environmental Zero Spills and
3.4 HES Written Plan: Does your written HES Plan include:
HES policy and management commitment and expectations? x
Clearly defined HES responsibilities and accountabilities for managers, x supervisors, and employees?
Resources for meeting HES requi rements? x
Periodic management system review of key processes, procedures, and standards x to ensure compliance and performance improvement?
Document control and record retention x process?
Written safe work procedures specific for x your work?
Documented employee fitness for duty (skills, knowledge and physical/medical x suitability for job) process?
tnspection/Audit program? X
Hazard Identification and risk control? X
3.5 Employee Engagement:
Are Periodic HSE performance appraisals conducted for all employees? x
0
D
0
D
D
D
D
D
0
0
3. Health, Environmental and Safety M.aoageme.nt
Key Elements Yes No NIA Comments
Does your company have a means of sharing Lessons Learned across the x Organization?
If you answered yes to above, how are Lessons Learned communicated to employees? yes
Do your employees participate in team activities to improve HES performance? x
Do your employees have the authority to )(
stop work for safety reasons?
Are HES issues, inspection results, investigation results and learnings x communicated to employees?
0
D
0
D
Lessons learned are communicated through safety meetings, JSA. SOP, and job descriptions
Employees participate in safety meetings, Observation cards, writing of Safety goals
3.6 HES Meetings: Do you hold periodic HES Meetings that include:
Field Supervisors? X D
Employees? )( 0
Sub-contractors? 0 0
Do you hold daily toolbox safety X 0 meetings?
Are the HES meetings documented with x 0 minutes and attendees list?
Do Managers participata in safety x D meetings? Uob titles?)
ln conjunction with safety meetings, does x 0 your company include environmental topics?
N/A
3. Health, Environ.mentaJ and Safety Management
Key Elements Yes No NJA Comments
3.7 Sub-Contractors:
Does your company use sub-contractors? No
If Yes, provide current list of subcontractor companies. If No, select "N/A!I for remaining questions of this section.
Is there a written contractor safety x management process?
Do you evaluate the ability of sub- 0 contractors to comply with applicable HES requirements as part of your selection process?
Provide example or criteria.
3.8 Inspections and Audits:
0
D
Do you have a written inspection/audit x 0 procedure?
Do you conduct self-inspections and x 0 audits and document them?
Do you track/measure corrective actions to verify completion within assigned time?
Describe verification process.
3.9 Hazard Identification and Control:
Do you have a documented process to
X 0
identify work-related hazards including x 0 task, work location, natural conditions, and materials?
Are practices and procedures developed x 0 based on the hazards identified to mitigate the risk to employees?
6
0
D N/A
3. Health, Environmental and Safety Management
Key Elements Yes No N/A Comments
3.10 Incident Reporting, Investigation and Statistical Data:
Do you have a written process to report, x 0 investigate, and record incidents?
Does your process provide a technique for x root cause analysis?
D
Do you have a process in place to track x 0 recommendations and corrective actions to completion within the assigned time?
Provide verification method.
Does your company have a process to x share lessons learned on incidents and near misses?
3.11 Behaviour-Based Safety:
Do you have a behaviour-based safety x (BBS) process in place?
0
Does your company have a documented x 0 inventory of critical safe behaviours associated with your work activities?
Are all employees required to participate in x 0 documented behaviour observations?
Does your company perform formal, x 0 documented, trend analysis of behaviour observations?
;
We use Tap Root System
Safe Start
3.12 Personal Protective Equipment (PPE):
Do you have a written PPE program that includes;
• PPE selection
• PPE use
• PPE care and maintenance
X
X
X
0 0 D
Is the program communicated x 0 to all employees?
Do you provide the required x 0 PPE for the jobs that you perform?
Do you require employees x 0 wo·rking on electrical equipment to wear plastic framed prescription safety glasses?
3.13 Regulatory Compliance:
Do you know the HES-related X D government and local regulations pertaining to your work? If you do, please list titles of the regulations.
OSHA 1910 (General Industry)
What Regulatory J Industry ISO 9000:2008 look Certificate attached standards does your company ·follow? (for example t$09001)
Are you certified under these 0 0 standards?
3.14 Pollution Prevention:
Do you follow IS014001? X 0 0
Does your pre-job planning x 0 0 process include environmental concerns?
Have you trained personnel in management?
your x [] waste
D
Does your company have x 0 0 waste management pfans?
Have you trained personnel in management?
your x 0 waste
0
Have afl your waste streams x 0 0 been identified?
Do you have a site-specific x 0 D spill prevention program?
3.15 Emergency Preparedness and Response:
Do you have written site- x D specific emergency response plans?
How is your emergency x 0 response plan communicated to your employees?
Do you document emergency x D response training and drills?
4. Fitness For Duty: Skills, Knowledge, and Training
Key Elements Yes No N/A Comments
4.1 Short-Service Employee (SSE): employees new to your oompany or new in their work assignment
4. Fitness For Duty: Skills, Knowledge, and Training
Key Elements Yes No N/A Commehts
Do you have a documented SSE program? x 0
If you do have an SSE policy, does it x 0 include a means to visually identify an SSE?
Does your SSE policy include a mentor x 0 being assigned to each SSE?
If yes, does it define the roles and x responsibi l ities of the mentor?
0
Does your company have job specific x 0 training requirements for SSEs?
4.2 Craft Training:
Have employees been trained In x 0 appropriate job skills?
Are employees' job skills certified where 0 required by regulatory or industry standards, including MMS Subpart "0,. where required?
4.3 Health, Environmental and Safety Orientation:
D
Do you have a HES orientation program for x 0 newly hired employees?
Does your orientation program include the x 0 requirements as agreed in the contract HES exhibit?
4.4 Health, Environmental and Safety Training Content
Mentor is responsible for training the new employee and making sure he can perfonn his job to the standard required. He will make the decision when a new employee is frt to be on his own and not requiring a mentor.
N/A
4. Fitness For Duty: Skills, Knowledge, and Training
Key Elements Yes No NJA Comments
Do you know the local regulatory and x 0 Operator's HES training requirements for your employees?
Have your employees received the x 0 required HES training and retrain ing?
Do you provide specific supervisory HES x D training for new supervisors and refresher training for existing supervisors?
Does the training program include work practices and procedures such as:
General safe work practices? X.
Crane Operator certification in accordance 0 with API RP 20
Do you employ riggers? X
If you employ riggers, are they certified to x API RP 20?
Equipment lock-out and tag-out (LOTO)? X
Permit-to-work procedures? X
Fall protection? X
Personal protective equipment? X
Vehicle/Driving safety? X
Electrical equipment grounding? X
Radiation Safety Training? 0 Chemical Handling? X
Drug and Alcohol? X
II
D
D
0
D
D
D
D
0
0
D
0
0 0
D
0
D
0
0 D
0
0 X
N/A
4. Fitness For Duty: Skills, Know1edge, and Training
Key Elements Yes No NJA Comments
Incident reporting and investigation? X 0 Emergency preparedness and response? X 0 Environmental protection? X D 0 Hazard identification and control? X D Hazcom? X 0 Respiratory Protection? X D "Right to Know" MSDS Training? X D 4.5 Training Records:
Do you have HES and crafts training x D records for each individual employee that include employee identification, date of training, and name of trainer?
5. Fitness For Duty: Medical Suitability and Industrial Monitoring
Key Elements Yes No
5.1 Medical Services:
Do you have a process to provide medical treatment for your employees?
X
Does your company require an authorized individual to accompany injured
X employees to the medical provider for initial treatment?
Does your company have restricted or light duty policy?
12
a written X
D
D
D
N/A Comments
We have employees certified in First Aid/CPR and we have an Occupational Clinic that we have set up on a regular basis
5. Fitness For Duty: Medical Suitability and Industrial Monitoring
Key Elements Yes No N/A Comments
Does your company utilize a specific medical provider that understands D injury/illness recordability and your x company's restricted or light duty policy?
5.2 Medical Examination:
Do you conduct medle<al exams employees for pre-placement capabili ty?
for x job
Do you have employees who wear x respirators (either air purifying or supplied air)?
Are your employees" fit tested" for x wearing a respirator?
Does your company have offshore crane 0 operators?
Do your offshore crane operators have API D RP 2D physicals?
5.3 Substance Abuse :
Do you have a substance abuse x monitoring program?
Are your company's employees subject to x pre-employment drug and alcohol screening?
Are your company's employees subject to x random drug and alcohol screening?
Are your company's employees subject to x probable cause drug and alcohol screening?
0
0
0
0
0
0
0
0
0
0
0
0
X
X
0
0
0
0
5. Fitness For Duty : Medical Suitability and Industrial Monitoring
Key Elements Yes
Are your company's employees subject to x post accident drug and alcohol scre-ening?
Is your company willing to participate in x Random Drug and AlcohoJ Testing?
5.4 Industrial Hygiene (IH): Yes
Do you perform IH monitoring on your 0 employees?
Where are your IH monitoring records kept?
Do you have a hearing conservation 0 program with annuaf testing?
6. Equipment and Materials
No
D
D
No
D
D
NJA Comments
D
D
N/A
X If you do, please indicate for what substances (e.g., asbestos, benzene, lead, radiation, total hydrocarbons. weld ing fumes)
X
Key Elements Yes No N/A Comments
6 .1 General :
Do you maintain updated and accessible x MSOS for your products and chemicals?
D
Does your company have a motor vehicle x D safety policy and process?
Does your company have a policy x D prohibiting the use of cell phones and hands free devices while operating motor vehicles ?
6.2 Equipment:
I~
0
6. Equipment and Materials
Key Elements Yes No N/A Comments
Do you conduct, document and follow up x inspections on operating equipment (e.g., cranes, forklifts, wireline units, power packs)?
Do you maintain operating equipment in x compliance with regulatory requirements including MMS and Coast Guard certification, callbratlon 1 maintenance system, etc.?
