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

CSMS

New Contracts

Data Bank

Pre-Qualification

Selection Risk Assessment

Qulification Phase: Select A Qualified Contractor

Contract Award

Pre-Job Activity Work In Progress Final Evaluation

Contract Implementation Phase: Ensure Field Safe Work

Contractor Health, Safety, and Environmental Management System

CSMS Forms and Checklists Rev-5: 2011

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

CSMS

New Contracts

Data Bank

Pre-Qualification Selection

Risk Assessment

Qulification Phase: Select A Qualified Contractor

Contract Award



Risk Assessment

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

Page 35 CUSTODIAN: SAFETY TEAM LEADER PAPER COPIES ARE UNCONTROLLED THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT

Appendix I.1. Form CSMS/RA/01

No Risk Area What Risk Exposure

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

People Assets Environment Reputation

1 Nature of work

2 Work location

3 Materials/equipment 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



DEFINITION OF CONSEQUENCES SEVERITY OF IMPACT

Consequences Severity Level

Potential

Severity

Impact

Definition

HEALTH AND

SAFETYF LOW

Slight Injury or

Health Effect- First aid

- No effect on work performance

E MEDIUM 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)

DMajor Injury or

Health Effect

- Prolonged LTI

- Agents capable of moderate health effects which are

reversible but with hospitalization

C HIGHPermanent

Disability

- Accident/ illness resulting permanent disability

- Agents capable of irreversible effects without loss of life

but with serious disability and prolonged hospitalization

B 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

A 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



DEFINITION OF LIKELIHOOD

LIKELIHOOD DEFINITION Quantifification

Almost Impossible (AI) Rare or never heard of in the industry 1 per year



RULE OF THUMB IN DEFINING THE RISK EXPOSURE

IMPACT SEVERITY

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

LIKELIHOOD



Appendix I.2. Form CSMS/RA/02

RISK ASSESSMENT RESUME Date : Project Period : Job Title : Contract No : Work Location : Risk Category : L (Low) M (Medium) H (High) Explanation :

Assessed by: Approved by:

(Contract Originator) (Team Leader)

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

Appendix II. Pre-Qualification Forms

CSMS

New Contracts

Data Bank

Pre-Qualification


Qualification Phase: Select A Qualified Contractor

Contract Award



Pre-Qualification



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)



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



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?



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?



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?



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?



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.



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?



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?



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

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

Gaps Score Site Visit

Remarks Before After

Evaluated by:



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

Staff HSE training: Item 3.2.

No HSE training established

HSE training established but not implemented.

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.



PRE-QUALIFICATION EVALUATION CRITERIA A B C D

Section 3: Organization, Responsibilities, Resources, Standards and Documentation (contd)

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 on-the- 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 training: Items 3.4 and 3.5.

No specialized HSE training established

Specialized HSE training established but not implemented.

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.

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,

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: 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.

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.




A B C D

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

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

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

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

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

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.



PRE-QUALIFICATION EVALUATION CRITERIA A B C D

Section 4: Hazards and Effects Management (contd)

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

Waste management: Item 4.5 (a f)

Company has no formal methods for the control of waste

Company has general procedures for waste disposal

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

Industrial Hygiene Items 4.6

No Industrial Hygiene procedure exists.

Basic procedure exists but is not enforced.

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

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

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




A B C D

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

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

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

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

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

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

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

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




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

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




A B C D

Section 6: Implementation and Performance Monitoring (contd)

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 contractors 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

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




A B C D

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

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 follow-up on action items

Section 8: Emergency Response Procedure Emergency Response Procedure : Item 8 No written Emergency Response.

Basic procedures only. 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.

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

Company is a member of at least one HSE association

Company is an active participant in at least one HSE association



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.

A B C D Subtotal Factor Total

SECTION 1 LEADERSHIP AND COMMITMENT 0 4 8 12

SUBTOTAL X1

SECTION 2 POLICY AND STRATEGIC OBJECTIVES

SECTION2 ITEM 2 .1

SECTION2 ITEM 2 .2

0

0

4

4

8

8

12

12

Subtotal X1/2

SECTION 3 ORGANIZATION, RESPONSIBILITY, RESOURCES, STANDARDS AND DOCUMENTATION

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

SECTION 3 ITEM 3.5

0

0

4

4

8

8

12

12

SECTION 3 ITEM 3 .6 (A B) 0 4 8 12

SECTION 3 ITEM 3 .7 (A B) 0 4 8 12

Subtotal X1/7

SECTION 4 HAZARDS AND EFFECT MANAGEMENT

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 X1/7

TOTAL (SECT 1-SECT 4)



SUBTOTAL (SECT 1 SECT 4)

A B C D Subtotal Factor Total

SECTION 5 PLANNING AND PROCEDURE

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



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 X1/4

SECTION 7 AUDIT AND REVIEW 0 3 7 10

SUBTOTAL X1

SECTION 8 EMERGENCY RESPONSE PROCEDURE 0 3 7 10

SUBTOTAL X1

SECTION 9 HSE MANAGEMENT ADDITIONAL FEATURES 0 2 5 8

SUBTOTAL X1

TOTAL RATING (SECT 1 SECT 9)



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 NAME TITLE TITLE DATE 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.


Appendix III. Selection Forms

CSMS

New Contracts

Data Bank

Pre-Qualification


Qualification Phase: Select A Qualified Contractor

Contract Award



Selection



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)



Appendix III.2. Form CSMS/SL/02:

EXAMPLE OF EXHIBIT H HEALTH, SAFETY, AND ENVIRONMENT

(Attached and part of Contract No.______________)

1. COMPANYS 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 COMPANYs 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 above-mentioned HSE requirements.

2. CONTRACTORS 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 COMPANYs 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 Contracts 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



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 CONTRACTORs 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, CONTRACTORs and COMPANYs Representatives and other related parties shall conduct a meeting to communicate work implementation including but not limited to review the COMPANYs and Contractor HSEMS, HSE Plan, risk assessment, interface plan, KPIs, emergency procedure, accident & incident reporting, peoples 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 CONTRACTORs arrival at the worksite. CONTRACTORs and COMPANYs Representatives must complete the Pre Job Activity Checklist.



3.2. Work In Progress CONTRACTORs and COMPANYs 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 CONTRACTORs and COMPANYs 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 CONTRACTORs and COMPANYs 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 KPIs 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 COMPANYs 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 COMPANYs 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, CONTRACTORs On-Site 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.



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 Checked

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 Executives or the Managers 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 contractors 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 contractors 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



Table 1 Checklist for HSE Plan (cont.)


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

Implementation and Performance Monitoring

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

Contractor has a procedure for investigating incidents.

Auditing and Review

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



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 Details

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 contractors personnel

Standards for contractors equipment

Training requirements (including site HSE induction)

Job/services description

Contractors personnel assigned

Contractors equipment/consumables/services assigned

Companys personnel assigned

Companys equipment/consumables/services assigned

Subcontractors 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.)



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



Section 1 Leadership and Commitment


Leadership and Commitment

Commitment to HSE aspects through leadership

Senior management should engender commitment to HSE issues at all levels through their personal style of leadership and management. Key elements include:

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. 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


HSE Policy Statement

General 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

Content 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 members HSE competencies, responsibilities and function.

Organisation clearly shows position of HSE professionals



HSE Organisation (contd)

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/ communications

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

Companys expectations on HSE management to be communicated in depth.

Access of contractors 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 contractors 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 Role of the contractors HSE advisers well defined

Job definition drafted.

Reporting/ follow-up

Reporting relationship with line management.

Direct access to the Chief Executive.

Does line management follow-up on advice offered.

HSE department Contractors 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 contractors HSE management in preparing and implementing:

operating and emergency plans manuals



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 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.

Identification Subcontractors to be identified at this stage of the project. Maintenance of approved subcontractor lists where HSE has been

considered.

Coverage/ awareness

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?

Where action is not agreed, is it explained why?

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.

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)



bulletins posters, etc.

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

Promotional methods

Possibilities include:

small give-aways with the HSE message competitions suggestion schemes

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

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 On-the-job orientation for supervisory staff. Established procedure in relation to follow-up of all new employees at the

worksite.

New employees Adequately trained and confident of their own abilities. Coached to improve their work practices rather than blamed for mistakes.

Accountability Employees know they are accountable for HSE performance. Aware that their HSE performances part of the contractors 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

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.

Course content Effective system for establishing the need for and the content of training courses.

Determining course effectiveness and relevance of training assessed.

Specialised Relevant training given to personnel prior to the execution or hazardous



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 contractors identification of regulations, codes and standards

Definition of the legislation, codes, standards, etc. reflecting the companys previous experience.

For contracts carried out i separate countries: different legislation requirements company assistance for foreign contractors

HSE Standards

Availability 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.

Control/ authorisation

Controlled documents Updated regularly Approval level indicated Procedure for obtaining deviations from standards Responsibility for authorization Standards in line with company requirements

Coverage Clear reference to national and international standards. Setting minimum requirements on health, safety and environmental

issues.

Section 4 Evaluation and Risk Management Checklist items Checked

Methods and Procedures for Hazards and Effects Management

Coverage Company assessment used as a starting point with additional hazards identified by the contractor.

Contractors 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 awareness

Contractor able to use material from previous similar projects and demonstrate awareness from past experience.

Coverage Contractor develops assessment of the scope and degree of exposure of



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

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.

PPE instruction/ training

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


HSE Procedures

Availability/ control

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

Deviations Procedure for obtaining. Responsibility and level.

Recording of authorised deviations.

Omissions Identify whether there are any areas where procedures for hazardous operations are not drafted.

Commitment to prepare.

Permit to work (PTW).

System in place. If the contractors own system is utilised, is it consistent with industry norms

and in line with company guidelines?

Training/ qualification

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

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



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

Potential use of company guidelines

Awareness By employees of procedures

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

Plans 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:

registry classification licensing survey test certification

Critical items for HSE inspection

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.

Schedule 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



Sufficient for day-to-day needs and consistent with relevant health programmes.

Adequate provision for supply of drugs, antidotes, etc.

Staffing Availability of adequately trained, experienced staff. Access to medical treatment facilities (if external).

Contingency, plans

Defined for possible incidents beyond capability of site facilities.

Accommodation 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.

Promotion Promotional material available to assist in maintaining standards. Appropriate for the contractors workforce in terms of:

Language. clarity, etc.

Hygiene and housekeeping

Procedures on on-site cleanliness and maintenance.

Environmental

Awareness Workforce aware of requirement to protect the environment whilst executing contract

Control Identify potential environmental hazards.

Develop procedures for handling materials and performing operations that may damage the environment.

Contingency plans.

Aims 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.

Monitoring/ restoration

Environmental monitoring to gauge the impact of operations. Plans appropriate and sufficiently detailed. Recovery and restoration of site after contract completion.

Audits Environmental audits of operations during the contract. Carried out by experienced individuals or companies.

Road Safety

Drivers: Competence and selection Driving Permits Driver induction Driver training

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

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

Local area characteristics and regulations

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



Driver Improvement

Selection

Vehicle specification Passenger Freight Vehicle maintenance

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

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

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

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

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


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

Availability and use of performance records. Feedback/review/discussion at HSE meetings. Presentation and distribution to employees.

Comparison of performance

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



misses, etc.)

environmental incidents (spilages, releases, contamination, etc.) other safety incidents (safety equipment failures, loss of capital

equipment)

material loss

Methods 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


HSE Auditing

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

Scope Compliance with the HSE Plan including:

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

Coverage 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.

Effectiv

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