(598295696) 08.0 Article 3.0 Section D - HSE (27012015)

Policy/Plan/Program:
ID-G-BU-00000-00000-00362 Rev.7
Contractor Health, Safety & Environmental Management System (C-HSE MS)
ConocoPhillips Indonesia
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Appendix D.1 - Contractor HSE PQ Questionnaires

COPI-HS-FR-00035 rev.4
Contractor HSE PQ Questionnaires

GENERAL INFORMATION
Company Name
Address
Telephone
Fax
Email
Company core business
Work experience in the
current core business
Contact Person
Title
Telephone
Fax
Email
SECTION 1 LEADERSHIP AND COMMITMENT

1. Com m i tm en t to H SE thr oug h l ead ershi p
a) How do senior managers as 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) Does your company have a HSE Management System? (Yes/No)

If yes, please attach.
ID-G-BU-00000-00000-00362 Rev.7
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Hints: (Please provide)
Provide evidence of Senior Management involvement in HSE matters (e.g. trip plan and report, safety
messages, HSE meeting attendance list, etc), organization chart
SECTION 2 POLICY AND STRATEGIC OBJECTIVES

2 .1 . H SE P olicy & Docum ents
a) Does your company have an HSE policy document that is applied in this region? (Yes/No)
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 . A vai labil ity of P o licy Stat em en ts to Em ploy ees

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

HSE policy
Evidence of communication (distribution list, display on bulletin board, email or letter

announcement, etc)
SECTION
3:
ORGANIZATION,
RESPONSIBILITY,
RESOURCES, STANDARDS AND DOCUMENTATION
3 .1 . Or ganiz a tions - Co m m i tm en t an d Co m m un icatio n

a) Provide your current Organization chart!
b) How is management involved in HSE activities, objective setting and monitoring?
c) What provision does your company make for HSE communication and meetings?

HSE meeting program and schedule at all level
Evidence of implementation (minutes of meeting, attendance list, presentation material
3 .2 . Staff H SE Traini ng P rogram

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)

HSE training program for staff
HSE Training matrix for staff (training matrix is training requirement for each position)
HSE training record for all staff related to the work

3 .3 . Em ploy ee Com petence an d G en eral H SE Tr aining
a) What arrangements does your company have to ensure employees have knowledge of basic
ID-G-BU-00000-00000-00362 Rev.7
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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?

HSE training program for existing and new employee
Orientation materials (booklet, hand out, etc),
HSE Handbook (outlines, explains and demonstrates new employee's job)
Evidence follow up observation of new employees work

3 .4 . Sp ecializ ed H SE Tr aining
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 . H SE Qualified S taf
Does your company have HSE specialist (related to your company's services) who can provide training
for other employees? (Yes/No)
If Yes, please provide the curriculum vitae

HSE specialized training program, including retraining period (e.g. radioactive, asbestos,
explosive, diving, etc)
List of qualified HSE professional employee
3 .6 . A ssessm en t of Sui t abili ty of Su bcon tract or s

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?

Assessment program and standard for subcontractor
Records/reports of assessment (e.g. pre qualification) and performance monitoring (e.g. work
in progress audit) results
3 .7 . H SE R egula tio ns a nd S tandar ds

a) What kind of HSE standards and regulations that your company refers to for the intended service?
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b) How do you ensure these are met and verified?
c) How do you update the standard and its dissemination?

List of HSE regulations and standards and its references (e.g. local, global industry regulatory
standard)
SECTION 4: HAZARDS AND EFFECT MANAGEMENT

4 .1 . H az ards an d Ef ect M anagem ent
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.

Hazards and effects management procedure/guideline
Sample of HSE hazards and effects management implementation (e.g. record of risk
assessments: JSA, HAZID, HAZOP, HAZAN, QRA, etc)
4 .2 . Ex posu re of th e W o rk force
What systems are in place to monitor the hazard's exposure of your workforce e.g. chemical or
physical agents?

Communication mechanism (e.g. email, orientation, notice board, safety sign, etc) to the
workforce of the major hazards that they are likely to be exposed
Result/report of hazards exposure monitoring (Chemical, physical and biological hazards such
as noise, radiation, vapors, fumes, temperature extremes etc.)
4 .3 . H andli ng of P ot en tial H az ards (chemical, physical and biological hazards such
as noise, radiation, vapors, fumes, temperature extremes, etc.)
How is your workforce advised on potential hazards, e.g. chemicals, noise, radiation, etc., encountered
in the course of their work?

Hazard Communication program (Chemical, physical and biological hazards such as noise,
radiation, vapors, fumes, temperature extremes etc.)
Database of potential hazards properties (e.g. MSDS, etc)
4 .4 . P ers onnel P rot ecti ve Equi pm en t

a) What arrangements does your company have for provision and upkeep 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.
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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?

List of PPE as company standard
PPE procedure
PPE inspection records
PPE inventory and training records
4 .5 . W ast e M a nag em ent

a) What systems are place for identification, classification, minimization and management of waste3
b) How do you ensure these are incompliance with local regulation?
c) 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.
d) Do you have procedures for waste disposal? (Yes/No)
e) Do you have procedures for spill reporting? (Yes/No)
f) Do you have procedures for spill clean up?(Yes/No)
g) Please provide details at any of your equipment related to environmental matters.
h) Do you assign an expertise to coordinate the environmental and how to ensure his/her
competencies?

Company waste management procedure/system
Evidence implementation of waste management system (waste identification/classification,

waste matrix, waste manifest/record)
4 .6 . I ndus trial H y giene

a) Do you have an industrial hygiene program? (Yes/No)
Please describe this process. If Yes, please provide the list.
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b) How do you identify industrial heath/hygiene?

c) If you procure hazardous substance, please explain the process of documentation and its
supervision

Industrial Hygiene program (e.g. Respiratory protection, noise protection, ergonomic, indoor air
quality control, illumination control, house keeping, personal hygiene)
Evidence of health hazards identification (monitoring results, e.g.: noise measurement,
illumination level, etc) and control mechanism (e.g. providing PPE, providing appropriate tools
for manual handling, shift control duration, providing barriers, etc)
4 .7 . Dr ugs a nd A lcoh ol
Do you have a drugs and alcohol policy in your organization? (Yes/No) If yes, please attach

Drugs and alcohol policy
Evidence of communication (distribution list, display on bulletin board, email or letter

announcement, etc)
Drugs and alcohol program (e.g. random check)
SECTION 5: PLANNING AND PROCEDURES

5 .1 . H SE and Operati on s P rocedur es / M anuals
a) Do you have HSE and Operations procedures manuals? (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?

HSE and Operations procedures manuals
HSE Document control procedure (e.g. system for updating and dissemination to employees)
5 .2 . Eq uip m ent Con trol and M ain tena nce

How do you ensure that plant and equipment used within your premises, 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?

Equipment inspection/certification and maintenance program
Evidence of third party inspection/certification
Evidence of equipment inspection records (internal) and follow up
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5 .3 . Trans por t Safety M anagem en t a nd M ain ten ance

What arrangement does your company have for vehicle incidents prevention?

Land transportation procedure
Evidence of implementation (e.g. drivers training, vehicle inspection and maintenance, vehicle
incident prevention program, etc)
SECTION 6: IMPLEMENTATION AND PERFORMANCE MONITORING

6 .1 . H SE M anag em en t a nd P erfor m ance M o ni tor ing of W or k A ctivi ties
a) What arrangement(s) does your company have for supervision and monitoring of HSE performance?
Please explain the criteria.
b) What arrangements does your company have for passing on any results and findings of this
supervision and monitoring to your:
(i) Base management
(ii) Site employees
c) Has your company received any award for HSE performance achievement? (Yes/No)

Company HSE performance monitoring system (e.g. procedure, man hours recording system,
incidents count and analysis, HSE performance reward program, etc)
Evidence of HSE performance recognition from clients
6 .2 . S tatu t ory N ot ifiab le I ncid en ts/ Dan ger ous Occurr ences, I m pr ovem
en t R equi rem en t and P ro hi bit ion N o tices
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.
Letter received from regulatory body regarding major incident in the last five years
Record of incident case occurred in your company
6 .3 . H SE P erfor m ance R ecords
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
Days Away From Work Cases (DAFWC) or LTIs
Total Recordable Cases (e.g. Medical Treatment, Restricted Work, Transfer to Another Job,
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Unconsciousness)
b) How is health performance recorded?
c) How is environmental performance recorded?

Injury rate (latest year injury rate comparison to contractors three preceding years average)
with reference to national and or international standard (e.g. Depnaker, OSHA, ANSI, etc)
6 .4 . I ncid ent I nves ti gat ion a nd R epor ti ng

a) Do you have a procedure for the investigation, reporting and follow-up of accidents, dangerous
occurrences or occupational illnesses? (Yes/No)
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.
c) Do you report lesson learn of any near miss ?

Incident reporting and investigation procedure
Evidence of incident report and investigation result
Evidence of incident investigation result/finding sharing (e.g. root cause and lesson sharing
using email, notice boards, etc)
Evidence of HSE performance improvement initiatives based on incident learning
SECTION 7: AUDIT AND REVIEW

a) Do you have a written policy on HSE auditing? (Yes/No)
b) How does this policy 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?
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Audit procedure
Audit program and implementation (schedule, coverage, audit team, report and follow up, etc)
SECTION 8: EMERGENCY RESPONSE PROCEDURE

Do you have an emergency response plan? (Yes/No).
How do you maintain readiness of the plan? And explain the command structure?

Emergency response plan/procedure
Emergency response team structure
Exercise program (schedule and report of drill and table top)
Evidence of communication (e.g. distribution list, email or letter announcement, etc)
SECTION 9: HSE MANAGEMENT - ADDITIONAL FEATURES

a) Does your company hold association(s) membership? (Yes/No)
If yes, please provide the list.
b) Is there any aspect of your HSE performance that you believe differentiates yourselves from your
competitors that not described elsewhere in your response to the questionnaire?
If yes, please explain.

List of association membership
Certificate of association membership (e.g. KADIN, APINDO, IAKKI, AK3, BSC)
Evidence of active participation in HSE association (e.g. attending association event, etc)
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Appendix D.2 - Contractor HSE PQ Evaluation Criteria

COPI-HS-FR-00084 Rev. 2
Contractor HSE PQ Evaluation Criteria

LEGEND:
= Mandatory
= Medium (M) Risk
= Significant (S) Risk
= M & S Risk
= S & H Risk
= M, S & H Risk
= High (H) Risk
GRADING CRITERIA:
A. Systems do not exist or are informal. Little awareness observed in the work force.
B. Requirements have been defined and a plan is in place but compliance is inconsistent.
C. Systems required to meet the expectation are in place. Compliance with processes and procedures
is good.
D. Systems required to meet the expectation are in place and compliance is assured. Best in class
performance is demonstrated.
Evidence
of
active
senior
management
involvement in HSE
aspects
Evidence of a positive
HSE culture in senior
management and at all
levels
Section 1: Leadership and Commitment

Commitment to HSE through leadership: Item 1(1)(a) (d)
No commitment from
senior management
HSE
disciplines
delegated
to
line
managers no direct
involvement by senior
management
Section 2: Policy and Strategic Objectives

HSE policy, documents and availability of Policy Statements to Employees: Items 2(1)(a) (c) and 2(2)
A policy statement exists A policy statement exists
but
responsibility for with clear responsibility
HSE is unclear.
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, Responsibility, Resources, Standards and Documentation

Organizations - Commitment and Communication : Item 3(1)(a) - (c)
No
management
involvement
or
commitment
toward
HSE activity
Management involvement
and commitment toward
HSE in special occasion
only, likewise for periodic
HSE meetings.
Staff HSE training Program: Item 3(2)
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
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A
No
HSE
established
training
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.
Employee Competence and General HSE Training : Item 3(3)(a) - (b)

No formal program
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-thejob
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 and HSE Qualified Staff : Items 3(4) and 3(5)
No specialized HSE
training established
Specialized HSE training Specialized

HSE Specialized
HSE
established
but
not training established and training established and
implemented.
implemented.
implemented
on
a
regular
basis.
Retraining periods are
established.
Qualified
HSE professional are
employed.
Assessment of Suitability of Subcontractors : Item 3(6)(a) - (b)

No assessment program Assessment program and
for
subcontractor standards
for
established.
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 regulations and

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

standards established
and in compliance with
local
and
global
industry
regulatory
standards.
HSE Regulations and Standards: Item 3(7)(a) - (c)

No HSE regulations and
standards available
HSE
regulations
and
standards established for
limited purposes only or
partial and in compliance
with
local
industry
regulatory standards only.
Section 4: Hazards and Effects Management

Hazards and Effect Management: Item 4(1)
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A
Company's HSE system Company's HSE system

does not include hazards makes reference to the
and effects assessment
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
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
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
Handling of 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 onsite
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.
Personal Protective Equipment: Item 4(4)(a) (d)

Basic PPE provided to
personnel
but
no
corporate procedure for
assessing
individual
needs
PPE
requirements PPE
requirements
formally assessed but formally assessed with
little effort made to spot checks on usage
ensure correct 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) (h)

Company has no formal Company has general Company
has
methods for the control procedures for waste procedures
for
the
of waste
disposal
disposal of each of the
main categories of site
wastes but makes no
provision for minimizing
environmental impact
Industrial Hygiene : Item 4(6) (a) (c)
Company has a formal

system
for
waste
management (including
identification,
minimization
and
classification),
which
actively
seeks
to
minimize environmental
impact
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A
No Industrial Hygiene
program exists.
Basic industrial hygiene A program exists and A program exists which

program exists but is not recognizes hazards but manages operations to
enforced.
is not followed up.
minimize human health
impacts providing a
workplace
free
of
recognized health
Drugs and Alcohol : Item 4(7)

No alcohol and drugs
policy written
An alcohol and drugs

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

policy
includes
establishing
responsibility
and
accountability,
and
widely distributed
Drugs
policy
with
clearly
established
responsibility,
accountability,
and
disciplinary clause is
distributed
to
all
employees;
and
is
visible on notice boards
Section 5: Planning and Procedures

HSE and Operations Procedures / Manuals : Item 5(1)(a) and (b)
No
HSE
and
Operations procedures
/ manuals is available
Basic HSE procedures /

manuals exist
Contractor has written

HSE and Operations
procedures / manuals
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
program
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
Equipment Control and Maintenance: Item 5(2)

No defined program 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 and Maintenance: 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
Section 6: Implementation and Performance Monitoring

HSE Management and Performance Monitoring of Work Activities: Item 6(1)(a) (c)
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A
No system for formally Informal/incidental

monitoring
HSE monitoring
performance at all
performance only
HSE
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
Statutory notifiable incidents, dangerous occurrences, improvement requirements and prohibition notices:
Items 6(2)
More
than
one One occurrence of a Occurrences relate to
occurrence
of
major major incident in the last minor incident(s) only
incident in last five years five years
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 Rate is not improving
insufficient information to
establish rate or rate
increases
Shows only minor rate

improvement
Rate steadily improving

by more than 20 per
cent per year
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
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
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.
Incident Investigation and Reporting: Item 6(4)(a) - (c)

Procedure are available Procedure are available
but
Findings
not and
Findings
generally communicated communicated to key
personnel only via limited
company internal memo
or similar media
Section 7: Audit and Review
Audit and Review : 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
Response.
Basic procedures only.
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A
Section 9: HSE Management - Additional Features

Membership of Associations: Items 9(a) and (b)
No memberships
Company
has Company is a member
Membership of at least of at least one HSE
one association but with association
no prominence given to
HSE
Company is an active
participant in at least
one HSE association
ID-G-BU-00000-00000-00362 Rev.7
Appendix D.4 - Contractor HSE PQ Evaluation Result

COPI-HS-FR-00067 Rev. 4
Contractor HSE PQ Evaluation Result

Company Name:
Address:
Telephone:
Facsimile:
Email:
Contact Person:
Company Core Business
Work experience in the core business:
Circle the number, which best represents this evaluation based on the criteria for rating purposes attached.
Section 1 Leadership and Commitment
Subtotal
Section 2 Policy and Strategic Objectives
Subtotal
Section 3 Organization, Responsibility, Resources,
Standards and Documentation
Item 3 (1) - Organizations - Commitment and
Communication
Item 3 (2) - Staff HSE training Program
Item 3 (3) -Employee Competence and General HSE
Training
Item 3 (4) and 3 (5) - Specialized HSE Training and HSE
Qualified Staff
A
0
B
4
C
8
D
12
12
12
12
12
12
Item 3 (6) - Assessment of Suitability of Subcontractors
12
Item 3 (7) - HSE Regulations and Standards

Subtotal
Section 4 Hazards and Effect Management
Item 4 (1) - Hazards and Effect Management
Item 4 (2) - Exposure of the workforce
Item 4 (3) - Handling of Potential Hazards
Item 4 (4) - Personal Protective Equipment
Item 4 (5) - Waste Management
Item 4 (6) - Industrial Hygiene
Item 4 (7) - Drugs and Alcohol
Subtotal
Section 5 Planning and Procedures
Item 5 (1) - HSE and Operations Procedures / Manuals
Item 5 (2) - Equipment Control and Maintenance
Item 5 (3) - Transport Safety Management and
Maintenance
Subtotal
Section 6 Implementation and Performance
Item 6 (1) - HSE Management and Performance
Monitoring of Work Activities
Item 6 (2) - Statutory notifiable incidents, dangerous
occurrences, improvement requirements and prohibition
notices
Item 6 (3) - HSE Performance Records
Item 6 (4) - Incident Investigation and Reporting
12
0
0
0
0
0
0
0
4
4
4
4
4
4
4
8
8
8
8
8
8
8
4
4
8
8
12
12
12
12
12
0
0
4
4
8
8
12
12
Subtotal
Section 7 Audit and Review
Subtotal
10
Section 8 Emergency Response Procedure
Subtotal
Factor
Total
1/6
0.00
1/7
0.00
1/3
0.00
1/4
0.00
12
12
12
12
12
12
12
0
0
Subtotal
10
Section 9 HSE Management Additional Features
Subtotal
Total Scoring (Sect 1 Sect 9)
8
0
0
0.00
Evaluation Date:
Validation Date:
For a bidder to qualify as acceptable, the minimum passing score must be equal or more than 65.24 for high risk work, 54.10 for
significant risk work, and 46.48 for medium risk work. The evaluation result is valid for 2 year. This validity can be revoked at any time if
the contactors fail to perform or due to other justifiable reasons such as contractor make any significant or noticeable changes. Your
commitment to HSE is highly appreciated.
EVALUATED BY:
NAME:
ACKNOWLEDGE BY:
NAME:
TITLE:
TITLE:
Coordinator CHSEMS

(598295696) 08.0 Article 3.0 Section D - HSE (27012015)

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(598295696) 08.0 Article 3.0 Section D - HSE (27012015)

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Appendix D.1 - Contractor HSE PQ Questionnaires

Contractor HSE PQ Questionnaires

Company core business

Work experience in the

current core business

SECTION 1 LEADERSHIP AND COMMITMENT

b) Provide evidence of commitment at all levels of the organization by:

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

d) Does your company have a HSE Management System? (Yes/No)

SECTION 2 POLICY AND STRATEGIC OBJECTIVES

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

2 .2 . A vai labil ity of P o licy Stat em en ts to Em ploy ees

Hints: (Please provide)

Evidence of communication (distribution list, display on bulletin board, email or letter

3 .1 . Or ganiz a tions - Co m m i tm en t an d Co m m un icatio n

Hints: (Please provide)

3 .2 . Staff H SE Traini ng P rogram

Hints: (Please provide)

HSE training record for all staff related to the work

Hints: (Please provide)

Orientation materials (booklet, hand out, etc),

HSE Handbook (outlines, explains and demonstrates new employee's job)

Evidence follow up observation of new employees work

Hints: (Please provide)

3 .6 . A ssessm en t of Sui t abili ty of Su bcon tract or s

Hints: (Please provide)

3 .7 . H SE R egula tio ns a nd S tandar ds

c) How do you update the standard and its dissemination?

Hints: (Please provide)

SECTION 4: HAZARDS AND EFFECT MANAGEMENT

Hints: (Please provide)

Hints: (Please provide)

Hints: (Please provide)

4 .4 . P ers onnel P rot ecti ve Equi pm en t

c) Do you provide training on how to use PPE? (Yes/No)

d) Do you have a program to ensure that PPE is impacted and maintained?

Hints: (Please provide)

PPE inspection records

PPE inventory and training records

4 .5 . W ast e M a nag em ent

e) Do you have procedures for spill reporting? (Yes/No)

f) Do you have procedures for spill clean up?(Yes/No)

g) Please provide details at any of your equipment related to environmental matters.

Hints: (Please provide)

Evidence implementation of waste management system (waste identification/classification,

4 .6 . I ndus trial H y giene

b) How do you identify industrial heath/hygiene?

Hints: (Please provide)

Hints: (Please provide)

Evidence of communication (distribution list, display on bulletin board, email or letter

SECTION 5: PLANNING AND PROCEDURES

Hints: (Please provide)

5 .2 . Eq uip m ent Con trol and M ain tena nce

Hints: (Please provide)

Evidence of third party inspection/certification

Evidence of equipment inspection records (internal) and follow up

5 .3 . Trans por t Safety M anagem en t a nd M ain ten ance

Hints: (Please provide)

SECTION 6: IMPLEMENTATION AND PERFORMANCE MONITORING

Hints: (Please provide)

b) How is health performance recorded?

c) How is environmental performance recorded?