CONTRACTOR SAFETY
COMPETENCY ASSESSMENT FORM
Organization Name:
Contractor Proprietor Name:
Organization Registered Address:
Business Registration Number:
Vendor Code:
Department:
‘Assessment Team:
Team Leader:
Team Member:
1
2.
3.
4,Annexure 13~Annual safety competency assessment'Star Rating System”
[(6 Star- 850-1000), (4 Star-750-849), (3 Star-650-749), (2 Star- 550-649), (1 Star- 450-549), (No Star-Less
than 450)]
Alll the requirements will be evaluated in a scale of 1 to 5 which will be weighted for star rating score
calculation.
Evaluation Criterion for Star rating and safety performance evaluation
Notinitiated the process /No System.
1 = Poor: weak safety system and process, Weak system of lead indicator identification, reporting
and compliance monitoring. Little awareness. Minimal or No ownership and commitment.
(Survival)
|
| 2 = Reasonable- Some system & process exists. Inconsistent system of lead indicator identification,
reporting and compliance monitoring. Awareness may be present but implementation of the
aspectof the Safety Management System is haphazard or notin evident at all. (Reactive stage)
3. = Good: Safety management system & process exists and documented, Improving trend of system
of lead indicator identification, reporting and compliance monitoring. The system is implemented
at minimum levels. Ownership and commitmentis visible at some extend. (Dependent stage )
4 = Very Good- Health and Safety Management System is addressed systematically and
documented and updated regularly, reaching the respective targets regularly. Good system of
lead indicator identification, reporting and compliance monitoring, Integration with other activities
athigh levels. Felt and visible ownership and commitment. (Independent stage)
5 = Excellent- Can be recognized as a leader in this particular aspect of the Health and Safety
Management System. Everyone is involved and high levels of integration and ownership &
commitment are demonstrated. Continuous improvements evident. (Interdependent stage)
“The contractor rated 3 Star or below will have to submit a Safety management system improvement
plan.“ype of Contract: Risk Parameter: (Risk of job where contractors to be engaged)
stign Rik: =
aiowrie -
abo - O
Manpower contract
‘Supervision contract:
Set apart contract:
Eee @
Transient contract:
Other Services: Oo
Tick the type of work the company is capable of undertaking,
Lifting equipment
Utlty Services
Maintenance and Services we
Building Maintenance
Electrical Maintenance and
Services
Mechanical Maintenance
Cleaning Services
and services
Transportation and Material
Handling
Instrumentation
Callration and Testing Catering Services
eet fT ge > he
‘Waste materials / slag /
reclaiming &cisposal Mining related activity
‘Manpower supply
Ling, Loading, Unioading
feeding & packaging Rail maintenance
Road maintenance
elas 2) a), a ee)
oO
Any Others, please
specify
Lene ta olsa|* oe
1. Whatistotal manpowerstrength of our organisation workingin Tata Stee!?
4.4 Numberof Supervisors and their qualification (Attach lis)
1.2. Numberofskited employees (Please attach ist of employee with skillevel)
4.3. Numberofunskiled employees:
4.4 Numberof Site Safety Supervisors and heir qualification (Attach list:
2. Total Value in Rupees working with Tata Steel (Less than § Lacs, >S lacs<25 Lacs, > 25 Laos< 1 crore, and> 1
crore) If more than one crore mention value.
3. Name of departments where you are engagedin currently in Tata Stee!
4, Organisational Structure of your organisation: (e.g. MD, GM, Managers etc)Attributes
SN
Requirements
Evaluation
(1055 scale)
Multiplying
factor
Max
Weighted
‘Score
‘Actual
Score
Audit
findings
14
Safety & Health
‘Management System
(Policy & Principles,
Safety Manuals, Safety
Organization) (Safety
manuals ~ (Look for HIRA
‘or JHA document, Legal
‘compliance system,
Emergency Planning
system, Safety dash
board, Safety audit &
review system,
Operational control, Asset
Management).
10
50
12
Procedure for selection
‘and deployment of skiled
employees, Managers,
‘Supervisors and Site
Safety Supervisors
10
50
4.0 Planning of
safety system
{and process:
13
‘Safety planning process
for safe execution of
jobs. (JHA, Audit pian,
‘Tools & equipment, Job
‘execution plan, HSE pian,
Permit required, Method
statement)
10
14
‘System and processes for
training on Safety
standard, Behavioural
based, Job specific, sil
development, emergency
preparedness for
employees and
supervisors,
10
50
15
‘System for two way
‘communication (Top ~
Bottom — Top) between
‘contractor leadership and
their workforce (Proprietor
engagement in line walk,
Safety meeting etc).
10
50
16
‘Annual assessment of
safety management
system & processes (Self
(or Third Party Audit)
10
2.0 Implementation]
Of safety system
and process
24
Capability of Workforce,
{(Skiled manpower,
‘Competent Supervisor,
Site Safely Supervisors
etc. )Verify through site
visit and Interview.
10
50
22
Conducting Tool box and
mass meeting regularly.
(Verify through Records
and Interview)
10Attributes
sn |
Requirements
Evaluation
(1t0 5 scale)
Multiplying
factor
Max
Weighted
Score
Actual
Score
‘Audit
findings
23
Providing & ensuring
sage of standard (IS/EN)
and right PPEs while
performing the job,
Ensure timely
replacements. (Verify
through site visit and
Interview),
10
50
24
Providing & ensuring safe
usage of standard,
certified and right tools &
tackles, equipment’s and
calibrated safety gadgets
(e.g, Gas detectors) while
performing the job. (Verify
‘through Reoords and Site
visit)
10
50
25
Ensuring a good
housekeeping free from
any slip / trip / fall hazards
at working sites. (Very
through site visit)
10
26
Self-Safety Initiative /
Project by contractor for
Safety Improvement
10
3.0 Chocking of
safely system
and procedures
aa
Contractor safety aucit by
the contractors!
supervisor and site safety
supervisors in the
field. (Verity records)
30
32
‘Corrective and preventive
action on self-audit report
specifically on 4 & 5
severity potential. (Verity
records & site visit)
30
33
‘Compliance to Generic
{and Specific Safety
clauses as per contract
(Verify through site visit |
and Interview based on
some Work order),
—s
4.0 Performance
rmeasure- Lead
Indicator
a4
Reporting, investigation
and learning of all incident
accident, Health issue.
30
42
Near miss and Unsafe act
condition reporting,
investigation and
corrective action.
30
43
‘Skil retention, amenities,
employees liability etc.
(Verify through records
‘and Interview)Attributes SN| Requirements Evaluation | Multiplying | Max | Actual | Audit
(1105 scale) | factor | Weighted | Score | findings
‘Score
44 | Campaign e.. (Safety 6 30
qui, Safety ki etc) o
develop Safety Culture.
(Weil through records
and Interview)
“45 | Reward, Recognition and 6 6 30
Consequence
Management System of
Contractor. (Very through
records)
5.4 | Zero Losttime feerious [0-60 score 60 60
injury or permanent ‘or more score
disability
z Tasco
52 | Zoro Fist aid case Dal sry ae aaa Be AS
5.0Periormance | 2 |Nor-injury incidents (eg. |0-20ser0 | af 890
are [oo Property Damage) ‘or more0 score
Fe :
imeret* 4 sasy von a om TG
reeleore potential of seventy 485
Peay {reference contractor
salty audit system)
85 | Safety noncompliance —_|0-20 score 2 a,
cost recovery /Penalty | 1-0 score 9°
imposed / Job stopped,
56 | Fatality yectecor 90 er
= -ve 200) score