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KUWAIT NATIONAL PETROLEUM COMPANY PRE-QUALIFICATION FOR ENGINEERING, PROCUREMENT AND CONSTRUCTION (EPC) CONTRACTORS PRE-QUALIFICATION QUESTIONNARIE SECTION

7 HEALTH, SAFETY AND ENVIRONMENT (HSE) FORM 7-1

Applicant Safety Performance Injury and Illness Data a. Employee hours worked last three years: Provide the following data: 2008 No. Rate Injury resulting in fatality Total No. of fatalities x 200,000 Fatality Rate= _________________ Total Employee Hours No. of Accidents resulting in Lost work day Cases (LWC) Total No. of LWC X 200,000 ________________ Total Employee Hours 2009 No. Rate 2010 No. Rate

Hours Year: Field: Total:

2008

2009

2010

LWC Rate =

No. of accidents other than lost work Day Cases No. of Non-LWC X 200,000 LWC Rate = _________________ Total Employee Hours Highest ranking safety/health/environment professional in the company: Title Telephone Fax: Yes Yes Yes Yes Yes No No No No No

Do you have or provide: a) Full Time Safety/Health /Environment Engineer b) Full Time Site Safety/Health /Environment Engineer c) Full time Job Safety/Health/Environment Officer Do you have a written Safety and Health Program? Does the program address the following key elements? -Management commitment and expectation

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KUWAIT NATIONAL PETROLEUM COMPANY PRE-QUALIFICATION FOR ENGINEERING, PROCUREMENT AND CONSTRUCTION (EPC) CONTRACTORS PRE-QUALIFICATION QUESTIONNARIE SECTION 7 HEALTH, SAFETY AND ENVIRONMENT (HSE) FORM 7-1

-Employee participation -Accountabilities and responsibilities for managers, Supervisors, and employees -Resources for meeting safety & Health requirements -Periodic Safety and Health performance appraisals for all employees -Hazard recognition and control Do you have written programs for the following: a) Hearing Conservation b) Respiratory Protection Where applicable, have employees been: Trained Fit Tested Medically approved c) Hazard Communication Do your employees read, write and understand English/Arabic such that they can perform their job tasks safety without an interpreter? If no, provide a description of your plan to assure that they can safely perform their jobs. Medical a) Do you conduct medical examination for: - Pre-employment - Replacement job Capability - Pulmonary - Respiratory b) Describe how you will provide first aid and other Medical services for your employees while on site Specify who will provide these services : _________________ c) Do you have personnel trained to perform first aid and CPR?

Yes Yes

No No

Yes Yes

No No

Yes

No

Yes

No

Yes

No

Yes

No

Yes Yes Yes Yes Yes

No No No No No

Yes

No

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KUWAIT NATIONAL PETROLEUM COMPANY PRE-QUALIFICATION FOR ENGINEERING, PROCUREMENT AND CONSTRUCTION (EPC) CONTRACTORS PRE-QUALIFICATION QUESTIONNARIE SECTION 7 HEALTH, SAFETY AND ENVIRONMENT (HSE) FORM 7-1

Do you hold site safety and health meetings for: Field Supervisors Employees New Hires Are the Safety and Health meetings Documented?

Yes Yes Yes

No No No Yes Yes Yes

Frequency_____ Frequency_____ Frequency_____ No No No

Personal Protection Equipment (PPE) a) Is applicable PPE provided for employees? b) Do you have a program to assure that PPE is Inspected and maintained? Do you have a corrective action process for addressing individual safety and health performance deficiencies? Equipment and Materials: a) Do you have a system for establishing applicable health Safety, and Environmental specifications for acquisition of Materials and equipment? b) Do you conduct inspections on operating equipment (e.g. Cranes, Forklifts, and JLGs) by third party agencies eg? Lloyds BV etc c) Do you maintain operating equipment in compliance with Regulatory requirement? d) Do you maintain the applicable inspection and maintenance Certification records for operating equipment? Inspection and Audits a) Do you conduct Safety and Health Inspections? b) Do you conduct Safety and Health program audits? c) Are corrections of deficiencies documented? Safety and Health Orientation a) Do you have a Safety & Health Orientation Program for new hires and newly hired or Promoted supervisors? b) Does program provide instruction on the following: - New worker Orientation?

Yes

No

Yes

No

Yes Yes

No No

Yes

No

Yes Yes Yes New Hires


Yes
No

No No No Supervisors
Yes No

Yes

No

Yes

No

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KUWAIT NATIONAL PETROLEUM COMPANY PRE-QUALIFICATION FOR ENGINEERING, PROCUREMENT AND CONSTRUCTION (EPC) CONTRACTORS PRE-QUALIFICATION QUESTIONNARIE SECTION 7 HEALTH, SAFETY AND ENVIRONMENT (HSE) FORM 7-1

-Safe Work Practices -Safety Supervision -Toolbox Meetings -Emergency Procedures -First Aid Procedures -Incident Investigation -Fire Protection and Prevention

Yes Yes Yes Yes Yes Yes Yes Yes

No No No No No No No No No

Yes Yes Yes Yes Yes Yes Yes Yes

No No No No No No No No No

-Safety Intervention -Hazard Communication c) How long is the Orientation program?

Yes

Yes

Hours Safety & Health/Environment training a) Do you now the regulatory safety health and Environments training requirements for your Employees? b) Have your employees received the required Safety & Health and Environment training and retraining? c) Do you have as specific Safety & Health and Environment training program for Supervisors? Do you have an Environmental Management System? If yes, attach a copy of the policy. Have you obtained accreditation under any Standards/System viz ISO14001? If Yes, attach the relevant certificates. Do you carry out Environmental Audit of your facilities? Yes Please furnish the detail on frequency, internal/external and copy of the last audit. Do you practice Environmental guidelines in storage of Hazardous chemical, Materials at site/facilities? Yes No No

Yes Yes Yes

No No No

Yes

No

Yes

No

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KUWAIT NATIONAL PETROLEUM COMPANY PRE-QUALIFICATION FOR ENGINEERING, PROCUREMENT AND CONSTRUCTION (EPC) CONTRACTORS PRE-QUALIFICATION QUESTIONNARIE SECTION 7 HEALTH, SAFETY AND ENVIRONMENT (HSE) FORM 7-1

If yes, furnish the code/standards of guidelines.

Do you take/adopt necessary precautions to control fugitive emissions form the site/facilities? If yes, furnish the methods/standards. Do you practice Environmental guidelines/standards in manufacturing facilities to reduce the air emissions, water & solid waste at the source? If yes, brief the measures taken at your facilities. Do you have procedures for taking appropriate actions to contain accidental spills/releases from the site/facilities? If yes, furnish the brief details. Has your organization at any time been subject to enforcement action by statutory authorities for violating Environmental regulations? If yes, furnish the brief details. What is the percentage towards Environmental expenses on your annual turnover? Are you aware of the prevailing environmental regulations in the state of Kuwait? INFORMATION SUBMITTAL Please provide copies of checked ( ) item with the completed PQF:
____ ____ ____ ____ ____ Insurance Certificate (s) Safety & Health Program Safety &Health Incentive Program Hazard Communication Program Respiratory Protection Program

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

____Environmental Policy ____ Accreditation Certification ____ Environmental Audit Reports & Procedures ____ Environmental Training Program (Outlines) ____ Procedure for spill control/fugitive emission

____ Housekeeping Policy ____ Accident/Incident Investigation Procedure ____ Unsafe Condition, Reporting Procedure, Control, etc.

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KUWAIT NATIONAL PETROLEUM COMPANY PRE-QUALIFICATION FOR ENGINEERING, PROCUREMENT AND CONSTRUCTION (EPC) CONTRACTORS PRE-QUALIFICATION QUESTIONNARIE SECTION 7 HEALTH, SAFETY AND ENVIRONMENT (HSE) FORM 7-1

____ ____ ____ ____

Safety Inspection Audit Procedure or form Safety & Health Training Program (Outline) Example of Employee Safety & Health Training Records Safety & Health Training Schedule (Sample)

Authorized Signature:________________________________ Name:__________________________ Date: _____________

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