Contractor Safety OHS-08/ R-0

Page 1 of 19

ADANI GROUP
OHS PROCEDURE FOR

Contractor Safety
OHS-08
DOCUMENT HISTORY:

Rev
Date Key Changes
No.
01/01/2016 0 Issued for implementation

Prepared by:

Ramakant Singh _____________________ 01 / 12 / 2015

Group Safety initiative (Signature) (Date)

Approved by:

Devprakash Joshi _____________________ 01 / 01 / 2016

COO Projects (Signature) (Date)

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 2 of 19

CONTENT

SR.
TOPIC PAGE NO.
NO.
1.0. PURPOSE & SCOPE 3

2.0. DEFINITIONS/ ABBREVIATIONS 3

3.0. PROCEDURE 3
3.1 - Contract and Contractor Classification 3

3.2 - Pre bid Contractor Selection and Review 4

3.3 - Contractor Mobilization and Work start Clearance 4

Requirements
3.4 - Contractor Safety compliance and Disciplinary Actions 5
3.5 - Contractor Incident record and Compliance
4.0. RESPONSIBILITIES 6

4.1 - The Business Site Head 6

4.2 - The Manager/ Head of Departments 6

4.3 - Engineer In Charge 6

4.4 - All Employees 7

4.5 - The Site Safety Head 7

4.6 - OHS frame work Element/Component owner 7

5.0. TRAINING 7
6.0. AUDITING 7

7.0. ATTACHMENTS & FORMS 7

 ANNEXURE-A: Site specific arrangement for Health & 9

Safety Plan and Policy
 ANNEXURE -1: Pre-Bid Contractor OHS 10
Qualification evaluation
 ANNEXURE -2: Contractor Mobilization and Work start 13
Clearance form
 ANNEXURE -3:Contractor Safety Performance 15
evaluation form
 ANNEXURE-4: Safety Noncompliance Intimation 16
 ANNEXURE-5: Safety Penalty deduction /Payment 17
Release-Hold Advise
 Appendix-1: Sample Site specific Penal Provision 18

8.0. CROSS REFERENCE 8

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 3 of 19

CONTRACTOR SAFETY

1. PURPOSE AND SCOPE:

The purpose of this procedure is to provide Contractor Safety program, the

minimum requirements for working under contract with Adani sites and includes all
contractors and subcontractors.

This procedure applies to Adani Group business locations and activities including
offices within India.

2. ABBREVIATION & DEFINITION:

HOD : Head of Department

PPE : Personnel Protective Equipment
MSDS : Material Safety Data Sheet
PTW : Permit to Work
JSA-RA : Job Safety Analysis- Risk assessment

3. PROCEDURE:

3.1. Contract and Contractor Classification:

a) The contract/Contractor is classified considering the scope of work and
the risk involved in the execution of job for which contract is awarded.
b) The Level–I Contact & Contractor Worker(s): Every regular, temporary, or
part-time contractor, including sub-contractors, contracted by Adani
Business or site that has the potential to perform a hazardous or high risk
work. This distinction is based on the contractor’s job scope, not the size
of the contract.
c) Level-II Contract & Contractor Worker(s) – Every regular, temporary, or
part-time contractor, including sub-contractors, contracted by Adani
Business or site that does not have the potential to perform a hazardous
or high risk work, Examples of Level II contractor workers are fire
extinguisher inspectors; consultants performing site audits or
inspections, and other low hazard service providers.
d) Irrespective of type of work involved, the contract are also classified as
under for the safety staff deployment requirement:

Safety staff Deployment requirement: Safety Officer Safety supervisor

CLASS – A: Deployed employees more
Plus One for Every 100
than 200 Nos. or/and Contract Value Minimum One
employee
above Rs. 100 Lac in a year.
CLASS – B: Deployed employees more Minimum One and
than 100 up to 200 Nos. or/and Contract thereafter additional
Nil
Value above Rs.50 Lac up to Rs. 100 Lac One for every 100
per year. employee.
Minimum One and
CLASS – C: Deployed employees up to
thereafter additional
100 Nos. or/and Contract Value up to Rs. Nil
one for every 100
50 Lac in a year
employee
Safety Officer: Minimum qualification B.SC. With Diploma in Industrial Safety from
recognized institute & good communication skill with an attitude to implement safety at
his site. Safety Officer shall have minimum 3 years of experience in similar jobs.
Safety supervisor: minimum qualification Intermediate with good communication skill. He
shall have experience as Safety Supervisor for a period of minimum 3 years in in similar
jobs.

e) Hazardous Work include, but are not limited to the following:

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 4 of 19

 Construction Work (including roof repair)

 Demolition Work
 Disturbing Asbestos or other fibrous material
 Excavation Work
 Installation or Removal of Equipment or Machinery
 Welding work
 Working on Lead Containing Materials
 Work with Hazardous chemicals

f) Higher risk Work are those identified and addressed in OHS Procedure
No. 12.0 which require PTW and special permit, including but not limited
to the following:
 Confined Space Entry
 Work at height,
 All Electrical Work
 Hot Work
 Work with and around Radioactive source
 Work for and related to Excavation
 Lifting and rigging, crane operation

3.2. Pre bid Contractor Selection and Review:

a) Each site will follow and send Pre-Bid Contractor OHS Qualification
evaluation form – Annexure -1 to all level –I & II contractor with a request
to Quote inquiry raised by the Business or concern department
b) The received filled annexure will be reviewed and evaluated by concern
engineer in charge of the contract who wants to hire the services of that
contractor.
c) The contractor firm having OHSAS or IS-18001 certification with
established safety management setup will be given preference.
d) The contractor firm does not have OHS Management systems have to
abide and follow Adani Business / Site OHS system and training
requirement.
e) Based on the evaluation and rating the Contractor will be approved for
further bidding or submission of offer.
f) In case of dispute or site do not find suitable contractor the Site head and
Safety head can decide further course of action.
g) On rare occasions, when a site emergency exists, the site can use a
contractor who has not been pre-qualified, If it is one-time occurrence. If
this is a re-occurring event, the responsible manager shall initiate a pre-
qualification process in order to get that contractor qualified.
h) Level-I contractors with acceptable health and safety submittals will be
approved as qualified to proceed in the Bid submission process.
i) Upon award of the contract, the contractor will then submit with any
additional requested detail as indicated on Annexure-1 like MSDS,
Certificate of Insurance, etc.).

3.3. Contractor Mobilization and Work start Clearance Requirements:

a) Each contractor will be assigned with Engineer In charge, the main
contact person and is responsible for implementation of all step of this
procedure.

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 5 of 19

b) The engineer in charge of the concern contractor will initiate process as

indicated in Annexure-2 and coordinate with other department as
necessary to issue work start clearance.
c) Each contractor required to meet all the conditions as agreed during pre-
bid qualification form Annexure-1, and submit additional details, proofs for
verification during mobilization.
d) The concern Engineer in charge of the contractor shall complete the
verification using Annexure-2 Contractor Mobilization and Work start
Clearance and complete or collect following details as per company
procedure:
 Safety Induction
 Contractor Mandatory and special PPE inspection
 Contractor Tools, Equipment Inspection
 Contractor employee Medical checkup Report
e) On successful completion of all the steps indicated in Annexure-2 the
engineer in charge shall take contractor’s authorized person signature.
f) By signing in the Mobilization and work start clearance form (Annexure-2),
and condition of contract, the contractor in turn agree that all of their
current employees (and any employees hired in the future) that will work at
Adani site follow these requirements.
g) Failure to comply with these rules can result in immediate removal from the
site or disqualification from future bids. Penal provision is attached as
Appendix-1.
h) When additional contractor employee, material or equipment arrives at the
site at a later time, required applicable steps and formality as indicated in
Annexure-2 shall be followed by Engineer In charge to review the
appropriate contractor safety requirement.

3.4. Contractor Safety compliance and Disciplinary Actions:

a) The site should finalize site specific penal provision applicable to

contractor based on the sample penal provision available as Appendix-1
b) The engineer In charge is responsible for safety compliance evaluation and
implementing disciplinary action during the tenure of work of concern
contractor assigned to him,
c) As per OHS-01 Site Safety Policy and rule, when person is found non-
compliant to the site Policy and rule, anyone can issue/report Safety
Noncompliance intimation to his immediate supervisor/manager along with
as attached in Annexure-4.
d) The engineer in charge is responsible for arranging Pre job discussion
before assigning work to the contractor and will communicate the work
method, hazard involved with precautions required as stipulated in PTW
and or JSA- RA related to the job and make necessary endorsement on the
concern PTW.
e) The engineer in charge shall keep record of safety performance parameter
as per Annexure-3 and evaluate the concern contractor performance every
month. The same performance is used for Payment Release/Hold advice for
the contractor running/ Final bill.

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 6 of 19

f) Based on the type, period and size of the contract At the minimum the
contractor shall attend, initiate and follow the safety target as finalized by
Engineer in charge for the followings:

 PPE inspection and compliance

 Safety committee meeting
 Tool box talk
 Tool, Equipment Inspection and compliance
 Legal compliance
 Training and promotional activity

g) Any one observing contractor safety noncompliance shall report it to the

concern engineer in charge in Annexure-4 Safety noncompliance.
h) The contractor safety noncompliance observed, reported and received by
Engineer in charge will be reviewed with contractor and informed for
penalty amount.
i) At the end of month consolidated penalty amount for respective contractor
will be sent to finance and Account department along with contractor
running/ final bill using Annexure-5 Safety Penalty deduction /Payment
Release-Hold Advise. Along with contractor performance Annexure-3.

3.5. Contractor Incident record and Compliance:

a) All contractors shall follow the site OHS-04 incident reporting,

investigation and follow-up procedure and report all incidents to the
Engineer in charge immediately.
b) Any incident attributed due to action or inaction of contractor or his
employee will attract penalty as per the site penalty matrix and corrective
action required to be implemented by concern contractor within reasonable
time.

4. RESPONSIBILITIES:

4.1. The business Site head or his designee is responsible:

a) To ensure implementation of this procedure at site level
b) To allocate and provide required resources to implement procedure.
c) To ensure that the annual review are completed at the site for this procedure
and require changes are incorporated in procedure.

4.2. The Managers / Head of Department are Responsible:

a) To assign Engineer In charge for the each contractor working under,

assigned to and for the department.
b) To identify and train all required employee to implement this procedure.
c) To ensure that the contractor and his employee understand the applicable
OHS procedure of the site.

4.3. Engineer In Charge:

a) To implement all steps of this procedure for the concern contractor

b) To evaluate Pre-bid and Work start requirement for contractor assigned to
him.

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 7 of 19

c) To maintain record required for all steps and document for concern
contractor.
d) To enforce penalty based on the noncompliance observation
e) To carry out pre job discussion and ensure training and qualification of
worker before assigning the job to the contractor.
f) To carry out contractor performance evaluation by carrying out on job
inspection of contractor work.

4.4. All Employee are responsible:

a) To promptly report the concern related to this procedure to concerned

immediate supervisor or the head of department.

4.5. The site Safety Head is responsible:

a) To assist Site Head in Implementation of this procedure.

b) Verify and audit the procedure implementation and record keeping
requirement annually using program evaluation scorecard. Annexure -1 of
procedure OHS-20-program evaluation element.
c) Review and suggest the improvement required in procedure based on the
observation record and other data.

4.6. Respective OHS frame work Element/Component owner is responsible:

a) To follow up with respective person responsible for implementation of the

respective procedure step of this procedure.
b) Maintain the record of information received for implementation and
compile the information for site.
c) To carry out quarterly self-assessment of the Element/Component using
Annexure -1 program evaluation score card of OHS-20 Program evaluation
procedure.
d) Coordinate and Prepare action plan to implement this procedure.
e) Report the action plan, resource requirement and status of this procedure
to the Site Head.
f) Maintain Annexure –A and review and update as and when changes in
information occur, or at the minimum once in a year.
g) Keep record of site specific improvement, arrangements, deviations and
exclusions done to implement this procedure in Annexure-A.
h) Send information to Group Safety related to best practice and major
deviation recorded in Annexure-A annually or when required for annual
review.

5. TRAINING:

Refer training procedure OHS -05 for training matrix for training need and available
training topics.

Contractors employee training need shall be evaluated using OHS -05 based on the
role and task assigned and ensures completion of training before start of the work

6. AUDITING:

This procedure, program shall be reviewed annually. The review shall be

documented shall reflect changes/updates based on audit findings, gaps, trends,
regulatory changes etc.

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 8 of 19

7. ATTACHMENTS & FORMS:

Annexure -A : Site specific Arrangements for

Annexure -1 : Pre-Bid Contractor OHS Qualification evaluation form
Annexure -2 : Contractor Mobilization and Work start Clearance form
Annexure -3 : Contractor Safety Performance evaluation form
Annexure -4 : Safety Noncompliance Intimation
Annexure -5 : Safety Penalty deduction /Payment Release-Hold Advise

Appendix-1 : Sample Site specific Penal Provision

8. CROSS REFERENCES:

OHS-05 : Induction and Training site training Matrix.

OHS-02A : Hazard Reporting
OHS-02B : Safety committee
OHS-03AA : Welding gas cutting
OHS-03H : Gas cylinder
OHS-03K : Ladders and Scaffold
OHS-06 : Planned Safety inspections
OHS-11 : Job Safety analysis & Risk assessment
OHS-18 : Medical services
OHS-18C : Medical Fitness for work
OHS-20 : Program Evaluation

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 9 of 19

Annexure-A

Site specific Arrangements Contractor safety

(To be filled in, updated once in a year by Element Owner, and kept along with procedure)

Part-A

Name of Business Site &

1
Location:

2 Name of Site Head:

Name of Site Safety Head /

3
Representative:
Name of OHS Element /
4
Component Owner:

5. Site Contract(s) detail:

Sr. Name of Contractor Job Total Duration Department Name

No /Firm scope Employee of in charge Engineer
. contract In charge

6. Site Safety noncompliance Penalty Detail:

Part-B
Site Specific improvement
A record (describe)
Site Specific Changes-
B Deviation, Exclusion record
(describe)

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 10 of 19

Annexure-1
PRE BID CONTRACTOR OHS QUALIFICATION EVALUATION FORM
(Level – I & II Contractor to Complete Sections all Questions)

RFQ Title:
Contractor Name:
Firm Reg. Nos:
Office Address:
with Labour Dept.
Phone/Fax:
(BOCW) etc.
Email address:
Total Permanent Total temporary
Nos. Nos.
employee: employee:
Type Nature of
business, Services:
ISO:9001 YES/NO ISO: 14001 YES/NO OHSAS:18001 YES/NO
Valid up to: Date Valid up to: Date Valid up to: Date
A]. Detail of similar work reference : (Past and Present Work) Add more lines if required
Sr. Period Contact person
Organization Type of work
No (From – To) (Mobile/Email)
1

3
B]. Certification
If ISO-18001 certified then would like to work as per
No of Procedure
your safe working procedure(s) Please attach your list ____Nos.
attached
of procedure(s):
If Not ISO-18001 certified then would like to work as
per our site safe working procedure(s)and Train your YES/NO
employee as required:
Attached Copy of Attach Organization Chart (with duties and
YES/NO YES/NO
Safety Policy: responsibilities-Adequately described)
C]. SAFETY PERFORMANCE : (Last three completed
previous years)
Third( last) second First (current)
Average Man-hours worked ( per year)
First aid injury (Nos.)
Reportable Injury (Nos.)
Fatal Injury (Nos.)
Notice of violation (Nos.) describe separately
Fines- Penalty: ( Rupees in Thousand)
Safety performance awards( If any) Attach
copy
Safety Training conducted (Nos.)
Employee trained by safety training (Nos.)
Able to provide
D]. Safety and other Qualification requirement for Requirement
Qualified Person(s)
(Filled by Site)
RFQ- Job (Attach training certificate if available) ( filled by firm)
(Remove lines which is not required) Number of Number
YES/NO YES/NO
person of Person
To be able to prepare Method statement for job
To be able to prepare Job safety analysis
To be able to carry out Risk- analysis
To be able to work as per- MS/JSA/RA if available
To build Scaffolding
To inspect Scaffolding
To work in Confined space
To work at height 0 to 10 mt

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 11 of 19

To work at height above 10 mt up to 120 mt

To carry out welding/ gas cutting
To operate crane, fork Lift, Hydra etc.
To operate EOT, gentry crane etc.
To carry out excavation 02 to 10 mt depth
To work on LV (up to 230V)Electrical equipment
To work on MV (up to 1000 V)Electrical equipment
To work on HV ( up to 66 kV) Electrical equipment
To work on EHV ( above 66 kV) Electrical
equipment
Other
Other
E]. Safety staff Deployment requirement: Safety Officer Safety supervisor
CLASS – A: Deployed employees more than 200
Plus One for Every 100
Nos. or/and Contract Value above Rs. 100 Lac in a Minimum One
employee
year.
Minimum One and
CLASS – B: Deployed employees more than 100 up
thereafter additional
to 200 Nos. or/and Contract Value above Rs.50 Lac Nil
One for every 100
up to Rs. 100 Lac per year.
employee.
Minimum One and
CLASS – C: Deployed employees up to 100 Nos. thereafter additional
Nil
or/and Contract Value up to Rs. 50 Lac in a year one for every 100
employee
Safety Officer: Minimum qualification B.SC. With Diploma in Industrial Safety from recognized
institute & good communication skill with an attitude to implement safety at his site. Safety Officer
shall have minimum 3 years of experience in similar jobs.
Safety supervisor: minimum qualification Intermediate with good communication skill. He shall have
experience as Safety Supervisor for a period of minimum 3 years in in similar jobs.
Safety staff Deployment requirement Agreed: YES/NO
F]. Do you carry out Medical Checkup of your employee (attach one sample report-
YES/NO
without name)
Do you take insurance of your employee YES/NO
Do your employee covered under ESIC: YES/NO PF Number:
G]. Do you issue PPE to your employee free of cost: YES/NO If “NO” attach your policy
List of PPE you plan to issue and bring and reissue at frequency based on RFQ
Attach the list
Job you are quoting: ( in following table format)
Sr. Individually PPE (Shared Replacement Make
No.
Name of PPE Price
issued (No’s) Use) (Nos.) frequency (Model)
1
2
H]. Attached Condition of Contract read and under stood YES/NO
Condition of Contract safety violation penalty clause understood and
YES/NO
agreed
Site visit and Pre bid discussion with Engineer In Charge and Safety
YES/NO
department completed:
I understand and agree by the above information supplied

Signature: _________________________

Authorized Person Name: _______________________________

Stamp:

Date:

Name of (RFQ )Site Engineer In charge( Mobile/

For Clarification and Question Contact:
Email)

For office Use:

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 12 of 19

E]. Contractor Qualification Review

Date Bid/RFQ: ______/______/______ Date Form Received ______/______/___
Specification Reviewed: ___
Contractor Qualification: Approved Not Approved
Sent:
Reason Why
Not Approved:
Reviewer(s): Engineer In Name: Signature:
charge
Commercial Name: Signature:
HOD review Name: Signature:
Site Safety Name: Signature:

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 13 of 19

Annexure: 2
CONTRACTOR MOBILISATION & WORK START CLEARANCE FORM
Name of Contractor Date: ___/___/____
M/s
Site Name: Order Number:
Description of Work:
Type Of Work: Mechanical -  Electrical-  Civil -  Others - 
Name Of Engineer In Name of Contractor
Charge Safety Officer/
Supervisor:
Mobil. No.: Mobile No.:

REQUIREMENT CHECK YES NO N/A

1. ISO/IMS/IS / any other- certification copy submitted
2. Safety policy copy submitted
3. Safe job procedure submitted is any
4. Safety officer/ supervisor deployment as applicable
5. Manpower trade training record/ certificate attached
6. Insurance valid policy copy attached
7. PF Number
8. Labour Department Registration and License Copy
9. Employee wise PPE issue done and issue register available ( check
PPE) – found satisfactory
10. Other special PPE available as required for work list available ( Check
PPE)- Found satisfactory
11. Portable Power tool List available – Checked and found satisfactory
– (As per OHS- 03-J Hand and power tool)
12. Lifting tool -verification as per list satisfactory (As per OHS- 12-H
Crane and rigging)
13. Assess Equipment Ladders, Scaffold-verification as per list
satisfactory (As per OHS- 03-K Ladders and Scaffold)
14. Welding machine- gas cutting set checked and found satisfactory-
(As per OHS-03AA Welding gas cutting)
15. Gas cylinder brought in by contractor – Satisfactory
16. (as per OHS-03H Gas cylinder)
17. Gate safety induction as per list of employee completed
18. ( as Per OHS-05 Induction and training)
19. Part – II Safety Induction as per list of employee completed
20. ( as Per OHS-05 Induction and training)
21. Employee Qualification, Training and driving license requirement
checked and verified as per employee list( refer respective OHS for
training and other requirement)
22. First-aid Box as necessary and agreed
23. Emergency vehicle and Ambulance as agreed
24. Employee medical check and fitness certificate for all employee(As
per OHS-18 and 18-C Medical services and fitness )
25. Qualified First-aiders (having valid certificate)
26. Qualified Doctor tied up:
27. Others if any
28. Others if any
We agree to abide by all company safety rules and maintain above arrangement for the
period of contract.
Authorized Person of Contractor :
Signature:
Name :_______________________
Designation:_________________________________ Date: ____/_____/_________

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 14 of 19

Signature of Site- Signature of the

In-Charge Engineer In-Charge
(Contractor)
Name Name
Date Date
“Work Start Clearance Certificate”
We have checked and verified the OHS requirement and compliances submitted as above for
M/s__________________________________________ against Work Order No ________________ for the
work area _________________________________ of _______________________ Plant site on Date:
___/____/_______
Allowed to start the work from Date: ____/____/_______ with following exception
Exception If Any:
1.
2.
3.
Signature of Head Department Name
of Department:
Designation: Date:

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

 Contractor Safety OHS-08/ R-0
Page 15 of 19

Annexure-3
Contractor Safety Performance Evaluation Form
Name Of Date
Contractor:
Department:
Frequency Monthly
Criteria Target Status/ Result
[+ P/- N]
1. No of PPE Noncompliance observation 0
2. No of Procedure/Rule Noncompliance 0
observation
3. No of Attendance Noncompliance 0
observation( safety staff)
4. No of Tool-Equipment Noncompliance 0
observation
5. Number of repeat observation 0
6. Number of times penalty imposed 0
7. No of own observation (closed by 100%
contractor within 30 day)
8. No of observation submitted by contractor
employee.
9. Safety Promotional activity
10. Safety Meeting Conducted
11. Tool box talk Conducted or attended
12. Other
[Expected 80% Positive] with improvement Performance:
Engineer In Head Of
charge Department
Signature Signature
Name Name
Date Date
Monthly Performance evaluation will be used for contractor running bill release
Site can add/modify monitoring parameter based on the type and size of contract

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 16 of 19

Annexure-4

Safety Noncompliance Intimation Sr. No: ___________

To:
HOD/ Engineer In charge
Name:
Department:
Date: __ / ___/ ____

The Contractor M/S: _____________________________________________________ and/ or

Employee Name: _____________________________ E.C. No/Gate Pass No:__________________
found noncompliant with company Safety rule related to:

PPE -  EQUIPMENT -  PROCEDURE /RULE -  SAFETY MANPOWER - 

Detail of Observation:

Please initiate necessary action as per the company/contract rule policy

Observer:
Signature person noncompliance:
Signature:
Name: ______________________________
Department: ____________________
Cc: Site safety Head
Employee Code:__________________

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 17 of 19

Annexure-5
Safety Penalty deduction/Payment release/Hold Advice

Safety Penalty deduction/Payment release/Hold Advice

To:
Finance and Account Department:
Name:
Date: _______________

Please arrange deduct and recover the amount of Rs. ______________________for the
safety violation penalty and other safety deductions as under from current R.A. Bill. The

The Contractor M/S ____________________________________________________________ safety

Work order No _________________ for work area______________________ on ______________

1) Penalty Imposed for safety Rule Violations Rs.______________

2) Penalty Imposed against Safety PPE Violation Rs.______________
3) Penalty Imposed for using unsafe equipment Rs. _______________
4) Penalty Imposed for Deployment of Safety Man power Rs.______________

Total Rs.______________

The supporting proof of noncompliance attached:

(Attach Annexure-4 -Safety Performance evaluation and Annexure-3-Safety noncompliance intimation for
the month/year as per bill period)
----------------------------------------------------------------------------------------------------------------------------------------------
Release/Hold balance payment of RA/Final bill attached for the
Month of _____2015.
From: Verified by Head of Department
Engineer In charge:___________________ Name:______________________
Department:_______________________
Name:______________________ Signature:_________________
Signature:_________________ CC: Site safety Head

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 18 of 19

Appendix-1
Sample Site Specific Penal Provision

PENALTY FOR VOILATION OF OHS NORMS

SN Topic Safety Violation Financial Penalties

1 Working at Nonuse of Full body harness / Fall arrestors and Rs.10,000 per violation
Height / Non anchoring of full body harness
Ladders and No protected against falling of person by suitable
Scaffolds means
2 Lifting Use of Lifting Appliances without Third party Rs.10,000 per violation
Appliances inspection certification under the Act.
and Lifting
Gears
3 Personal Not wearing / using PPE Rs.200 per single violation
Protective required for the Job.
Equipment Using damaged PPE.
Using wrong PPE.
Using PPE without
conform to BIS Std.
4 Traffic (a) Over loading of vehicles Rs.5,000 per first violation
Management (b) Unfit Drivers or Operators and Rs.10,000 for
(c) Unlicensed vehicles subsequent violations
(d) Absence of Reversing Alarm or Rs.1,000 per first violation
(e) Absence of fog light (at winter) or and Rs.2,000 for
(f) Hand brakes not in working condition. subsequent violations
(g) Mishandling/ Splashing of material on roads
(h) Non-cleaning of Vehicles and thereby creating
a traffic safety hazard to road User
5 Occupational (a) Violation of any clause as described in Rs.5,000 per single
Health / Factory Act & Rules violation Compounded to a
Others (b) Dust control measures at sites not maximum of Rs.25,000 at
practiced. any single instance
6 Injury and (a) Fatal accidents Rs.5, 00,000 or 5% of the
Incidence Contract value, whichever
Reporting is less, for first fatality,
Rs.10, 00,000 or 10% of
the Contract value,
whichever is less, for
second and their after
Owner may at its
discretion impose
appropriate penalty or may
terminate/reject the
Contract at the risk & cost
of the Contractor
(b) Grievous Injury Rs.3,00,000 or 3% of the
(Grievous Injury as defined by Workmen Contract value, whichever
Compensation Act) is less, for first injured
person and
Rs.5,00,000 or 5% of the
Contract value, whichever

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT

Contractor Safety OHS-08/ R-0
Page 19 of 19

is less, for every

subsequent grievously
injured person

(c) Dangerous Occurrence Rs.1,00,000 or 1% of the

Contract value, whichever
is less, for first violation
and Rs.2,00,000 or 2% of
the Contract value,
whichever is less, for
subsequent violations
(d) Any Incident Involving injury to the Public Rs.50,000 or 5% of the
Contract value whichever is
less for first violation and
Rs.1,00,000 or 1% of the
Contract value whichever is
less for subsequent
violations
7 Electrical (a) Non-compliance of Electrical safety norms Rs.2,000 per single
Safety (b) Exposed electric lines fermentative violation Compounded to a
damage and circuits in the workplace. maximum of Rs.50,000 or
(c) Inserting of wires directly into the socket. 5% of the Contract value,
(d) Improper grounding for electrical appliance whichever is less, at any
(e) Electrical cables running on the ground single instance
8 Welding & (a) Flash back arrester, NR valve and regulator Rs.5,000 per single
Cutting not present or not in working condition. violation Compounded to a
Safety (b) Fail to put cylinders in a cylinder trolley. maximum of Rs.20,000 at
(c) Damaged hose and fail to use hose clamps. any single instance
(d) Using Domestic LPG cylinders
(e) Isolating switch not provided on Welding
m/c
(f) Improper grounding and return path.
(g) Damaged / Bare welding cable.
Consolidated penalty shall be maximum limit of 10% of the contract value.

Adani Group OHS Effective Date: January 01, 2016

THIS DOCUMENT IS UNCONTROLLED IN HARD COPY FORMAT