Heath, Environmental and Safety Competency Questionnaire

1. Health, Environmental and Safety Management

1.1 HSE Organization: Does your organization have the following:

a) A director or senior manager responsible for HSE? ……………………………………………..
Please identify most senior person in organisation responsible for HSE performance.

1.2 HSE Benefits: Do you have or provide for your employees: Yes No N/A Comments
a) Medical insurance?
b) HSE training?

1.3 HSE Management System.

Attach a copy of your HSE Policy including the organisation and arrangements for safety and health and briefly describe your safety management system providing the following:
a) HSE MS certified to an ISO/ OHSAS (or equivalent) standard or any Safety and Health awards received by your company
b) a corporate HSE policy and if available membership / Involvement in relevant Safety groups
c) Clearly defined HSE responsibilities and accountabilities for managers, supervisors, and employees
d) regular Senior Management review of key processes, procedures, and standards to ensure compliance and performance improvement
e) document control and record retention process
f) written safe work procedures
g) Monitoring / Inspection / Audit program
h) hazard identification and risk control processes

1.4 Employee Engagement: Yes No N/A Comments

a) HSE performance appraisals for all employees?
b) Do your employees participate in team activities to improve HSE
performance?
c) Do your employees have the authority to stop work for safety reasons?
d) Are HSE issues, inspection results, investigation results and learnings
communicated to employees?

1.5 Sub-Contractors: Yes No N/A Comments

a) Does your company use sub-contractors?
b) If yes, is there a written contractor safety management process?
c) Do you evaluate the ability of sub-contractors to comply with applicable
HSE requirements as part of your selection process?

1.6 Incident Reporting, Investigation and Statistical Data: Yes No N/A Comments
a) Do you have a written process to report, investigate, and record
incidents?
b) Do you use a root cause analysis tool?
c) Do you have a process in place to track recommendations and
corrective actions to completion within the assigned time?
d) Does your company have a process to share lessons learned on
Heath, Environmental and Safety Competency Questionnaire

2. Fitness For Duty: Skills, Knowledge, and Training

2.1 Short-Service Employee (SSE): employees new to your company or new

Yes No N/A Comments
in their work assignment
a) Do you have a documented SSE program?

2.2 Craft Training: Yes No N/A Comments

a) Do you have a programme or strategy for training local hires? Please
describe.
b) Have employees been trained in appropriate job skills?
c) Are employees’ job skills certified where required by regulatory or
industry standards?

2.3 Health, Environmental and Safety Training Content: Yes No N/A Comments
a) Do you know the local regulatory HSE training requirements for your
employees?
b) Have your employees received the required HSE training and
retraining?
c) Do you provide specific supervisory HSE training for new supervisors
and refresher training for existing supervisors?

2.4 Training Records: Yes No N/A Comments

a) Do you have HSE and crafts training records for individual
employees?

3. Fitness For Duty: Medical Suitability and Industrial Monitoring

3.1 Medical Services: Yes No N/A

a) Do you have a process to provide medical treatment for your
employees?
b) Do you conduct medical exams for employees for pre-placement job
capability?

3.2 Substance Abuse: Yes No N/A Comments

a) Do you have a substance abuse monitoring program?

3.3 Health Surveillance and Industrial Hygiene (IH): Yes No N/A Comments
a) Do you perform Health Surveillance on your employees? If so, please
describe.
b) Do you perform IH monitoring on your employees? If so, please
indicate for what substances
c) Do you have a hearing conservation program with annual testing?
Heath, Environmental and Safety Competency Questionnaire

4. Equipment and Materials

4.1 General: Yes No N/A Comments

a) Do you maintain updated and accessible MSDS for paints and
chemical?
b) Does your company have a motor vehicle safety policy and process?

4.2 Equipment: Yes No N/A Comments

a) Do you conduct, document and follow up inspections on operating
equipment (e.g., cranes, forklifts)?
b) Do you maintain operating equipment in compliance with regulatory
requirements?

5. Environmental Management:

5.1 Environmental Management System: Yes No N/A Comments

a) Does your company have an Environmental Management plans?
b) Is the Environmental Management System certified to ISO 14001?

Confirm that the above Environmental Management Plan will clearly address how TENDERER shall ensure compliance with all required Project and legislative environmental requirements.
TENDERER to provide summary details within this Form 2 response.