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Documented, dated and authorised by top management
Appropriate to the nature and scale of the organisations OSH risks
Commits to:
Continuous improvement
Compliance with legislation
Compliance with other requirements
Prevent ill health and injury
Provides framework for setting and reviewing objectives?
Communicated to all persons under the control of the organisation.
Available to interested parties
Implemented and maintained?
Subject to review to ensure ongoing suitability?

4.3.1) Hazard Identification, Risk Assessment And Determining Controls
Procedure(s) and process for identifying hazards, subsequent risk assessment determining
controls is documented?
Process includes reference to:
Document control
Procedure(s) ensure that the following requirements are taken into account:
Routine and non-routine activities
All persons having access to the workplace
Human behaviour/factors
Hazards originating outside the workplace
Hazards in the vicinity of the workplace
Infrastructure, equipment etc.
Changes in the organisation
Modification to the OSHMS
Legal and other requirements
Design of the workplace
Management of change
Risk assessment methodology determined, proactive and consistently applied
Hierarchy of controls considered and applied
Risk assessments reviewed and controls updated
Records of process enable it to be audited?
Process is carried out by competent persons?

4.3.2) Legal & Other Requirements

Procedure in place to describe how access is gained to legal and other requirements, how to
keep track of changes, and who does this?
Mechanism in place to record these requirements, make sure they are communicated and
understood by persons working under the control of the organisation
Records and procedure are controlled documents and regularly reviewed

Facilitator: Aswadi Page 1/7

There is a means of accessing the original laws, regulations etc.?
Register or listing includes (as applicable):
Laws, regulations
Codes of practice
Schemes, e.g. responsible care
Licences, authorisations, permits, certificates
Planning permission
And the means of accessing changes to all of the relevant other requirements
Legal and other requirements taken into account when developing, implementing or changing
The procedure links to the Evaluation of Compliance (clause 4.5.2)

4.3.3) Objectives & Programmes

Is there a process for selecting and documenting the objectives?
Are objectives set at relevant levels and functions within the organisation?
Are there records to show how the objectives were selected?
Are there links to:
Significant risks
Policy commitments
Legal and other requirements
The views of interested parties?
Are objectives:
Management programmes or action plans in place for achieving objectives
Do programmes show designated responsibility and authority for achieving objectives, the
means and a time frame by which objectives are to be achieved?
Programmes subject to planned reviewed


4.4.1) Resources, Roles, Responsibility, Accountability and Authority.
Evidence of Top management taking responsibility for the OSHMS
Roles and responsibilities defined, accountabilities and authorities allocated in manuals, job
specifications, organisation charts, procedures etc
Including responsibilities in emergency situations
Responsibilities etc. documented and communicated e.g. staff aware.
Management Appointee nominated (See clause 4.4.1 note 2).
Management appointee responsibilities defined by clause 4.4.1 para 2 a and b.
Means of communicating the ID of the management appointee
Personnel taking OSH responsibility and recognise the need to comply with OSHMS
Resources provided, defined and adequate?
Training provided to meet competence needs for responsibilities.

4.4.2) Competence, Training & Awareness

Procedure(s) documented and include:
Means of identifying training needs
Provision of training to meet needs
A means of evaluating the effectiveness of training

Awareness training (link OSH consequences of work activities, OSH Policy. EM preparedness)
All necessary training and skills in place?
A means of verifying the training/competence of persons under the control of the organisation
other than employees
Are there records to identify delivery of training and to verify competence? Communication
Procedure to define processes for internal and external communication?
Staff aware of procedure?
Staff know the process for making a safety complaint or representing a safety issue
Communications relevant to emergencies covered in procedures?
Arrangements for communicating with contractors and other visitors to the workplace
Documented arrangements for receiving, documenting and responding to relevant
communications from external interested parties Participation & Consultation

Established, implemented and maintained a procedure(s) for the participation of workers by
appropriate involvement in hazard identification, risk assessments and determination of
appropriate involvement in incident investigation;
involvement in the development and review of OSH policies and objectives;
consultation where there are any changes that affect their OSH;
representation on OSH matters.
Workers are informed about their participation arrangements, including who is their
representative(s) on OSH matters?
Documented arrangements in place for consultation with contractors where there are changes
that affect their OSH?
The organisation to ensure that, when appropriate, relevant external interested parties are
consulted about pertinent OSH issues?

4.4.4) Documentation
Documented Policy and Objectives
Description of the scope of the OSHMS
Description of the main elements of the OSH management system, their interaction and
reference to related documents, e.g. system procedures, other systems etc.
Documents, including records, required by this OHSAS standard
Documents, including records, determined by the organisation to be necessary to ensure the
effective planning, operation and control of processes that relate to the management of its OSH
Documents are subject to document control disciplines?

4.4.5) Control of Documents

Procedure in place to define mechanism for the control of documents.
Procedure includes:
Approval of documents for adequacy prior to issue
Arrangements to review and update as necessary and re-approve documents

Measures to ensure that changes and the current revision status of documents are identified
Measures to ensure that relevant versions of applicable documents are available at points of
Reference to a master list of documents and a list of document holders to ensure they are
available to those who need them
Removal and disposal of obsolete documents unless retained for reference or historical
reasons. A means of identification if retained
Arrangements to ensure that documents of external origin determined by the organisation to
be necessary for the planning and operation of the OSH management system are identified
and their distribution controlled

4.4.6) Operational Control

Documented procedures, to cover situations where their absence could lead to deviations
the OSH policy
Operational and the
control objectivesare in place for all relevant significant risks?
Hierarchy of controls applied
Controls related to purchased goods, equipment and services in place

Are operational controls subject to effective document control and available where needed?
Controls related to contractors and other visitors to the workplace

Are operational control procedures communicated to suppliers and contractors where needed
Management of change considered where appropriate
Are Permit to Work systems in use if relevant

4.4.7) Emergency Preparedness & Response

Procedure in place to identify potential emergency situations, develop and document
to prevent,
The control
planning and mitigate
of emergency the effects?
responses take account of the needs of relevant interested
e.g. emergency
All potential services and
emergency neighbours
situations identified e.g.:
Toxic gas/fumes
The weather
Power cuts
Equipment failure
Emergency procedures and plans are documented and subject to document control
Responsibilities are clear and known to relevant staff

Plans are periodically tested where practicable. Interested parties involved as appropriate
There is a schedule for future tests?
Records of tests, emergencies and false alarms are maintained?

Procedures are amended in the light of experience from tests, drills and incidents if necessary
Emergency equipment maintained, e.g. fire extinguishers, sprinkler systems, alarms emergency
lighting, spill kits etc. (See clause 4.3.1)
Staff with emergency response responsibilities are trained and competent

4.5.1) Performace Measurement & Monitoring
Procedures established, implemented and maintained to monitor and measure OSH
performance on a regular basis
Procedure(s) include both qualitative and quantitative measures, appropriate to the needs of
the organisation
Is there monitoring of the extent to which the organisations OSH objectives are met?
Is the effectiveness of controls (for health as well as for safety) monitored?
Proactive measures of performance that monitor conformance with the OSH programme(s),
controls and operational criteria identified
Procedure(s) include reactive measures of performance that monitor ill health, incidents
(including accidents, near-misses, etc.), and other historical evidence of deficient
OSH performance
Procedure(s) provide for recording of data and results of monitoring and measurement
sufficient to facilitate subsequent corrective action and preventive action analysis
Monitoring instruments and equipment calibrated and maintained to ensure accuracy of
Methods of calibration are defined and traceable to National Standards Calibration status is
Are the records of calibration and maintenance activities retained? Records are kept of
calibration certificates and of which instrument was used for each test

4.5.2) Evaluation of Compliance

Procedure(s) for periodically evaluating compliance with applicable legal requirements in

Records maintained of the results of the periodic evaluations
Procedure for evaluating compliance with other requirements to which the organisation
subscribes in place
Does the organisation keep records of the results of the periodic evaluations?

4.5.3) Incident Investigation Of Non-conformity, Corrective And Preventive Action Incident Investigation
Procedures established, implemented and maintained to record, investigate and analyse
incidents in order to determine underlying OSH deficiencies and other factors that may
be causing or contributing to the occurrence of incidents
Procedures include arrangements to identify the need for corrective action, identify
opportunities for preventive action and identify opportunities for continuous improvement?
Results of investigations communicated
Investigations performed in a timely manner?
Any identified need for corrective action or opportunities for preventive action dealt with in
accordance with the relevant parts of
Legal and other requirements addressed
The results of incident investigations documented and maintained?
Staff trained to undertake incident investigation Non-conformity, Corrective Action and Preventive Action
Procedure(s) for dealing with actual and potential non-conformity(ies) and for taking corrective
action and preventive action implemented
Procedure(s) define requirements for identifying and correcting non-conformity(ies) and taking
action(s) to mitigate their OSH consequences?

Corrective action - Procedure(s) define requirements for investigating non-

conformity(ies), determining their cause(s) and taking actions in order to avoid their
Preventive Action - Procedure(s) define requirements for evaluating the need for action(s) to
prevent non-conformity(ies) and implementing appropriate actions designed to avoid
their occurrence?

The results of corrective action(s) and preventive action(s) recorded and communicated

The effectiveness of corrective action(s) and preventive action(s) reviewed and confirmed
Does the procedure require that the proposed actions shall be taken through a risk
prior to implementation where the corrective action and preventive action identifies new or
changed arising
Changes hazardsfrom
or the need for
corrective new and
action or changed controls?
preventive action made to the OSH management
system documentation?
Staff recognise and report non-conformances?

Non-conformance identified by Internal Audit handled in accordance with the procedure

4.5.4) Control Of Records

Records maintained as required by the Standard to demonstrate conformity to the
requirements of its OSH management system and of this OHSAS Standard, and the
results achieved?
Procedure define arrangements for:
protection e.g. computer back-up,
retrieval records readily retrievable
retention retention times defined
Are records legible, identifiable and traceable?

4.5.5) Internal Audit

Procedure in place to describe the audit process:
Production of schedule/programme based on risk significance and the results of previous
Responsibilities and competencies for planning audits
Carrying out the audit
Reporting audits
Establishing audit criteria, scope, frequency of audits
Non-conformance reporting and close-out
Schedule covers all areas/procedures and OSHMS functions in a given time?
Document control and approval of audit paperwork including schedule?
Internal auditors trained. Able to identify a OSHMS and safety non-conformance. Have an
understanding of applicable legal and other requirements.
Non-conformances actioned in a timely manner?


Frequency and format of reviews is documented. NB there is no specific requirement for a

Attendees at meeting listed in procedure? e.g. Management Appointee and senior

Reviews take place at specified frequency?
Reviews included all the required inputs and outputs
Records, e.g. meeting minutes are kept?
Actions assigned and followed up?
Outputs from management review available for consultation and communicated to relevant