Professional Documents
Culture Documents
Sn.
Questioniers 5 4 3 2 1
Policy Statement
Established objectives
Safety Budget
Accountability
Supervisory / Management Training
Employee Training
Management
Involvement Investigations
and Risk Management on Meeting Agendas
Commitment
Facility Inspections
Approval of Safety Policies and Procedures
Safety Performance Responsibility
Claims Management
Claims Costs and Claims Trends
Safety Recommendations
Injury Reporting
Incident Investigation
Job Profiles
Roles
and Performance Evaluations
Responsibilties
Management Roles
Timely Reporting
Claims Communications
Claims Training
Incident Investigation
Analysis
Safety Coordinator
Authority
Leads Safety Committee
Safety Programs
Management Involvement
Analysis
Safety Coordinator
Emergency Action Team
Safety Training
Ergonomics
Continues Education
Self Audits
Risk Management
Facility Safety Inspections
Grounds Safety Inspections
Fleet Safety Inspections
Heavy Equipment Safety Inspections
Hazard Identification
ATV or Utility Vehicle Inspections
Hand and Power Tool Inspections
Ladder Safety Inspections
Behavioral Safety Inspections
Fleet Safety
Hazard Communication
Chemical Hygiene
Respiratory Protection
Lockout Tagout
Confined Space Entry
Hearing Conservation Program
Equipment / Machine Guarding
Electrical Safety
Fall Protection Systems
Hazard Identification Personal Protective Equipment
Hazard Specific Controls
Emergency Action Plan (EAP)
Fire Prevention Plan
Traffic Control Plan
Ergonomics
Manual Material Handling
Power Industrial Truck (PIT), often Forklift, but could be
other
Trenching and Excavation
Welding
Compressed Gas
Hand and Power Tool Program
Consumer Aggression
Violent Offenders
Hazard Identification:
Additional Worksite Hazards:
Define the
controls in place for
each as applicable.
Patient Handling
Working with Livestock
Hazard Identification: Working with Wildlife
Additional Worksite Hazards:
Define the Unexploded Ordinance
controls in place for
each as applicable. Handling Fire Arms or other weapons
Handling Explosives
Airplane Operations
Helicoptor Operations
Wildland Fire Fighting
Structural Fire Fighting
Working in or around waterways
Print Press Operation
Hazard Identification [type additionally identified hazards specific to your
Other Worksite Hazards: organization here]
Open positions are advertised in multiple venues for a
standardized amount of time.
Job postings include the job requirements.
Job postings include the requirement to pass a drug
screen before employment.
A formal application process is in place.
The application has been approved by legal counsel.
Application is reviewed and content is verfied by
appointed personnel.
References are provided by the candidate and checked by
the employer.
Written job desciptions are in place for all positions.
Job descriptions outline the physcial requirements of the
job.
Job descriptions include expectations of safe work
practices.
Potential candidates are screened by meeting the
minimum qualifications which have been defined.
Training
New Employee Training for All
Emergency Procedures
Return to Work (RTW) The return to work plan is documented using the
Management Components transitional duty tracking form (or other form of
documentation) after every transitional duty team
meeting.
A copy of the transitional duty tracking form is provided
to the employee to provide at the next health care
provider's visit.
The return to work progress of injured employees is
regularly communicated to the workers compensation
carrier.
Company:
Auditor Name
NCR
S. NO. AUDIT CRITERIA
RANK
MANAGE
1
1.1 Has the HSEQ Policy been defined and ap
management of the
Is it appropriate to organization?
the nature, scale and H
1.2 organization activities, products to
Does it include a commitment or service
customer s
1.3
improvement and prevention of pollution?
Does it include a commitment to comply with
1.4
and
Doeswith other requirements
it provide the frameworkto which the orga
for setting
1.5 objectives and targets?
1.6 Is it communicated to & understood by all emp
1.7 Is it available and deployed in the working area
is reviewed periodically to ensure t hat it r
1.8 appropriate to the organization
2 HEAL
2.1 Is health management procedure in place
Is there a program to monitor health of the
2.2 exposed to health hazards.
3 H
3.1 Is Hazard and Risk management procedure ava
3.2 Does all hazard associated with the activities id
Does the proposed control measures adequa
3.4 rate?
3.5 Does the control measures prioritized in a pro
3.6 Is there a system to review and re evaluate the
3.7 Ensure worker involvement in hazard identifica
3.8 Check the close-out of PDF Reports
4 E
4.1 IS Environmental Impact and aspects of the ac
4.2 Does the proposed mitigation measures ade
risk rate?
Does the mitigation measures prioritized in
4.3 PD)
4.4 Is there a system to review and re evaluate the
Is there a program to measure and mon
4.5
discharges to the environment?
5 WA
5.1 Are wastes categorized as recyclable (n
recyclable (non-hazardous), hazardous & bio-m
5.2 Is waste generated recorded and maintained
Does waste disposed through out approve
5.3 specialized contractor
5.3 Are Waste segregation bins available and deplo
6 LEGA
6.1 Does all applicable legal and other requiremen
6.2 Does the organization evaluating comp
requirement?
6.3 Are there records of the evaluation?
7 O
Are HSEQ Objectives and targets established
7.1 each relevant function and level?
7.2 Are objectives achievable and measurable?
7.3 Have programs been established for achie
targets?
Check that the means and timeframes for ach
7.4 target has been determined, and is adhered to
7.5 Check middle management awareness of obje
7.6 Check that responsibility has been assigned
objectives.
Check that a documented system is used to
7.7 progress for all objectives and targets.
8 EMERGEN
8.1 Are all emergency situations Identified?
8.2 Ensure emergency procedures of deferent situ
8.3 Ensure emergency drills are being carried out
9
9.1 Ensure approved vender list in place
9.2 Ensure that suppliers and contractors are
approval
9.3 Ensure verification of purchased product
9.4 Ensure purchased product that does not m
reported on NCR.
Ensure that last update of purchase proced
9.5
implementation.
10 IMPLE
10.1 Check the organization chart
10.2 Ensure that all roles and responsibilities are as
11 TRAINING AW
11.1 Ensure training program in place
11.2 Check the implementation of the training prog
11.3 Check the records of training and HSEQ awaren
12
12.1 Check the means of Communication (external
Ensure appropriate involvement of wo
12.2 investigation
12.3 Ensure meeting, Toolbox talks are being carried
12.4 Ensure safety signs, posters and safety flashes
13 C
Ensure document including records of H
13.1 controlled and approved
13.2 Ensure that HSEQ manuals and SOPs are contr
13.3 Ensure changes and current revisions statu
identified
Ensure that relevant version of applicable d
13.4
point of use.
14
14.1 Is there a documented procedure for control o
14.2 Are records suitably maintained, identified, sto
14.3 Are retentions periods know and adhered to?
14.4 Are records easily retrieved?
14.5 Are computer records backed up and suitably s
15 A
Are procedures in place to ensure that Acc
15.1 identified, reported and recorded?
15.2 Ensure accident investigations are being carrie
15.3 Ensure root causes are being identified
Ensure corrective and preventive actions are a
15.4 carried
Check theoutfollow-up
to preventprocess,
recurrence?
which ensures a
15.5 the specified time?
15.6 Is the effectiveness of action reviewed?
15.7 Does accident communicated to the employee
16 CONTROL OF M
16.1 Is equipment used identified?
Is calibration, undertaken within defin
16.2 frequencies?
16.3 Is the calibration status of equipment evident?
17 PR
17.1 Are inspection tests such as (load test, M
hydraulic test) undertaken
17.2 Is there a tracking system in place to identify u
17.3 Is there a preventive maintenance program for
17.4 Are storage conditions adequate?
18 NON CONFORMANC
18.1 Does non conformances identified, corrected a
18.2 Check whether the investigating nonconform
cause and taking actions in place to avoid recu
18.3 Evaluate the effectiveness of the action taken
18.4 Check the non conformance register.
19
19.1 Is Customer feedback recorded and maintaine
19.2 Is customer feed back analyzed and are
identified.
19.3 Are customer complaints recorded , and closed
19.4 TRANS
19.5 Is On line IVMS device Installed in the vehicles
Is IVMS report generated and reviewed and
19.6 the violations
19.7 Does all drivers holding ADSD Card.
19.8 Is journey management procedure in place
20
20.1 Is there an audit schedule in place?
20.2 Is the schedule properly implemented?
20.3 Is there an action plan to follow up audit findin
20.4 Are audit findings being close with in the assig
21
21.1 Are management reviews conducted at dete
documented?
Are all required agenda items discussed
21.2 improvement?
21.3 Is top management involved?
22
22.1
22.2
22.3
22.4
Date of Audit:
TOTAL SCORE :
RESULT
DEFINITION SCORE
ctation is recognized to be an HSEQ MS requirement.
eongoing
an HSEQ 0
or MS requirement but is only partially being complied with nd shows significant gaps
planned.
1
implemented
ment and there
this Expectation is an adequate
beyond plan
the current in place
level to fully implement it.
of compliance. 2
n originally
ted and there planned
is an adequate plan in place to fully implement it. 3
rdance
et withwith or better
negligible than the plan.
noncompliance. 4
e to ensure continuous compliance and improvement.
DATE
AUDIT CHECKLIST GUIDE PAGE
POLICY REQUIREMENTS:
(Review whether there is consistency with the
PROCESS TOOLS / RESOURCES: overall goal of the top management. Check if PERSONNEL REQUIREMENTS:
(Review whether needed resources such as top management is monitoring the process
(Review awareness, applied knowledge,
production equipment, tooling, utilities, work performance)
authority, responsibility, training records,
environment, PPEs, monitoring devices are contribution, motivation, physiological
available, maintained, calibrated, etc.) attributes, etc.)
ISO / TS CLAUSES :
NONCONFORMANCE HANDLING :
(Review whether relevant ISO/TS clauses
(Review disposition if output is different from
requirements are effectively addressed)
what is expected, responsibility for quality,
controls applied in case of nonconformance,
countermeasures, etc.)
ISO / TS CLAUSES :
NONCONFORMANCE HANDLING :
(Review whether relevant ISO/TS clauses
(Review disposition if output is different from
requirements are effectively addressed)
what is expected, responsibility for quality,
PERFORMANCE INDICATOR : controls applied in case of nonconformance,
countermeasures, etc.)
(Review whether performnace metrics is suitable
and effective to meet the objectives, performance
trends, improvement plans, analysis, etc.)
Prepared by:
AUDIT PLAN Approved by:
Involvement Ö Ö Ö Ö Ö
Policy Statement Ö Ö Ö Ö Ö Ö Ö Ö
Established objectives Ö Ö Ö Ö Ö Ö Ö
Safety Budget Ö Ö Ö Ö Ö Ö Ö
Accountability Ö Ö Ö Ö Ö Ö Ö
Supervisory / Management Training Ö Ö Ö Ö
Employee Training Ö Ö Ö Ö Ö
Investigations Ö Ö Ö
Risk Management on Meeting
Agendas Ö Ö Ö
Facility Inspections Ö Ö Ö Ö Ö Ö Ö
Approval of Safety Policies and
Procedures Ö Ö Ö
Safety Performance Responsibility Ö Ö Ö
Claims Management Ö Ö Ö
Claims Costs and Claims Trends Ö Ö Ö
Safety Recommendations Ö Ö Ö
Page 30 of 131
Prepared by:
AUDIT PLAN Approved by:
Injury Reporting Ö Ö Ö Ö Ö Ö Ö
Incident Investigation Ö Ö Ö Ö Ö Ö
Cultivates a Positive Culture Ö Ö Ö Ö Ö Ö
Injury Reporting Ö Ö Ö Ö Ö Ö
Incident Investigation Ö Ö Ö Ö Ö Ö Ö
Cultivates a Positive Culture Ö Ö Ö Ö
Material planning Ö Ö Ö Ö Ö
Page 31 of 131
Prepared by:
AUDIT PLAN Approved by:
Personnel recruitment Ö Ö Ö Ö Ö
General affairs Ö Ö Ö Ö Ö Ö
Information technology Ö Ö Ö Ö Ö
Business planning Ö Ö Ö Ö Ö Ö Ö
Management review Ö Ö Ö Ö Ö Ö
Complaint handling Ö Ö Ö Ö Ö
Documentation management Ö Ö Ö Ö Ö Ö Ö Ö Ö
Environmental programs Ö Ö Ö Ö Ö Ö Ö Ö Ö Ö Ö Ö Ö
Lead Auditor
Control plan audit Ö Ö Ö Ö Ö Ö Ö Ö Ö Ö
Page 32 of 131
Prepared by:
AUDIT PLAN Approved by:
Page 33 of 131
Date:
Revision:
Time Frame
Description
MAR
MAY
NOV
OCT
DEC
AUG
APR
JUN
FEB
JAN
SEP
JUL
Ö Ö MANAGEMENT RESPONSIBILITY
Contract review
Production scheduling
Ö Purchasing
Ö Ö In-coming inspection
Ö Parts machining
Ö Ö Heat treating
Ö Ö Metal forging
Ö Ö Parts plating
Ö Ö Parts coating
Time Frame
Description
Page 34 of 131
Date:
Revision:
Time Frame
Description
MAR
MAY
NOV
OCT
DEC
AUG
APR
JUN
FEB
JAN
SEP
JUL
Description
MAR
MAY
NOV
OCT
DEC
AUG
APR
FEB
JUN
JAN
SEP
JUL
Ö Parts assembly
Ö Ö Ö Ö Work-in-process inspection
Ö Ö Ö Ö Outgoing inspection
Time Frame
Description
MAR
MAY
NOV
OCT
DEC
AUG
APR
FEB
JUN
JAN
SEP
JUL
Ö Product packaging
Ö Product delivery
Material planning
Page 35 of 131
Date:
Revision:
Time Frame
Description
MAR
MAY
NOV
OCT
DEC
AUG
APR
JUN
FEB
JAN
SEP
JUL
Personnel recruitment
General affairs
Information technology
Ö Ö Ö Business planning
Ö Ö Ö Management review
Ö Ö Complaint handling
Ö Ö Documentation management
Ö Ö Ö Environmental programs
Page 36 of 131
Date:
Revision:
Time Frame
Description
MAR
MAY
NOV
OCT
DEC
AUG
APR
JUN
FEB
JAN
SEP
JUL
Page 37 of 131
DATE
AUDIT CHECKLIST NOTES
PAGE
INTERVIEWED CLASSIFICATION
AUDIT FINDINGS AREA
PERSON MA MIN OFI
Audited by: Acknowledged by:
Safety Dashboard Questi
Category Component QUESTIONNAIRE
Not Applicable
Demonstrates a strong
Management Commitment Involvement commitment to safety in all
aspects
Hazard Identification
Chemical Hygiene
Hazard Specific Controls
Hazard Identification:
Additional Worksite Hazards: Welding
Define the controls in place for
each as applicable.
Hazard Identification:
Additional Worksite Hazards: Compressed Gas
Define the controls in place for
each as applicable.
Hazard Identification:
Additional Worksite Hazards: Hand and Power Tool Program
Define the controls in place for
each as applicable.
Hazard Identification:
Additional Worksite Hazards: Consumer Aggression
Define the controls in place for
each as applicable.
Hazard Identification:
Additional Worksite Hazards: Violent Offenders
Define the controls in place for
each as applicable.
Hazard Identification:
Additional Worksite Hazards: Patient Handling
Define the controls in place for
each as applicable.
Hazard Identification:
Additional Worksite Hazards: Working with Livestock
Define the controls in place for
each as applicable.
Hazard Identification:
Additional Worksite Hazards: Working with Wildlife
Define the controls in place for
each as applicable.
Hazard Identification:
Additional Worksite Hazards: Unexploded Ordinance
Define the controls in place for
each as applicable.
Hazard Identification:
Additional Worksite Hazards: Handling Fire Arms or other weapons
Define the controls in place for
each as applicable.
Hazard Identification:
Additional Worksite Hazards: Handling Explosives
Define the controls in place for
each as applicable.
Hazard Identification:
Additional Worksite Hazards: Airplane Operations
Define the controls in place for
each as applicable.
Hazard Identification:
Additional Worksite Hazards: Helicoptor Operations
Define the controls in place for
each as applicable.
Hazard Identification:
Additional Worksite Hazards: Wildland Fire Fighting
Define the controls in place for
each as applicable.
Hazard Identification:
Additional Worksite Hazards: Structural Fire Fighting
Define the controls in place for
each as applicable.
Hazard Identification:
Additional Worksite Hazards: Working in or around waterways
Define the controls in place for
each as applicable.
Hazard Identification:
Additional Worksite Hazards: Print Press Operation
Define the controls in place for
each as applicable.
Preventative maintenance
Recordkeeping
Repair logs
Recordkeeping
Incident investigation forms
Recordkeeping
Claims notes
Recordkeeping
Management has drafted and stands behind the Management has signed the safety
organization's safety policy statement. policy statement.
Clear objectives are set on an annual basis and Objectives are written but no metric
communicated to the entire organization. Metrics developed to measure efforts.
are established to identify successes.
Funds are adequately allocated for safety efforts. Funds are allocated for safety on a
Individual departments budget for safe operations. request basis.
Managers and supervisors have a role in providing The safety coordinator provides all
or arranging for job specific safety training. safety training.
Safety is an active agenda item in each management Safety is occassionally on the agenda
meeting. in management meetings.
Management is involed with all facility safety Management participates in safety
inspections. inspections at least once per year.
Managers and supervisors are actively involved in Human Resources and /or the Safety
claims management through timely investigations to Coordinator handles all claims
serving on the RTW Team management activities.
Supervisors complete the First Report of Injury Injuries are reported to supervisors,
(FROI) and submit to HR within 24 hour of notice. but HR or Safety Coordinator
Supervisors and managers are accountable for completes the FROI timely.
accurate completion of FROI.
Provides recognition and feedback for employee Provides recognition and coaching
who deliberately work safely. Provides timely broadly to the organization via email,
coaching to employees who are observed working in staff meetings, or other means.
unsafely.
Works with supervisors and management to address Assists employees with special
documented requests for special safety needs of accomodation requests without
employees. involving supervisor.
Safety standards are expected but not
Safety standards are incorporated to job profiles. formally written.
Serves as the point of contact for the insurer to Supervisor, Safety Coordinator, and/or
begin processing the claim. HR serves as initial point of contact.
Actively participates in job specific safety training. Signs off on Job Safety Training.
Demonstrates understanding.
Reports injuries or incidents as soon as possible and Injury and incident reporting is usually
within the same workday. timely.
Always wears the required PPE. Keeps PPE clean Uses PPE when Safety Coordinator or
and well maintained. Supervisor is present.
Maintains good housekeeping in work areas. Uses
warning or caution signs if work area will be Cleans work area when told to do so.
disturbed.
Plans work with safety forecasting. Arranges work Follows safety rules and guidelines as
process safely. Controls or mitigates hazards before they are written.
starting task.
Helps coworkers work safely. Openly communicates Will work as a team and talk safety as
hazards and controls of tasks. Informs others as other employees do. Does not
information is available. address safety on his/her own.
Safety management is a half time
Safety management is a full time position. position.
Can stop work if conditions or practices are unsafe. Works with supervisor on resolving
safety issues.
Chairs committee and takes on the
Delegates projects, follows up on completion. committee work load.
Analyzes accident reports and loss reports from Reviews information and provides
insurance carrier. Works to implement effective direction. Follow through and metrics
corrective action. Has established metrics to
identify success. lack.
Work activities are reviewed on a scheduled interval Work activites are addressed on an
with timely feedback provided to employees. unscheduled, as needed basis.
A written fire prevention plan is in place and The fire prevention plan is known, but
followed. not written.
[type your current hazard controls here] [type your current hazard controls
here]
Always Sometimes
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Yes Maybe
Yes Maybe
Yes Maybe
Yes Maybe
Yes Maybe
Yes Maybe
Yes Maybe
Yes Maybe
(Monthly) (Quarterly)
Yes Maybe
Yes Maybe
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Yes Maybe
Yes Maybe
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Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Opportunity 2018
0 Points
No visible authority.
No continuing education.
No self audits.
No evidence of inspections.
No evidence of inspections.
Never
Never
Never
Never
Never
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No
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(Less)
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Comments
Management Commitment
Involvement
Supervisory / Management
Management Commitment Training
Safety Performance
Management Commitment Responsibility
Management Commitment Claims Management
Implementation of Taqa Sanjel Policy. Management has drafted and stands behind the
organization's safety policy statement.
No evidence of management
being involved in the safety
process.
No evidence of management
being involved with the safety
policy statement.
No evidence of managers or
supervisors involvement in safety
training.