VERIFIABLE CONTRACTOR HSE QUESTIONNAIRE

Lusail Real Estate Development Company (LREDC) places a high level of importance on safety for its employees, contractors and the public.
We believe a review of your safety record, management accountability and safety program will provide key indicators for use in our
contractor selection process and provide assistance as to how we may work as a team to achieve our safety expectations. Enclosed with
every set of enquiry documents is "Health, Safety and Environmental Guidelines." This is separately available for your review before
performing work for Lusail. Please complete the following questionnaire and return it with your tender submission.

This questionnaire is submitted in relation to Contract Number:

Contract Title:

By: Date:

Contractor/Consultant/Developer Name:

Address:

Please answer the following questions:

Verified By

No. Question Comment (LUSAIL EHS)

Date Signature

1 Primary type of business / work / service

2 Do you have an HSE management system in place which is

referenced to the latest release of QCS? (If yes - please
provide a copy of the index, and a site specific HSE Plan.)

3 Provide injuries / illness / lost workdays for this year plus

previous three: (Use data for the facility servicing Qatar)

YEAR 2016 2017 2018 2019

Provide
Number of
Hours Worked
(for total
employees by
Total No. of
Injuries/ Illness
Total no. of
Lost- Work
Recordable Incident
Rate

Severity Rate

Note 1 Calculate Recordable Incident Rate as

Total No. of Injuries in Year x100,000

Divided by Total Man hours

APPENDIX D: CONTRACTOR TECHNICAL PROPOSAL Page 23 of 29

Note 2 Calculate Severity Rate as

Total No. of Lost Workdays in year x 100,000

Divided by Total man hours
4 Has your company had a fatality in the last three years?
(If yes attach explanation)
5 Are accident reports reviewed?
6 Who is responsible for accident investigation and
corrective actions?
7 Do your field supervisors participate in employee safety
meetings?
8 How often are formal safety meetings held?
9 Does your company conducts "Toolbox Safety Meetings",
pre- start safety briefing or STARRT conducted by
foreman/supervisor and housekeeping before each job?
10 How often are documented on-site field operations safety
inspections conducted?
11 Do you have a written HSE policy signed by management?
12 Do you provide HSE INDUCTION to new employees?
13 Does your company have pre-employment physical
exams?
14 Does your company have a drug and alcohol testing
program?
15 Do you provide your employees with safety training
(comment plus check all that apply)
Construction General Defensive Driving
Safety Awareness
Respiratory Fire Safety Training
Protection
Hazard First Aid/CPR: Certified
Communication
Emergency Action Ergonomics
Plans
Confined Space Rigging and Slinging
Awareness
Confined Space: Fall Protection
(check following) Electrical Safety
Certified entrant
Injury / Illness
Reporting
Certified attendant
Site Safety Induction
Certified attendant Permit to Work

Interface and leadership

Certified rescue
Personal Protective Hearing Conservation
Equipment
NORM Awareness Heat Stress
Management
Food Safety &
personal Hygiene
16
Does your company have a training program for newly
hired or promoted first line supervisors?

17 Does your organization have an HES organization chart? (if

yes please attach with returned questionnaire)

18 Does your organization measure the HSE performance of

APPENDIX D: CONTRACTOR TECHNICAL PROPOSAL Page 24 of 29

 your contractors?

19 Does your organization frequently audit contractor’s work

for compliance with contract safety requirements?

20 Describe the health, environmental and safety standards

your organization work to. (Global, regional etc.)

21 Does your organization have a key performance indicator

system in place?

(if yes please briefly describe)

22 Has your organization carried out simple, comprehensive

risk assessments for workplace potential hazards?

(if yes please include sample copies with returned

questionnaire)

23 Do you have an Environmental Policy in your Company

that includes the topic of Sustainability?

24 Do you have an Environmental Manager who also deals

with the topic Sustainability? If yes, please send us copy of
his CV.

25 What kind of Environmental friendly / Sustainability

initiatives have you already incorporated into a former
project? (Please list max. 5 initiatives like Tree planting,
paper recycling etc.)

26 Is your company ISO 14001/ 18001 or 45001 / 9001

certified – if yes please provide evidence

27 Is your company following standards set by Qatar Labor

Law on Workers Accommodation and Welfare? Does
these standards include Third party Catering Services at
The Camp? Please note that self- cooking at camps is not
allowed.

28 Do you conduct workers accommodation inspection

including your sub-contractors?

29 Do you have an awards or recognition scheme for good

HSE practice, if so please attach evidence.

ADDITIONAL INFORMATION REQUIRED – TO BE RETURNED WITH THE COMPLETED QUESTIONNAIRE:

A method statement identifying the hazards and risks of the contracted work and how your organization plans to carry out these tasks
safely.
A list of construction projects previous and current, and brief details of work performed for last three years.

Verification Audit
In the event the undersigned is short-listed for the contract, it is agreed that QA and EHS representatives of LUSAIL to verify the validity of
the information received may audit information responses in this questionnaire.

Questionnaire completed by (printed Title: On behalf of (company name)

name):

APPENDIX D: CONTRACTOR TECHNICAL PROPOSAL Page 25 of 29

Signature: Date: 12/04/2020

LUSAIL APPROVAL (LUSAIL use only below this line)

DEPARTMENT: NAME (print): SIGNATURE:

EHS DEPARTMENT NAME (print): SIGNATURE:

ORIGINATOR: NAME (print): SIGNATURE:

CONTRACT NUMBER:

APPENDIX D: CONTRACTOR TECHNICAL PROPOSAL Page 26 of 29