05-Contractor EHS Criteria

Contractor EHS Management System Criteria
A (0) B (4) C (8) D (12)

Section 1: Leadership and Commitment
Commitment to EHS through leadership: Item 1 (1)
No commitment from senior EHS disciplines delegated to Evidence of active senior Evidence of a positive EHS
management line managers – no direct management involvement in culture in senior
involvement by senior EHS aspects management and at all
management levels
Section 2: Policy and Strategic Objectives

EHS policy documents and availability: Items 2(1) and 2(2)
A policy statement exist but A policy statement exists EHS policy establishes Policy with clearly
responsibility for EHS is with clear responsibility for responsibility for EHS in established responsibility
unclear EHS but not in a widely languages easily and accountability; is
distributed document understood, but not widely distributed to all employees;
distributed and is visible on notice
boards
Section 3: Organization, Responsibilities, Resources, Standards and Documentation
EHS communication and meeting programmes: Item 3(1)
No management Management involvement Regular management Regular management

involvement toward EHS and commitment toward involvement and involvement and
activity EHS in special occasion commitment toward EHS. commitment toward EHS.
only, likewise for periodic EHS meetings performed on Regular EHS meetings
EHS meetings a regular basis at performed and employees
management and supervisor are assigned topic to
level discuss on a rotational basis
Staff EHS training Item3(2)
No EHS training established EHS training established but EHS training established and EHS training established
not implemented implemented but only to a and fully implemented to all
limited staff only staff related to the work
Section 3: Organization, Responsibilities, Resources, Standards and Documentation (cont’d)
Employee competency and EHS training: Item 3(3)(a) – (d)
No formal programme Formal program established Formal program established Formal program established
to update employee and implemented for and implemented for
knowledge on EHS. Verbal employee and new employee and new
instructions on company employee on EHS. Update employee knowledge on
procedures only for new employee knowledge on EHS. Employee handbook
employees but no on-the job EHS. Employee handbook provided and supervisor
orientation by supervisor provided and supervisor outlines, explains and
outlines, explains and demonstrates new
demonstrates new employee’s job. With:
employee’s job follow-up observation of the
new employee’s work is
CSMS training – SELECTION – attachment, page : 1

also included. Supervisor
has explained to him safe
practices and emergency
duties
Specialized training: Item 3(4) (a) and (b) and 3(5)
No specialized EHS training Specialized EHS training Specialized EHS training Specialized EHS training
established established but not established and established and
implemented implemented implemented on a regular
basis. Retraining periods
are established. Qualified
EHS professional are
employed
Subcontractors: Item 3(6) (a) – (c)
No assessment program for Assessment program and Assessment program and Assessment program and
subcontractor established standards for subcontractor standards for subcontractor standards for subcontractor
are established, covering are established and are established and fully
limited area only but not implemented implemented. Quality
implemented yet, assurance for compliance in
place
EHS Performance Standards: Item 3(7) (a) – (c)
No EHS performance EHS performance standards EHS performance standards EHS performance
standards available established for limited established and in standards established and
purposes only or partial and compliance with local in compliance with local and
in compliance with local industry regulatory standards global industry regulatory
industry regulatory standards standards
only
Section 4: Hazards and Effects Management

Hazards and Effects Assessment: Item4(1)
Company’s EHS system Company’s EHS system Company’s EHS system Company’s EHS system has
does not included hazards makes reference to the need includes methods for the a comprehensive set of
and effects assessment to assess hazards and assessment of major methods for the assessment
effects but has no hazards and effects of all EHS hazards and
comprehensive structure to effects and applies the to all
carry this out of its contracts with
documentation
Exposure of the workforce: Item 4(2)
Company does not actively Company advise the Company has formal Company has a set of
advise the workforce nor workforce of the major methods for monitoring formal methods for
monitor exposure hazards that they are likely exposure to the major monitoring exposure to all
to be exposed to but only hazards foreseeable hazards (linked
monitors exposure randomly to its hazards and effects
assessment method) and
applies them to all contracts
Personal protective equipment: Item 4(3)
Basic PPE provided to PPE requirements formally PPE requirements formally Procedures in place to
personnel but no corporate assessed but little effort assessed with spot checks assess all PPE
procedure for assessing made to ensure correct on usage requirements monitor and
individual needs usage enforce usage and
replacement needs. Stock

inventories monitored, kept
above demand levels.
Training in use provided
where needed
Section 4: Hazards and Effects Management (cont’d)

Waste Management: Item 4(4)
Company has no formal Company has general Company has procedures for Company has a formal
methods for the control of procedures for waste the disposal of each of the system for waste
waste disposal main categories of site management (including
wastes but makes no identification, minimization
provision for minimizing and classification), which
environmental impact actively seek to minimize
environmental impact
Alcohol and Drugs: Item 4(5)
No alcohol and drugs policy An alcohol and drugs policy An alcohol and drugs policy Drugs policy with clearly
written statement exists but not in a includes establishing established responsibility
widely distributed document responsibility and accountability , and
accountability, and widely disciplinary clause is
distributed distributed to all employees;
and is visible on notice
boards
Section 5: Planning and Procedures

HSE or operations manual: Item 5(1) (a) and (b)
No EHS procedures / Basic EHS procedures / Contractor has written EHS Contractor has procedures
manual is available manual exist procedure / manual to cover to cover all EHS precaution /
all hazardous operations manual typical contractor
EHS plan requirements with
a system of updating and
dissemination to employees
Equipment control and maintenance: Item 5(2)
No defined programme to Program relies on outside A written programme In additional to C, periodic

ensure control and courses, i.e. company outlining supervisory inspections conduced by top
maintenance of plant and / inspections. Supervisory guidelines, responsibilities, management or by teams of
or equipment inspection of equipment frequency and follow-up is in specialists
confined to worksite effect
personnel only
Transport Safety Management: Item 5(3)
No special attention paid to Importance of transport Company has a general Company has a complete
transport safety as an area safety acknowledged but left management strategy with strategy and set of plans
of hazardous activities to core business manager / some procedures for its and procedures covering
supervisors to enact competent issues vehicles, drive and
individually operations management
Section 6: Implementation and Performance Monitoring

Management and performance monitoring of work activities: Items 6(1)
No system for formally Informal / incidental Company has a system for Company has a
monitoring HSE performance monitoring HSE performance monitoring HSE performance comprehensive system for
at all only in key areas monitoring performance in

all areas with feedback to
employers for improvement
and has received awards for
achievement
Section 6: Implementation and Performance Monitoring (cont’d)

Safety program Item: 6(2) (a) – (b)
No formal program Periodic safety meetings for Safety meetings performed Safety meetings
special operations only on a regularly scheduled performance in a regularly
basis with the supervisor or basis and employees are
safety representative assigned topics to discuss
on a rotational basis
HSE Performance records (Latest year injury rate comparison to contractor’s three preceding years average): Items 6(3) (a) –
(b)
Contractor supplied Rate is not improving Shows only minor rate Rate steadily improving by
insufficient information to improvement more than 20 per cent per
establish rate or rate year
increases
Incident Investigation and reporting: Item 6(4) (a) – (b)
Procedure are available but Procedure are available and Procedure are available and As in C but with the
Findings not generally Findings communicated to Findings communicated to additional of details of
communicated key personnel only via all employees via specific implication for improving
limited company internal company notice HSE performance
memo or similar media
Section 7: Auditing and Review

Auditing: Item 7(1) (a) – (b)
Audit process is cursory only Company EHS documents Company EHS documents As in C but additionally
– EHS documents are not include reference to auditing include detail of how auditing specifies management’s role
explicit about auditing but there are no specific is to be implemented with in audit and follow-up on
details about scheduling and schedules/coverage for the action items
coverage key areas
Section 8: Emergency Response Procedure

Emergency Response Procedure
No written Emergency Basic procedures only Emergency procedures Emergency procedures

Response written for major scenarios, written for major scenarios,
e.g. fire/explosions, H2S, e.g. fires/explosions, H2S,
evacuation, release of toxic evacuation, release of toxic
or flammable materials and or flammable materials and
medical emergencies. No medical emergencies.
requirements established for Procedures documented in
drill frequencies an Emergency Procedures
Manual which is widely
distributed. Frequency of
conducting drills established

Section 9: Company Specific Information

Contractor EHS Management System Evaluation
Contractor :
Address :
Date :
Contractor Safety Contract :
Phone :
Circle the number, which best represents this evaluation based on the criteria for
rating purposes attached
A B C D Subtotal Factor Total

SECTION 1 – LEADERSHIP AND COMMITMENT 0 4 8 12
SUBTOTAL X1
SECTION 2 – POLICY AND STRATEGIC 0 4 8 12
OBJECTIVES
SUBTOTAL X1
SECTION 3 – ORGANIZATION, RESPONSIBILITY,
RESOURCES, STANDARDS AND
DOCUMENTATION
SECTION 3 ITEM 3 (1) 0 4 8 12
SECTION 3 ITEM 3 (2) 0 4 8 12
SECTION 3 ITEM 3 (3) (A) – (D) 0 4 8 12
SECTION 3 ITEM 3 (4) (A) and (B) AND 3 (5) 0 4 8 12
SECTION 3 ITEM 3 (6) (A) – (C) 0 4 8 12
SECTION 3 ITEM 3 (7) (A) – (C) 0 4 8 12
SUBTOTAL X1/6
SECTION 4 – HAZARDS AND EFFECT
MANAGEMENT
SECTION 4 – ITEM (1) 0 4 8 12
SECTION 4 – ITEM (2) 0 4 8 12
SECTION 4 – ITEM (3) 0 4 8 12
SECTION 4 – ITEM (4) 0 4 8 12
SECTION 4 – ITEM (5) 0 4 8 12
SUBTOTAL X1/5
TOTAL (SECT1-SECT4)
SUBTOTAL (SECT 1 – SECT 4)
A B C D Subtotal Factor Total
SECTION 5 – PLANNING AND PROCEDURE
SECTION 5 – ITEM 5 (1) (A) and (B) 0 4 8 12
SECTION 5 – ITEM 5 (2) 0 4 8 12
SECTION 5 – ITEM 5 (3) 0 4 8 12

Cont from page (1)
SUBTOTAL X1/3
SECTION 6 – IMPLEMENTATION AND
PERFORMANCE MONITORING
SECTION 6 – ITEM 6 (1) 0 4 8 12
SECTION 6 – ITEM 6 (2) (A) – (B) 0 4 8 12
SECTION 6 – ITEM 6 (3) (A) – (D) 0 4 8 12
SECTION 6 – ITEM 6 (4) (A) – (C) 0 4 8 12
SUBTOTAL X1/4
SECTION 7 – AUDIT AND REVIEW 0 3 7 10
SUBTOTAL X1
SECTION 8 – EMERGENCY RESPONSE 0 3 7 10
PROCEDURE
SUBTOTAL X1
TOTAL RATING (SECT1-SECT9)
SUMMARY
The numerical values below are the weighted ratings calculated above. The total represents the overall score for the
Contractor.
TOTAL RATING *)
EVALUATED BY:
Purchasing Rep: EHS Rep: Dept. User Rep:
NAME NAME NAME

TITLE TITLE TITLE
DATE DATE DATE
*) FOR A BIDDER TO QUALIFY AS ACCEPTABLE, THE TOTAL RATING MUST BE EQUAL OR MORE THAN
64. IF INSUFFICIENT NUMBERS OF Bidders ARE QUALIFIED, SELECTION SHALL BE MADE FROM THE FIVE
BIDDERS HAVING THE HIGHEST TOTAL RATING, PROVIDED THAT THE PRIMARY FACTORS THEREOF
MUST BE THE HIGHEST RELATIVE TO THE OTHER BIDDERS'PRIMARY FACTORS.

Selection Form
Date:
Inspector:
Contract No:
Subject:
INSPECTION RESULT
Evaluated Items Min. Req. Inspect. Result Remarks
SUMMARY & RECOMMENDATION
Inspected by: Team

1. EHS Rep:
2. Dept. User Rep:
3. Purchasing Rep:

Pre-Job Activity Form
PRE-JOB ACTIVITY CHECKLIST
Date :
Project Period :
Job Title :
Contract No. :
Work Location :
Address :
Contractor Reps: Department User:

(Name/Date) (Name/Date)

No ITEM YES NO N/A REMARKS
I. Work Plan
1.1 Has the SHEP issue been addressed in
the work program or procedure and
reviewed with the contractor?
1.2 Has the Contractor reviewed the ZZ
Indonesia SHEP Handbook and Permit
System?
1.3 Has the contractor's equipment, related
to the job to be performed, passed
safety inspection?
1.4 Are all critical jobs identified and
analysed?
1.5 Are the procedures for critical jobs
written and reviewed with the contractor
before the work begins?
1.6 Are materials handling equipment and
procedures available?
1.7 Is the facility schedule available? (e.g.
camp, warehousing, delivery of
construction materials or equipment on
site, contractor responsibility for
loading, unloading, storing of contractor
ZZ Indonesia furnished materials)
1.8 Contractor's competent person as the
safety representative :
1.81. Is he/ she available?
1.82. Does he/she have sufficient
authority to implement
change?
1.9 Does the Contractor have he
following minimum Safety
Program and provide tools to
ensure its implementation
1.9.1. Supervisor safety background
and experience?
1.9.2. Indoctrination of new employees?
1.9.3. Safety meetings?

1.9.4. Safety inspections?
1.9.5. Safety promotion?

1.9.6. Has the Supervisor and
employees fully communicated about
safety issues?
1.9.7. Emergency drills'?
1.9.8. Accident Investigation / reporting?
1.9.9. Other ?

I. Work Plan (cont’d)
1.10 Does the Contractor have Incentive
programs for an effort to Reduce
occupational injuries, Illnesses and
environmental Damages?
1.11 Does the Contractor have disciplinary
action programs in case of non-
compliance?
II. Potential Hazards

2.1 Does the Contractor system for
potential identification (e.g. for usafe
acts and/or conditions) and ensure its
implementation?
2.2 Does the Contractor provide a proper
hazard control system for the following
items and verify their implementation?
2.2.1. Housekeeping?
2.2.2. Machine guarding?
2.2.3. Chemicals?
2.2.4. Flammable and explosive

materials?
2.2.5. Radioactive materials?
2.2.6. Waste-trash collection?
2.2.7. Maintenance of equipment,

guards, tools, etc.?
2.2.8. Work permit system?
2.2.9. Personal protective equipment

(PPE)?
2.10. Other ?

III. Emergency Response Plans and Procedures
3.1 Are the Contractor's employees aware
of their role in an emergency?
3.2 Do they know how to report an
emergency?
3.3 Have they received specific
instructions about use during and after
an emergency?
3.4 Does the Contractor personnel trained
to administer first aid and
cardiopulmonary resuscitation (CPR)?
3.5 Are adequate first aid applies available?
3.6 Have the first aid kits been
approved by a physician?
3.7 Have arrangements been made with ZZ
Indonesia, ambulance service, hospital,
or others to handle medical care
ranging from first aid to life-threatening
injuries andilinesses?
3.8 Is Contractor's Contact Person available
during emergency?
3.9 Does the Contractor provide itsown
medical doctor?
IV. Pre-Job Safety Meeting

4.1 Is a pre-job saf ety meeting scheduled
to be conducted before commencing the
work?
4.2 Is the meeting attended by suitable
contractor representation?
V. Site Orientation
5.1 Site conditions under which the work
will have to be performed:
5.1.1 Is access to the project and the
work area available?
5.1.2 Is (Are) contractor lay-down
area(s) sufficient?
5.1.3 Are communication links for on the
job and external-to-job
available?

5.1.4 Are disposal areas available for
cleanup purposes and are there
cleanup areas where more than
one contractor is working?
5.2 Are the alarm systems available and the
Contractor employees made aware of
them?
5.3 Have exit routes and' gathering areas
been established; where head counts
are to be performed in case of an
emergency?
5.4 Availability of emergency
reportingequipment:
5.4.1. Paging system?
5.4.2. Radio system?
5.4.3. Telephone system?
5.4.4, Others ?
5.5 Are emergency telephone
numbers posted throughout the site?

VI. Finalized SHEP Requirements
6.1 Have all SHEP requirements and issues
(ref. to ZZ lndonesia's SHEP
requirements and applicable Indonesian
Government Rules and Regulations)
concerning the work been reviewed and
finalized by ZZ Indonesia and the
Contractor?
6.2 Have affected parties been notified of
any changes to these SHEP
requirements by the responsible party?
VII. SHEP Training
7.1 Does the contractor ensure that jobs
requiring certification are performed by
workers who possess the appropriate
documentation and certificates?
7.2 Does the contractor provide training for
its managers and supervisors to ensure
that they are capable of administering
the safety program?
7.3 Is there a training plan for contractor
employees?
7.4 Is the training plan addressed


VII. SHEP Training (cont’d)
7.4.1 Safety and health?
7.4.2 Material Safety Data Sheets and
hazard communication
program?
7.4.3 Safety orientation?
7.4.4 First aid and cardiopulmonary
resuscitation (CPR)?
7.4.5 Fire fighting?
7.4.6 Firewatch?
7.4.7 Water survival?
7.4.8 Hydrogen sulphide?
7.4.9 Transportation and storage of
hazardous materials?
radioactive materials?
explosive materials?
7.4.12 Fall protection?
7.4.13 Drug and alcohol policy?
7.4.14 Forklift and crane operations?
7.4.15 Housekeeping?

VII. SHEP Training (cont’d)
7.4.16 Entry into confined spaces and
requirement for standby
personnel
7.4.17 Permit systems?
7.4.18 Abrasive blansting and
hydroblasting?
7.4.19 Respiratory protection?
7.4.20 Use of personnel protective
equipment (PPE)?
7.4.21 Control of hazardous energy
sources?
7.4.22 Excavating, shoring and

trenching?
7.4.23 Emergency response plan?
7.5 Is there documentation on file to verify
that the training has been
completed?
7.6 Is there a method available to determine
the understanding of the Contractor
employees concerning the training
materials (written or verbal
exXYZnation, walk-though demons-
tration, on-the-job evaluation, etc.)?
VIII. Contractor’s Management Commitment
8.1 Have all SHEP issues been
communicated to the Contractor’s upper
management?

Work In Progress
SAFETY INSPECTION CHECKLIST
Date :
Period :
Job Title :
Contract No. :
Work Location :
Contractor’s Name :
Address :



I. Housekeeping
1.1 Job-site looks neat
1.2 Raw materials stored properly
1.3 Walking surfaces neat and clean
1.4 Escape routes clean and clear
1.5 "No Smoking" properly posted
1.6 Trash emptied regularly
1.7 Materials not in danger of failing
1.8 Nails removed from wood planks/scrap
1.9 Lighting adequate
1.10 Healthy work place and
Poor Excellent
Housekeeping (Rating) 1 2 3 4 5 6 7 8 9 10
II. Personal Protective Equipment (PPE)

2.1 Hard hats in use
2.2 Proper footwear worn
2.3 Hearing protection where needed
2.4 Eye/face protection share needed
2.5 Gloves/protection clothing where
needed
2.6 Inspection procedures for PPE
2.7 Proper shirts worn
2.8 Proper respirators where needed

II. Personal Protective Equipment (PPE)
2.9 Fit-tests for respirator
2.10 Respirators cleaned, stored properly
2.11 Respirators individually assigned
2.12 Fall protection for work over 6 feet high
2.13 Explosimeters work properly

Personal Protective Equipment (PPE) Poor Excellent
(Rating) 1 2 3 4 5 6 7 8 9 10
III. Fire Prevention and Fire Protection

3.1 Proper fire extinguishers available for
use
3.2 Fire extinguishers inspected tagged
3.3 Employees trained in procedures
3.4 Wooden material stored properly
3.5 Flammable materials stored properly
3.6 Used rags in metal cans with covers
3.7 Fuel cans FM approved
3.8 Hor work permits
Fire Prevention and Fire Protection Poor Excellent
(Rating) 1 2 3 4 5 6 7 8 9 10

IV. Signs, Signals, and Barricades
4.1 Hazards barricades properly
4.2 Hazards marked appropriately
4.3 Unsafe tools tagged
Signs, Signals, and Barricades (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10
V. Hazard Communication
5.1 Written program
5.2 List of hazardous chemicals
5.3 MSDS file maintained
5.4 Chemicals properly labelled
5.5 Emergency spill control materials
available
Hazard Communication (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10
VI. Hazardous material (Waste, Lead, Asbestos, Radioactive, Explosive)
6.1 Site specific health and safety plan
6.2 Employees trained, certified, licensed

Hazardous material (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10


VII. Hand and Power tools
7.1 Equipment inspected regularly
7.2 Damaged equipment removed from
service
7.3 Grounding is not defeated
7.4 GFCI use is wet, outside, or metallic
areas
7.5 Proper switches on tools working
7.6 Tools stored securely when not in use
7.7 Double insulated tools used
7.8 Power actuated tool operators licensed
7.9 Guard are in place
Hand and Power tools (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10
VIII. Electrical safety
8.1 Precautions taken near overhead lines
8.2 Temporary lights guarded
8.3 Non-metal ladders used near electricity
8.4 Signs and tags to warn of electrical
hazards
8.5 Non-conductive head protection used
8.6 Containers of flammable material
bonded
8.7 Electrical cords checked for damage

VIII. Electrical safety (cont’d)
8.8 Flexible cord not used for fixed wiring
8.9 Lock out / tag out procedures in place
Electrical safety (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10
IX. Welding, Cutting, and Grinding

9.1 Hoses checked for leaks, damage
9.2 Ground to welder checked prior to use

9.3 Welder weak long-sleeved
cotton/leather
9.4 Goggles and eyeshades used
9.5 Welding areas isolated, protected
9.6 Fire watch and extinguishers in
attendance
9.7 Welding area free from fire hazards
9.8 Torches lighted by friction lighters
Welding, Cutting, and Grinding (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10
X. Compressed Gases
10.1 Cylinders secured properly
10.2 Oxygen, gas cylinders separated
10.3 Contents marks on all cylinders

X. Compressed Gases (cont’d)
10.4 Valve caps on when transported/not in
use
10.5 Flashback arrestors on torched
Compressed Gases (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10
XI. Confined spaces

11.1 Entry permit procedures followed
11.2 Air monitoring performed
11.3 Ventilation used
11.4 Respiratory protection used
11.5 Harness, lifeline, and hoisting apparatus
used
Confined spaces (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10
XII. Ladders
12.1 Appropriate for use
12.2 Non-slip safety feet
12.3 Ladder tied off
12.4 Ladders long enough for use

12.5 Pitch less than 1:4
12.6 Ladder inspected for condition
Ladders (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10

XIII. Scaffolds
13.1 Guard-rails and toe boards in place
13.2 Correctly anchored
13.3 Proper flooring
13.4 Flooring secured to scaffold structure
13.5 Barricades installed around scaffold
areas
Scaffolds (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10
XIV. Excavations
14.1 Competent person on-site
14.2 Employee protection from cavies
14.3 Egress w/in 25” (7,6 m) of employees
14.4 Air monitoring over 4” (1,2 m)
14.5 Material 2” (0.6 m) from edge
14.6 Underground installations located,
14.7 Excavations properly barricaded
14.8 Employees not exposed to falling loads
14.9 Bridges/walkways w/ standard rails
Excavations (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10

XV. Mechanized Equipment
15.1 Seat belts installed and used
15.2 Rollover protection installed
15.3 Equipped with horn
15.4 Fuelling at safe locations
15.5 Fire extinguishers in every place
15.6 Equipment stored properly when nor

used
15.7 Back-up alarms operating
Mechanized Equipment (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10
XVI. Cranes and Hoists

16.1 Inspections on crane documented
16.2 Load rating chart in cab
16.3 Hand signals posted
16.4 Swing radius guarded
16.5 Overhead power lines protected
16.6 Ropes, slings, chains, hooks, inspected
daily
16.7 Safety hooks used
16.8 Safe working loads determined
16.9 Tag lines used on all lifts
Cranes and Hoists (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10

XVII. Wall Openings
17.1 Opening, holes, chutes, skylights
protected
17.2 Standard rails provided
17.3 Floor over 4 feet (1,2 m) high guarded
17.4 Screen provided where necessary
Wall Openings (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10

SAFETY PROGRAM CHECKLIST
Date :
Period :
Job Title :
Contract No. :
Work Location :
Address :



I. Safety Meeting
1.1 Does the contractor periodically conduct
safety meeting attended by XYZ Rep?
1.2 In safety meeting recorded and
documented?
1.3 Are safety meeting topics related with
the job being performed?
Safety Meeting (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10
II. Safety Inspections

2.1 Does the contractor conduct safety
inspections together XYZ Reps on a
periodic basis?
2.2 Are documents (typical Checklist
attached) of safety inspection file and
available?
Safety Inspections (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10
III. Safety Promotion

3.1 Is Contractor’s management
commitment demonstrated through their
employees’ safety attitude and
performance?
3.2 Does the Contractor’s management
actively demonstrated support for
improved safely program?
Safety Promotion (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10

IV. Supervisory / Employee Safety Communication
4.1 Are the Contractor’s employees able to
communicate all SHEP issues to their
management?
4.2 Are on-job and external-to-job
communications links established?

Supervisory / Employee Safety Poor Excellent
Communication (Rating) 1 2 3 4 5 6 7 8 9 10
V. Emergency Drill and Exercise

5.1 Do the Contractor’s employees conduct
or participate in emergency drills and
exercises?
5.2 Are the Contractor’s employee’s familiar
with their role in an emergency?
5.3 Do the Contractor’s employee know
where to report in an emergency
Emergency Drill and Exercise (Rating) Poor Excellent
1 2 3 4 5 6 7 8 9 10
VI. Accident, Incident Investigation / Reporting

6.1 Are all accidents/incidents investigated
to determine their cause, and is
corrective action taken?
6.2 Are serious incidents and near misses
reported to XYZ immediately?
6.3 Does the contractor have a written
accident / incident investigation
procedure?

VII. Accident, Incident Investigation / Reporting
6.4 Is a report completed for:
6.4.1 Fatalities?
6.4.2 OSHA-recordable accidents?
6.4.3 Vehicle accidents?
6.4.4 Equipment damage?
6.4.5 Spills?
6.4.6 Fires?
6.4.7 Near misses?
6.4.8 Contractor injury resulting from
XYZ action or equipment?
6.5 Is the Contractor involved in an accident
/ incident investigation team and follow-
up?
6.6 Does the Contractor develop a monthly
statistical summary (typical form
attached) that illustrates its safety
performance?

Accident, Incident Investigation / Poor Excellent
Reporting (Rating) 1 2 3 4 5 6 7 8 9 10

INTERIM EVALUATION CHECKLIST
Date :
Period :
Job Title :
Contract No. :
Work Location :
Address :


No ITEM RATING REMARKS

SAFETY INSPECTION (HAZARD & INDUSTRIAL HYGIENE)
1 Housekeeping
2 Personal Protective Equipment (PPE)
3 Fire Prevention and Fire Protection
4 Signs, Signals and Barricades
5 Hazard Communication
6 Hazardous Material
7 Hand and Power Tools
8 Electrical Safety
9 Welding, Cutting, and Grinding
10 Compressed Gases
11 Confined Spaces
12 Ladders
13 Scaffolds
14 Excavations
15 Mechanized Equipment
16 Cranes and Hoists
17 Wall Opening

1 Safety Meetings
2 Safety Inspections
3 Safety Promotion
4 Supervisory/Employee Safety
Communication
5 Emergency Drills and Exercises

6 Accident, Incident Investigation/Reporting
SAFETY PERFORMANCE Contractor Reps:

1. No of First Aids :
2. No of Recordable Cases :
Name/Title
3. No of Lost Workday Cases :
4. No of Equipment Damage Incidents :

Signature/Date
5. No of Spills / non-Compliance Cases :

XYZ Job Reps:
Name/Title
Signature/Date

Final Evaluation
FINAL EVALUATION CHECKLIST
Date :
Period :
Job Title :
Contract No. :
Work Location :
Address :
Contractor Reps: EH&S Manager:

(Name/Date)


1 Housekeeping
2 Personal Protective Equipment (PPE)
3 Fire Prevention and Fire Protection
4 Signs, Signals and Barricades
5 Hazard Communication
6 Hazardous Material
7 Hand and Power Tools
8 Electrical Safety
9 Welding, Cutting, and Grinding
10 Compressed Gases
11 Confined Spaces
12 Ladders
13 Scaffolds
14 Excavations
15 Mechanized Equipment
16 Cranes and Hoists
17 Wall Opening

1 Safety Meetings
2 Safety Inspections
3 Safety Promotion
4 Supervisory/Employee Safety
Communication
5 Emergency Drills and Exercises

6 Accident, Incident Investigation/Reporting
SAFETY PERFORMANCE Contractor Reps:

1. No of First Aids :
2. No of Recordable Cases :
Name/Title
3. No of Lost Workday Cases :
4. No of Equipment Damage Incidents :

Signature/Date
5. No of Spills / non-Compliance Cases :

XYZ Safety Officer:
Name/Title
Signature/Date

05-Contractor EHS Criteria

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05-Contractor EHS Criteria

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Contractor EHS Management System Criteria

A (0) B (4) C (8) D (12)

Section 2: Policy and Strategic Objectives

No management Management involvement Regular management Regular management

Staff EHS training Item3(2)

CSMS training – SELECTION – attachment, page : 1

Specialized training: Item 3(4) (a) and (b) and 3(5)

Subcontractors: Item 3(6) (a) – (c)

EHS Performance Standards: Item 3(7) (a) – (c)

Section 4: Hazards and Effects Management

Exposure of the workforce: Item 4(2)

Personal protective equipment: Item 4(3)

CSMS training – SELECTION – attachment, page : 2

Section 4: Hazards and Effects Management (cont’d)

Alcohol and Drugs: Item 4(5)

Section 5: Planning and Procedures

Equipment control and maintenance: Item 5(2)

No defined programme to Program relies on outside A written programme In additional to C, periodic

Transport Safety Management: Item 5(3)

Section 6: Implementation and Performance Monitoring

CSMS training – SELECTION – attachment, page : 3

Section 6: Implementation and Performance Monitoring (cont’d)

Incident Investigation and reporting: Item 6(4) (a) – (b)

Section 7: Auditing and Review

Section 8: Emergency Response Procedure

No written Emergency Basic procedures only Emergency procedures Emergency procedures

CSMS training – SELECTION – attachment, page : 4

CSMS training – SELECTION – attachment, page : 5

A B C D Subtotal Factor Total

CSMS training – SELECTION – attachment, page : 6

Purchasing Rep: EHS Rep: Dept. User Rep:

NAME NAME NAME

CSMS training – SELECTION – attachment, page : 7

SUMMARY & RECOMMENDATION

Inspected by: Team

CSMS training – SELECTION – attachment, page : 8

PRE-JOB ACTIVITY CHECKLIST

Contractor Reps: Department User:

CSMS training – SELECTION – attachment, page : 9

1.9.3. Safety meetings?

1.9.5. Safety promotion?

CSMS training – SELECTION – attachment, page : 10

II. Potential Hazards

2.2.2. Machine guarding?

2.2.4. Flammable and explosive

2.2.5. Radioactive materials?

2.2.6. Waste-trash collection?

2.2.7. Maintenance of equipment,

2.2.8. Work permit system?

2.2.9. Personal protective equipment

CSMS training – SELECTION – attachment, page : 11

IV. Pre-Job Safety Meeting

CSMS training – SELECTION – attachment, page : 12

PRE-JOB ACTIVITY CHECKLIST

CSMS training – SELECTION – attachment, page : 13

No ITEM YES NO N/A REMARKS

PRE-JOB ACTIVITY CHECKLIST

No ITEM YES NO N/A REMARKS

CSMS training – SELECTION – attachment, page : 14

CSMS training – SELECTION – attachment, page : 15

Contractor Reps: Department User:

CSMS training – SELECTION – attachment, page : 16

No ITEM YES NO N/A REMARKS