Minor Scope - Subcontractor HSSE

Prequalification Grading Form

PEC-HS-FRM-X-16226 Rev 0

Subcontractor:

Address:

Subcontractor HSSE Contact:

Phone:

Rating (0-3) Remarks

Q-1 HSSE Policy

Does your company have a documented HSSE Policy? If YES, please attach a signed and dated copy

Q-2 HSSE leadership Commitment

Is Senior management involvement in HSSE management visible? If YES, provide evidence such as
(MOM of HSSE meetings, Site walkthrough etc.)
Q-3 Hazard & Risk Management
Do you have a process to assess risks specific to your scope of work? If YES, provide Task Risk
Assessments relevant to the scope of work and Risk Register
Q-4 Training & Competency
Do you provide new employee induction/ orientation, Job specific training relevant to the scope of work? If
YES, please provide your HSSE Training Matrix
Q-5 Organisation

Please provide your corporates organisation chart and CV of the HSSE focal point

Q-6 Documentation/ Management System

Do you have a Project HSSE Plan for a similar scope of work? If YES, please provide a copy

Q-7 Operational Control Procedures

Do you have HSSE operational control procedures or HSSE work instructions specific to your activities
(i.e. security arrangements, lifting procedure, chemical handling, loading and unloading of material,
blasting, welding, etc.); if yes provide copies
Q-8 HSSE Management System Certification
Is your Company’s HSSE Management system certified to an international standard (ISO / OHSAS)?
If YES, please provide a copy of certificate
Q-9 Handling of chemicals
Do you have a process to identify assess, control, and mitigation of hazards encountered form Chemicals/
Hazardous substances relevant to the scope of work? If YES, provide sample COSHH assessment and
Chemical Hazards register.
Q-10 Personal protective equipment

Do you maintain the list of the PPE relevant to the scope of work? If YES, please submit

Q-11 Equipment control and maintenance

Do you ensure plant and equipment are correctly registered, controlled, and maintained in a safe work
condition? If YES, please submit your Equipment inspection/ maintenance log, third party inspection log
and sample certificate copies
Q-12 Lower Tier Subcontractor Management
Do you have a process for lower tier subcontractors HSSE capabilities assessment and management? If
YES, provide sample records of prequalification assessments and performance evaluation
Q-13 Road Safety Management
Do you implement a risk based approach to identify the need of In-Vehicular Monitoring System (IVMS)
on your vehicles and defensive driving training?? If YES, provide details of the process also sample IVMS
report and DDT certificate
Q-14 Inspections
Does your company schedule and conduct HSSE inspections? If YES, provide a sample inspection
schedule for all tasks, areas, components, plant, equipment etc.
Q-15 Environmental Management
Do you have an Environmental Aspect/ Impact register, environmental management plan and a waste
management plan specific to the scope of work? If YES, please provide samples from a previous project
Q-16 Health& Welfare Management
Does your company assure the health, fitness and welfare of your employees? If YES, provide sample
copies of pre-employment medical, fitness to work and sample inspection records on water, catering,
hygiene, and accommodation

Q-17 Statutory notifiable incidents, Improvement requirements and prohibition notices

Has your company suffered any statutory notifiable incidents, improvement requirement / prohibition
notices by the relevant national regulatory body for HSSE / other enforcing authority? If YES, provide
details of it and follow-up preventative measures taken
Q-18 HSSE performance achievement awards
Has your company received any award for HSSE performance achievement? Please provide certificates
and/or photographs as evidence
Q-19 HSSE performance records

Have you maintained your HSSE records of your last five years?

*
TOTAL RATING = 0.0

Date of assessment:

Evaluated by:

Designation:

* Total Rating : (2.1 to 3) - Acceptable without any comment; (1.1 to 2) - Acceptable with improvement plan; (0 to 1) - Acceptable only on accomplishing the improvement plan and management approval
Controlling Document: PEC-HS-PRO-X-13858

Controlling Document: PEC-HS-PRO-X-13858 1 of 1