Document No F-HSE-02

SHORT SERVICE EMPLOYEE Revision 00

ASSESSMENT ( ORIENTATION) Release Date August 14, 2011
Page 1 from 2

This Check List to be completed within 30 days from the date to a person became a Short Service Employee

Name Department / Company

Date of request Date of Employment
Status Location : Office
WorkShop Project
Location Report to
Current Job Title Experiences in current position
Last Job Title Is this employee in compliance Yes No
with drug & Alcohol Policy
Last Medical Check up Have copy Medical Checkup Yes No
record have been received by HR

SECTION I –
YES NO NA
1 Have HR & HSE policies been review?
2 Have Drug, Alcohol & Weapon Policies been review?
3 Did you receive Health, Safety & Environmental Orientation Books
4 List of Training Required
Basic First Aid Training
Basic Fire Fighting Training
Level 2 First Aid Training
Level 2 Fire Fighting Training
Basic Sea Survival Training
Helicopter Underwater Escape Training
Log out / Tag out Procedures
Confined Space
Work Permit
If yes please provide copy of related Training Certificated
Have you been informed and explained the company “Accident Report” forms
5
and reviewed how to use the reports by your direct supervisor or HR?
Have you been informed to the company policy which relation to reporting
6 any “Near Misses”, and review with you the reason why you must reporting,
how to make the report ?
Have you been informed the “Observation Card” and review what the
7
function of the card is and when to utilize the card?
Have you been advised the company policy relation to attend or conduct a
8 Monthly Operation & Safety Meeting, also being informed to you and how to
use the reporting forms , when to use the Safety Meeting forms?
Have you have been inform to the company / customer policy relation to
9 Working Permit Regulation, when to use, how the process and what are the
reason and function?
Have you received PPE as per company regulation?
10
2 coverall/Uniform 1 set of Safety Glasses
1 set of Safety Boot 1 set of ear plugs
1 pair of Safety helmet 1 pair of rain coat
Other Specialize PPE …………………………………….

Have you have been coaching how to use the PPE and maintenance of PPE
11
by your direct supervisor/HSE ?
Have you have been informed by your direct supervisor where you can get the
12
PPE replacement and procedure of PPE replacement?
 Document No F-HSE-02
SHORT SERVICE EMPLOYEE Revision 00
ASSESSMENT ( ORIENTATION) Release Date August 14, 2011
Page 2 from 2

SECTION II
YES NO NA
1 Last “Medical Screening” validity of screening

SECTION III
YES NO NA
1 Do you have been inform or trained on HSE regulation on work related:
2 Do you have been informing on HSE regulation on related work: Forklift,
Overhead Crane, that only certified personnel allow operating that equipment?

Additional comment:

I have reviewed all above points and have read the Employee Orientation Leaflet and understand all
what I have read and review. And I know where to look any additional information relation to HSE or
Operation procedures.

Supervisor name Employee / 3RD Party name

Signed Signed

Date Date

Copy to be send to: Manager / Supervisor or person whom performing the induction,
H.S.E. Manager, HRD.