LAMPIRAN-15

ATTACHMENT-15

TECHNICAL HSE EVALUATION SHEET

No ITEM REQUIREMENTS Evaluation Criteria BIDDERS NAME

PASS/FAIL
1 HSE Policy Statement Bidder shall submit HSE Policy signed by Managing Director the Policies contain highest Management
commitment in Health, safety, and environment

2 Draft HSE Plan relevant to Contract/Project Bidder shall develop an HSE Plan prepared following to the activities to be carried out according to The draft of the HSE Plan includes all the elements
Activities SOW and existing Work/Environmental/Social conditions during the execution of the Contract specified in the Appendix E HSE Requirements

3 Risk Assessments Bidder shall develop a specific Risk Assessment prepared following to the activities to be carried Specific Risk Assessment of the service requested with
out according to the SOW and Work/Environmental/Social conditions existing during the the Tender SoW
execution of the Contract

4 HSE Management System Bidder shall possess Safety and Environmental Valid ISO14001:2015 and/or ISO45001:2018
Management System Certifications, and Environmental Manual

5 Vehicles* Bidder shall provide list of vehicles intended to be used for the execution of the Contract (cars,
trucks, ATVs, SUV, cranes, forklifts, man-lifts, etc.) along with relevant technical certifications
The list includes models of vehicles that are intended
to be used during the execution of the contract which
comply with the requirements established in opi sg
hse 025 ups r01, as well as including the commitment
to present from KOM the complete list of inclusive
vehicles plate, technical specifications and certificates
of conformity

6 HSE Performances of the last three years
Bidder shall provide HSE Performances of the last three years, inclusive of the following data, for HSE Performance Data of last 3 years with parameters
each year: specified on the Requirements
• total worked manhours
• LTIF: lost time injury frequency rate (LTIF = number of lost time injuries – fatalities + permanent
total disabilities + lost work day cases - per 1,000,000 worked hours)
• TRIR: total recordable injury rate (TRIR = number of total recordable injuries – fatalities +
permanent total disabilities+ lost time injuries + medical treatment cases + restricted work day
cases - per 1,000,000 worked hours)
• number of lost workdays for each Lost Work Day Case
• number of fatalities
• number of occupational diseases
The calculation must not take commuting accidents into account and will only include accidents
that have resulted in at least one day of absence following the day of occurrence.
In addition, BIDDER shall provide the following documentation: investigation report relevant to
each accident, corrective actions taken after each accident and declaration of the absence of legal
proceedings associated with the events.

Note:
a.) Bidder shall refer to tender document Appendix E HSE Requirements for details