APPENDIX 1 – TECHNICAL QUESTIONNAIRE

BIDDER’S RESPONSE
NO REQUIREMENT
(OR TO CONFIRM COMPLIANCE)
9 Section T9 : HSE Questionnaire

 BIDDER to submit response to the HSE

Questionnaire as specified below.
 The HSE submission/attachment shall be of
BIDDER’s own company.
 Attachment Shall include:

9.1 HSE Policy Yes, please refer to

- Does your company have a HSE Policy attachment 1; Syamiras HSE-
- If YES, please attach a copy MS, Element 2: HSE Policy
Statement

9.2 HSE Manual Yes, please refer to

- Does your company have a HSE Manual? attachment 2; Syamiras HSE
- If YES, please attach a copy Manual

9.3 HSE Management System Yes, please refer to

- Do your company have a HSE Management System? attachment 1; Syamiras HSE-
- If YES, please provide a copy of your HSE MS
Management System Manual

9.4 Risk/Hazard Management Yes, please refer to

- Does your company have manage Risk/Hazard attachment 3; Copy of
- If YES, please provide a sample copy of Risk/Hazard Syamiras JHA
Assessment (example: HEMP, JHA , HSE Case, etc).

9.5 HSE Performance Yes, please refer to

- Have you maintained records of your incidents and attachment 4; Syamiras HSE
HSE Performance for the last three (3) years? Statistic Report
- If YES, please submit latest summary of Safety
Statistic Report as follows;
i. Year 2011 (January to December)
ii. Year 2012(January to December)
iii. Year 2013(January to December)
iv. Year 2014 (January to April)
- The Safety Statistic Report shall specify the
number on Non Lost Time Injuries, number and
type of injuries, total hours worked by workforce
for each corresponding year, frequency rates and
 your company definition of Lost Time Incident.
- Sample of HSE Performance/ HSE Statistic report
is as per item D of Appendix ii- example of
submission

9.6 HSE Incident Register (if any) Yes, please refer to

- In case of any incident recorded in year 2013 and attachment 5; Syamiras
year 2014, BIDDER to submit the HSE Incident Incident Register and Report
Register and detail incident report which shall
contain but not limited to the following;
i. Name of subsidiary involved (if applicable)
ii. Project detail
iii. Description in incident
iv. Root courses
v. Action taken by BIDDER
- Sample of HSE Incident Register is as per item E of
Appendix ii – “Example of submission”.

9.7 HSE Meeting Yes, we do it quarterly.

- Does your company conduct any HSE Meeting? Please refer to attachment 6;
- If YES, please submit latest four (4) signed copy of Syamiras HSE Meeting
the HSE minutes of meeting (MOM)
- Please also specify how frequent does your
company conduct the HSE Meeting.

9.8 Organization Chart Yes, please refer to

- Does your company have dedicated HSE attachment 1; Syamiras HSE
Department within the organization? MS, Element 3: Organization
- If YES, please submit a copy of organization chart,
specifying the HSE Department and it Head of
department.
- If NO, please specify the person in charge of
managing HSE in your company.