Personal Protective Equipment System Review Checklist (User Sheet)

Score Adequacy Scoring Criteria Adequacy Score 0.00

System is mature - one or more feedback, review, 5.00
and improvement cycles are complete; required Not Adequate but Effective Adequate and Ef-
>3.0 – 4.0 revisions to System documentation have been fective
made.
System is deployed; procedures are fully
>2.0 – 3.0 documented; users trained, ongoing verification 4.00
and measurement occurring.
System charactristics are documented, approved
and resourced; procedures for key System tasks
>1.0 – 2.0 are identified and under development; deployment
3.00
is in progress.

EFFECTIVENESS
System is being developed to address hazard/risk.
≤1.0

(Documented, Planned and Practiced)

2.00
Scope Effectiveness Scoring Criteria. Effectiveness Score 0.00
Implementation consistently conforms to all System
requirements; quality of implementation is
>3.0 – 4.0 excellent; all objectives are being achieved.
Practices are effective and proven to be 1.00
sustainable.
Implementation conforms to the important System Adequate but Not Ef-
and most other requirements; quality of fective
>2.0 – 3.0 implementation is good; main objectives are being
0.00
achieved. 0.00 1.00 2.00 3.00 4.00 5.00
Implementation conforms to the important System
requirements; quality of implementation is ADEQUATE
>1.0 – 2.0 acceptable; some objectives are being achieved.

Implementation does not always conform to

System requirements; quality of implementation
≤1.0 need improvement; none of the objective achieved.

(Effective and Sustained)

Department OEMS Assurance

OEMS System Assurance Checklist Actual Score
Quarterly Assurance Status Update
Requirement Reference Requirements Expectations (Documented, Planned, Leave blank Yes / No / Not Adequacy Effectiveness Summary of Assessment Evidences Agreed Priority (Action to be closed within P1 - 3 Due Date Action Party Department Q1 (%) Q2 (%) Q3 (%) Q4 (%) Status of closure Actual Closed Date
No. Practiced, Effective, Sustained) Applicable (Good Observation and Gaps) Corrective months, P2 - 6 months, P3 - 12 months) (Close/Open)
Actions

02.02.07 L2 Personal Protective Equipment

4.1 PTS 18.00.02 Establish, implement, maintain and improve All requirements incorporated in L3 procedure 0
Section 4.9, documented information on PPE. are approved and contents are comprehensive in
PTS 18.52.16 • Roles and responsibilities of key personnel. reference to PETRONAS, Downstream, external
and • PPE system requirements. and OPU specific requirements.
Downstream o Selection of correct PPE for the work through
Requirement assessment, field trial, fit testing (where 0
applicable). 0
o Where and when PPE must be worn. 0
o Types of PPE to be worn. 0
o Arrangement for issuance, inspection,
4.2 PTS 18.00.02 Comply with the PPE requirements stated in PTWs, 0
maintenance, replacement, storage and disposal of
Section 4.9 safety rules, regulations, standards, operating 1) Tools: 0
PPE.
procedures and instructions. a) PTW Sections on PPE
o Requirement of fit testing for designated
respiratory protective equipment user. b) Approved body websites
• Training requirements for the selection, use, c) DOSH Approved Suppliers
maintenance and storage of PPE. d) Operating procedures
• Periodic PPE reviews to ensure quality and 2) Communication on plan and tools undertaken
suitability. 3) Staff is trained and competent.
• Assurance process including monitoring and
tracking closure of action items. Evidence of activities and processes are 0
• Retention and safe-keeping of records implemented as per requirements, planned and
specified tools.

1) All evidences of implemented practices are 0

consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance etc.
3) Evidences which reflect the effectiveness of
the PPE system:
a) Tier 1 PPE Compliance Audit Actual vs plan
b) No PPE related incidents

0
4.3 PTS 18.52.16 Establish the minimum PPE requirements based on 0
Section 4 workplace hazards associated with specified jobs an 1) Tools: 0
the risk to personnel performing the tasks. The a) PPE Matrix
implemetation of PPE requirement shall covers the b) Induction Training Pack covering the
location and duration of PPE usage. minimum PPE Matrix requirement
c) Attendance sheet for induction training
2) Communication on plan and tools undertaken
3) Staff is trained and competent.

1) Evidence of activities and processes are 0

implemented as per requirements, planned and
specified tools.
2) Evidences for implementing, maintaining and
controling documented information in relation to
PPE system:
a) Approved PPE Matrix
b)Updated Induction Training Pack covering the
minimum PPE Matrix requirement
c) Completed attendance sheet for induction
training

1) All evidences of implemented practices are 0

consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance etc.

0
4.4 PTS 18.52.16 Ensure suitable PPE are selected and used for 0
Section 5 personal protection: 1) Tools: 0
• Head protection a) PPE Matrix
• Eye and face protection b) List of approved PPE providers from DOSH
• Hearing protection Website
• Respiratory Protection c) Approved MSA
• Body/torso protection 2) Communication on plan and tools undertaken
• Hand protection 3) Staff is trained and competent.
• Foot protection
1) Evidence of activities and processes are 0
implemented as per requirements, planned and
specified tools.
2) Evidences for implementing, maintaining and
controling documented information in relation to
PPE system:
a) Approved PPE Matrix

1) All evidences of implemented practices are 0

consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance etc.
3) Evidences which reflect the effectiveness of
the PPE system:
a) Tier 1 Personal Protective Equipment
Compliance Audit Actual vs plan.

0
4.5 PTS 18.00.02 Establish requirement for fitness evaluation of 0
Section 4.9 personnel prior to the use of respiratory protective
equipment.

Open
 4.5 PTS 18.00.02 Establish requirement for fitness evaluation of
Section 4.9 personnel prior to the use of respiratory protective 1) Tools:
equipment.
4.6 PTS 18.00.02 Ensure Fit Testing is conducted to designated
Section 4.9 respiratory protective equipment user.
4.7 PTS 18.52.16 Selection of correct PPE for the work through
Section 5 assessment, field trial, fit testing (where applicable) 1) Tools:
and user feedback.
4.8 PTS 18.52.16 Ensure proper issuance, maintenance, repair,
Section 5 cleaning and disposal of PPE:
• Comply with cleaning and maintenance
guidelines.
• Keep records of issuance, tests, inspection and
maintenance work carried out on PPE for meeting
regulatory requirements (if required).
4.9 PTS 18.52.16 Provide proper storage of PPE to prevent
Section 5 contamination in the workplace and other areas.
(e.g. segregration of defect PPE for disposal)
4.10 Downstream Monitor, track and report implementation of PPE
Requirement activities through suitable performance indicators.
Open
0
a) Fitness Certificate
b) Medical checkup by AME
2) Communication on plan and tools undertaken
3) Staff is trained and competent.
1) Evidence of activities and processes are 0
implemented as per requirements, planned and
specified tools.
2) Evidences for implementing, maintaining and
controling documented information in relation to
PPE system:
a) Fitness Certificate endorsed by AME
(Approved Medical Examiner)
1) All evidences of implemented practices are 0
consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance etc.
0
0
1) Tools: 0
a) Fit Test Certificate
2) Communication on plan and tools undertaken
3) Staff is trained and competent.
1) Evidence of activities and processes are 0
implemented as per requirements, planned and
specified tools.
2) Evidences for implementing, maintaining and
controling documented information in relation to
PPE system:
a) Completed Fit Test Certificate
1) All evidences of implemented practices are 0
consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance etc.
0
0
0
a) PPE Selection Criteria Checklist.
2) Communication on plan and tools executed.
3) Staff is trained and competent.
1) Evidence of activities and processes are 0
implemented as per requirements, planned and
specified tools.
2) Evidences for implementing, maintaining and
controling documented information in relation to
PPE system:
a) Completed PPE Selection Criteria Checklist
1) All evidences of implemented practices are 0
consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance etc.
0
0
1) Tools: 0
a) Inspection and Maintenance Record for PPE
(Respiratory Proctection Equipment, e.g. SCBA)
2) Communication on plan and tools undertaken
3) Staff is trained and competent.
1) Evidence of activities and processes are 0
implemented as per requirements, planned and
specified tools.
2) Evidences for implementing, maintaining and
controling documented information in relation to
PPE system:
a) Updated and Valid Inspection and
Maintenance Record for PPE (Respiratory
Proctection Equipment, e.g. SCBA)
1) All evidences of implemented practices are 0
consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance etc.
3) Evidences which reflect the effectiveness of
the PPE system:
a) Tier 1 Personal Protective Equipment
Compliance Audit Actual vs plan.
0
0
1) Tools: 0
a) Storage Container / Plastic
2) Communication on plan and tools executed.
3) Staff is trained and competent.
Evidence of activities and processes are 0
implemented as per requirements, planned and
specified tools.
1) All evidences of implemented practices are 0
consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance etc.
3) Evidences which reflect the effectiveness of
the PPE system:
a) Tier 1 Personal Protective Equipment
Compliance Audit Actual vs plan .
0
0
 4.10 Downstream Monitor, track and report implementation of PPE
Requirement activities through suitable performance indicators. 1) Tools: 0
a) Tracking tool (e.g. No of noncompliance
related to PPE)
2) Communication on plan and tools undertaken
3) Staff is trained and competent.

1) Evidence of activities and processes are 0

implemented as per requirements, planned and
specified tools.
2) Evidences for implementing, maintaining and
controling documented information in relation to
PPE system:
a) Updated tracking tool with the following data
e.g:
- UAUC (Unsafe Acts, Unsafe Conditions)
- Behavioural Observation Form
- Signature
1) All evidences of implemented practices are 0
consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Evidences which reflect the effectiveness of
the PPE system:
a) Tier 1 PPE Compliance Audit Actual vs plan
b) No PPE related incidents
3) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance and
investigation findings.

0
4.11 PTS 18.07.02 Conduct assurance activities at planned interval to 0
provide information whether the system: 1) Plan: 0
• Conform to the above requirements. a) Assurance plan (HSE Plan)
• Effectively implemented and maintained. 2) Tools:
a) Tracking closure sheet.
b) Tier 1 checklist
3) Communication on plan and tools executed
4) Staff is trained and competent.

1) Evidence of activities and processes are 0

implemented as per requirements, planned and
specified tools.
2) Evidences for implementing, maintaining and
controling documented information in relation to
PPE system:
a) Completed tier 1 PPE checklist
b) Findings presented in the Leadership Meeting
(e.g. PLT)
c) Analytics on the common PPE findings

1) All evidences of implemented practices are 0

consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance etc.
3) Recommendations fully implemented.

0
Management DBE-01.14- Conduct annual Management System Review to 0
System Review L2-625 ensure the system suitability, adequacy and 1) Communication on plan and tools conducted. 0
effectiveness which aligned with the strategic 2) Staff is trained and competent._x000D_
directions of the Business.
1) Data gathering & analysis conducted 0
2) MSR result pack completed & uploaded in
ECM_x000D_
3) Provide update to element directions/policies
after MSR_x000D_
4) Tracking of gap closure after MSR._x000D_

1) All evidences of implemented practices are 0

consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness.
e) Updated element directions/policies.
f) 100% completed gap closure from MSR
review.
g) Achieved or exceed the target KPIs.
2) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance etc.
Practices are effective and sustainable for 0
minimum 3 years.
a) All the record of practices are consistently
complied to the requirements and OPU target
from for the last 3 consecutive years.
b) No high findings or repetitive medium
findings from external or corporate assurance.

Performance Measurement - Number of incidents caused by PPE non-

compliance.
- Number of ZeTo violation with regards to PPE
while handling hazardous chemicals.
- Number of safety inspection or audit for PPE.
- Closure of PPE audit findings.
- Number of unsafe observations related to PPE
non-compliance.

Adequacy & Effectiveness 0.00 0.00

Score

Department OEMS Assurance

Assessor
Name:
HCU/OPU/Department/Section:
Date of Assessment:

Head of Department (HOD)

Name:
HCU/OPU/Department/Section:
Date:

Open