Document No:

Occidental of Oman OMAN-HES-XXX

Approved by:
Health, Environment & Safety
Evaluation Checklist
Effective Date: XXX
This Oxy Oman HSE Evaluation Checklist aims to collect information about the implementation and status of applicable HSE
program elements listed below. The main purpose of this evaluation is to establish the effectiveness of the implemented
program elements and control risks, improve safety performance, and increase awareness related to the subject programs.
The below programs were selected based on the current incident and risk trends which require follow-up from Oxy and
Contractors to avoid reoccurrence of similar incidents.

HSE Program Elements Evaluated:

 Safe Driving Practices (No Backman/ No Move, 360-degree Check, Reversing Camera)
 Lifting Chain Slings Use and Inspection Survey

Oxy Contractors are requested to complete the below questionnaire to help establish the extent of the listed program
element implementation and identify further needed actions.

COMPANY NAME RYBOA HAIMA TRADING CO.LLC LOCATION SAFAH

FOCAL POINT FOR
DATE 09.02.2023
PROGRAM,
DEPARTMENT TIME 1530 HRS
ADDRESS
COMPANY CONTRACTOR SUB-CONTRACTOR
Yes No
No Banksman, No Move Comments (or N/A)
 
Do you have written program for the subject including procedure / guideline which mandate
1.1 Yes
the need of Banksman where needed. Please provide evidence and copy of written program.
Have the Risk Assessments / JSAs been updated for Spotters / Banksman for relevant vehicle
1.2 Yes
movement operations?
Are there regular checks and reports to determine if a banksman or spotter is present at site
1.3 Yes
during vehicle movement Operations?
Is there a record of Spotter / Banksman training available? Please share evidence on training
1.4 Yes
program and training records.
Does the company Banksman/Spotter use standard signals and/or verbal commands through
1.5 Yes
two-way radios to direct the loads? Please specify which in the comments.
Are there records available for periodically reviewing and checking the competency of spotter
1.6 Yes
and banksman? Please share evidence of recent reviews.
1.7 Is Personal Protective Equipment available for Spotter / Banksman (high visibility vest)? Yes
Yes No
360 Degree Check Comments (or N/A)
 
Do you have written program for the subject including procedure / guideline which mandate
2.1 Yes
the 360 Degree check. Please provide evidence and copy of written program.
Do your employees practice scanning up to 12 seconds ahead, checking your mirrors every 8-
2.2 10 seconds, and checking your blind spots before turning? Please provide evidence and copy
of written program.
2.3 Are the driver’s seats and mirrors adjusted correctly? Carry check for your fleet.
2.4 Do the drivers complete the daily vehicle inspection checklist?
Yes No
Reversing Camera Comments (or N/A)
 
Describe the total current count of your vehicles:
- Heavy Vehicles (> 2.5 tons empty weight)
3.1 - Light Vehicles (< 2.5 tons empty weight)
The standard vehicles, hatchbacks, SUVs and 4WD are generally considered light vehicles.
Trucks and equipment haulers are generally considered heavy vehicles.
Has your organization installed reversing cameras on your fleet of vehicles? Describe as a
number of vehicles having such system by type of vehicle as per above:
3.2
- Heavy Vehicles (> 2.5 tons empty weight)
- Light Vehicles (< 2.5 tons empty weight)

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 If the answer to 3.2 is No, describe any current steps your organization is taking to evaluate
use of reversing cameras?
3.3 - Piloted the use of reverse cameras (Yes/No)
- In procurement process for reverse cameras (Yes/No & describe as % of vehicle
fleet type)
What is planned implementation date for having reversing cameras on your vehicle fleet?
Describe as a target date for by type of vehicle as per above:
3.4
- Heavy Vehicles (> 2.5 tons empty weight)
- Light Vehicles (< 2.5 tons empty weight)
3.5 Provide the specifications of the reversing cameras. Share different allowed specifications.
At a minimum, is the reverse monitoring system equipped with a color display and clear
3.6
image quality even in low light conditions?
Yes No
Lifting Chain Slings Use and Inspection Survey Comments (or N/A)
 
Identify independent or chains associated with equipment (e.g. hoists) in use in your
4.1 operation for lifting and load bearing. Provide a list with use, location applied,
type/specification of chain, as well as a picture.
If chains are used for lifting, provide information on how 3 rd party inspections and certification
4.2
are carried out for such chains. Share some examples of inspection records, if applicable.
Have the Risk Assessments / JSAs been updated for use of lift chains? Share examples of
4.3
these documents.
If chains are used for secondary securing and as a retention tool, are they:
- tagged with rated weight,
4.4 - examined/tested, and
- conforming to the original equipment manufacture’s specifications?
Share example records for such chains.
Has your management system specified accountable person who take the responsibility of
4.5
inspection of such chains? Provide evidence of this element.
RECOMMENDATIONS:

The signature(s) below document that the appropriate elements have been discussed and understood with all questions answered to the
satisfaction of all parties, who accept responsibility for maintaining a safe working environment at all times.
NAME DESIGNATION SIGNATURE
NAME DESIGNATION SIGNATURE

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