HSE Form No 338 HSE Subcontractor Selection Forms Indo

HSE Audit Cover Page
Element No. Maximum Score

S/N
(Vendor & Subcontractor Selection Process)
(Link)
Description
(%)
1 100
1 Management Leadership & Commitment
2 2 100
Employee Roles & Responsibility
3 3 100
Hazard Control and Risk Assessment
4 4 Documents, Records & Regulatory Compliance 100
5 5 100
HSE Training & Competency
6 6 100
HSE Communications, Promotion & Recognition
7 7 100
HSE Rules & Procedures
8 8 100
Emergency Preparedness & Response
9 9 100
Health and Medical Programs
10 10 100
Contractors, Suppliers and Offsite Work
11 11 100
Project & Product Safety
12 12 100
Security & Travel Safety
13 13 100
Audits & Inspections
14 14 100
Incident Reporting & Investigation
15 15 100
Pressure Testing
16 16 100
Process Assessment & Improvement
Total Average Score 100
S/N Link Description Remark
Need to transfer the

value from grey column
to the audit year by
1 Audit Score Company result of Audit Score for 5 years using Copy then Paste
special the select Value
only
Need to be clear after

each audit
2 Audit Finding Audit Finding, Comments and recommendation Summary presentation. Print and
keep a records for that
year.
3 Site Finding Site finding pictures, description and comment
Page 1 of 22 Form No. 338 Rev 0

Scoring Criteria
Each question is scored 0 to 3 points.
The internal scoring of each element follows its title.

Audit scores are determined through interviews, reviews of
written records & the audit scoring criteria document.
In event, if question is not applicable, please indicate zero
Scoring Criteria:
0 pts - No requirements/procedures/control
1 Pts - no clear requirements/procedures, but there is some control
2 Pts - there is requirements/procedures documented
3 Pts - there is review/evaluation/continous improvement

Category Definition
The absence of one or more required system elements or a situation which raises significant doubt that
products or services will meet specified requirements.
A group of category 2 non-conformities indicating inadequate implementation or effectiveness of the

system relevant to an element of the standard.
Non-Conformance Major:
(NC 1) A category 2 non-conformity that is persistent (or not corrected as agreed by the organisation) shall be up-
graded to category 1.
Non-fulfillment of legal requirements which is not formally accepted/clarified with authorities
A lapse of either discipline or control during the implementation of system/procedural requirements, which
does not indicate a system breakdown or raise doubt that products or services will meet requirements.
Non-Conformance Minor:
(NC 2)
Overall system requirement is defined, implemented and effective.
An observation is not a non-conformance, but something that could lead to a non-conformance, if allowed
Observation: to continue uncorrected; or an existing condition without adequate supporting evidence to verify that it
(OBS) constitutes a non-conformance.
Opportunities for improvement relates to areas and/or processes of the organisation which may meet the
minimum requirement of the standard, but which could be improved.
Opportunity for Improvement:
An opportunity for improvement may be system or performance related and is normally addressed based
(OFI)
on the auditor’s own experience, knowledge of industry’s best practice or practices within another
unit/department of the organisation.
A noteworthy effort is a statement of recognition made to the customer, on the basis of:
Situations where the organisation has undertaken significant improvements since the last audit;
Note-worthy effort:
(NWE)
Performance that exceeds expectations in terms of efficiency and/or effectiveness and could be a model
for best practice.

Element 1- Management Leadership & Commitment
No Description Allocate Score Guide Line Audit Score Evidence Remarks
Score
0 No requirements/procedures/control
1.1 Does the site has a HSE Policy which is endorsed by 1

The site has developed an HSE policy which is endorsed by the management. This policy is
posted in a few locations in the facility
1 the management and is it prominently posted
throughout the facility (front entrance, conference The site has developed an HSE policy which is endorsed by the management. This policy is
2
rooms, bulletin boards, etc.)? 2
posted in multiple locations throughout the facility
3
The site has fully implemented the HSE Policy. Copies of the Policy and HSE Poster are
posted in multiple locations throughout the facility.
1 The policy is not routinely communicated to employees (i.e – annually)

2 1.2 Has the policy been communicated to all employees
and do they have a general understanding of the intent? The policy has been communicated to 70% + employees. Temporary employees are
3
2
usually not briefed on the policy during orientation
The policy has been communicated to all employees (permanent & temporary) and the
3 results documented. Ninety (90) to 100% of employees are aware of the HSE policy and
the basic content. This does not mean that the policy needs to be memorized.
1.3 Is management held accountable for HSE (e.g. MRAs- 1 Not all levels of management have written HSE objectives.
3 Major Responsibility Area and objectives)? Do objectives
include key actions versus primarily statistical measures?
All levels of management are held accountable for HSE but the primary metrics are 2
2 statistical.
3
All levels of management are held accountable for HSE via MRA’s and/or objectives and
the metrics include both statistical and non-statistical measures.
1.4 Is management visibly involved in HSE? Does 1 Top management is not involved in the HSE process
4 management actively participate in the HSE process (e.g.
audits, investigations, meetings, observations, etc.)? A majority of mangers are actively involved in the HSE process. Some of the top
3
2
management are not actively involved.
3
All managers are actively involved in the HSE process. HSE is regularly discussed in all
meetings, managers periodically participate in audits, attend meetings, etc.
1
The facility does not have formal written objectives for HSE or only statistical metrics for
1.5 Has the facility established HSE objectives that safety.
5 include injury, illness and environmental (air, waste,
water reduction, etc.) metrics and action plans? The facility has formal written objectives for safety but not environmental.
2
2
3 The facility has formal written objectives for HSE
1 The policy states a commitment for continual improvement

6 1.6 Does policy commit to continuous improvement?
The policy clearly states a commitment for continuous improvement and comply with
2
2
current applicable OSH statutory legislation.
3
The policy clearly states a commitment for continuous improvement and comply with
current applicable OSH statutory legislation and review on regular basis
Total Score Max=100% 78

Auditor’s comments
Clause Type of Finding Assesment Finding Comment

Element 2- Employee Roles & Responsibility
Allocate
No Description Score Guide Line Audit Score Evidence Remarks
Score
1
Most employees belief that management and/or the HSE staff is most responsible for
their safety.
1 2.1Do employees feel that they are responsible for their
own safety and the safety of their co-workers? The majority of employees interviewed feel they are most responsible for their safety
2
2
but not the co-workers
3
The majority of employees interviewed indicated that they are responsible for their own
safety and for watching out for their co-workers.
1 Most employees state that they do not regularly correct at-risk behavior.
2 2.2 Do employees regularly correct at-risk behaviour and

reinforce safe behaviour when they observe it? 2
The majority of employees state they correct at-risk behavior, but a few examples of
unsafe practices are observed during the site tour that would indicate otherwise.
3
The majority of employees interviewed state that they correct at-risk behavior. This is
3 also observed in the facility and verified through interviews with management and HSE
staff.
1
Several areas have substandard housekeeping. Multiple instances of at-risk behavior
are observed.
3 2.3 Do employees follow HSE rules, procedures and
display high standards? 2
2 Most areas are orderly and with good housekeeping. Some at-risk behavior is observed
3
Employees are observed working safely during the plant tour. Work areas are well
organized and housekeeping is outstanding.
1 The site has not assigned anyone the HSE coordination responsibility
4 2.4 Has the site assigned an individual (s) as the HSE
Manager/Coordinator and/or subject matter expert? The site has assigned an individual (s) to coordinate safety, but not the other areas
2
2
(health and/or environmental)
3
The site has assigned the responsibility for coordination of the HSE process to an
individual(s).
1 The job responsibilities have not been clearly defined or communicated

5 2.5 Has the individual (s) role and responsibilities been
clearly defined? 2
2 The job responsibilities are discussed but are not formally documented.
3
The site has developed a job description for the individual (s) responsible for
coordinating the HSE process


Element 3- Hazard Control & Risk Assessment
Allocate
No Description Score Score Guide Line Audit Score Evidence Remarks
1 Controls are not in place for several potential hazards in the facility.
1 3.1 Is there a system in place to identify and adequately

control hazards?
2 The facility has identified and initiated controls in place for most of the potential hazards. 2
The facility has identified and initiated a variety of controls in place for the majority of potential
3
hazards. These include mechanical guarding; ventilation systems; personal protective equipment
(PPE); procedures such as Job Safety Analysis (JSA), lock and tag, confined space entry and hot
work; etc
1
A formal risk assessment tool is not used to assess work areas.
2 3.2 Has a risk assessment been conducted for all work

activities, including use of PPE? 3
2 A formal risk assessment has been conducted for most (> 50%) work areas.
3 3.5 A formal risk assessment has been conducted for the majority (80% or >) of work areas
3.3 Has an inventory been established that identifies
activities, products and services that have aspects that
interact with the environment and does the inventory 1 Little or no work has been completed to identify the site environmental aspects.
3 include abnormal, as well as normal operations, start-up
and shutdown activities, use of raw materials and natural
3
2 An inventory has been conducted for some but not all of the environmental aspects.
resources, aesthetic aspects (noise, glare, etc.) and past
activities? An inventory of all environmental aspects and their impact on the environment has been
3
completed
3.4 Is there procedures to address all Hazards in the 1 Controls are in place but are not being used in multiple instances.
4 workplace to an acceptable level (ALARP). (effective
monitoring programme)
3
2 Controls are in place for high and medium hazard but are not being used in a few instances.
3
Controls are in place for all high and medium hazard and physical agent exposure levels

4 OBS = Observation There is no measureable for the risk of every activities
Page 6 of 22 Form No. 338 Rev. 0

Element 4- Documents, Records, Regulatory Compliance
Allocate
1
The site has completed an evaluation within the past 5 years of applicable laws,
4.1 Has the facility identified all laws & regulations, regulations & other legal requirements.
1 ordinances & other legal requirements relevant to its
activities and operations? The site has completed an evaluation within the past 2 years of applicable laws,
2
regulations & other legal requirements.
3
The site has completed a current evaluation of applicable laws, regulations & other legal
requirements for its activities and operations
1
The site does not have access to services to monitor changes to applicable laws and
regulations.
2 4.2 Does the company have a mechanism for tracking
changes in potentially applicable laws and regulations? 2
The site has access to services (intranet, subscription, Consultant) but has not assigned
resources to regularly monitor them for changes to applicable laws and regulations
3
The site has access to services (intranet, subscription, consultant) and has assigned
resources to monitor and assess changes to applicable laws and regulations.
1
HSE documentation pertaining to applicable laws and regulations are disorganized and
difficult to monitor compliance with applicable laws and regulations
3 4.3 Are records available that document compliance with
applicable laws & regulations?
2 HSE records are in place but document is missing for some laws and regulations.
3 HSE records are in place that document compliance with applicable laws and regulations.


Element 5- HSE Training & Competency
Score
5.1 Is there a formal HSE training program in place for all 1 A formal HSE training program is in place but does not include the majority of the functional areas.
1 employees at the site (managers, technical, staff and
office, temporary, new employees, service and 0
contractors)? 2 A formal HSE training program is in place but does not include 1 or 2 functional groups
3
A formal HSE training program is in place and includes all functional areas (managers, technical, staff,
office, temporary, service, new employees, contractors)
1
A formal orientation program is in place for 1 or less of the three areas (new hires, contractors and
visitors).
2 5.2 Is there an HSE orientation program in place for new
hires, contractors and visitors? 2
2 A formal orientation program is in place for 2 of the three areas (new hires, contractors and visitors)
3 A formal HSE orientation program is in place for new hires, contractors and visitors
1 Training records are not well documented for HSE training.

3 5.3 Are training records documented? 2
2 Training records are documented for most required HSE training.
3 Training records are documented for all required HSE training.


Element 6- HSE Communication, Promotion & Recognition
Allocate
Score
1 HSE is not routinely communicated to employees

1 6.1 Are HSE issues, activities, programs, etc. regularly
communicated HSE is communicated most of the time through normal modes – safety meetings, HSE websites,
3
2
etc. Some key information is not communicated to all employees.
3
HSE is communicated within the site/business by a variety of methods including meetings (both
safety and other), bulletin boards, intranet, news letters, incentive programs, etc.
Signs, banners, etc. are not used in several areas. PPE requirements and other information are not
1 clearly marked.
2 6.2 Are signs, banners and recognition programs used to
communicate HSE? 2
2 Signs, banners, etc. are used in the site, but are not visible in a few areas
3
Signs, banners, etc are used in the site to clearly indicate HSE policies, procedures and other
important information. PPE requirements, warnings, etc. are visible and easy to understand
6.3 Does the company use the signs and/or banners from 1 Very few of the signs and/or banners are used at the facility.
3 international symbol or native language(include English)
understood by all?
0
2 The signs and/or banners are used in line with international symbol at the facility.
3 The signs and/or banners are used throughout the facility (international symbol )


Element 7- HSE Rules & Procedures
Score
7.1 Are HSE rules and procedures in place and include 1 HSE rules are not in place for most functional areas.
1 requirements for all areas (shop, office, field services,
engineering, marketing/sales, etc.)?
1
2 HSE rules and procedures are in place for the majority of the functional areas.
3 Written HSE rules and procedures are in place for all functional areas of the business/site.
7.2 Do the rules and procedures include specific
requirements for areas such as control of hazardous 1 All or most of the areas are practiced, but formal procedures are not in place.
2 energy, hot work, confined space entry, hazard
communication, management of change, working at
1
2 All of the key areas are practiced, but formal procedures are not developed for all of the areas.
heights, etc.?
3
Formal procedures for areas such as control of energy, hot work, confined space entry, hazard
communication is in place as appropriate.
1 Compliance issues are reported and/or observed in most work areas.
Observations and incident investigations indicate that compliance with HSE rules and procedures is good.
3 7.3 Are rules and procedures understood, followed and
uniformly enforced? 2 During plant tours compliance is observed to be at or near 100% in most areas. Multiple compliance 2
instances may be observed for 1 or more rules or work groups (i.e. – eye glasses, hearing protection, etc.).
Observations and incident investigations indicate that compliance with HSE rules and procedures is
3 excellent. During plant tours compliance is observed to be at or near 100%. A random occurrence of non-
compliance may be observed.

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Element 8- Emergency Preparedness & Response
Score
8.1 Has the company identified the potential emergency
situations that could impact the facility? (Hurricane,
tornado, earthquake, flooding, pandemics, fire,
community unrest, criminal acts, including actions by 1 The facility has not conducted an assessment of the potential situations that could impact the facility
1 activist groups and sabotage, area incidents like train
derailment with leakage of hazardous chemicals causing 2
shelter in place warning, incidents occurring on a 2
The facility has assessed and identified most of the potential situations that could impact the facility but
neighbour's property that may affect the facility like a has not looked at all areas.
chemical spill, fire, explosion, etc. labor actions - social
unrest / strike / riots etc.)?
3
The facility has conducted a risk assessment and list of the potential situations that could impact the
facility.
8.2 Has a written plan been developed and does it 1 The site does not have a formal written emergency plan.
2 specifically address the likely emergency scenarios or at
least contain a statement as to why they are not The written emergency plan includes only the basic types of potential emergencies (personal injury and
2
applicable to the given site? 2
fire)
3 A written emergency plan has been developed that addresses all of the likely emergency scenarios
8.3 Does the Emergency Response plan clearly indentify The Emergency Response Plan does not list the primary or alternative person (s) responsible for
the primary and alternate person responsible for 1
coordinating the site’s actions.
3 coordinating the site's actions before, during and
immediately after the event? (Note: the primary person The Emergency Response Plan identifies the primary person responsible for coordinating the site’s actions.
1
2
is normally the HSE manager if one exists at the facility) The alternate personnel are either not mentioned or the person (s) no longer works at the site.
3
The Emergency Response Plan identifies the primary and secondary personnel responsible for coordinating
the site’s actions.
1
The site emergency plan is reviewed every 3+ years. It is not common practice to include site emergencies
8.4 Does the site review and revise, as necessary, its in the review.
4 emergency plans on a periodic basis and after the
occurrence of accidents or emergency situations? The site emergency plan is reviewed every 1-2 years. Emergency situations that occur during the year are
1
2
included in the review.
3 The site emergency plan is reviewed annually and soon after an emergency situation.
1
A number of site employees have not been trained on the evacuation procedure and a practice has not
been conducted in over 2 years.
5 8.5 Have all employees been trained on emergency
evacuation procedures, including an annual drill? All or most of the site employees have been trained on the evacuation procedure, but a practice drill has
2
2
not been conducted in over 1 year.
3
All site employees have been trained on the evacuation procedures and a practice drill has been completed
within the past year.
8.6 Have appropriate emergency equipment and/or 1 Some areas of the facility do not have enough emergency equipment available.
6 facilities been provided and are maintained in working
order? The facility has appropriate emergency equipment in place, but a formal system for maintaining it is not in
1
2
place.
3
The facility has appropriate emergency equipment in place and a process to ensure that it is maintained
and in working order

Page 11 of 22 Form No. 338 Rev.0

Element 9- Health & Medical Programs
Score
1 A medical surveillance program has not been established.

9.1 Has a medical surveillance program been
1 implemented that meets applicable local regulatory
requirements?
2
A medical surveillance program is in place, but an assessment of the regulatory and company requirements
has not been made.
2
An assessment of the regulatory program has been made and a medical surveillance program established
3 to meet the requirements.
9.2 Does the company have arrangements with a local 1 A local clinic or physician is not used.
2 clinic/physician to treat occupational injuries, illnesses,
physical exams, etc.?
1
2 The site uses a local clinic/physician but only uses them for physical exams.
3
The site has made arrangements with a local clinic/physician to treat occupational injuries, illnesses,
conducts physical exams, etc.
9.3 Is there adequate monitoring to ensure personnel 1 The site/business has not yet identified hazardous substance hazardous substance used in its operation
3 exposure to any hazardous substance are within the
permissible exposure limit (PEL/TLV) The site/business has identified the hazardous substance used in its operation and is in the process of
2
2
developing a comprehensive plan to address these causes
3
The site/business has identified the hazardous substance used in its operation and has developed a
comprehensive action plan to address personnel exposure to the identified substances

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Element 10- Contractors, Suppliers & Offsite Work
Allocate
1 The site does not have a formal procedure for contractors/suppliers. These entities are handled informally.
1 10.1 Does the site have a written procedure for
contractors and suppliers? 1
2 The site has a written procedure for contractors but does not include suppliers
3 The site has a written procedure for contractors/suppliers.
10.2 Does the procedure require that the 1 No formal review of the contractor/supplier HSE program or performance is conducted prior to selection.
2 contractor/supplier's HSE performance and program be
evaluated for final selection? The facility reviews the contractor/supplier HSE program and performance, but usually after the selection
2
2
has been made.
3
The facility requires that key contractors/suppliers submit their HSE program and performance prior to
being selected
10.3 Is there a training/orientation program in place for 1 An HSE orientation is conducted, but the program on documentation is not in place.
3 Company's contractor/supplier employees to perform
their duties in a manner that complies with applicable 1
local HSE requirements, and procedures? 2 An HSE orientation is in place for contractors but not suppliers.
3 A comprehensive HSE orientation program is in place for contractor/suppliers and the results documented.
10.4 Are periodic HSE audits performed for company's 1 Auditing for contractor/suppliers is done informally or not at all.
4 contractor/supplier to ensure they are following site
rules and procedures? Contractor audits are incorporated into the formal audit program, but supplier audits are not yet part of
1
2
the program.
3 Contractor/Suppliers are incorporated into the formal audit program. The results are documented.


Element 11- Project & Product Safety
Score
1 The facility/business evaluates new and existing products design and potential hazards on an informal basis.
1 11.1 Is the Company familiar with Project HSE plan (if
applicable - for Project Supplier) The facility/business has a formal process in place but does not include HSE. HSE is included informally, as
2
2
deemed necessary by the review team.
3
The facility/business has a formal process in place to evaluate new and existing product designs and
potential hazards.
1
Project HSE plan are usually posted in the work area or on the intranet. Meetings and other interactive
means of communication to employees are not normally done.
2 11.2 Is Project HSE plan been communicate to all staff
whom are involved in this project. Project HSE plan are communicated to employees through meetings or written communications.
1
2
Following the communication they are posted in the work area.
3
Project HSE plan are communicated regulary through meetings, written communication and then posted
in the work area. Periodic updates are provided throughout the contractual period.
Product manuals are developed for all products and include HSE information. Individuals are generally
1 aware of most of the codes and standards applicable to the site product lines, but have not been formally
3 11.3 Does the company use relevant / international
industry standard for manufacturing.
trained.
Product manuals are maintained for all products and include HSE information. Individual (s) have been
2
2
formally trained in some of the codes and standards applicable to the site product lines.
3
Product manuals are maintained for all products and include HSE information. Individual (s) have been
formally trained in the codes and standards applicable to the site product lines.


Element 12- Security & Travel Safety
Allocate
1 The facility does not have an effective process for monitoring visitors at the site.
12.1 Is there a central control point that all visitors must
The facility has a designated place that all visitors must report to prior to entering the site. A review of the
1 go to in order to be authorized for entry into the
company facility? Are visitors escorted throughout the
2 sign-in process indicates that improvement can be made regarding the control of visitors. An identification
badge is not always worn.
2
site and required to wear identification badges?
3
The facility has a designated place that all visitors must report to prior to entering the site. A requirement is
in place that all visitors must be escorted while at the facility and wears an identification badge.
1 Less than 70% of the employees who drive on company business have completed defensive driving training.
2 12.2 Do employees who drive on company business
receive defensive driving training? 2
2 70-89% of the employees who drive on company business have completed defensive driving training.
3 90% or higher of the employees who drive on company business have completed defensive driving training.
12.3 Does the company implemented the Journey 1 The facility had not implemented the Corporate Journey Management Procedure
3 Management Procedure or similar procedures or policy
to address driving safety?
2
2 The facility has implemented most of the Corporate Journey Management Procedure.
3 Journey Management Procedure

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OFI = Opportunity for improvement
OBS = Observation

Element 13- Audits & Inspections
Allocate
1 A formal audit and inspection is not in place

1 13.1 Is there a formal written HSE audit and inspection
program in place? 1
2 An audit and inspection program is in place but not documented.
3
A formal written HSE audit and inspection program is in place
1 Audits at the facility focus primarily on conditions.

2 13.2 Do audits and inspections focus on both conditions
and behaviour? 2
2 Audits at the facility focus mostly on conditions with some focus on behavior.
3 Audits at the facility focus on both conditions and behavior.
13.3 Is the company audited by 3rd parties (customers, 1 3rd Party audits are performed at the site and closure is not tracked
3 governmental agencies, insurance carriers, certification
groups). If so, is there a process in place to 1
address/close recommendations? 2 3rd Party audits are performed at the site and closure is tracked, but on an informal basis
3 3rd Party audits are performed at the site and a formal process is in place to close recommendations
13.4 Is there a formal preventative maintenance (PM) 1 A formal PM program is not in place.
4 program in place for critical operating equipment (e.g.,
fire and rescue, slings/chains, cranes and hoists, fork- 1
trucks, bores/lathes/bending machines, etc.)? 2 The site PM program is conducted, but documentation could be improved.
3 A formal preventative maintenance (PM) program is in place for all critical operating equipment.
1 A process for monitoring closure on audit recommendations is not in place.

5 13.5 Is there a effective method to track and monitoring
for all inspection and audit findings? 1
2 An informal process is in place to monitor closure on all audit recommendations.
3 A formal process is in place to document closure on all audit recommendations.

2 Click to select

Element 14- Incident Reporting & Investigation
Allocate
Score
14.1 Are employees, contractors, visitors, etc. 1 There is no formal requirement to report incidents.
1 encouraged to report all incidents including recordable,
near miss, first aid, environmental releases/spills, etc.? The facility requires that all incidents be reported, but records and interviews indicate that does not always
1
2
happen.
3
The facility formally requires that personnel who work at the facility (company, Contractors, visitors)
report all incidents.
1 The site uses an incident investigation form, but a written procedure is not in place.
2 14.2 Is there a written procedure for incident

investigation ? 2
A formal written incident investigation and reporting procedure is in place and meets most of the company
reporting requirements.
1
A formal written incident investigation and reporting procedure is in place that meets the reporting
3 requirements of the company
14.3 Is there a system in place to identify, implement, 1 Incident investigation corrective actions are not normally monitored.
3 track and document incident investigation corrective
actions?
1
2 Incident investigation corrective actions are monitored, but on an informal basis.
3
A formal system is in place to identify, implement, track and document incident investigation corrective
actions.


Element 15- Pressure Testing
Allocate
1 Control measures are in place to warn of pressure testing at only a few worksites.
1 15.1 Does the site has a effective pressure testing
procedure and control measure ? 1
2 Control measures are in place to warn of pressure testing at most worksites.
3 Control measures are in place to warn of pressure testing at all worksites.
15.2 Is there a documented training/competency
program to qualify personnel performing testing 1 The training/competency program is primarily an OJT approach.
2 activities, and does it include classroom, practical on the
job application and competency (testing) modules as
1
2 A documented training/competency program is in place but does not include all of the key components.
components of the program?
3
A documented training/competency program is in place and includes key components (classroom,
practical (OJT) and knowledge (testing) modules
15.3 Are there adequate control measures in place to 1 Control measures are in place to warn of pressure testing at only a few worksites.
3 indicate pressure testing being conducted - to keep
clear? (i.e. barricades, warning lights, signs, etc.)
1
2 Control measures are in place to warn of pressure testing at most worksites.
3 Control measures are in place to warn of pressure testing at all worksites.
15.4 Are pressure tests always performed within test 1 Pressure testing is conducted without shielding or within a test cell for multiple applications.
4 cells or other controlled environments using adequate
shielding?
1
2 Some pressure testing is done without shielding or within a test cell.
3
All pressure testing is performed within test cells or using adequate shielding
15.5 Is there a control measure in place to ensure that 1 Equipment is not routinely checked to ensure that it is neither shipped nor received under pressure.
5 equipment is neither shipped or received under
pressure? Equipment is checked to ensure that it is neither shipped nor received under pressure, but a formal
1
2
process in not in place.
3
A formal process is in place to ensure that equipment is neither shipped nor received under pressure.


Element 16- Process Assessment & Improvement
Allocate
1 A formal annual evaluation of the HSE process is not done.

16.1 Is the overall HSE program evaluated on an annual
1 basis by the site management team and/or Corporate
HSE Audit Team?
2
The facility conducts an annual formal evaluation of their HSE process. This done primarily by the HSE Staff
and/or committee.
2
The facility conducts an annual formal evaluation of their HSE process. This is conducted by the
3 management team in conjunction with the HSE Staff and/or the Corporate HSE Audit Team.
1 A formal evaluation was not conducted

16.2 Did the evaluation focus on company Safety
2 Management System, regulatory requirements, high risk
activities and major causes of incidents? 2
The formal evaluation focused on regulatory compliance and major causes of incidents, but not the 1
company HSE Management System
The formal evaluation focused on the company HSE Management System, regulatory requirements, high
3 risk activities and major causes of incidents
1 A formal evaluation and report was not conducted

16.3 Was a report generated which identifies findings
3 and recommendations for improvement, and was it used
to develop the annual HSE Action Plan? 2
A formal report was not generated, but most of the evaluation items were included in the annual HSE 2
action plan.
A report was generated and the results used to
3 develop the annual HSE action plan


Company Performance in HSE Audit
Company Name
Address Auditor Name Signature Date
Established on 1
No of Employees (YTD) 2
Products or Services 3
Awards Achievement 4
CEO/President/GM
Contact person Auditee's Name Signature Date
Tel number 1
Mobile number 2
Fax Number 3
E-mail 4
S/N Elements Description Current 2023 2021 2020 2019 2018
1
Management Leadership & Commitment 78
Audit Score Summary for Company
Employee Roles & Responsibility 73
2
Hazard Control and Risk Assessment 92

3
Documents, Records & Regulatory
Compliance
0
4
HSE Training & Competency 44

5 1
HSE Communications, Promotion & 16 2
Recognition
56
6
10
HSE Rules & Procedures 50
0
7 15 3
Emergency Preparedness & Response 50
80
8
Health and Medical Programs 56
60
9
14 4
Contractors, Suppliers and Offsite Work 42
10
40
Project & Product Safety 56
11
20
Security & Travel Safety 67 00
12 13 00
0000 5
0
Audits & Inspections 40
13
Incident Reporting & Investigation 33

14
Pressure Testing 33
15 12 6
Process Assessment & Improvement 56
16
TOTAL SCORE 51.528 0 0 0 0 0
11 7
Description Level Percentage
System under development 0 0% to 25%

10 8
9
System is documented and being implemented with a few elements being met. 1 26% to 50%
1-System functioning and being verified.

2-Result measured & 2 51% to 75% Current 2023 2021 2020 2019 2018
3-Key procedures documented
System sustained and supported by on-going improvement Process and all

elements satisfied. 3 75% to100%

Audit Summary
Element Clause Type of Finding Assesment Finding Comment
0 0 0 0
0 0 0 0
Element 1 0 0 0 0
HSE Policy,
Objective &
Organization 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Element 2 0 0 0 0
Employee Roles
& Responsibility
0 0 0 0
0 0 0 0
0 0 0 0
4 0
0 0 0 0
Element 3 0 0 0 0
Hazard Control
and Risk
Assessment 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Element 4
Documents, 0 0 0 0
Records &
Regulatory 0 0 0 0
Compliance
0 0 0 0

Element 4
Documents,
Records &
Regulatory
Compliance Audit Summary
0 0 0 0

Audit Summary
0 0 0 0
0 0 0 0
Element 5 0 0 0 0
HSE Training &
Competency 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Element 6
HSE 0 0 0 0
Communication,
Promotion & 0 0 0 0
Recognition
0 0 0 0
0 0 0 0
Click to select 0
0 0 0
Element 7 0 0 0 0
HSE Rules &
Procedures 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Element 8 0 0 0 0
Emergency
Preparedness &
Response 0 0 0 0
0 0 0 0

Element 8
Emergency
Audit Summary
Preparedness &
Response
0 0 0 0

Audit Summary
Click to select 0
0 0 0 0
Element 9 0 0 0 0
Health and
Medical
Programs 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0
0 0 0 0
Element 10 0 0 0 0
Contractors,
Suppliers &
Offsite Work 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Element 11 0 0 0 0
Project &
Product Safety 0 0 0 0
0 0 0 0
0 0 0 0
Click to select 0
OFI = Opportunity for

0
improvement
Element 12 OBS = Observation 0

Security and
Travel Safety 0 0 0 0
0 0 0 0

Element 12
Security and
Travel Safety
Audit Summary
0 0 0 0

Audit Summary
2 Click to select 0
0 0 0 0
Element 13 0 0 0 0
Audits &
Inspections 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Element 14 0 0 0 0
Incident
Reporting &
Investigation 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Element 15
0 0 0 0
Pressure Testing
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Element 16
Process
Assessment & 0 0 0 0
Improvement
0 0 0 0
0 0 0 0

Process
Assessment &
Improvement
Audit Summary
0 0 0 0
Company:
Audit Score: 51.5277777778 Level-XXX Select year of audit from Audit score
under TOTAL SCORE
Auditors: 0
Audit Date: 30-Dec-99

Date
Time
SITE INSPECTION REPORT

Location
Supplier representative
Prepare by (NOV-PROFAB)
No. Photo Description/Finding Location Remarks

Date
Time

Location

Date
Time

Location
10
11
12
13

Date
Time

Location
14
15
16
17
18

Date
Time

Location
19
20
21

Interview Questionnaires
Allocate
Evidence of this process is demonstrated (70% of the interviewees Interview of employees/contractors

10
able to recalls the policy)
Evidence of this process is demonstrated (50% of the interviewees
5
1.1 HSE policy is communicated or cascaded down to able to recalls the policy)
employees and contractors. 0 No evidence of this
Max Score= 10
Evidence of programme and employee who replied to receive Auditor to ask any 2 employees if they
20 received adequate safety and health
adequate safety and health training (70%) training.
Evidence of programme and employee who replied to receive
There is a programme to identify training needs and 10
3.2 provide adequate safety and health training to
management, supervisors, workers and safety personnel. 0
adequate safety and health training (50%)
No evidence of this
Max Score= 20
Interview at least 2 employees from
10 Toolbox meeting was conducted weekly different department
5 Toolbox meeting was conducted

4.8 Regular HSE toolbox meetings are conducted.
0 No evidence of this
Max Score= 10
Interviewed employee who recalls attending an event organise Auditor to interview 3 persons, do not
40 in Item No.1 and can briefly describe what was learnt at the show table to the person being
event (70%) interviewed
Interviewed employee who recalls attending an event organise
20 in Item No.1 and can briefly describe what was learnt at the
7.3 All staff participated actively in promotional activities
0
event (50%)
None of the two interviewed attended any event or could
remember what was learnt
Max Score= 40
Auditor to ask any 2 employees to confirm.
10 At least two employees are aware
5 At least one employees is aware

11.7 All employees are aware of the risk assessments for the
work activities they carry out. 0 No evidence of this
Max Score= 10
Auditor asks any 2 workers and both know the hazards Auditor interviews any 2 workers
5
involved and the precautions to take
Workers handling hazardous chemicals know the hazards 0 Both or one worker failed to answer correctly
12.8 involved, the precautions to take, and the appropriate
PPE to use.
Max Score= 5
Allocate
Allocate
Score

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HSE Audit Cover Page

Element No. Maximum Score

S/N Link Description Remark

Need to transfer the

Need to be clear after

3 Site Finding Site finding pictures, description and comment

Page 1 of 22 Form No. 338 Rev 0

The internal scoring of each element follows its title.

1 Pts - no clear requirements/procedures, but there is some control

2 Pts - there is requirements/procedures documented

3 Pts - there is review/evaluation/continous improvement

Page 2 of 22 Form No. 338 Rev 0

A group of category 2 non-conformities indicating inadequate implementation or effectiveness of the

Non-fulfillment of legal requirements which is not formally accepted/clarified with authorities

Page 3 of 22 Form No. 338 Rev 0

1.1 Does the site has a HSE Policy which is endorsed by 1

1 The policy is not routinely communicated to employees (i.e – annually)

3 The facility has formal written objectives for HSE

1 The policy states a commitment for continual improvement

Total Score Max=100% 78

Page 4 of 22 Form No. 338 Rev 0

2 2.2 Do employees regularly correct at-risk behaviour and

1 The job responsibilities have not been clearly defined or communicated

Total Score Max=100% 73

Page 5 of 22 Form No. 338 Rev 0

1 3.1 Is there a system in place to identify and adequately

2 3.2 Has a risk assessment been conducted for all work

Total Score Max=100% 92

Page 6 of 22 Form No. 338 Rev. 0

Total Score Max=100% 0

Page 7 of 22 Form No. 338 Rev. 0

1 Training records are not well documented for HSE training.

3 Training records are documented for all required HSE training.

Total Score Max=100% 44

Page 8 of 22 Form No. 338 Rev. 0

1 HSE is not routinely communicated to employees

Total Score Max=100% 56

Page 9 of 22 Form No. 338 Rev 0

1 Compliance issues are reported and/or observed in most work areas.

Total Score Max=100% 44

Page 10 of 22 Form No. 338 Rev. 0

Total Score Max=100% 50

Page 11 of 22 Form No. 338 Rev.0

1 A medical surveillance program has not been established.

Total Score Max=100% 56

Page 12 of 22 Form No. 338 Rev 0

3 The site has a written procedure for contractors/suppliers.

Total Score Max=100% 42

Page 13 of 22 Form No. 338 Rev. 0

Total Score Max=100% 56

Page 14 of 22 Form No. 338 Rev. 0

3 Journey Management Procedure

Total Score Max=100% 67

OFI = Opportunity for improvement

Page 15 of 22 Form No. 338 Rev. 0

1 A formal audit and inspection is not in place

1 Audits at the facility focus primarily on conditions.

3 Audits at the facility focus on both conditions and behavior.

1 A process for monitoring closure on audit recommendations is not in place.

3 A formal process is in place to document closure on all audit recommendations.

Total Score Max=100% 40

Page 16 of 22 Form No. 338 Rev. 0

2 14.2 Is there a written procedure for incident