QUEENSLAND RAIL CONTRACTOR SAFETY AND ENVIRONMENT PREQUALIFICATION ASSESSMENT -

CATEGORY 2 CONTRACTOR

OVERVIEW
This Safety and Environment Questionnaire / Assessment document is specifically intended for Queensland Rail Activities.
The responses provided in this Questionnaire must relate to the current Safety and Environment policies, systems and history of operation within your business.

The questions will provide Queensland Rail with an overview of your Safety and Environment policies, systems and history.
The information provided will be evaluated and scored by Queensland Rail. Further submissions concerning the Safety and Environment management processes
may be required prior to the contract being awarded.

Queensland Rail ensures all provided information is classified and treated as confidential.

APPLICANT INSTRUCTIONS
STEP 1: Complete company contact details in the 'Contractor's Details' tab

STEP 2: Complete 'Section 1 - Cat 2 Questionnaire' tab

1 Provide a response to each question from the selection in the drop menu in the 'Contractor Response' column. All Mandatory questions must have
either a "Yes" or "No" response. All other questions may be responded with a "Yes", "No", "Partial" or "Not Applicable" answer.

An explanation must be provided for all questions answered as "No", "Partial" or "Not Applicable". (The 'Additional Contractor Comments' field
can be used to record this explanation). Where "No", "Partial" or "Not Applicable" is selected a Queensland Rail representative will verify the
explanation provided.

2 Please indicate whether evidence is provided to support the responses for each question by selecting a response from the drop menu in the 'Evidence
Provided' column.

Review the guidance provided in the corresponding 'Example of Evidence' column to indicate what processes or systems you may have in your
organisation. If evidence is available in full or partial form, please select "Yes" or "Partial". Select "No" if no evidence is able to be provided.

3 In the 'Contractor's Supporting Evidence' column, list all of the documentation, information and other references that is provided as part of the
submission to support the responses in this Questionnaire. Ensure you provide all of this documentation / evidence as part of your submission.

Note: You must clearly reference all evidence provided using the question number that the evidence relates to.

4 Use the 'Additional Contractor Comments' column to provide any additional information as required.

STEP 3: Complete 'Section 2 - Performance History' tab

1 Each question must be completed and relevant evidence provided as applicable. An explanation must be provided for all questions that are not
applicable.

2 Insert additional information in the Additional Comments field.

QUEENSLAND RAIL OFFICIAL

MD-18-401 (Version 1.0)
© 2018 Queensland Rail
QUEENSLAND RAIL CONTRACTOR SAFETY AND ENVIRONMENT PREQUALIFICATION ASSESSMENT -
CATEGORY 2 CONTRACTOR
OVERVIEW
This assessment provides the scoring to be applied for Category 2 contractor Safety and Environment prequalification assessment.
The assessment is based on the responses and the supporting evidence provided by the contractor in this document.

All information provided by the contractor must be validated by a Queensland Rail Assessor to ensure the minimum Queensland Rail Safety and Environment requirements are being met.
The information contained in this assessment is confidential and must not be communicated to other parties.
This Safety and Environment Questionnaire / Assessment document is specifically intended for Queensland Rail Activities.

QR ASSESSOR INSTRUCTIONS
STEP 1: Review the application for completeness. Has the Queensland Rail Assessor received this document and support documentation in a form that can clearly be read? If not,
request clarification by discussing the application with the Authorised Person. Any incomplete questionnaires are to be returned to the applicant for completion before
starting the evaluation process.

STEP 2: Queensland Rail Contractor Safety and Environment Prequalification Questionnaire / Assessment initial considerations - first 3 TABS:
TAB - 'Contractor's Instructions'. Read and understand what Queensland Rail has requested from the applicant.
TAB - 'QR Assessor Instructions'. Read and understand these instructions.

TAB - 'Contractor's Details'. Ensure the details have been completed. The Applicant's Company Details will automatically be incorporated into the Section 1 - Cat 2
Questionnaire and Section 2 - Performance History worksheets.

STEP 3: TAB - 'Section 1 - Cat 2 - Questionnaire', complete cells 'Queensland Rail Assessor' cell L2 & 'Assessment Date' cell L3 recording your name and the date of the assessment.

Check to see if the responses from the drop-down menu in the 'Contractor Response' column for each question have been completed. All Mandatory questions must have
either a "Yes" or "No" response. All other questions may be responded with a "Yes", "No", "Partial" or "Not Applicable" answer

Check to see if evidence has been provided to support the responses for each question in the 'Evidence Provided' column.

An explanation must be provided for all questions answered as "No", "Partial" or "Not Applicable". (The 'Additional Contractor Comments' field can be used to record this
explanation).

Where "No", "Partial" or "Not Applicable" is selected the Queensland Rail Assessor will verify the explanation provided. Seek clarification if the comments are insufficient or
incomplete.

Review the 'Contractor's Supporting Evidence' column for all of the documentation, information and other references that has been provided as part of the submission to
support the responses in the Questionnaire.

Review and confirm the supporting evidence provided addresses the associated question.

Undertake the Assessment of the responses and evidence reviewed, applying the following dropdown scoring matrix in the 'Queensland Rail Score' Column:
"Yes" The contractor's response meets the Queensland Rail Criteria.
"No" The contractor's response does not in any respect meet the Queensland Rail Criteria or evidence has not been provided.
"Partial 75%" The contractor's response meets 75% of the Queensland Rail Criteria.
"Partial 50%" The contractor's response meets 50% of the Queensland Rail Criteria.
"Partial 25%" The contractor's response meets 25% of the Queensland Rail Criteria.
"NA" In the Contractor's opinion the Queensland Rail Criteria is not applicable.
Note! Only a "Yes" or "No" option is valid for a Mandatory Question.

Where "No", "Partial 75%", "Partial 50%", "Partial 25%" or "Not Applicable" is selected the Queensland Rail Assessor will verify the explanation provided and include an
appropriate comment in the 'Queensland Rail Comments' column.

If unsure, request additional clarification, by discussing the application with the Queensland Rail Authorised Person.

STEP 4: TAB - 'Section 2 - Performance History', confirm that all 'Performance History' questions have been answered and relevant evidence provided as applicable. An explanation is
required for all questions that are responded as 'not applicable'.

STEP 5: Following the evaluation of the data - select the TAB - 'Risk Scoresheet' in this spreadsheet to review the overall score.

This worksheet illustrates the progressive weighted markings for each question and the total <80% Red and >80% Green is locked and a record only. The overall score is also
represented in the Section 1 – Cat 2 Questionnaire on the last line.

Score Criteria: To proceed with the sourcing process, all the mandatory criteria must be met AND a minimum overall score of 80% must be achieved.

If either of these conditions are not met, the Safety and Environment Prequalification is returned to contractor and cannot be progressed until the mandatory criteria is met
and a minimum overall score of 80% is achieved.

NOTE: Further submissions concerning safety and environment management processes may be required prior to the contract being awarded based on the contractor category and at
the discretion of the Authorised Person with support from the applicable Safety Advisor.

QUEENSLAND RAIL OFFICIAL

MD-18-401 (Version 1.0)
© 2018 Queensland Rail
CONTRACTOR'S DETAILS
Company Name:
ACN:
Trading Name:
ABN:
Company Contact Name:
Position:
Phone:
Registered Address:
Physical Address:
Company Description: [Describe the work activities or services to be provided under the proposed
Services/Products contract]

QUEENSLAND RAIL OFFICIAL

MD-18-401 (Version 1.0)
© 2018 Queensland Rail

QUEENSLAND RAIL CONTRACTOR SAFETY AND ENVIRONMENT PREQUALIFICATION QUESTIONNAIRE (CATEGORY 2 CONTRACTOR)
SAFETY AND ENVIRONMENT MANAGEMENT
ITEM
1. Policy
Safety and Environment
Management System (SEMS) &
Policy
2. Legal and Other Requirements
Legislation
3. Hazard Identification & Risk Management
Risk Management
Environmental Risks
Hazard and Risk
Hazard Observations
4. Planning and Performance
Objectives and Strategy
5. Organisational Resources, Accountabilities and Responsibilities
6. Training, Competency and Awareness
Training & Competency
7. Contractor and Procurement Management
Purchasing
Subcontractors
8. Documentation and Document Control
Documentation
9. Communication and Consultation
Consultation
10. High Risk Controls
Safe Systems of Work
QR HSE Pre-Qualification Questionnaire
CONTRACTOR: 0
*ASSESSMENT DATE:
*QUEENSLAND RAIL ASSESSOR:
CONTRACTOR
EVIDENCE PROVIDED
RESPONSE CONTRACTOR'S SUPPORTING
EXAMPLES OF Mandatory = Yes or No QUEENSLAND RAIL MAX
# QUESTION NOTE Mandatory = Yes or No EVIDENCE ADDITIONAL CONTRACTOR COMMENTS QUEENSLAND RAIL COMMENTS SCORE
EVIDENCE Non-Mandatory = SCORE VALUE
Non-Mandatory = (Include document references relating to the question)
Yes, No, Partial or NA
Yes, No or NA
Details of a formalised Safety and Environment Management System. The Safety and
Environment Management System provides the means by which the Safety and Environment
Does the organisation have a documented 'Safety and Environment Policy commitments are communicated and implemented. It incorporates the management
1.1 Management System' (SEMS) that includes a Safety and Environment Policy Mandatory standards, procedures, similar that describe the intent and requirements in regard to Safety 30 0
that is authorised and signed by senior management? and Environment management.
The Safety and Environment Management System includes a Safety and Environment Policy
which is signed by senior management.
Safety and Environment legislation register
Does the organisation have a method for keeping up to date with legislative
Subscription to legislation changes
2.1 requirements / change, and including requirements within Safety and Mandatory
Industry association memberships
20 0
Environment documents?
Copies of relevant Acts, Regulations, Codes of Practice
Does the organisation have a documented 'Hazard Identification and Risk
Management Process' in place to ensure that health and safety risks are Documented procedure for hazard identification, risk assessment and examples of
3.1 controlled so far as is reasonably practicable (SFAIRP) and which includes the Mandatory completed risk assessment forms and risk register/s. 20 0
development and maintenance of a risk register relevant to the company's
work activities?
Does the organisation have a documented 'Environmental Management Details of formalised 'Environmental Management Plan' that may include biodiversity, waste
3.2 Plan' which includes actions, controls and responsibilities for managing management, land rehabilitation, environmental emissions, prevention / minimisation of 20 0
environmental risks? environmental damage, weed management, and pest management.
Does the organisation have a method to document and assess hazards
relevant to its work activities? Series of JSAs / SWMSs / SOPs / procedures / or similar, documenting Safety and
Environment hazards, risks and controls
10.2 Mandatory
Safe observations / hazard report
10 0
Field verification checklist / inspection checklist / similar
Example: Proactive Safety and Environment intervention /Interaction / safe observation
Does the organisation have a 'Safe Observation Process' (or similar) in place
14.1
to report hazards and identify safe and unsafe work practices?
program that addresses at-risk work practices. Hazard reporting program that encourages 15 0
employee hazard reporting and samples of hazard reports.
Example of Safety and Environment improvement strategy/program that may include
elements for improving Safety and Environment culture, reducing incidents, empowering
Does the organisation have a method for Safety and Environment planning
individuals and improving overall Safety and Environment performance.
4.1 and measuring its Safety and Environment performance against identified
Process for capturing and measuring Safety and Environment performance (e.g. details of
15 0
strategy / targets / objectives / priorities / key performance indicators?
target injury frequency rates, environmental targets, training hours, % close-out of corrective
actions, incidents, injuries)
0 0
Documented procedure/ process on training and competency. Examples of training
database/registers detailing qualifications, tickets, licences and inductions.
Safety and Environment training register (incl. induction, high risk work licences,
Does the organisation ensure that training records and evidence of qualifications, training)
6.1
competencies for all workers are available at the workplace?
Mandatory
Safety and Environment training database
20 0
Process for ensuring refresher training, re-certification or similar to maintain currency
Process for verifying competency of personnel, including familiarisation training and
assessment
Does the organisation consider ergonomic and environmental principles Documented procedure for purchasing or examples of purchasing where Safety and
7.1 when purchasing equipment (Inc. electrical items, hand tools, PPE) and/or Environment has been evaluated e.g. buying machinery, waste minimization, noise controls, 10 0
plant? recycling, hazardous substances. Example risk assessments.
Does the organisation have documented processes for the engagement and
If subcontractors are engaged, you MUST provide evidence of subcontractor management
7.2 management of subcontractors, including assessing their Safety and
procedures or processes that include prequalification and review of subcontractor capability.
15 0
Environment capability? (If not applicable indicate 'NA')
Does the organisation have a document control procedure (to ensure
documents are kept up to date with a current version number and date) and
Document control procedure, records management procedure or examples of records
8.1 a procedure to manage its Safety and Environment records (indicating their
management.
10 0
location, retention times, responsible custodians, and any confidentiality
conditions)?
Does the organisation have a method for, consulting with and Documented Safety and Environment Committee charter/agenda/minutes, toolbox
9.1 communicating to employees (and subcontractors) about Safety and Mandatory meetings, pre-start meetings, safe observations (or similar), correspondence letters to sub- 20 0
Environment? contractors (where relevant)
Does the organisation have safety management processes / safe systems of
work for high risk work activities?
Evidence provided must cover the following activities where applicable:
- Land Transport/Chain of Responsibility
- Heavy Lifting (Cranes)
- Working at Heights/Prevention of Falls/Prevention of Falling Objects
- Working in an electrified or non-electrified rail corridor
- Confined Space Entry
- Hazardous Materials (dangerous goods, hazardous substances, asbestos,
lead)
- High Voltage/Electrical Risks Documented requirements/processes for management of high risk work activities including
- Excavation/Trenching site hazard inspection checks, safety risks included in JSAs / SWMSs / procedures / plans,
- Air/Maritime Risks Safety and Environment risk register, equipment registers, specific rules.
- Plant, including powered mobile Plant & Equipment
10.1 - Manual Handling for high risk tasks Mandatory
Examples of plans to include as applicable: Traffic Management Plan, Environmental
20 0
- Noise Risks Management Plan, Asbestos Management Plan, Lifting Plan.
- Environmental issues (air, culture, noise, biodiversity, land management,
waste, water) Evidence must be provided for ALL applicable activities to meet this criterion
- Construction/Development/Demolition
Confidential Page 4 of 9
 CONTRACTOR
EVIDENCE PROVIDED
RESPONSE CONTRACTOR'S SUPPORTING
EXAMPLES OF Mandatory = Yes or No QUEENSLAND RAIL MAX
ITEM # QUESTION NOTE Mandatory = Yes or No EVIDENCE ADDITIONAL CONTRACTOR COMMENTS QUEENSLAND RAIL COMMENTS SCORE
EVIDENCE Non-Mandatory = SCORE VALUE
Non-Mandatory = (Include document references relating to the question)
Yes, No, Partial or NA
Yes, No or NA

Does the organisation have written procedures / policies requiring the Documented procedure for risk assessment and examples of completed risk assessment
Risk Assessment 10.3
employees to complete a JSA / JHA / SWMS before non-routine tasks? forms JSA / JHA / SWMS.
20 0

Does the organisation have standard operating procedures/work instructions

SOPs 10.3 (or similar) for all work activities undertaken (in addition to those identified Examples of SOP's/work instructions or procedures. 10 0
in 10.1)

QR HSE Pre-Qualification Questionnaire Confidential Page 5 of 9


ITEM
Inspection and maintenance
PPE
Fitness for Work
11. Management of Change
Management of Change
12. Protective Security and Emergency Management
Emergency Management
13. Measuring and Monitoring
Safety and Environment
Performance
Monitoring Programs
14. Incident Management
Incident Reporting and
Investigation
15. Assurance and Auditing
Audit and Assurance
16. Management Review
Management Review
QR HSE Pre-Qualification Questionnaire
CONTRACTOR
EVIDENCE PROVIDED
RESPONSE CONTRACTOR'S SUPPORTING
EXAMPLES OF Mandatory = Yes or No QUEENSLAND RAIL MAX
# QUESTION NOTE Mandatory = Yes or No EVIDENCE ADDITIONAL CONTRACTOR COMMENTS QUEENSLAND RAIL COMMENTS SCORE
EVIDENCE Non-Mandatory = SCORE VALUE
Non-Mandatory = (Include document references relating to the question)
Yes, No, Partial or NA
Yes, No or NA
Electric test and tag of electrical power tools
Completed plant / machinery risk assessments
Does the organisation have a process for inspection and maintenance of
Copies of inspection records for plan / equipment / machinery (relevant to the work scope)
10.4 powered tools / plant / equipment / machinery (relevant to the scope of
Maintenance log books / records
20 0
work)? (If not applicable indicate 'NA')
Process for tagging out and / or disposal procedure for faulty / damaged / defective
equipment
Does the organisation have a documented process to manage PPE selection,
10.5 use and maintenance? Procedure/document outlining how PPE is selected, used and maintained. 10 0
Does the organisation have processes to manage worker health risks? Health risks included within JSEAs / SWMSs / SOPs / procedures / or similar
(Consider as relevant: fitness for work, fatigue, heat stress, drug and alcohol Safety and Environment risk register
influence, exposure to or inhalation of chemicals / dusts / fibres, exposure to Fitness for work requirements; pre-employment and ongoing medicals, health surveillance
bites / stings / microbes, noise, vibration or similar) Drug and alcohol testing program procedure including random and for cause testing.
Specific shift or working rules relating to fatigue and heat stress
10.6 Hazardous substance handling procedures / JSAs / SWMSs / risk register / SDSs 10 0
Does the organisation have a documented 'Return to Work / Rehabilitation' Rehabilitation policy and associated procedure, workers compensation subscription,
10.7 10 0
Policy for management of workers compensation / return to work cases? evidence of return to work programs
Does the organisation have a documented management of change process to
Management of change procedure or examples of material, plant, procedure change &
11.1 manage and review its Safety and Environment hazards and controls as part Mandatory
assessment of Safety and Environment has occurred.
20 0
of work or changes?
Emergency response plan / procedures
Emergency contacts / response / retrieval / or similar, embedded within JSAs / SWMSs /
procedures / or similar
Does the organisation have a process to identify and document first aid, fire, Specific training in first aid, spill response, emergency response scenarios
12.1
spill and emergency response procedures?
Mandatory
Documented process that outlines the methods of communication and responsible persons
20 0
in event of an emergency situation
List of the organisations emergency contacts
Medical and Emergency related training
Procedure/document outlining the requirements for recording and reporting of Safety and
13.1
Does the organisation have documented processes to record, analyse, trend
Environment performance.
Examples of Safety and Environment reports/statistical analysis trends may include 15 0
and report Safety and Environment performance statistics?
diagrams / charts / dashboards / documented minutes from monthly Safety and
Environment management meetings with outcomes.
Documented procedure/program outlining how employee occupational exposure is managed
13.2 Does the organisation have an Occupational Hygiene Monitoring program? i.e. expected climactic conditions, noise, dust, fumes, particulates, contact with liquids, 15 0
vibration, documented health risk assessment.
14.2
Does the organisation have documented 'Incident Reporting and
Mandatory
Incident reporting & investigation procedure, incident report form that includes an
20 0
Investigation Process' in place? investigation section.
Does the organisation have a documented 'Internal Auditing Process' which Procedure/document outlining the organisations internal audit process.
15.1 includes a schedule which includes regular Safety and Environment Mandatory Examples of auditing schedules/field/operational audits, review meetings/reports/ that have 20 0
inspections at workplaces? occurred within the previous 12 months.
Has the organisation's Safety and Environment Management System' (SEMS)
been audited by either an external accredited auditor or a recognised
Details of the Safety and Environment Management System and latest score should be
accredited authority?
15.2
E.g. N.S.C.A., Du-Pont Stop, SafetyMAP, WorkCover - S.A.B.S., WorkCover -
provided. 20 0
Copies of accreditation certificate/s.
Self Insurer Performance Standards, ISO 14001, ISO 9001, Civil Contractors
Federation, Integrated Management System, AS 4801.
Does the organisation's Safety and Environment management system have a Procedure/document outlining how Safety and Environment Management System is
16.1
documented process for regular review by management?
Mandatory
regularly reviewed by management.
15 0
Overall Score % 0.0
Confidential Page 6 of 9
QUEENSLAND RAIL CONTRACTOR SAFETY AND ENVIRONMENT PREQUALIFICATION QUESTIONNAIRE -
(CATEGORY 2 CONTRACTOR)
SAFETY AND ENVIRONMENT PERFORMANCE HISTORY
Contractor Company Name: 0
Date: 12/30/1899
1 Organisational References
Name of Principal and Contract Name for last three contracts.
Contract 1:
1.1
Contract 2:
Contract 3:
2 Contract Statistics
Lost Time Injury Frequency Rate (LTIFR) for last three contracts. (LTIFR = Lost time incidents (LTI) X 1,000,000) / Total number of hours worked)
Contract 1:
2.1
Contract 2:
Contract 3:
Total Recordable Injury Frequency Rate (TRIFR) for last three contracts. (TRIFR = Recordable incidents (Fatality, LTI, RWC, MTC) X 1,000,000) / Total number of hours worked)
Contract 1:
Contract 2:
2.2 Contract 3:
Please provide a definition of TRIFR classification criteria for the organisation (if different from above)

Number of First Aid Injuries for last three contracts.

Contract 1:
2.3
Contract 2:
Contract 3:
Total days lost due to injury for last three contracts.
Contract 1:
2.4
Contract 2:
Contract 3:
Number of serious environmental incidents and non-compliances for last three contracts.
Contract 1:
2.5
Contract 2:
Contract 3:
3 Annual Statistics
Provide Industry Average Lost Time Injury Frequency Rate (LTIFR) and the organisation's LTIFR year to date (YTD) and previous three years.
(LTIFR = Lost time incidents (LTI) X 1,000,000) / Total number of hours worked)
Industry Average:
3.1 Current YTD:
Year 1:
Year 2:
Year 3:
Provide Industry Average Total Recordable Injury Frequency Rate (TRIFR) and the organisation's TRIFR YTD and previous three years.
(TRIFR = Recordable incidents (Fatality, LTI, RWC, MTC) X 1,000,000) / Total number of hours worked)
Industry Average:
3.2 Current YTD:
Year 1:
Year 2:
Year 3:
Number of first aid injuries for current YTD and previous three years.
Current YTD:
3.3 Year 1:
Year 2:
Year 3:
Number of environmental incidents and non-compliances for current YTD and previous three years.
Current YTD:
3.4 Year 1:
Year 2:
Year 3:
Number of manhours.
Current YTD:
3.5 Year 1:
Year 2:
Year 3:
Number of improvement notices from a regulatory authority in previous three years?
Current YTD:
3.6 Year 1:
Year 2:
Year 3:
Number of breach notices from a regulatory authority in previous three years?
Current YTD:
3.7 Year 1:
Year 2:
Year 3:
Number of prosecutions from a regulatory authority in previous three years?
Current YTD:
3.8 Year 1:
Year 2:
Year 3:
Number of workers compensation claims in previous three years?
Current YTD:
3.9 Year 1:
Year 2:
Year 3:
Current insurance premium costs? Must include a copy of the Certificate of Currency (CoC) and a report from WorkCover
3.10
Page 7 of 9
3.10
Current YTD:
Additional Comments:

Page 8 of 9
 QUEENSLAND RAIL CONTRACTOR SAFETY AND ENVIRONMENT PREQUALIFICATION ASSESSMENT
(CATEGORY 2 CONTRACTOR)

Summary Score Table By: SEMS Management Standard

Contractor Company Name: 0
Queensland Rail Assessor: 0
Assessment Date: 12/30/1899 Mandatory Criteria met No
Overall Score (At least 80% required) 0.0%
Summary Score Table: By SEMS Management Standard
SEMS Management Standard Maximum Possible Score Score Obtained % Maximum Score Weighted SEMS Score (%)

1. Policy 30 0 0.0% 0.0

2. Legal and other Requirements 20 0 0.0% 0.0
3. Hazard Identification & Risk Management 65 0 0.0% 0.0
4. Planning and Performance 15 0 0.0% 0.0
5. Organisational Resources, Accountabilities and Responsibilities 0 0
6. Training, Competency and Awareness 20 0 0.0% 0.0
7. Contractor and Procurement Management 25 0 0.0% 0.0
8. Documentation and Document Control 10 0 0.0% 0.0
9. Communication and Consultation 20 0 0.0% 0.0
10. High Risk Controls 100 0 0.0% 0.0
11. Management of Change 20 0 0.0% 0.0
12. Protective Security and Emergency Management 20 0 0.0% 0.0
13. Measuring and Monitoring 30 0 0.0% 0.0
14. Incident Management 20 0 0.0% 0.0
15. Assurance and Auditing 40 0 0.0% 0.0
16. Management Review 15 0 0.0% 0.0
TOTAL 450 0 0.0% 0.0

Detailed Score Table: By Group

Maximum Possible Maximum Possible Score Grouped Group Sub- % Maximum Group Weighted
SEMS Management Standard Group % Weighting SEMS Score
Score Group Score Obtained Weighting total Score Score (%)

1. Policy SEMS & Policy 30 30 0 7.0% 7.0% 0 0.0% 0.0 0.0

2. Legal and other Requirements Legislation 20 20 0 5.0% 5.0% 0 0.0% 0.0 0.0
Risk Management 20 0 5.0%
Environmental Risk Management 20 0 5.0%
3. Hazard Identification and Risk Management 65 5.0% 0 0.0% 0.0 0.0
Hazard and Risk 10 0 3.0%
Hazard Observation 15 0 4.0%
4. Planning and Performance Objectives and Strategy 15 15 0 4.0% 4.0% 0 0.0% 0.0 0.0

5. Organisational Resources, Accountabilities and Responsibilities 0 0 0 0.0%

6. Training, Competency and Awareness Training & Competency 20 20 0 5.0% 5.0% 0 0.0% 0.0 0.0
Purchasing 10 0 3.0%
7. Contractor and Procurement Management 25 7.0% 0 0.0% 0.0 0.0
Subcontractors 15 0 4.0%
8. Documentation and Document Control Documentation 10 10 0 3.0% 3.0% 0 0.0% 0.0 0.0
9. Communication and Consultation Safety and Environment Committee 20 20 0 5.0% 5.0% 0 0.0% 0.0 0.0
Safe Systems of Work 20 0 5.0%
SOPs 20 0 5.0%
Equipment 10 0 3.0%
10. High Risk Controls PPE 20 100 0 5.0% 27.0% 0 0.0% 0.0 0.0
10 0 3.0%
Fitness for Work
10 0 3.0%
Equipment 10 0 3.0%
11. Management of Change Management of Change 20 20 0 5.0% 5.0% 0 0.0% 0.0 0.0
12. Protective Security and Emergency Management Emergency Management 20 20 0 5.0% 5.0% 0 0.0% 0.0 0.0
Safety and Environment Performance 15 0 4.0%
13. Measuring and Monitoring 30 8.0% 0 0.0% 0.0 0.0
Monitoring Programs 15 0 4.0%
14. Incident Management Incident Reporting and Investigation 20 20 0 5.0% 5.0% 0 0.0% 0.0 0.0
20 0 5.0%
15. Assurance and Auditing Audit and Assurance 40 5.0% 0 0.0% 0.0 0.0
20 0 5.0%
16. Management Review Management Review 15 15 0 4.0% 4.0% 0 0.0% 0.0 0.0
450 450 0 117% 100% 0 0.0 0.0

QR HSE Pre-Qualification Assessment Scoresheet Confidential Page 9 of 9