Form Doc.

HSE-28
(Contractors HSE Requirements) Rev: 2
Date: 05/09/2023
Page : 1-of-1

1. Company Details

Name:

Address:

Contact Person:

Telephone:

Fax:

Email:

2. Total Manpower ofCompany :

3. Type of activity to be performed at BQP :

4.

5. HSE Pre-qualificationsQuestionnaires:

# Details

Duly signed HSE Policy available? (if ‘yes’ then attach a copy)
01 As per MINISTERIAL DEGREE 286 /2008 Article 10; this is mandatory requirement if
employed 10 or more workers

Availability of HSE Programme? (if ‘yes’ then attach a copy)

02 As per MD 286 /2008 Article 10; this is mandatory requirement if employed 10 or
more workers

03 Clearly understood for the Project HSE Plan requirements and can be
complied?

04 Have any similar past working experience?

05 Have qualified HSE Officer and can be dedicated for this project? (if ‘yes’ then
 attach a copy of his CV)
Submitted HSE training records of Supervisors and Workers? (copy to be
06
attached)

07 Aware for all the HSE Legal requirements?

08 Submitted list of vehicles and equipment with their registration, applicable third
party certifications and Operator’s license copy?

09 All lifting equipment and tackles possess valid third party certification?

Have Safety Training Programme/Procedures? (submit a copy of the

10
training matrix)

11 Have Emergency Response Procedure? (copy to be attached)

12 Do you have Accident Reporting Procedures? (copy to be attached)

13 Commercial Registration available? (copy to be attached)

15 List of workers along with Residence card copy?

16 Workers Compensation Policy? (copy to be attached)

17 Provide details of HSE performance for the last 1 years in below format:

Year
Total Man hours worked
Total Safe Man hours worked
No. of LTIs
No. of Fatalities
No. of Near Miss
No. of First Aid Cases
No. of Environmental Incidents
 Note: Provide any other additional / supplementary information that would help us to understand your HSE
Management System or your Company’s activities.

For BPQ and its Project Consultant Use only

Overall HSE Assessment of the above subcontractor (Pass / Fail)

Evaluated by : Approved by ( QA/QC Dept.)

Name : Name :

Company: Company:

Designation: Designation:

Signature: Signature:

Date: Date:

* Projects to be evaluated by BPQ Department Manager