CBRE QHSE Management Plan Inputs Questionnaire (1)

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Yes

  No

  N/A

• Will CBRE be expected to work on energized (live) battery systems (below 50V)?

  Yes

  No

  N/A

• Will CBRE be expected to work on energized (live) electrical equipment (above 50V)?

  Yes

  No

  N/A

• Will CBRE be expected to work on energized (live) high-voltage electrical equipment (above 600V)?

  Yes

  No

  N/A

• Has an arc flash hazard analysis been conducted on the site’s electrical systems?

  Yes

  No

  N/A

• Automated Process Machinery/Robotic Automation

  Yes

  No

  N/A

• Does the site have “robots” or other moving or packaging equipment?

  Yes

  No

  N/A

• Is perimeter guarding used to establish a “safeguarded space” for robots used in the work environment?

  Yes

  No

  N/A

• Will CBRE be expected to service, maintain, or work around these systems?

  Yes

  No

  N/A

• Hazardous Energy Control (Lock-out/Tag-out)

  Yes

  No

  N/A

• Will CBRE be expected to perform hazardous energy control (lock out/tag out) for maintenance work on powered equipment (pressure, electrical energy, mechanical energy, etc.)?

  Yes

  No

  N/A

• Does the site have a written hazardous energy control (lock out/tag out) program for maintenance work on powered equipment (pressure, electrical energy, mechanical energy, etc.)?

  Yes

  No

  N/A

• Does the site have equipment-specific procedures for equipment that requires LOTO?

  Yes

  No

  N/A

• Noise

  Yes

  No

  N/A

• Responses

  Yes

  No

  N/A

• General

  Yes

  No

  N/A

• Client Name

• Site address/location(s)

• Account Director

  Yes

  No

  N/A

• CBRE HSE Transition Team Lead

  Yes

  No

  N/A

• CBRE Site Leader

  Yes

  No

  N/A

• Client QHSE Point of Contact

• Go-Live Date

  Date

• How many CBRE employees will support the site?

• Will an account HSE Manager be hired for the site/customer?

  Yes

  No

  N/A

• Scope of Contract

  Yes

  No

  N/A

• M&E (Mechanical & Electrical)

  Yes

  No

  N/A

• Cleaning

  Yes

  No

  N/A

• Ground Maintenance

  Yes

  No

  N/A

• Security

  Yes

  No

  N/A

• Reception

  Yes

  No

  N/A

• IT White Space

  Yes

  No

  N/A

• Projects

  Yes

  No

  N/A

• Other: Specify:

• Risk Assessments / Safe Systems of Work

  Yes

  No

  N/A

• Is an HSE Risk Assessment been performed? If yes, please provide a copy

  Yes

  No

  N/A

• Have Job Hazards Analysis (JHA) been performed? If yes, please provide copies for each JHA

  Yes

  No

  N/A

• Have Personal Protective Equipment Assessments been performed? If yes, please provide copies

  Yes

  No

  N/A

• Are there client-specific QHSE programs CBRE will be expected to follow? If yes, please provide

  Yes

  No

  N/A

• Fire Safety

  Yes

  No

  N/A

• Will CBRE be expected to inspect and maintain fire suppression systems?

  Yes

  No

  N/A

• Will CBRE be expected to inspect and maintain fire alarm systems?

  Yes

  No

  N/A

• Will CBRE be expected to respond to fires?

  Yes

  No

  N/A

• Will CBRE be expected to re-fuel or maintain fuel-containing systems (e.g., diesel generators)?

  Yes

  No

  N/A

• Will CBRE be expected to perform welding, brazing, or other hot work?

  Yes

  No

  N/A

• Hazardous Materials

  Yes

  No

  N/A

• Will CBRE be expected to handle hazardous materials (liquids, gasses, etc.)?

  Yes

  No

  N/A

• Does the site have an inventory of all hazardous chemicals & other materials?

  Yes

  No

  N/A

• Has a facility-wide survey of asbestos-containing building materials been performed? If yes, please provide a copy of the survey or Asbestos Management Plan

  Yes

  No

  N/A

• Has a facility-wide survey of lead-containing paint or substrates been performed? If yes, please provide a copy

  Yes

  No

  N/A

• Does the site use toxic chemicals?

  Yes

  No

  N/A

• Does the site have a new chemical procurement policy for contractors such as CBRE?

  Yes

  No

  N/A

• Will CBRE be cutting or grinding on cement containing materials such as concrete or raised floor tiles containing cement?

  Yes

  No

  N/A

• Are there ventilation systems to manage the generation of dust and/or toxic chemicals?

  Yes

  No

  N/A

• Are there refrigerant leak detectors located in chiller room areas?

  Yes

  No

  N/A

• Is CBRE responsible for the calibration and maintenance of the refrigerant leak detectors?

  Yes

  No

  N/A

• Please provide a complete site inventory of chemicals in use at the site and their location as a separate document

  Yes

  No

  N/A

• Working at Heights

  Yes

  No

  N/A

• Will CBRE be expected to work at heights above four (4) feet?

  Yes

  No

  N/A

• Does work at heights require CBRE to wear fall protection equipment?

  Yes

  No

  N/A

• Will CBRE be expected to work on the rooftop?

  Yes

  No

  N/A

• Confined Spaces

  Yes

  No

  N/A

• Will CBRE be expected to enter confined spaces?

  Yes

  No

  N/A

• Is there an inventory of confined spaces at the site? If yes, please provide a copy

  Yes

  No

  N/A

• Is there a site-specific written confined space program?

  Yes

  No

  N/A

• Will CBRE be expected to work in areas with high noise (> 85 dBA)?

  Yes

  No

  N/A

• Will CBRE be expected to perform work that requires the use of hearing protection?

  Yes

  No

  N/A

• Other High-Risk Activities

  Yes

  No

  N/A

• Does the site have a work-control program requiring written authorization for high-risk maintenance operations (e.g., confined space entry, welding, work at heights, energized electrical work, etc.)?

  Yes

  No

  N/A

• Will CBRE be expected to participate in the emergency response team (ERT) other than as a support role related to their job function(s)?

  Yes

  No

  N/A

• Will CBRE be expected to clean up spills of fuel or other hazardous chemicals?

  Yes

  No

  N/A

• Will CBRE be expected to inspect, repair or service any process equipment with unique, high hazards?

  Yes

  No

  N/A

• Will CBRE be expected to operate a motor vehicle on public roads as part of its responsibilities?

  Yes

  No

  N/A

Contractor Safety

• Yes

  No

  N/A

• Does the site have a contractor safety approval process?

  Yes

  No

  N/A

• Does the site have contractor safety training requirements?

  Yes

  No

  N/A

• Does the site have a work-control program requiring written authorization for contractors performing high-risk maintenance or renovation activities?

  Yes

  No

  N/A

• Is there an existing training matrix that specifies training requirements by job title/function, department, etc. that would affect CBRE?

  Yes

  No

  N/A

Material Handling

• Contractor Safety

  Yes

  No

  N/A

• Will CBRE be expected to operate cranes, hoists, or lifts?

  Yes

  No

  N/A

• Radiation & Laser Safety

  Yes

  No

  N/A

• Does the site have equipment or sources that uses or emits ionizing radiation (X-rays, gamma, etc.) that CBRE will be exposed to?

  Yes

  No

  N/A

• Does the site have equipment that uses high-powered lasers (Class 3B or Class 4) that CBRE will be exposed to?

  Yes

  No

  N/A

• Material Handling

  Yes

  No

  N/A

• Will CBRE be expected to operate forklifts or aerial lifts (e.g., scissors lift)?

  Yes

  No

  N/A

• Will CBRE be expected to lift more than 30 lbs without lifting aids?

  Yes

  No

  N/A

• Are their ergonomic assessments performed? Are there ergonomic concerns?

  Yes

  No

  N/A

• Hazardous Waste

  Yes

  No

  N/A

• Hazardous Waste

  Yes

  No

  N/A

• Will CBRE be expected to handle or manage hazardous waste?

  Yes

  No

  N/A

• Will CBRE be expected to prepare or sign hazardous waste manifests?

  Yes

  No

  N/A

• Will CBRE be expected to manage universal and electronic waste? Are there current tools for tracking?

  Yes

  No

  N/A

• Regulatory Permits and Agencies

  Yes

  No

  N/A

• Regulatory Permits and Agencies

  Yes

  No

  N/A

• Will CBRE be expected to manage or track any HSE-related permits on behalf of the site (e.g., air emissions, radiation, hazardous materials)?

• Will CBRE be expected to serve as the primary contact for any regulatory agencies (OSHA, EPA, Fire Department)?

  Yes

  No

  N/A

• Is the facility on an existing EPA Superfund site or is there any known environmental contamination?

  Yes

  No

  N/A

• Are there any recent HSE related regulatory or corporate audit findings? If yes, please provide a summary

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Are there any HSE key performance indicators (KPI) or related metrics for which CBRE will be required to track, report and/or be evaluated?

  Yes

  No

  N/A

• Will CBRE be expected to participate as a member(s) of the safety committee?

  Yes

  No

  N/A

• Are there any client-required auditing and inspection requirements?

  Yes

  No

  N/A

• Miscellaneous

  Yes

  No

  N/A

• Miscellaneous

  Yes

  No

  N/A

• Will CBRE perform maintenance/repair to elevators?

  Yes

  No

  N/A

• Will CBRE use, build or modify scaffolds (e.g. rolling scaffolds)?

  Yes

  No

  N/A

• Will CBRE use, build or modify scaffolds (e.g. rolling scaffolds)?

  Yes

  No

  N/A

• Will CBRE need to perform or enter any trenches/excavations (septic lines)?

  Yes

  No

  N/A

• Will CBRE perform maintenance / cleaning on cooling towers?

  Yes

  No

  N/A

• Will CBRE have special onboarding client-specific training?

  Yes

  No

  N/A

• Will CBRE work in and/or maintain a cafeteria?

  Yes

  No

  N/A

• Are there any on-site medical services?

  Yes

  No

  N/A

• Is there a digital SDS System?

  Yes

  No

  N/A

• Is there a digital SDS System?

  Yes

  No

  N/A

• Is there a Business Continuity Plan?

  Yes

  No

  N/A

• Are there any other Client specific QHSE programs CBRE should be aware of?

  Yes

  No

  N/A

• Is there any type of Portal site that CBRE will have access to and be required to report into?

  Yes

  No

  N/A

• Will CBRE deliver mail? Are there suspicious package handling procedures?

  Yes

  No

  N/A

• Will CBRE operate and/or maintain a fitness facility?

  Yes

  No

  N/A

• Will CBRE be maintaining any LEED buildings?

  Yes

  No

  N/A

• Will CBRE be responsible for indoor air quality complaints?

  Yes

  No

  N/A

• Will CBRE be responsible for pest control or pest removal services?

  Yes

  No

  N/A

• Other Requirements: