Delta Company Ltd. (For Audit Use)

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Auditing Area

• Project location:

  Select Al Maather Al Hazem Al Waha Mahjar HIndawiah Bawat Al Khatam Taima Hail 69KV Dammam Al Khuzam Murjan

  • Al Maather
  • Al Hazem
  • Al Waha
  • Mahjar
  • HIndawiah
  • Bawat
  • Al Khatam
  • Taima
  • Hail
  • 69KV Dammam
  • Al Khuzam
  • Murjan

• Auditable Unit Name

• Date of Audit

  Date

SECTION 1: Premises and Housekeeping

• Obvious unrepaired damage buildings

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Visual

• Record and check safety reps report

  Yes

  No

• Unsafe condition of floors, carpets, roadways, walkways, elevated platforms

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Visual

• Record and check safety reps report

  Yes

  No

• Have these deviations have been reported.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Reporting system

• Record and check safety reps report

  Yes

  No

• Corrective actions taken in timely manner (quick response).

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Documented proof, requested, current & completed work orders

• Check date recorded, and date of work order requested

  Yes

  No

• Premises divided into areas and delegated to Safety Representatives/Supervisions/HSE's (on plan or in writing).

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Plan 100% coverage

• Are all areas covered by Safety Reps.

  Yes

  No

1.2 Good lighting: Natural and Artificial

• Sample of "lights out"

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Visual

• Especially in hazardous/high risk areas

  Yes

  No

• Poorly lit areas

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Visual

• Especially in hazardous/high risk areas.

  Yes

  No

• Reporting of lights out by safety reps/supervision/HSE monthly

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Example of report, emergency light checklist report

• What system is there to report defective lighting?

  Yes

  No

• Lighting survey and monitoring of light intensities

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Survey all areas covered, min. max based on SEC standards

• Detailed, professional and complete report?

  Yes

  No

1.3 Ventilation: Natural and Artificial

• Study done for ventilation problems

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Study copy, all areas covered, min, max based on SEC standards

• Detailed, professional and Complete report?

  Yes

  No

• Have been survey results and recommendations been auctioned/planned

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: System enhancement/modification requests for areas above/below standard

• ?

  Yes

  No

• Confined space area are identified, study done.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Study copy, all expected CS covered?

• ?

  Yes

  No

• Have survey results and recommendations been actioned/applied?

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Plan 100% coverage

• Are all areas covered by Safety Reps.

  Yes

  No

• Ventilation/extractions provided and maintained

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Maintenance program

• Including FMD reports

  Yes

  No

• Environmental monitoring/heat stress/sampling

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Documents

• Outdoor max. Temperature <50 degrees celcius

  Yes

  No

1.4 Plant Hygiene Facilities

• Facilities in a clean hygienic stage

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Visual

• Examine, toilets, kitchens, lunch rooms, refrigerators, microwaves

  Yes

  No

• No food in unauthorized areas

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Visual

• Examine, toilets, kitchens, lunch rooms, refrigerators, microwaves

  Yes

  No

• Regular monthly inspections

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Weekly

• Examine, toilets, kitchens, lunch rooms, refrigerators, microwaves

  Yes

  No

• Checklist used signed, monitored

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Completed checklists

• Examine, toilets, kitchens, lunch rooms, refrigerators, microwaves

  Yes

  No

1.5 Pollution: Air, Ground, and Water

• Study to determine whether a pollution problem exists

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Copy of study

• ?

  Yes

  No

• Have study results and recommendation been auctioned/applied

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: E.g. work orders, new equipment/procedures

• ?

  Yes

  No

• Hazardous waste identified

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: List of all Hazardous wastes

• ?

  Yes

  No

• Obvious pollution/ uncontrolled fuel, oil leakage or hazardous waste

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Visual

• ?

  Yes

  No

• Is the problem being dealt with

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Documents

• ?

  Yes

  No

• Is the problem being dealt with

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Plan 100% coverage

• Are all areas covered by Safety Reps.

  Yes

  No

1.6 Aisles and Storage Demarcated

• Floors demarcated as per standard

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Plan 100% coverage

• Are all areas covered by Safety Reps.

  Yes

  No

• Uninformed demarcation code used

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Demarcation adhered to

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Demarcation under electrical/mechanical equipment

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Fire equipment location uniformly marked "keep clear' areas demarcated and maintained.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Equipment unobstructed

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

1.7 Good Stacking and Storage Practices

• Stacking neat, stable and controlled

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Safe

  At Risk

  N/A

• Storage in cupboards, on shelves neat and tidy

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• Are all areas covered by Safety Reps.

  Yes

  No

• No stacking on top of windowsills, cabinets, etc.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Unsafe conditions related to stacking an storage is reported and action taken

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

1.8 Housekeeping

• Under roof areas free of junk and materials

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Plan 100% coverage

• Are all areas covered by Safety Reps.

  Yes

  No

• Outside areas free of junk and materials

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Safety rep/appointees/HSE controlling areas by reporting (good general good housekeeping)

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Copies of recent checklists

• Is housekeeping being checked on checklist?

  Yes

  No

• Corrective actions

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Check system

• ?

  Yes

  No

1.9 Scrap and Refuse Bins Removal System

• Scrap bins provided

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Regular controlled removal

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Removal schedule

• ?

  Yes

  No

• Separate bins for rags, oily materials, scrap, etc.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: is it used per categorization

• ?

  Yes

  No

• Bin locations demarcated

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

1.10 Color coding: Plant and pipelines

• Uniform color coding

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Copy of standard

• ?

  Yes

  No

• Color keyboard (legend) displayed

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Knowledge of colors (own code acceptable)

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Ask employee

• ?

  Yes

  No

SECTION 2: Mechanical, Electrical and Personnel Safeguarding

2.1 Machine/Hazardous Equipment guarding

• All hazardous moving machine/ electrical parts within normal reach completely guarded/fenced/enclosed

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Guards must offer 100% protection

• ?

  Yes

  No

• All guards installed are listed,, checked and maintained

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: All guards on register and checked according to standard-monthly

• ?

  Yes

  No

• Inspection guards/front/back/back panels

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Monthly checklist

• ?

  Yes

  No

2.2 Lock-System and Usage "LOTO"

• Written procedure available, updated and applied

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Copy of standard special business line or sector or department/division-(not 5-Star Procedure)

• ?

  Yes

  No

• One key, one lock, and one authorized person is applied whenever LOTO is required

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: No master keys, no unauthorized lock cutting

• ?

  Yes

  No

• Are there task specific procedures available?

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Clear for all employees when to use LOTO

• ?

  Yes

  No

• Are all affected staff trained?

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Attendance/certificate document

• Ask employee/supervisor how to lock a critical valve

  Yes

  No

• All equipment can be isolated and locked (including where fuses are drawn or valves in chemicals lines, etc.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Follow system, check equipment and valves

• ?

  Yes

  No

• LOTO are monitored, supervised and controlled by competent person and authorized person/LOTO station available and well arranged.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Check system, ask employee using LOTO

• Assigned in writing by AU manager?

  Yes

  No

• Do field activities match SEC policy and procedures

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Check current jobs

• ?

  Yes

  No

• Locks numbered and all use locks are recorded on permit

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Check old and current permits and locks were being used

• ?

  Yes

  No

• Type, quality and condition of LOTO tools and parts

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Proper type is for LOTO

• E.g. Isolated tools/parts used for electrical LOTO

  Yes

  No

• Removal of locks and tags after job is finished is controlled and monitored.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: No old lock/tags on equipment after the job is done

• ?

  Yes

  No

2.3 Labeling switches, isolator a and valves

• All isolator so/switches/circuits/cables and contact breakers labeled and well arranged

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Switch, CB's, valves,etc

• ?

  Yes

  No

• Are there emergency stop button, red colored?

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Arc flash labelling done?

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Fully detailed arc flash info, stickers & stickers & Signs

• ?

  Yes

  No

• Are all critical isolator so/valves identified (natural gas, main water supply, process emergency shut off, etc.)

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Map of critical valves

• ?

  Yes

  No

2.4 Ladders, stairs, walkways (scaffolding)

• Condition of ladders, stairs, walkways, scaffold, etc.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Visual

• ?

  Yes

  No

• Ladders (portable/fixed) and scaffolds numbered, on registered

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Ladder checklist

• ?

  Yes

  No

• Are ladders inspected periodically for deficiencies and does supervisors ensure corrective actions are taken.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Broken/poor condition ladder are marked and banned

• Replacement maintenance report

  Yes

  No

• Stairways landing, open end platforms etc. toeboards.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Stairways: four or more risers required handrail

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

2.5 Lifting gear and Records

• Condition of cranes/man baskets/hooks/chains/slings, etc.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Visual

• Including contractors equipment, lifting gears and employees

  Yes

  No

• Safe Work Load marked.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: All lifting equipment clearly marked with a permanent label indicating SWL and ID No this includes all types of slings and "D" shackles and any other equipment send for lifting purposes such as jack

• Including contractors equipment, lifting gears and employees

  Yes

  No

• Listing gear identified and corrected in register

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• Including contractors equipment, lifting gears and employees

  Yes

  No

• Safety latches on all hooks where practicable.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Carried out by an approved inspection authority and certificate issued for each piece of equipment

• Including contractors equipment, lifting gears and employees

  Yes

  No

• Operator/driver trained and licensed

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• Including contractors equipment, lifting gears and employees

  Yes

  No

• Storage and inspection of lifting tackle.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Chain, wire rope and slings, D shackles

• Including contractors equipment, lifting gears and employees

  Yes

  No

2.6 Compressed Cylinders: Pressure Vessels & Records

• Pressure vessel on register, tests and inspection carried our (test pressure 1.3 x MSWP)

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Register, inspections

• Registers correctly filled in and up to date

  Yes

  No

• Relief valves locked or sealed Red line on pressure gauge

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Are all gas cylinder stored properly? And used in a safe manner.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Check storage area & procedures

• ?

  Yes

  No

2.7 Hazardous Substances Control

• Person designated to coordinate the list of MSD's

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: List or online up to date

• Who coordinate this program

  Yes

  No

• Has a hazardous substance risk assessment and analysis been conducted based on an alphabetical list?

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: All hazardous substances covered?

• ?

  Yes

  No

• Persons designated to coordinate the list of MSD's

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Are MSDS' applicable to the products being used

• Are all areas covered by Safety Reps.

  Yes

  No

• MSDS sheets available in department, by buyer and first aid.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: MSD's

• ?

  Yes

  No

2.8 Risk Assessment (HIRA)

• Assessor a have attended risk assessment workshops

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Plan 100% coverage

• Are all areas covered by Safety Reps.

  Yes

  No

• Hazard identification done covering all possible hazards using proper analysis techniques(audit hazel, fmea, etc)

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Document

• ?

  Yes

  No

• Risk register for all workplace activities kept

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Copy of register

• ?

  Yes

  No

• Validity of Government license

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Plan 100% coverage

• Are all areas covered by Safety Reps.

  Yes

  No

• Risk assessment completed as per standard

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Plan 100% coverage

• Are all areas covered by Safety Reps.

  Yes

  No

• Probability, severity and frequency considered

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Plan 100% coverage

• Are all areas covered by Safety Reps.

  Yes

  No

• All expected risk in the work place are assessed especially in risk areas

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Percentage of completion RA Reports

• ?

  Yes

  No

• All hazards and risks have been dealt with (treated, tolerated, terminated, or transferred)

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Documentation & visual

• ?

  Yes

  No

• Re-assessment of the risks after correction actions applied

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Documented proof

• Is the risk after the correction actions applied ALARP?

  Yes

  No

• Hazard identification and Risk Assessment awareness (toolbox) training, knowledge share and publicity

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Certificates, workshops attendance list, posters

• ?

  Yes

  No

2.9 Motorized Equipment: Checklist, licensing

• Condition of vehicles/equipment/seat belts use

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Monitor seat belt usage

• ?

  Yes

  No

• Daily checklist completed by driver/ operator

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Test system, reports completed?

• ?

  Yes

  No

• Driving cab, load area are clean and tidy

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: No unsafe storage

• ?

  Yes

  No

• Employee attended and passed defensive driving course

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: 50% employees=5 PTW, 40%=4 PTW, 30%3 PTW, 20%=2 PTW, 10%=1 pt

• ?

  Yes

  No

• Driver/operator training syllabus

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Internal licensing

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Identification of drivers/operators

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Validity of Government licenses

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

2.10 Portable Electrical Equipment

• Condition of all cords, plugs, switches, etc.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• All portable equipment identified, checked and register kept (all equipment fed through a flexible cable from plug point-110, 220, 380 or 500V)

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Register or checklist

• ?

  Yes

  No

• Are faulty items marked/tagged and removed from use?

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

2.11 Electrical Equipment

• List of all high risk electrical equipment and maintenance schedules

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Clear and comprehensive

• Have and MV equipment only

  Yes

  No

• Records of maintenance available

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Maintenance program

• Have and MV equipment only

  Yes

  No

• Reports to management on completed maintenance

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Record kept

• Have and MV equipment only

  Yes

  No

2.12 General Electrical Installation and Flameproof

• Electrical installation safe/earth leakage, GFCI

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Substations/panel/DB/faceplates locked or closed

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Condition of all cords, plugs, switches, etc.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Is there any unsafe temporary wiring? or any damaged or faulty switches, plugs, joints, fuse boxes or distribution boards, etc.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Flameproof equipment -annual checks and record of checks, e.g. Logbook

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: if applicable-register

• ?

  Yes

  No

2.13 Hand Tools

• Condition of hand tools

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Regular checks by supervisor

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Storage of tools (includes hammers, chisels, files, brooms, mops, spades, wheelbarrows, handcarts, etc.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Are damaged items marked/tagged and removed?

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Flameproof equipment -annual checks and record of checks, e.g. Logbook

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

2.14 Ergonomics

• Survey carried out using a checklist covering all premises, furniture and jobs

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Filled checklist by employee

• ?

  Yes

  No

• Develop checklists per standard

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: High risk list covers (risk assessment)
  -body posture,
  -excessive force jobs,
  -overreaching

• Work at height,<br>-repetitive,<br>-fatigue and static load,<br>-area clearances

  Yes

  No

• Follow-up action/surveys as required

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Applied corrective actions

• ?

  Yes

  No

• Ergonomics Commitee formed and top 10 hazards in current year identified

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: List top 10 ergonomics hazards to resolve agree on corrective action, implementation Action Plan

• Are all areas covered by Safety Reps.

  Yes

  No

• Operators comfortable -seating/computer and work stations -accessibility-valves, switches, levers, etc. -heat stress workload

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

2.15 Head Protectors

• Risk assessment done/signs posted

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Risk assessment

• ?

  Yes

  No

• Provided and worn where necessary

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Risk assessment

• ?

  Yes

  No

2.16 Eye Protectors

• Risk assessment done/signs posted

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Risk assessment

• ?

  Yes

  No

• Eye protection provided and worn

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Risk assessment

• ?

  Yes

  No

2.17 Footwear

• Safety footwear provided

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Risk assessment

• ?

  Yes

  No

• Safe footwear being worn and in good condition

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Risk assessment

• ?

  Yes

  No

2.18 Protective Equipment

• Risk assessment done/signs posted

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Risk assessment

• ?

  Yes

  No

• Protective clothing provided and maintained

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Arc flash PPE/levels defined/worn

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• All clothing worn: adequate, clean and in good repair

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: arc flash clothes not modified

• ?

  Yes

  No

2.19 Respiratory Equipment

• Risk assessment done/signs posted

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Risk assessment

• ?

  Yes

  No

• Correct types provided, used checked and controlled

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Personnel trained in use of respiratory equipment

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

2.20 Hearing Conservations

• Noise survey conducted and areas zoned

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Noise Risk assessment

• ?

  Yes

  No

• Reduction of noise at source

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Applied corrective action

• ?

  Yes

  No

• Hearing acuity testing 6-monthly

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Audogram

• ?

  Yes

  No

• Approved hearing protectors provided and worn

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

2.21 Safety Harness

• Fall protection risk assessment done/sign posted

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Risk assessment

• ?

  Yes

  No

• Safety harness provided and used

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Condition and regular checks

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Training in use of safety harness given

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

2.22 Hand Protection

• Risk assessment done/sign posted

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Risk assessment

• ?

  Yes

  No

• Gloves, barriers cream, etc. provided and worn/used

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

2.23 Control of Usage, issue maintenance and Record of personal protective equipment

• Commitment obtained from wearer accepting conditions and requirements to wear ppe/arc flash ppe

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Statement

• ?

  Yes

  No

• Regularly checks by supervisor

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Are damaged items marked, listed and removed immediately from service?

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Records, lists, logs

• ?

  Yes

  No

• Record of equipment issued

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

2.24 Notices and Signs: Electrical, Mechanical,Protective Equipment, Symbolic Safety Signages

• Standardized signs posted where required- in good condition

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Display of signs of information and training

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Training

• ?

  Yes

  No

• Electrical warning notices/live conductors and substations

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

SECTION 3: Fire Protection and Prevention Protection

3.1 Fire Extinguishing Equipment

• Fire risks identified and assessed for all areas

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Fire Risk Assessment

• ?

  Yes

  No

• Action plans to correct deviations?

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: All correction actions applied?

• ?

  Yes

  No

• Adequate number of correct types of fire extinguishing equipment provided and correctly located.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

3.2 Locations Marked, Floor Clear

• Equipment location uniformly marked "keep clear"areas demarcated and maintained

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Equipment unobstructed

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

3.3 MaintenAnce of Equipment

• All fire extinguishing equipment numbered/identified on register and checked monthly

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Register

• Clearly identifying location, type & capacity

  Yes

  No

• Maintenance at least annually

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

3.4 Storage of flammable and Explosive Material

• Storage provided with suitable doors, windows (if any), ventilation, bund, etc.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Store/magazine neat, tidy and clean/bonding

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• List of flammables, precautions and storage capacity displayed?

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Spill control/secondary containment

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

3.5 Alarm System

• Independent alarm

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Back up alarm

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Is these test alarm

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: schedule and records showing date& time

• At least once every three months

  Yes

  No

• Employees know the sound of alarm

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

3.6 Firefighting Drill and Instruction

• Fire teams adequate to risk as determined by fire risk assessment

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Team available on all shifts

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Fire drills-minimum once a year

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Proof

• Complete report

  Yes

  No

• At least one evacuation drill per year (where not possible), at least publicized plan

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Someone in each department, other than fire team, trained in the use of fire extinguishers

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Proof of training

• ?

  Yes

  No

3.7 Security Systems

• Control of entry and exit of persons, vehicles, etc.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Security staff reporting unsafe practices/conditions

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• Copies of report

  Yes

  No

• One person per shift trained on 5 star Safety Workshop

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Plan 100% coverage

• Verification:

• ?

  Yes

  No

3.8 Emergency Planning

• Emergency plans available, updated, signed

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Copy of plan available, updated & Signed

• Does it cover all scenario

  Yes

  No

• Separate first aid and services teams trained and included in emergency drills

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Coordinator to take control

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Employee training on site emergency plan

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Training proof, events reports

• ?

  Yes

  No

• Control Center/emergency equipment

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

3.9 Fire Prevention and Protection Coordinator

• Appointed in writing, duties defined

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Appointment letter

• ?

  Yes

  No

• Minimum training FPA one week course or similar

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Training proof

• ?

  Yes

  No

SECTION 4: Accident Recording and Investigation

4.1 Occupation Injury/Disease Record

• Description of accident in register

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Records

• ?

  Yes

  No

• Official record/register/record of injuries as required by legislation or claimed GOSI (work men's group)

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Records

• ?

  Yes

  No

• Reportable accidents being reported to authorities

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Records

• ?

  Yes

  No

• Minor injuries being recorded

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Records

• ?

  Yes

  No

4.2 Internal Accident/Near Miss Reporting and Investigation(Occupational Injury and/or disease)

• Internal report of all injuries/diseases/near miss incidents

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Accident records

• ?

  Yes

  No

• Investigation by designated investigator

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Appointed by A/I

• ?

  Yes

  No

• Causes identified/basic/immediate

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Investigations form

• ?

  Yes

  No

• Effective recommendations

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Are they effective

• ?

  Yes

  No

• Action taken/signed by manager

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Reasonable time

• ?

  Yes

  No

4.3 Injury/Disease/Near Miss Statistics

• Progressive statistical data: monthly and 12 months

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Graph

• ?

  Yes

  No

• Graphic display of experience/graph/bar chart

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Graph

• ?

  Yes

  No

• Analysis of injuries, part of body, department, etc.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Chart

• ?

  Yes

  No

• Statistics circulated to top managers and discussed at safety committee meetings

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Proof of this

• ?

  Yes

  No

• Statistics displayed on notice boards

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Visual proof

• ?

  Yes

  No

4.4 Internal Accident Reporting and Investigation (Damage, and other)

• Internal repor-damage and other

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Damage reports

• ?

  Yes

  No

• Investigation:Designated investigator

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Appointment of A/I

• ?

  Yes

  No

• Cause identified/basic/immediate

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Investigations forms

• ?

  Yes

  No

• Effective recommendations

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Are they effective

• Are they effectively

  Yes

  No

• Action taken/signed by manager

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Reasonable time

• ?

  Yes

  No

4.5 Accident (Damage) Statistics Kept

• Monthly and progressive 12 months

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Appointed A/I

• ?

  Yes

  No

• Estimated and/or actual costs

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Costing

• ?

  Yes

  No

• Statistics circulated to top managers

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Proof of this

• ?

  Yes

  No

4.6 Cost of Risks:Apportioning of Costs

• Estimated costs of injuries and damage

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Graph circulated to managers monthly

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Other insurance claims compared to premiums

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

4.7 Near Miss Incident and Accident Recall

• Talks by foremen/supervisors used in conjunction with safety talks, meetings

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Attendance sheets

• ?

  Yes

  No

• Review of previous events/accident

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Proof

• ?

  Yes

  No

SECTION 5

5.1.Manager Designated as Responsible for Safety and Health

• Appointed in writing (whether full or part time)

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Designation of subordinate managers

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• All managers and employees signed authority, responsibility and accountability for OSH commitment

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Endorsement of pertinent program documents (e.g. inspection reports, committee minutes and accident investigations) visible felt leadership

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Proof of involvement

• ?

  Yes

  No

5.2 Person(s) Appointed for Safety and/or Occupational Hygiene Coordination.

• Appointed in writing (whether full or part time)

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Appointment

• This is the safety coordinator not the Safety Represent

  Yes

  No

• Duties and responsibilities defined

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Duties

• This is the safety coordinator not the Safety Representative

  Yes

  No

• Safety training:5 Star System training workshops

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Training record

• This is the safety coordinator not the Safety Representative

  Yes

  No

• Safety system inspecting and auditing Course/Nebosh 1 week

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:Auditors certificate

• This is the safety coordinator not the Safety Representative

  Yes

  No

5.3 Designation of Safety Representatives in Accordance with SEC Requirements

• Written appointment of Safety Representative (10%)

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Appointment

• ?

  Yes

  No

• Routine discussion of duties

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Proof of this

• ?

  Yes

  No

• Monthly inspection of work areas using a checklists for reporting back

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Completed checklist

• ?

  Yes

  No

• Training:Safety Representative Course/Accident Investigation/other

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Certificates

• ?

  Yes

  No

5.4 Safety Committees

• Safety committees established as per standard

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Safety reps are part of committee?

• Committees must have meet 10 times to qualify for full points

  Yes

  No

• Are all departments/divisions/sections represented

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• Committees must have meet 10 times to qualify for full points

  Yes

  No

• Meeting once a month

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Copy of minutes

• ?

  Yes

  No

• Minutes kept, detailing action to be taken and responsibility for the action

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Action taken

• ?

  Yes

  No

• Endorsed by Management and chairman of the safety committee

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Signed off

• Manager chaired all meeting

  Yes

  No

5.5 Other Communication Systems

• Toolbox talks related to possible hazards applicable to the task in hand

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Attendance lists

• ?

  Yes

  No

• Small group Activity System (productivity/quality Control Circles

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Proof of this

• ?

  Yes

  No

5.6 First Aiders and Facilities

• Facilities to meet SEC requirements (full time nurse)

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Check of box contents and treatment records

• Are all areas covered by Safety Reps.

  Yes

  No

5.7 First Aid Training

• Five percent of complete staff to be trained or retrained to at least general level of first aid per year (Points allocated proportionally to % trained, e.g. 5% = 5, 4% = 4, etc.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: List of first Aiders valid certificate

• ?

  Yes

  No

5.8 Posters, Bulletins, Newsletters, Safety Films and Internal Competitions, etc.

• Posters displayed at specified display points rotated at least once a weekly and explained.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Safety newsletter/bulletin-3 monthly

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Copy of this

• ?

  Yes

  No

• Safety Videos/DVD screened-all to see

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Attendance register

• ?

  Yes

  No

5.9 Safety and Star Grading Board

• Internal safety competition

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Attendance register

• ?

  Yes

  No

• Up-to-date Safety Notice board policy/standard

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Attendance register

• ?

  Yes

  No

• Board promoting Road Safety

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Attendance register

• ?

  Yes

  No

5.10 Suggestion Scheme

• Formal/through safety committees

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Suggestions received

• ?

  Yes

  No

• Record of suggestions and acknowledgements

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

5.11 Safety Reference Library

• Safety Manual, Health and Safety system booklet, "black book", MSDS, 5 Star Standards

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: List of books/magazine

• ?

  Yes

  No

5.12 AnnUal Report-Safety Achievements

• Annual achievements publicized (report y AU manager on KPI's, etc

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Copy of annual report

• ?

  Yes

  No

5.13 Induction and Job Safety Training

• Safety rules for all employees

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Proof rules issued to employees

• ?

  Yes

  No

• Induction includes safety instructions

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: proof of induction

• ?

  Yes

  No

• Job/task training includes the safety aspects of the job

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Proof of this

• ?

  Yes

  No

5.15 Medical Examinations

• 5% of staff, including management, trained each year (points to be allocated proportionally to the percentage of staff trained)

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

5.15 Medical Examinations

• Pre-employment medical employees

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Man-job specification available to medico

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Regular medical school-e.g., scheduled substance food handlers, senior managers, equipment operators

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

5.16 Plant Inspection:Safety Reps

• Monthly inspection by Safety Reps or appointees submitting reports

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Inspection reports all areas covered monthly

• ?

  Yes

  No

• Checklist based on the 5-Star System being used

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Correction actions taken- follow-up and monitoring of uncorrected/ completed observations

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: status list of all observations

• ?

  Yes

  No

• Reports considered and auctioned/signed by Management

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

5.17 Management Self-Audits

• Audit by team including management

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: complete report

• Does AU conduct its own internal Audits

  Yes

  No

• Each element of the 5 Star Safety System given consideration.

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: self audits

• Does AU conduct its own internal Audits

  Yes

  No

• At least 6 monthly self-audit

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: every 6 months

• Does AU conduct its own internal Audits

  Yes

  No

• Follow-up cation taken

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: Action plan

• Does AU conduct its own internal Audits

  Yes

  No

5.18 Safety Specifications: Purchasing and Engineering Control New Plant and Contractors

• Safety specifications for purchasing new plant: machine guarding, color coding, LOTO requirements

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Re-commissioning/pre acceptance inspection, deviations corrected

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Pre-bid documents completed and filled by all contractors

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification:

• ?

  Yes

  No

• Contractors to comply with 5 Star safety rules, work area inspected, and deviations corrected

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: inspection of contractors site inspection reports

• ?

  Yes

  No

• Contractors reporting injuries and fatalities

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: statistical report for all contractors

• ?

  Yes

  No

• AU follow-up on deviations recorded and corrective action applied

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: status report for each contractors

• ?

  Yes

  No

• After submission, all contractor's evaluations kept including safety program

  Select Good Better Satisfactory Unsatisfactory Defective Not Applicable

  • Good
  • Better
  • Satisfactory
  • Unsatisfactory
  • Defective
  • Not Applicable

• Verification: evaluation reports?

• All contractors have been evaluated?

  Yes

  No