Title Page

  • Document number

  • Conducted on

  • Prepared by

  • Location

Part I. HSE Management

  • is the HSE Policy posted at S+N facilities in a visible place?

  • Have the country managing director signed the adherence to the HSE Policy?

  • Is there a HSE annual strategic plan to cover local commercial areas?

  • Has the HSE Manual been divulged and implemented in the local commercial area?

  • Are HSE objectives covered in the winning behaviors of every employee?

  • Is the local Sustainability information sent to corporate HSE on a quarterly basis?

  • Is there an active Safety Committee in place?

Part II. HSE Program/System

  • Has the local commercial area and active HSE program/system?

  • Is the HSE program/system aligned with the corporate HSE policies and procedures?

  • Is the HSE program/system aligned with local HSE regulations?

  • Is the HSE program included on the onboarding training?

  • Does the commercial area keep records of HSE corporate or local audits/inspections?

Part III. Risk management

  • Has been conducted a risk assessment covering commercial, surgical services and warehousing operations?

  • Has been determined a risk hierarchy control based on the results obtained in the risk assessment?

  • Are employees informed about the risks present in their work areas?

  • Are the employees properly trained on the risk control actions in their work areas?

Part IV. Corrective actions

  • Are corrective actions generated as a result of a work related incident?

  • Are corrective actions generated as a result of a HSE corporate or regulatory audit?

  • Are Single Point Lessons (SPL´s) communicated throughout the commercial area?

  • Are the corrective actions met in a scheduled deadline?

  • Is evidence attached when a corrective action is closed?

  • Is there an emergency response plan implemented?

  • Is there an emergency response team properly trained on the emergency response plan?

  • Are emergency drills conducted at least once a year involving all the employees?

  • Are disciplinary actions taken when employees do not follow HSE procedures or local regulations?

Part V. Incident investigation

  • Are all significant incidents reported to global HSE?

  • Are work related incidents immediately reported to employee direct supervisor and local HSE representative?

  • Are work related incidents reported and investigated according to global procedure GPR-HSE-008.1 Management of Incidents and dangerous occurrences?

  • Are work related incident information included on the period OSHA and Sustainability report on a quarterly basis?

  • Are work related incidents reported to local authorities?

Part VI. Contractor safety

  • Do commercial operations implement the requirements described on GPR-HSE-003.17 Control and Safety of Visitors and Contractors at S&N Sites Rev B?

  • Is there a HSE contractor orientation training implemented on site?

  • When directly supervised by S+N work related cases occurred to contractor workers are included on the monthly sustainability report?<br>

  • Do contractor companies meet an approval process, based on corporate and local regulations?

Part VII. Waste management

  • Is there a waste stream classification program implemented on site?

  • Are dangerous and non dangerous waste, disposed and treated asrequired by local regulations and corporate procedure GPR-HSE-<br>003.34 Management and Minimization of Waste Rev B?

  • Are there waste reduction initiatives implemented on site ?

  • Are waste management metrics reported on a quarterly basis to the sustainability report?

  • Does the commercial operation keep documentation of waste shipments?

Part VIII. Storage and handling of chemical products

  • Are Safety Data Sheets available of the stored chemical products ?

  • Is Personal Protective Equipment worn if recommended by the chemical product manufacturer ?

  • In case of chemical product leakage ,is there a containment system or chemical spill kit available ?

  • Are flammable and combustible liquids stored inside of an approved FM cabinet?

  • Does the facility meet the maximum storage capacity for flammable and combustible liquids?

  • Does the flammable and combustible liquid storage area have an installed fire detection & protection system?

Part IX. Driver Safety

  • Does the employee/contractor have a valid Driver's license?

  • Does the employee/contractor have a current vehicle registration?

  • Does the employee/contractor have a current insurance and accident reporting documents?

  • If applicable, are vehicle inspection records up to date?

  • EXTERIOR VEHICLE CONDITION. Is vehicle exterior clean and undamaged?

  • Is the windshield in good condition (no cracks, stars)?

  • Vehicle not leaking fluids (water, oil, antifreeze, fuel, etc.)?

  • All exterior lights functional?

  • Outside mirrors attached and adjustable?

  • Are tires in good condition?

  • INTERIOR VEHICLE CONDITION. Is vehicle interior clean, organized and undamaged?

  • Are dashboard gauges functioning and warning lights out?

  • Does vehicle’s horn sound?

  • Are all interior lights functioning?

  • Are seat belts and rear view mirror in good condition?

  • VEHICLE SAFETY EQUIPMENT. If required, is vehicle equipped with an appropriate fire extinguisher?

  • If yes to A, is the inspection record complete and current?

  • If permitted (or required) by local law, does the employee/contractor have a hands free device?

  • Does the employee/contractor have a current first aid kit?

  • If required, is the vehicle equipped with reflective safety triangles or other equipment as required by local law?

Part X. Ergonomics

  • Is commercial area aligned with corporate procedure GPR-HSE-003.30 Workplace Ergonomics Rev.B ?

  • Has the commercial operation performed an ergonomics assessment (including potential musculoskeletal disorders) at work stations?

  • MANUAL WEIGHT LIFTING & HANDLING. Is there a maximum weight to be lifted manually by gender? (consider local regulation if available)

  • Is the commercial operation in alignment with GPR-HSE-003.4 Safe Lifting and Manual Handling Rev B

  • Lifting – Back Straight while lifting or placing?

  • Lifting – tested weight of unknown object before attempting to lift?

  • Lifting – Not twisting (“squaring” hips to pick up and put down location)?

  • Lifting – Lifting with Legs & buttocks, not back? Feet offset for stability?

  • Lifting – Did associate request help lifting >50 lbs. (23 Kg)?

  • Lift or Carry – Was employee/contractor “hugging” load to body?

  • Carry – Did employee/contractor create a “clear path” before lift and carry?

  • Overhead – Not lifting objects >14 lbs (6.4 Kg), above 6’10” (2 m)?

PART XI. Surgical services safety

  • Are the surgical services technicians in alignment with GPR-HSE-003.7 Driving on Company Business Rev B?

  • Are the surgical services technicians in alignment with GPR-HSE-003.6 Management of Biological Hazards Rev B?

  • Are the surgical services technicians in alignment with GPR-HSE-003.21 Control of Ionizing Radiation Sources Rev B?

  • Are the surgical services technicians in alignment with GPR-HSE-003.16 Safety of Employees at Non-Smith & Nephew Locations Rev<br>B?

Part XII. Warehouse safety

  • Is the warehouse operation in alignment with GPR-HSE-003.4 Safe Lifting and Manual Handling Rev B?

  • When applicable is the warehouse operation in alignment with GPRHSE-003.12 Safe Use of Powered Industrial Vehicles (Fork Lift<br>Trucks) Rev B?

  • Is the warehouse operation in alignment with GPR-HSE-003.13 Safe Loading and Off-Loading of Materials Rev B?

  • Is the warehouse operation in alignment with GPR-HSE-003.18 Safe Storage and Handling of Materials Rev B?

  • RACK STORAGE SAFETY. Is the warehouse operation conducting a monthly inspection to high bay storage racks covering the following items:<br>• Damaged or corroded uprights<br>• Damaged bracing<br>• Damaged load bars/beams<br>• Damaged or missing back up bars<br>• Load bars are fully engaged and safety clips, pins, or bolts are in place<br>• Loads do not exceed maximum rated capacities<br>• No dents, kinks, or otherwise damaged components<br>• All racks are plumb, level, and square<br>• Rack aisles are clear of obstructions<br>• All components are properly tightened<br>• Grid/mesh between load beams<br>• Presence of upright guarding

Action Plan

  • Is an action plan required? If YES provide detail.

Audit summary

  • COMPLIANT- All requirements are being met.

  • MINOR NON COMPLIANCE- Some requirements are not being met – work is still performed safely.

  • MAJOR NON COMPLIANCE - Significant issues not addressed or repeated non-compliance, work must not proceed until resolved.

  • Is follow up necessary? If YES by whom?


  • Auditor(s) signature:

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