Title Page
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Document number
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Conducted on
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Prepared by
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Location
Part I. HSE Management
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is the HSE Policy posted at S+N facilities in a visible place?
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Have the country managing director signed the adherence to the HSE Policy?
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Is there a HSE annual strategic plan to cover local commercial areas?
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Has the HSE Manual been divulged and implemented in the local commercial area?
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Are HSE objectives covered in the winning behaviors of every employee?
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Is the local Sustainability information sent to corporate HSE on a quarterly basis?
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Is there an active Safety Committee in place?
Part II. HSE Program/System
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Has the local commercial area and active HSE program/system?
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Is the HSE program/system aligned with the corporate HSE policies and procedures?
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Is the HSE program/system aligned with local HSE regulations?
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Is the HSE program included on the onboarding training?
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Does the commercial area keep records of HSE corporate or local audits/inspections?
Part III. Risk management
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Has been conducted a risk assessment covering commercial, surgical services and warehousing operations?
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Has been determined a risk hierarchy control based on the results obtained in the risk assessment?
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Are employees informed about the risks present in their work areas?
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Are the employees properly trained on the risk control actions in their work areas?
Part IV. Corrective actions
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Are corrective actions generated as a result of a work related incident?
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Are corrective actions generated as a result of a HSE corporate or regulatory audit?
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Are Single Point Lessons (SPL´s) communicated throughout the commercial area?
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Are the corrective actions met in a scheduled deadline?
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Is evidence attached when a corrective action is closed?
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Is there an emergency response plan implemented?
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Is there an emergency response team properly trained on the emergency response plan?
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Are emergency drills conducted at least once a year involving all the employees?
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Are disciplinary actions taken when employees do not follow HSE procedures or local regulations?
Part V. Incident investigation
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Are all significant incidents reported to global HSE?
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Are work related incidents immediately reported to employee direct supervisor and local HSE representative?
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Are work related incidents reported and investigated according to global procedure GPR-HSE-008.1 Management of Incidents and dangerous occurrences?
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Are work related incident information included on the period OSHA and Sustainability report on a quarterly basis?
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Are work related incidents reported to local authorities?
Part VI. Contractor safety
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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?
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Is there a HSE contractor orientation training implemented on site?
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When directly supervised by S+N work related cases occurred to contractor workers are included on the monthly sustainability report?<br>
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Do contractor companies meet an approval process, based on corporate and local regulations?
Part VII. Waste management
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Is there a waste stream classification program implemented on site?
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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?
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Are there waste reduction initiatives implemented on site ?
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Are waste management metrics reported on a quarterly basis to the sustainability report?
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Does the commercial operation keep documentation of waste shipments?
Part VIII. Storage and handling of chemical products
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Are Safety Data Sheets available of the stored chemical products ?
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Is Personal Protective Equipment worn if recommended by the chemical product manufacturer ?
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In case of chemical product leakage ,is there a containment system or chemical spill kit available ?
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Are flammable and combustible liquids stored inside of an approved FM cabinet?
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Does the facility meet the maximum storage capacity for flammable and combustible liquids?
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Does the flammable and combustible liquid storage area have an installed fire detection & protection system?
Part IX. Driver Safety
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Does the employee/contractor have a valid Driver's license?
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Does the employee/contractor have a current vehicle registration?
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Does the employee/contractor have a current insurance and accident reporting documents?
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If applicable, are vehicle inspection records up to date?
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EXTERIOR VEHICLE CONDITION. Is vehicle exterior clean and undamaged?
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Is the windshield in good condition (no cracks, stars)?
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Vehicle not leaking fluids (water, oil, antifreeze, fuel, etc.)?
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All exterior lights functional?
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Outside mirrors attached and adjustable?
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Are tires in good condition?
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INTERIOR VEHICLE CONDITION. Is vehicle interior clean, organized and undamaged?
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Are dashboard gauges functioning and warning lights out?
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Does vehicle’s horn sound?
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Are all interior lights functioning?
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Are seat belts and rear view mirror in good condition?
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VEHICLE SAFETY EQUIPMENT. If required, is vehicle equipped with an appropriate fire extinguisher?
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If yes to A, is the inspection record complete and current?
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If permitted (or required) by local law, does the employee/contractor have a hands free device?
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Does the employee/contractor have a current first aid kit?
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If required, is the vehicle equipped with reflective safety triangles or other equipment as required by local law?
Part X. Ergonomics
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Is commercial area aligned with corporate procedure GPR-HSE-003.30 Workplace Ergonomics Rev.B ?
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Has the commercial operation performed an ergonomics assessment (including potential musculoskeletal disorders) at work stations?
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MANUAL WEIGHT LIFTING & HANDLING. Is there a maximum weight to be lifted manually by gender? (consider local regulation if available)
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Is the commercial operation in alignment with GPR-HSE-003.4 Safe Lifting and Manual Handling Rev B
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Lifting – Back Straight while lifting or placing?
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Lifting – tested weight of unknown object before attempting to lift?
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Lifting – Not twisting (“squaring” hips to pick up and put down location)?
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Lifting – Lifting with Legs & buttocks, not back? Feet offset for stability?
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Lifting – Did associate request help lifting >50 lbs. (23 Kg)?
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Lift or Carry – Was employee/contractor “hugging” load to body?
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Carry – Did employee/contractor create a “clear path” before lift and carry?
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Overhead – Not lifting objects >14 lbs (6.4 Kg), above 6’10” (2 m)?
PART XI. Surgical services safety
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Are the surgical services technicians in alignment with GPR-HSE-003.7 Driving on Company Business Rev B?
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Are the surgical services technicians in alignment with GPR-HSE-003.6 Management of Biological Hazards Rev B?
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Are the surgical services technicians in alignment with GPR-HSE-003.21 Control of Ionizing Radiation Sources Rev B?
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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
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Is the warehouse operation in alignment with GPR-HSE-003.4 Safe Lifting and Manual Handling Rev B?
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When applicable is the warehouse operation in alignment with GPRHSE-003.12 Safe Use of Powered Industrial Vehicles (Fork Lift<br>Trucks) Rev B?
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Is the warehouse operation in alignment with GPR-HSE-003.13 Safe Loading and Off-Loading of Materials Rev B?
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Is the warehouse operation in alignment with GPR-HSE-003.18 Safe Storage and Handling of Materials Rev B?
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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
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Is an action plan required? If YES provide detail.
Audit summary
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COMPLIANT- All requirements are being met.
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MINOR NON COMPLIANCE- Some requirements are not being met – work is still performed safely.
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MAJOR NON COMPLIANCE - Significant issues not addressed or repeated non-compliance, work must not proceed until resolved.
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Is follow up necessary? If YES by whom?
Signatures
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Auditor(s) signature: