HSE Contractor Performance Report

• HSE Contractor Performance Monitoring Report

• Contractor Name :

• Location
  Address

• Date:

  Date

• Contractor Representative and/or employee name(s)

• Type of Work:

• Conducted by:

• Instruction: complete all items. Any item with "no" or "at risk" must have action documented. All Reports must be kept as evidence. Email to yourself or your administrator and save in local teamroom or designated folder. File naming convention: include type, month/yr and your name/initials.

Observation of HSE Performance Behaviours and Conditions

• All contractor employees have completed site HSE orientation and applicable HSE training? If "no" implement and record action.

  Yes

  No

  N/A

• Has contractor safety declaration been signed and dated? If "no": create and complete action

  Yes

  No

  N/A

• Are all (sub) contractor aware of site emergency procedures? If "no" create and complete action.

  Yes

  No

  N/A

• Are all (sub)contractor employees aware of how to address and report HSE observations such as unsafe behaviour and/or conditions? If "no" implement and document actions.

  Yes

  No

  N/A

• Has the general contractor put adequate First Aid in place? If "no" create and record action to GC.

  Yes

  No

  N/A

• Have (sub) contractors provided safety observations to us on regular basis? If "no" create and document action.

  Yes

  No

  N/A

• Are all (sub) contractors' risk assessments, safe work and HSE procedures, method statements and work permits in place and being followed. If "no" document action to contractor rep. Stop work where appropriate.

  Yes

  No

  N/A

• Has the (sub)contractor provided PPE personal protective equipment per risk assessment? I "no" implement and record action.

  Yes

  No

  N/A

• Are (sub)contractors identified PPE appropriately? If "no" record action to contractor rep.

  Yes

  No

  N/A

• Are all applicable work authorizations / permits up-to-date and in place?

  Yes

  No

  N/A

• Has (sub)contractor effectively implemented all applicable life safety critical control measures --fall protection, electrical safety, arc flash and permit confined spaces? If "no" stop work: ensure contractor informed and document prior to work continuation.

  Yes

  No

  N/A

• Are the (sub)contractor work activities securely fenced and/or public and employees adequately protected from work activity hazards? If "no" ensure contractor informed, control measures implemented and documented.

  Yes

  No

  N/A

• Has the Health & Safety Checklist (Pre-work) been reviewed with (sub)contractors and signed off on?

  Yes

  No

  N/A

• Auditor: i hereby declare that I have completed the Contractor Performance Monitoring Report on contractor identified on cover page. Name / Signature Auditor:

• Name / signature of Contractor Rep