HSE Management System

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Section 1 - HSE Management

1.1 HSE Overview

• 1.1.1 Does your organization have a written QHSE Policy?<br>

  Yes

  No

  N/A

• 1.1.2 Does your organization have a QHSE Managment System? Is it certified by a recognised independent authority (e.g. N.S.C.A., Safety MAP, WorkCOver-Self Insurer, ISO 9001, ISO 18001, AS/NZS 4801, ISO 14001?

  Yes

  No

  N/A

1.2 Responsibilities

• 1.2.1 Are QHSE responsibilities clearly identified for all levels of staff?

  Yes

  No

  N/A

1.3. HSE Consultation

• 1.3.1 Is there a workplace QHSE committee or regular meetings conducted with employees (e.g. safety meetings, tool box talk etc.)?

  Yes

  No

  N/A

• 1.3.2 Are employees involved in decision making over QHSE matters?

  Yes

  No

  N/A

• 1.3.3 Does your organization have a QHSE representative? Have they received HSE training?

  Yes

  No

  N/A

• 1.3.4 How does your organization identify and communicate QHSE issues (e.g. legislative, regulatory, industry)?

  Yes

  No

  N/A

1.4 QHSE Management System

• 1.4.1 Is a documented risk assessment tool in place or conducted prior to the commencement of a job (i.e. risk identification, assessment, control and review procedures - SWMS, JSEA, etc.)?

  Yes

  No

  N/A

• 1.4.2 Does your organization have a permit to work system (e.g. Hot Work, Confined Space, etc.)?

  Yes

  No

  N/A

• 1.4.3 Does your organization have a process for the selection, assessment, monitoring and review of sub-contractors that incorporates HSE requirements?

  Yes

  No

  N/A

• 1.4.4 Do you have procedures in place for the maintenance & inspection of plant equipment owned and/or operated by your organization (e.g. front end loader/backhoe, excavator, compressor, borer, electrical equipment, fire-fighting equipment, forklift, etc.)?

  Yes

  No

  N/A

• 1.4.5 Do you have procedures for selection, use, storage, handling, spill management & disposal of hazardous substances and dangerous goods (e.g. corrosives, poisons, flammable liquids and gases, etc.)?

  Yes

  No

  N/A

• 1.4.6 Do you have procedures for identifying, assessing and controlling risks associated with manual handling (e.g. controls in place - hand trucks, forklifts, cranes, etc.)?

  Yes

  No

  N/A

• 1.4.7. Does your organization have procedures to prevent & reduce environmental emissions & damage?

  Yes

  No

  N/A

• 1.4.8 Do your environmental procedures address containment and recovery processes?

  Yes

  No

  N/A

• 1.4.9 Does your organization have emergency response plans and/or management process? (e.g. fire, medical emergencies, environmental issues, etc.)?

  Yes

  No

  N/A

• 1.4.10 Does your organization conduct regular HSE audits of your HSE Management System by external parties?

  Yes

  No

  N/A

1.5 Hazard Management

• 1.5.1 Is there a process by which employees can report hazards at workplaces (and potential health, safety & environmental hazards)?

  Yes

  No

  N/A

• 1.5.2 Provide an example of the Hazard Management process to be used by your organization. (e.g. identification, assessment, control & review).

  Yes

  No

  N/A

• 1.5.3 Does this process involve a regular Hazard Register?

  Yes

  No

  N/A

• 1.5.4 How does your organization communicate hazards to your employees and your sub-contractors?

  Yes

  No

  N/A

1.6 HSE Training & Induction

• 1.6.1 Describe how HSE Training & Induction is conducted in your organization (e.g. confined space entry training, new hire orientations, first aid, waste management & disposal, etc.)

  Yes

  No

  N/A

• 1.6.2 Are records maintained of all training (certificates & licenses) and induction programs undertaken for employees (existing and new employees) in your organization?

  Yes

  No

  N/A

• 1.6.3 How does your organization plan to manage inductions for personnel involved in projects with ISS?

  Yes

  No

  N/A

• 1.6.4 Is there other specific HSE training for employees?

  Yes

  No

  N/A

1.7 HSE Workplace Inspection

• 1.7.1 Does your organization have a process for regular (e.g. weekly, monthly) HSE inspections at worksites?

  Yes

  No

  N/A

• 1.7.2 Are standard workplace inspection checklists used to conduct health, safety and environmental inspections?

  Yes

  No

  N/A

• 1.7.3 How is information presented to stakeholders (i.e. workers, management, clients, etc.)?

  Yes

  No

  N/A

1.8 Incident Management

• 1.8.1 Is there a documented incident management and investigation procedure?

  Yes

  No

  N/A

• 1.8.2 Is there a system for the notification of incidents to regulatory agencies?

  Yes

  No

  N/A

• 1.8.3 Is there a system for investigating incidents to determine root causes? Does the system identify and implement appropriate corrective actions?

  Yes

  No

  N/A

1.9 HSE Offences

• 1.9.1 Has the organization had any enforcement activity or been convicted for a HSE offense in the past 3 years (e.g. improvement/prohibition notices, etc.)?

  No

  Yes

  N/A

1.10 Quality

• 1.10.1 What systems are in place to demonstrate that all HSE requirements of a contract are being met and maintained (e.g. compliance with Standards, Codes of Practice and Specifications, etc.)?

  Yes

  No

  N/A

Section 2 - HSE Performance Monitoring & Statistics

2.1 Performance Monitoring

• 2.1.1 Is there a system for recording and analyzing HSE performance statistics?

  Yes

  No

  N/A

• 2.2.2 Are employees regularly provided with information on your HSE performance?

  Yes

  No

  N/A

2.2 Statistics

2.2.1 Current Days Away/Restricted or Transfer (DART) Rate and DART Rate for previous 3 Years

• Current - YTD: (use comment to add rate)

  Yes

  No

  N/A

• Year 1: (use comment to add rate)

  Yes

  No

  N/A

• Year 2: (use comment to add rate)

  Yes

  No

  N/A

• Year 3: (use comment to add rate)

  Yes

  No

  N/A

2.2.2 Current - YTD Number of First Aid Injuries and for previous 3 Years

• Current - YTD: (use comment to add rate)

  Yes

  No

  N/A

• Year 1: (use comment to add rate)

  Yes

  No

  N/A

• Year 2: (use comment to add rate)

  Yes

  No

  N/A

• Year 3: (use comment to add rate)

  Yes

  No

  N/A

2.2.3 Total Recordable Incident Rate (TRIR) for current year and previous 3 Years

• Current - YTD: (use comment to add rate)

  Yes

  No

  N/A

• Year 1: (use comment to add rate)

  Yes

  No

  N/A

• Year 2: (use comment to add rate)

  Yes

  No

  N/A

• Year 3: (use comment to add rate)

  Yes

  No

  N/A

2.2.4 Number of Environmental Incidents & Non-Compliances for current YTD and previous 3 Years

• Current - YTD: (use comment to add rate)

  Yes

  No

  N/A

• Year 1: (use comment to add rate)

  Yes

  No

  N/A

• Year 2: (use comment to add rate)

  Yes

  No

  N/A

• Year 3: (use comment to add rate)

  Yes

  No

  N/A

Summary/Grading----Check Yes to ONE

• SUPERIOR - Has well exceeded all requirements

  Yes

  No

  N/A

• ADVANCED - Has exceeded some minimum requirements

  Yes

  No

  N/A

• ACCEPTABLE - Has met all minimum requirements

  Yes

  No

  N/A

• NOT ACCEPTABLE - Has only met some minimum requirements

  Yes

  No

  N/A

• NOT ACCEPTABLE - Has not responded or met any requirements

  Yes

  No

  N/A

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