HSE Management System

• Client / Site

• Location
  Address

• Conducted on

  Date

• Prepared by

Section 1 - HSE Management

HSE Overview

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

  Yes

  No

  N/A

• Does your organization have an HSE Managment System? Is it certified by a recognized independent authority. If so what was the latest result.

  Yes

  No

  N/A

Responsibilities

• Are health and safety responsibilities clearly identified for all levels of staff?

  Yes

  No

  N/A

HSE Consultation

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

  Yes

  No

  N/A

• Are employees involved in decision making over HSE matters?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

HSE Management System

• Is a documented Job Safety & Environmental Analysis (JSEA) conducted prior to commencement of a job (i.e. risk identification, assessment, control and review procedures)?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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

• 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

• 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

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

  Yes

  No

  N/A

• Do your environmental procedures address containment and recovery processes?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Hazard Management

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

  Yes

  No

  N/A

• Does this process involve a regular Hazard Register?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

HSE Training & Induction

• 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

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

  Yes

  No

  N/A

• Is there other specific HSE training for employees?

  Yes

  No

  N/A

HSE Workplace Inspection

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Incident Management

• Is there a documented incident management and investigation procedure?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

HSE Offences

• 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

Section 2 - HSE Performance Monitoring & Statistics

Performance Monitoring

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Statistics

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

• Current Year

• Year 1

• Year 2

• Year 3

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

• Current Year

• Year 1

• Year 2

• Year 3

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

• Current Year

• Year 1

• Year 2

• Year 3

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

• Current Year

• Year 1

• Year 2

• Year 3

Summary/Grading

• Final Rate

  SUPERIOR - Has well exceeded all requirements

  ADVANCED - Has exceeded some minimum requirements

  ACCEPTABLE - Has met all minimum requirements

  NOT ACCEPTABLE - Has not responded or met any requirements

Completion

• Click + to add people involved in the HSE process

People Involved

• Full Name and Signature

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