• Client / Site

  • Location
  • Conducted on

  • Prepared by

Section 1

Section 1 - HSE Management

HSE Overview

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

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


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

HSE Consultation

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

  • Are employees involved in decision making over HSE matters?

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

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

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)?

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

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

  • 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.)?

  • 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.)?

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

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

  • Do your environmental procedures address containment and recovery processes?

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

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

Hazard Management

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

  • Does this process involve a regular Hazard Register?

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

HSE Training & Induction

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

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

  • Is there other specific HSE training for employees?

HSE Workplace Inspection

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

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

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

Incident Management

  • Is there a documented incident management and investigation procedure?

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

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

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.)?

Section 2

Section 2 - HSE Performance Monitoring & Statistics

Performance Monitoring

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

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


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



  • Final Rate


  • Click + to add people involved in the HSE process

  • People Involved
  • Full Name and Signature

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