Information
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Client / Site
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Location
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Conducted on
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Prepared by
Section 1
Section 1 - HSE Management
HSE Overview
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Does your organization have a written HSE Policy?<br>
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Does your organization have an HSE Managment System? Is it certified by a recognized independent authority. If so what was the latest result.
Responsibilities
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Are health and safety responsibilities clearly identified for all levels of staff?
HSE Consultation
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Is there a workplace HSE committee or regular meetings conducted with employees (e.g. safety meetings, tool box talk etc.)?
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Are employees involved in decision making over HSE matters?
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Does your organization have a HSE representative? Have they received HSE training?
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How does your organization identify and communicate HSE issues (e.g. legislative, regulatory, industry)?
HSE Management System
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Is a documented Job Safety & Environmental Analysis (JSEA) conducted prior to commencement of a job (i.e. risk identification, assessment, control and review procedures)?
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Does your organization have a permit to work system (e.g. Hot Work, Confined Space, etc.)?
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Does your organization have a process for the selection, assessment, monitoring and review of sub-contractors that incorporates HSE requirements?
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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.)?
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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.)?
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Do you have procedures for identifying, assessing and controlling risks associated with manual handling (e.g. controls in place - hand trucks, forklifts, cranes, etc.)?
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Does your organization have procedures to prevent & reduce environmental emissions & damage?
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Do your environmental procedures address containment and recovery processes?
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Does your organization have emergency response plans and/or management process? (e.g. fire, medical emergencies, environmental issues, etc.)?
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Does your organization conduct regular HSE audits of your HSE Management System by external parties?
Hazard Management
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Is there a process by which employees can report hazards at workplaces (and potential health, safety & environmental hazards)?
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Does this process involve a regular Hazard Register?
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How does your organization communicate hazards to your employees and your sub-contractors?
HSE Training & Induction
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Are records maintained of all training (certificates & licenses) and induction programs undertaken for employees (existing and new employees) in your organization?
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How does your organization plan to manage inductions for personnel involved in projects with ISS?
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Is there other specific HSE training for employees?
HSE Workplace Inspection
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Does your organization have a process for regular (e.g. weekly, monthly) HSE inspections at worksites?
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Are standard workplace inspection checklists used to conduct health, safety and environmental inspections?
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How is information presented to stakeholders (i.e. workers, management, clients, etc.)?
Incident Management
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Is there a documented incident management and investigation procedure?
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Is there a system for the notification of incidents to regulatory agencies?
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Is there a system for investigating incidents to determine root causes? Does the system identify and implement appropriate corrective actions?
HSE Offences
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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
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Is there a system for recording and analyzing HSE performance statistics?
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Are employees regularly provided with information on your HSE performance?
Statistics
Current Days Away/Restricted or Transfer (DART) Rate and DART Rate for previous 3 Years
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Current Year
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Year 1
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Year 2
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Year 3
Current - YTD Number of First Aid Injuries and for previous 3 Years
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Current Year
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Year 1
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Year 2
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Year 3
Total Recordable Incident Rate (TRIR) for current year and previous 3 Years
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Current Year
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Year 1
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Year 2
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Year 3
Number of Environmental Incidents & Non-Compliances for current YTD and previous 3 Years
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Current Year
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Year 1
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Year 2
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Year 3
Summary
Summary/Grading
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Final Rate
Completion
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Click + to add people involved in the HSE process
People Involved
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Full Name and Signature