Section 1 - HSE Management

1.1 HSE Overview

  • 1.1.1 Does your organization have a written HSE Policy?

  • 1.1.2 Does your organization have a HSE Managment System? Is it certified by a recognized independent authority (e.g. N.S.C.A., Du-Pont Stop, Safety MAP, WorkCOver-Self Insurer, ISO 18001, AS/NZS 4801, Civil Contractors Federation Integrated Management System)? If so what was the latest result.

1.2 Responsibilities

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

1.3 HSE Consultation

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

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

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

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

1.4 HSE Management System

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

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

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

  • 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.)?

  • 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.)?

  • 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.)?

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

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

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

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

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)?

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

  • 1.5.3 Does this process involve a regular Hazard Register?

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

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.)

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

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

  • 1.6.4 Is there other specific HSE training for employees?

1.7 HSE Workplace Inspection

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

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

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

1.8 Incident Management

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

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

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

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.)?

Section 2 - HSE Performance Monitoring & Statistics

2.1 Performance Monitoring

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

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

2.2 HSE Statistics

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

  • Current - YTD: (use comment to enter number of first aid cases)

  • Year 1: (use comment to enter number of first aid cases)

  • Year 2: (use comment to enter number of first aid cases)

  • Year 3: (use comment to enter number of first aid cases)

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

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

  • Year 1: (use comment to add rate)

  • Year 2: (use comment to add rate)

  • Year 3: (use comment to add rate)

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

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

  • Year 1: (use comment to add rate)

  • Year 2: (use comment to add rate)

  • Year 3: (use comment to add rate)

Section 3 - Quality Management System

3.1 Quality Policy

  • 3.1.1 Has top management established a quality policy that:
    a) Is approved (i.e signed) by top management?
    b) Includes a statement of commitment to meet requirements and continually improve?
    c) Is communicated / displayed?

3.2 Quality Manual

  • 3.2.1 Does the organization have a quality manual, including-
    a) The scope of the QMS and details of any exclusions
    b) The documented procedures of the QMS or reference them?
    c) A description of interactions between the processes of the QMS?

3.3 Quality Procedures

  • 3.3.1 Does the organization have formal procedures in place for the following:
    a) Control of Documents
    b) Control of Records
    c) Internal Auditing
    d) Non-Conforming Product Control
    e) Corrective Actions
    f) Preventive Actions

3.4 Quality Management System Compliance

  • 3.4.1 Management Representative: Has top management appointed a member of management that has responsibility and authority for the QMS?

  • 3.4.2 Management Review: Has a Quality Management Review Meeting been held within the last 12 months?

  • Date of last review:

  • 3.4.3 Competence, Training and Awareness: Are records of personal competence, awareness and training maintained and available?

  • 3.4.4 Identification and Traceability: If appropriate, does the organization identify the product by suitable means throughout product realization?

  • 3.4.5 Calibration / Control of Monitoring and Measuring Equipment: Is the measuring equipment calibrated at specified intervals against standards traceable to international or national standards?

  • 3.4.6 Internal Audits: Are internal audits conducted at planned intervals to determine if the QMS is complaint?

HSEQ Management System Audit Summary

  • A review of the HSEQ documents provided by the company / contractor named above indicated that the company's / contractor's compliance with International Snubbing Services HSEQ assessment criteria is assessed as follows:

  • SUPERIOR - Has well exceeded all requirements

  • ADVANCED - Has exceeded some minimum requirements

  • ACCEPTABLE - Has met all minimum requirements

  • NOT ACCEPTABLE - Has only met some minimum requirements

  • NOT ACCEPTABLE - Has not responded or met any requirements

Persons Participating in Audit Print/Sign

  • Sign Name

  • Sign Name

  • Sign Name

  • Sign Name

  • Sign Name

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