• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Section 1 - HSE Management

1.1 HSE Overview

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

  • 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:<br>a) Is approved (i.e signed) by top management?<br>b) Includes a statement of commitment to meet requirements and continually improve?<br>c) Is communicated / displayed?

3.2 Quality Manual

  • 3.2.1 Does the organization have a quality manual, including-<br>a) The scope of the QMS and details of any exclusions<br>b) The documented procedures of the QMS or reference them?<br>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:<br>a) Control of Documents<br>b) Control of Records<br>c) Internal Auditing<br>d) Non-Conforming Product Control<br>e) Corrective Actions<br>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

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.