Title Page

  • Document No.

  • Client / Site

  • Personnel

  • Conducted on

  • Prepared by

  • Location

Element 1 - General Requirements

General Requirements

  • Key to Self-Assessment Rating
    1 Little or no documentation within the S&HMS; little or no implementation of those items.
    2 Some evidence of documentation within the S&HMS; implementation is inconsistent or on an ad hoc basis (with no or little supporting documentation).
    3 Reasonable documentation within the S&HMS; reasonable but somewhat inconsistent implementation/application.
    4 Documentation within the S&HMS; full implementation and consistent application across the operation
    5 Documentation within the S&HMS; total integration into normal operations; regular review demonstrating continuous improvement and best practice.

  • Senior management demonstrate visible leadership and proactive commitment to achieving S&H Excellence.

  • Document Findings (Click on paperclip to add an action)

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  • The organisation operates on the premise that S&H is integral to all operational management systems

  • Document Findings (Click on paperclip to add an action)

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  • A well-structured S&HMS is established, documented, maintained and continually improved.

  • Document Findings (Click on paperclip to add an action)

  • Photos

  • Where site operations are conducted by a major contractor or multiple contractors, there is a system to ensure a consistent approach to S&H.

  • Document Findings (Click on paperclip to add an action)

  • Photos

  • There is active employee involvement, effective consultation and communication.

  • Document Findings (Click on paperclip to add an action)

  • Photos

  • There is demonstrated commitment to S&H at all levels of the organisation.

  • Document Findings (Click on paperclip to add an action)

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Element 2 - Safety & Health Policy

Safety & Health Policy

  • Key to Self-Assessment Rating
    1 Little or no documentation within the S&HMS; little or no implementation of those items.
    2 Some evidence of documentation within the S&HMS; implementation is inconsistent or on an ad hoc basis (with no or little supporting documentation).
    3 Reasonable documentation within the S&HMS; reasonable but somewhat inconsistent implementation/application.
    4 Documentation within the S&HMS; full implementation and consistent application across the operation
    5 Documentation within the S&HMS; total integration into normal operations; regular review demonstrating continuous improvement and best practice.

  • S&H policy is implemented at all levels of the organisation and is demonstrated to be the basis of the site’s S&HMS.

  • Document Findings (Click on paperclip to add an action)

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  • The S&H policy is visibly displayed and is known to mine workers (company employees, contractors and other major stakeholders).

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  • There is commitment to the organisation’s overall S&H objectives.

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  • S&H policy is implemented at all levels of the organisation and is demonstrated to be the basis of the site’s S&HMS.

  • Document Findings (Click on paperclip to add an action)

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Element 3 - Planning for hazard and risk identification, assessment and control

Planning for hazard and risk identification, assessment and control

  • Key to Self-Assessment Rating
    1 Little or no documentation within the S&HMS; little or no implementation of those items.
    2 Some evidence of documentation within the S&HMS; implementation is inconsistent or on an ad hoc basis (with no or little supporting documentation).
    3 Reasonable documentation within the S&HMS; reasonable but somewhat inconsistent implementation/application.
    4 Documentation within the S&HMS; full implementation and consistent application across the operation
    5 Documentation within the S&HMS; total integration into normal operations; regular review demonstrating continuous improvement and best practice.

  • All S&H activities are defined, documented and adequately resourced for the effective implementation, operation, review and improvement of the S&HMS.

  • Document Findings (Click on paperclip to add an action)

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  • A hazard management system is in place ensuring that all operational hazards are identified, ranked and appropriately managed to an acceptable level of risk.

  • Document Findings (Click on paperclip to add an action)

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  • There are formal procedures for analyzing S&H data including, where warranted, hazard/risk register(s) identifying hazards and documenting major hazards/risks in all work areas.

  • Document Findings (Click on paperclip to add an action)

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  • Trends are identified for accidents, incidents, substandard conditions and practices, hazards and disease.

  • Document Findings (Click on paperclip to add an action)

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  • A recognised system of risk assessment is used to rank risks and put in place appropriate controls.

  • Document Findings (Click on paperclip to add an action)

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  • People performing hazard and risk identification, assessment and control are appropriately trained and competent.

  • Document Findings (Click on paperclip to add an action)

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Element 4 - Legal and Other Requirements

Legal And Other Requirements

  • Key to Self-Assessment Rating 1 Little or no documentation within the S&HMS; little or no implementation of those items. 2 Some evidence of documentation within the S&HMS; implementation is inconsistent or on an ad hoc basis (with no or little supporting documentation). 3 Reasonable documentation within the S&HMS; reasonable but somewhat inconsistent implementation/application. 4 Documentation within the S&HMS; full implementation and consistent application across the operation 5 Documentation within the S&HMS; total integration into normal operations; regular review demonstrating continuous improvement and best practice.

  • There is a well-established system for identifying and communicating S&H legislation, standards and codes

  • Document Findings (Click on paperclip to add an action)

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  • Regular compliance reviews examine the organisation’s capability of meeting legal obligations and other recognised standards.

  • Document Findings (Click on paperclip to add an action)

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Element 5 - Objectives, targets and management plans

Objectives, Targets And Management Plans

  • Key to Self-Assessment Rating
    1 Little or no documentation within the S&HMS; little or no implementation of those items.
    2 Some evidence of documentation within the S&HMS; implementation is inconsistent or on an ad hoc basis (with no or little supporting documentation).
    3 Reasonable documentation within the S&HMS; reasonable but somewhat inconsistent implementation/application.
    4 Documentation within the S&HMS; full implementation and consistent application across the operation
    5 Documentation within the S&HMS; total integration into normal operations; regular review demonstrating continuous improvement and best practice.

  • Clear, measurable objectives, targets and plans based on the S&H policy are established, implemented and communicated.

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  • Objectives and targets include a system of positive KPIs.

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  • Management plans include usage criteria (e.g. monitor monthly, measure quarterly, review annually).

  • Document Findings (Click on paperclip to add an action)

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Element 6 - Resources, structure and responsibilities

Resources, Structure And Responsibilities

  • Key to Self-Assessment Rating
    1 Little or no documentation within the S&HMS; little or no implementation of those items.
    2 Some evidence of documentation within the S&HMS; implementation is inconsistent or on an ad hoc basis (with no or little supporting documentation).
    3 Reasonable documentation within the S&HMS; reasonable but somewhat inconsistent implementation/application.
    4 Documentation within the S&HMS; full implementation and consistent application across the operation
    5 Documentation within the S&HMS; total integration into normal operations; regular review demonstrating continuous improvement and best practice.

  • A well-established system outlining resources, responsibilities, authorities and accountabilities is in place, clearly defined and effective.

  • Document Findings (Click on paperclip to add an action)

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  • An organisational chart is established, up to date and well communicated.

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  • Roles and responsibilities are formally documented and communicated to all people in the management structure and/or work group.

  • Document Findings (Click on paperclip to add an action)

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  • Adequate budget plans are in place for resource commitments (e.g. financial, personnel and equipment commitments) of the S&H management plan.

  • Document Findings (Click on paperclip to add an action)

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  • There is active employee involvement, effective consultation and communication.

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  • Contractors are aware of areas of accountability and responsibility.

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Element 7 - Competency, training and awareness

Competency, Training And Awareness

  • Key to Self-Assessment Rating
    1 Little or no documentation within the S&HMS; little or no implementation of those items.
    2 Some evidence of documentation within the S&HMS; implementation is inconsistent or on an ad hoc basis (with no or little supporting documentation).
    3 Reasonable documentation within the S&HMS; reasonable but somewhat inconsistent implementation/application.
    4 Documentation within the S&HMS; full implementation and consistent application across the operation
    5 Documentation within the S&HMS; total integration into normal operations; regular review demonstrating continuous improvement and best practice.

  • Competency requirements are identified by training needs analysis.

  • Document Findings (Click on paperclip to add an action)

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  • A training program achieves a high level of competency and awareness of S&H for all employees throughout the organisation.

  • Document Findings (Click on paperclip to add an action)

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  • People carrying out tasks and/or operating equipment where there is a requirement for specific competency are appropriately trained and authorised to do so.

  • Document Findings (Click on paperclip to add an action)

  • Photos

  • There is a well-established system for recording competency, training and awareness for all workers, including trainees and contractors.

  • Document Findings (Click on paperclip to add an action)

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  • All people understand the process and equipment they are using.

  • Document Findings (Click on paperclip to add an action)

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  • S&H training courses being undertaken are assessed for effectiveness and appropriateness.

  • Document Findings (Click on paperclip to add an action)

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Element 8 - Communication, consultation and reporting

Communication, consultation and reporting

  • Key to Self-Assessment Rating
    1 Little or no documentation within the S&HMS; little or no implementation of those items.
    2 Some evidence of documentation within the S&HMS; implementation is inconsistent or on an ad hoc basis (with no or little supporting documentation).
    3 Reasonable documentation within the S&HMS; reasonable but somewhat inconsistent implementation/application.
    4 Documentation within the S&HMS; full implementation and consistent application across the operation
    5 Documentation within the S&HMS; total integration into normal operations; regular review demonstrating continuous improvement and best practice.

  • Formal communication processes are in place to ensure S&H issues are communicated effectively

  • Document Findings (Click on paperclip to add an action)

  • Photo's

  • There is a system for detecting and reporting accidents, incidents, near misses, hazards, substandard conditions, substandard practices and defects.

  • Document Findings (Click on paperclip to add an action)

  • Photo's

  • Provision exists for immediate and longer term corrective action and follow-up, including the tracking of same.

  • Document Findings (Click on paperclip to add an action)

  • Photo's

  • Employees are involved in, understand and use reporting systems.

  • Document Findings (Click on paperclip to add an action)

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  • There is a formal system for communicating all documents related to the S&HMS.

  • Document Findings (Click on paperclip to add an action)

  • Photo's

Element 9 - Safety and health documentation

Safety and health documentation

  • Key to Self-Assessment Rating
    1 Little or no documentation within the S&HMS; little or no implementation of those items.
    2 Some evidence of documentation within the S&HMS; implementation is inconsistent or on an ad hoc basis (with no or little supporting documentation).
    3 Reasonable documentation within the S&HMS; reasonable but somewhat inconsistent implementation/application.
    4 Documentation within the S&HMS; full implementation and consistent application across the operation
    5 Documentation within the S&HMS; total integration into normal operations; regular review demonstrating continuous improvement and best practice.

  • S&H information (paper or electronic) describes the core elements of the S&HMS, their interaction and links to related documents.

  • Document Findings (Click on paperclip to add an action)

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  • A S&HMS is in place and includes supporting documentation (such as SOPs, JSAs and work permits) to ensure its effectiveness.

  • Document Findings (Click on paperclip to add an action)

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  • Employees are aware of the S&H system, and the S&H manual (paper or electronic) is readily accessible. Relevant parts are understood by all.

  • Document Findings (Click on paperclip to add an action)

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  • There is a comprehensive system in place for reviewing, updating and communicating S&H documentation.

  • Document Findings (Click on paperclip to add an action)

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  • All employees are aware of and have a good working knowledge of relevant S&HMS documentation.

  • Document Findings (Click on paperclip to add an action)

  • Photo's

  • S&H documentation (paper or electronic) describes the core elements of the S&HMS, their interaction and links to related documentation.

  • Document Findings (Click on paperclip to add an action)

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Element 10 - Control of documents and data

Control of documents and data

  • Key to Self-Assessment Rating
    1 Little or no documentation within the S&HMS; little or no implementation of those items.
    2 Some evidence of documentation within the S&HMS; implementation is inconsistent or on an ad hoc basis (with no or little supporting documentation).
    3 Reasonable documentation within the S&HMS; reasonable but somewhat inconsistent implementation/application.
    4 Documentation within the S&HMS; full implementation and consistent application across the operation
    5 Documentation within the S&HMS; total integration into normal operations; regular review demonstrating continuous improvement and best practice.

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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.