Supplier / Contractor Pre-Award HSSE Questionnaire (Version 1 - 1 June 2011)

Supplier / Contractor

A.N. Other plc

Date of Assessment

Wednesday, September 01, 2010

Completed By

John Smith

Required KPIs are listed on the 2nd tab

HSSE stands for Health, Safety, Security & Environment

Please cover all aspects in your responses to the questions

Keyword

Question

Response
Document

Leadership & HSSE Culture

Committment to HSE
aspects through
leadership

1.1

a)

How are senior managers personally involved in HSE management for example objectivesetting and monitoring?

b)
c)

Provide evidence of commitment at all levels of the organisation?

a)

Does your company have an HSE policy document?

If the answer is YES please attach a copy.

b)

Who has overall and final responsibility for HSE in your organisation?

c)

Who is the most senior person in the organisation responsible for this policy being carried out
at the premises and on site where his employees are working? Provide name and title.

d)

Itemise the methods by which you have drawn your policy statements to the
attention of all your employees?

e)

What are your arrangements for advising employees of changes in the policy?

a)

Does your company have strategic HSE objectives?

If the answer is YES please attach a copy.

b)

Itemise the methods by which you have communicated your strategic HSE objectives to the
attention of all your employees?

How do you promote a positive culture towards HSE matters?

HSSE Policy & Strategic Objectives

HSE contract strategic

objectives

HSE Policy Documents

HSE Objectives

2.2

Organisation, responsibilities, resources, standards and documentation

HSE standards

Contractor management process

Cometence assurance

General HSE training

HSE training of managers, supervisors and HSE critical

positions

Organisational structure for HSE management

2.1

HSSE Policy

a)

How is your organisation structured to manage and communicate HSE effectively?

b)

Do HSE meetings promote HSE awareness?

c)

Do client and contractor meet regularly to discuss and action any interface situations?

d)

What provision does your company make for HSE communication meetings?
Please provide an organisation chart

a)

Have the managers and supervisors at all levels who will plan, monitor, oversee and carry out
the work received formal HSE training in their responsibilities with respect to conducting work
to HSE requirements?

b)

If YES please give details. Where the training is given in-house please describe the content
and duration of courses. Please provide an example of training matrix.

c)

How have you identified areas of your companys operations where specialised training is
required, for instance training related to health hazard such as radiation, asbestos and
chemicals?

d)

What specialist HSE resources does your organisation have available?

e)

How does your company provide HSE specialised training for HSE staff?

a)

What arrangements does your company have to ensure new employees have knowledge of
basic industrial HSE, and to keep this knowledge up to date?

Details of content

b)

What arrangements does your company have to ensure new employees also have knowledge
of your HSE policies, practices and company requirements?

Details of content

c)

What arrangements does your company have to ensure new employees have been instructed
and have received information on any specific hazards arising out of the nature of the
activities?

Details of content

a)

Does your organisation have a competence system in place?

If YES, please describe the scope and content of your competence system.

b)

What arrangements does your company have to ensure existing staff HSE knowledge is up to
date?

a)

Does your company have a contractor management process or system?

If yes, provide an outline of the process.

b)

How do you assess contractors, HSE competence or HSE performance?

c)

Where do you define the company standards you require your contractors to meet?

d)

How do you ensure these standards are met and verified?

a)

How do you identify new industry or regulatory standards that may be applicable to your activities?

3.1

3.2

3.3

Organisation chart

Training matrix

3.4

3.5

3.6

Contractor management process outline

Supplier / Contractor Pre-Award HSSE Questionnaire (Version 1 - 1 June 2011)

Supplier / Contractor

A.N. Other plc

Date of Assessment

Wednesday, September 01, 2010

Completed By

John Smith

Required KPIs are listed on the 2nd tab

HSSE stands for Health, Safety, Security & Environment

Please cover all aspects in your responses to the questions

HSE standards

Keyword

Question

3.6

b)

Is there an overall structure for producing, updating and disseminating standards?

c)

Are your company standards aligned with OGP/industry guidelines or recommended

practices? If yes state which one.

a)

How does your company identify hazards, assess risk, control and mitigation
consequences, to a level as low as reasonably practicable?

a)

Do you have specific policies and programmes on specific health hazards e.g. substance
abuse, blood borne thogens, malaria pandemic diseases etc.

b)

What type of health hazards (chemical, vibration, noise, radiation, etc) are
associated with the scope of your services? Explain how occupational health
hazards are identified, assessed and controlled.

c)

What systems are in place to control these hazards and monitor the effectiveness of these
controls? Is workers regular exposure monitoring part of these systems?

a)

What type of safety hazards (mechanical guarding, work at height, lifting and hoisting,
confined space entry, explosive atmospheres etc.) are associated with the scope of your
services?

b)

What systems are in place to control these hazards and monitor the effectiveness of these
controls?

a)

What type of logistics hazards (land transport, air transport, marine transport, materials
handling etc.)are associated with the scope of your services?

b)

What systems are in place to control these hazards and monitor the effectiveness of these
controls?

a)

What type of environmental hazards (chemical spill, atmospheric emissions, waste disposal
etc.) are associated with the scope of your services?

b)

What systems are in place to control these hazards and monitor the effectiveness of these
controls?

a)

What type of security hazards (terrorism, hostage taking, robbery, hostile local population etc.)
are associated with the scope of your services?

b)

What systems are in place to control these hazards and monitor the effectiveness of these
controls?

a)

What type of social hazards are associated with the scope of your services?

b)

What systems are in place to control these hazards and impacts and monitor the effectiveness
of these controls?

Response
Document

Risk Management

4.1

Safety hazards

4.3

Logistics hazards

4.4

Environmental
hazards

4.5

Security hazards

4.2

4.6

Social responsibility
hazards

Health Hazards

Risk Assessment &

Control

4.7

Planning & Procedures

HSE operations
manual

5.1

a)

Do you have a company HSE-MS manual (or operations manual with integrated HSE
requirements) which describes in detail your company approved HSE working practices
relating to your work activities?
If the answer is YES please attach a copy of an index and relevant supporting documentation.

Infrastructure and
equipment integrity

5.2

a)

How do you ensure that infrastructure, plant and equipment used within your operations (own
premises, client site, or at other locations) are correctly certified, registered, controlled and
maintained in a safe working condition?

Management of
change

5.3

a)

How do you manage changes and assess associated risks e.g. personnel, equipment,
processes, documentation?

Emergency planning
and response

a)

What arrangements does your company have for emergency planning and response?

5.4
b)

Which emergency situations are included?

Implementation and performance monitoring

HSE-MS implementation and active performance monitoring of work
activities

a)

What arrangements does your organisation have for monitoring the implementation of your
HSE-MS?

b)

How does your company assure the implementation of work procedures within your work-site
operations e.g. compliance with procedures, toolbox talks, safety meetings, supervision, job
observations?

c)

How do you monitor employee HSE performance e.g. hazard identification systems, HSE
participation?

d)

What active HSE monitoring is performed (i.e. where no incident has occurred)?

e)

How do you report and correct deficiencies identified?

f)

How do you communicate the results of active performance monitoring to relevant personnel?

6.1

HSSE-MS manual index & supporting

information

Supplier / Contractor Pre-Award HSSE Questionnaire (Version 1 - 1 June 2011)

Supplier / Contractor

A.N. Other plc

Date of Assessment

Wednesday, September 01, 2010

Completed By

John Smith

Required KPIs are listed on the 2nd tab

HSSE stands for Health, Safety, Security & Environment

Please cover all aspects in your responses to the questions

Keyword

HSE incident and investigation follow-up

HSE performance monitoring

Safety performance
indicators

Statutory notifiable
incidents or non
compliance notices

6.2

6.3

6.4

6.5

a)

See separate spreadsheet called Contractor Assessment KPI Data

a)

How is health performance monitored and recorded?

b)

How is environmental performance monitored and recorded?

c)

How is security performance monitored and recorded?

d)

How and what near miss incidents are reported?

e)

How often is HSE performance reviewed? By whom?

f)

How is logistics performance monitored and reported?

g)

Do you record vehicle incidents?

a)

What types of HSE incident are investigated?

b)

What process is used to investigate HSE incidents?

c)

Who conducts HSE incident investigations?

d)

How are the findings of an incident investigation followed up to ensure effective prevention of
recurrence?

e)

How is incident learning communicated to all relevant personnel?

a)

Has your company suffered any statutory notifiable incidents in the last five years (safety,
occupational health and environmental)?
Answers with details including dates, country and location, summary of incident and follow-up
preventative measures taken.

Document

Details of statutory notifiable incidents

or non compliance notices

HSE auditing and management review of HSE-MS

Management review and follow-up

Audits

a)

Do you have a written procedure for HSE auditing?

If yes, please attach a copy.

b)

Who is involved in conducting HSE audits? How are audit team members selected to have
specific expertise and be independent from the activities being audited?
What are the qualifications required for auditors?

c)

How does your company schedule HSE audit and what scope of auditing is covered? e.g.
internal, regulatory compliance, supplier/contractor, HSE management system implementation.

d)

How does management follow up on audit findings and ensure effective close out of action items?

a)

Do you have a written procedure for management review of the HSE-MS?

If yes, please attach a copy

b)

How often are HSE-MS reviews conducted and who is involved in the process?

c)

How are identified actions and improvement efforts recorded and tracked to effective completion?

Audit procedure

7.1

7.2

Response

Question

Management review procedure for

HSE-MS

HSE management - additional features

Certification of your
HSE-MS

8.1

Please provide information on any certification which you have received from certification bodies

Membership of
associations

8.2

Describe the nature and extent of your companys participation in relevant industry, trade, and
governmental organisations

Additional features of
your HSE-MS

8.3

Does your organisation (globally, regionally or locally) have any HSE features or arrangements
not described elsewhere in your response to the questionnaire?

Company specific information

END

Supplier pre-qualification Questionnaire - HSSE Data

See Glossary of terms for definition of each item

EXPOSURE

Current
Year

Year -1

Current
Year

Year -1

Current
Year

Year -1

Total Manhours worked

Exposure - Driving (km)
Exposure - Site Work (hours)
SAFETY
Fatalities
FAT
Lost Time Incidents
LTI
Lost Workday Cases
LWC
Restricted Workday Cases
RWC
Medical Treatment Cases
MTC
First Aid Cases
Total Recordable Cases (sum FAT, LWC, MTC, or RWC)
TRC
Near Miss Incidents
Fatal Accident Rate (per 108 hours)

FAR

Lost Time Injury Frequency (per 10 hours)

LTIF

Total Recordable Case Frequency (per 106 hours)

TRCF

ENVIRONMENT
Loss of Primary Containment (recordable

LOPC

Year -2

Year -3

Year -4

Year -2

Year -3

Year -4

Year -2

Year -3

Year -4