Appendix 3A - Contractor HSE Capability Assessment Questionnaire

References

PDO HSE Procedure Contract HSE Management-PR-1171

1. General guidelines for preparation of questionnaire

This questionnaire has been developed to help assess the extent to which HSE and its management is organised by Tenderers
organisation. In completing this questionnaire Tenderer should include all relevant activities, not just those on Company sites.
In preparing the response, emphasis should be placed on providing complete answers with supporting documentation as far as
practicable. The submission to be delivered in one folder and all evidence listed. Responses and any supporting documentation must
relate specifically to the development and implementation of Tenderer organisation HSE Management System. If Company requirements
are exceeded, Tenderer is requested to include the details in its submission.
The submission should be truthful and validated (Signed) by Tenderers company CEO.
Following submission, an evaluation of Tenderers organisation will be performed using the PDO HSE Evaluation tool. This evaluation will
consider together with Hazards and Effects register (s), historical HSE performance and any other audits and verification that may be
required. The scoring from the evaluation will result in a Company HSE BANDING i.e. Green, Amber or Red. The record of this score, HSE
banding may have a direct influence on the future contract arrangements with PDO dependant on the result.
This evaluation will consider this Questionnaire together with Hazards and Effects register(s), historical HSE performance any other audits
and verification that may be required. In all but extreme instances there will be a follow-up meeting at the contractor office and or work
site. To reduce the time and resource of the process a full and complete submission/ (with evidence in each case) is required.
CONTRACTOR Submit the sheet in WORD of EXCEL format although supporting evidence may be accepted in PDF or other format
CONTRACTOR Enter the answers to the questions in the Contractor Response Column (remember to submit appropriate evidence, we
have added a further guide to evidence here)
NB: if contractor/s has a doubt on what evidence should be submitted, the Company will provide guidance.

Contractor Name......................................Tender Number.........................December/2011/Ver0

Owner/MSE12

2. Questionnaire for Contractor HSE Capability Assessment

Name of Contractor Verification Checklist Contractor HSE Capability Questionnaire
Questionnaire item

Contractor Response

1. Leadership and Commitment

a) How are senior managers
personally involved in HSE
management?
b) Provide evidence of commitment
at all levels of the organization.
c) How do you promote a positive
culture toward HSE matters?
2. Policy and Strategic
Objectives
2.1 HSE Policy Documents
a) Does your company have an HSE
Policy document?
b) Who has overall and final
responsibility for HSE in your
organization?
c) Who is the most senior person in
the organization responsible for
this Policy being carried out at
the premises and on site where
his employees are working?
Provide name, title and
experience.
2.2 Availability of policy Statements to Employees?
a) Itemise the methods by which
you have drawn your policy
statement to the attention of
your employees?
b) What are your arrangements for

PDO Verification

Contractor Name......................................Tender Number.........................December/2011/Ver0

Owner/MSE12

advising employees of changes

in the Policy?
3. Organisation, responsibilities, Resources, Standards and Procedures
Questionnaire item

Contractor Response

3. 1 Organisation, responsibilities, Resources, Standards and Procedures

a) How is management involved in
HSE activities, objective setting
and monitoring?
b) How is your company structured
to manage and communicate
HSE effectively?
c) What provision does your
company make for
communication meetings?
3.2 Competence and training of managers/supervisors/senior site staff/HSE
advisers
a) Have the managers and
supervisors at all levels who will
plan, monitor, oversee and carry
out the work received formal
training in their responsibilities
with respect to conducting work
to HSE requirements?
3.3 Competence and general HSE training
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?
b) What arrangements does your
company have to ensure new
employees have knowledge of
your HSE Policies and practices

PDO Verification

Contractor Name......................................Tender Number.........................December/2011/Ver0

Owner/MSE12

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? What training do you
provide to ensure that all
employees are aware of
company requirements?
Questionnaire item

Contractor Response

PDO Verification

d) What arrangements does your

company have to ensure existing
HSE staff knowledge is up to
date?
e) What arrangements does your
company have to ensure job
competency for those jobs
involving HSE hazards and risks?
3.4 Specialised training
a) How have you identified areas of
your company's operations
where specialised training is
required to deal with potential
hazards? (Please itemise and
provide details of training given).

b) If the specialised work involves

radioactive, asbestos removal,
chemical or other occupational
health hazards, how are the
hazards identified, assessed and
controlled?

3.5 HSE Qualified Staff additional training

a) Does your company employ any
staff who possess HSE

Contractor Name......................................Tender Number.........................December/2011/Ver0

Owner/MSE12

qualifications that aim to provide

training in more than the basic
requirements?
3.6 Assessment of suitability of Subcontractors/ other companies
a) How do you assess:
i) HSE competence of
subcontractors?
ii) HSE record of the
Subcontractors and companies
with whom you place contracts?
b) Where do you spell out the
standards you require your
Contractors to meet?
Questionnaire item

Contractor Response

PDO Verification

c) How do you ensure these

standards are met and verified?
3.7 Standards
a) Where do you spell out the HSE
performance standards you
require to be met?
b) How do you ensure these are
met and verified?

c) How do you identify new industry

or regulatory standards that may
be applicable to your activities?
d) Is there an overall structure for
producing, updating and
disseminating standards?
4. Hazards and Effects Management
4.1 Hazards and effects assessment
What techniques are used within
your company for the identification,
assessment, control and mitigation
of hazards and effects?
4.2 Exposure of the workforce
What systems are in place to

Contractor Name......................................Tender Number.........................December/2011/Ver0

Owner/MSE12

monitor the exposure of your

workforce to chemical or physical
agents?
4.3 Handling of chemicals
How is your workforce advised on
potential hazards (chemicals, noise,
radiation, etc.) encountered in the
course of their work?
4.4 Personal protective equipment
What arrangements does your
company have for provision and
upkeep of protective equipment and
clothing, both standard issue, and
that required for specialised
activities?
Questionnaire item

4.5 Waste management

What systems are in place for
identification, classification,
minimisation and management of
waste?
4.6 Drugs and alcohol
Do you have a drugs and alcohol
policy in your organisation? If so,
does it include pre-employment and
random testing?
5. Planning and Procedures
5.1 HSE or operations manuals
a) Do you have a company HSE
manual (or Operations Manual
with relevant sections on HSE)
that describes in detail your
company approved HSE working
practices relating to your work
activities? If the answer is YES
please attach a copy of
supporting documentation.

Contractor Response

PDO Verification

Contractor Name......................................Tender Number.........................December/2011/Ver0

Owner/MSE12

b) How do you ensure that the

working practices and
procedures used by your
employees on-site are
consistently in accordance with
your HSE policy objectives and
arrangements?
5.2 Equipment control and maintenance

Contractor Name......................................Tender Number.........................December/2011/Ver0

Owner/MSE12

Questionnaire item

Contractor Response

How do you ensure that plant and

equipment used within your
premises, on-site, or at
other locations by your employees
are correctly registered, controlled
and maintained
In a safe working condition? Is HSE
Critical equipment specifically
identified and
Included in your preventative
maintenance system?
Provide a short overview of
your preventative
maintenance system.
5.3 Road Safety Management
What arrangements does your
company have for combating road
and vehicle incidents?
6.0 Implementation and Performance Monitoring
6.1 Management and performance monitoring of work activities
a) What arrangements does your
company have for supervision
and monitoring of performance?
b) What type of performance
criteria is used in your company;
give examples?
c) What arrangements does your
company have for passing on
any results and findings of this
supervision and monitoring to
your:
Base management?
Site employees?

PDO Verification

Contractor Name......................................Tender Number.........................December/2011/Ver0

Owner/MSE12

Questionnaire item

Contractor Response

PDO Verification

6.2 HSE performance achievement awards

Has your company received any
award for HSE performance
achievement?

6.3 Statutory notifiable incidents /dangerous occurrences

Has your company suffered any
statutory notifiable incidents in the
last five years (safety, occupational
health and environmental)?
(Answers with details including
dates, country, most frequent types,
causes and follow-up preventative
measures taken).
6.4 Improvement requirement and prohibition notices
Has your company suffered any
improvement requirement or
prohibition notices by the relevant
national body, regulatory body for
HSE or other enforcing authority or
been prosecuted under any HSE
legislation in the last five years? (If
your answer is YES please give
details).

6.5 HSE performance records

Contractor Name......................................Tender Number.........................December/2011/Ver0

Owner/MSE12

Questionnaire item

Contractor Response

PDO Verification

a) Have you maintained records of

your incidents and HSE
performance for the last five
years? (If YES, please provide the
following: Number of Fatalities,
Lost Time Injuries, Lost Workday
Cases. Medical Treatment Cases
and Restricted Work Day Cases.
Also include the Fatal Accident
Rate, Lost Time Injury Frequency
and Total Recordable Incident
Rate (TRCF) for each year.
(NOTE: Please include your
company definitions of the
above-mentioned terms for
clarification refer to the OGP
Safety Performance Accident
Data Report).

b) How is health performance

recorded?

c) How is environmental
performance recorded?

d) How often is HSE performance

reviewed? By whom?

6.6 Incident investigation and reporting

a) Who conducts incident
investigations?
b) How are the findings following an
investigation, or a relevant
incident occurring elsewhere,

Contractor Name......................................Tender Number.........................December/2011/Ver0

Owner/MSE12

communicated to your
employees?
c) Are near miss safety learning
reported?
Questionnaire item

7. Auditing and Review

7.1 Auditing
a) Do you have a written policy on
HSE auditing?

Contractor Response

PDO Verification

b) How does this policy specify the

standards for auditing (including
unsafe act auditing) and the
qualifications for auditors?

c) Do your company HSE Plans

include schedules for auditing
and what range of auditing is
covered?

d) How the effectiveness of auditing

is verified and how does
management report and follow
up audits?

8. HSE Management Additional features

8.1 Memberships and Associations
Describe the nature and extent of
your companys participation in
relevant industry, trade, and
governmental organisations?
8.2 Additional features
Does your company have any other
HSE features or arrangements not

Contractor Name......................................Tender Number.........................December/2011/Ver0

Owner/MSE12

described elsewhere in your

response to the questionnaire?
9. Company Specific Information

Typical Evidence
Section 1 Leadership & Commitment
1.
2.
3.
4.

Minutes of senior management meetings

Recent Site pictures of senior managers attending site functions, award ceremonies
Company HSE planning for the current or past 12 months
Copies of the senior managers commitment statement to HSE activities

Section 2 - Policy and Strategic Objectives

1. Policy statement, Names and CVs of the senior persons in the company stating what HSE experience and or training hey have
2. Pictorial evidence of policy document situated in the work places
Section 3 Organisation, responsibilities, Resources, Standards, and Documentation
1. Company organisation chart
2. Organisation chart to shoe how HSE will be managed for the particular project or contract
Section 4 Hazard and Effects Management
Section 5 Planning and Procedures
Section 6 Implementation and Performance monitoring
Section 7 Auditing and review
Section 8 HSE Management additional features

Contractor Name......................................Tender Number.........................December/2011/Ver0

Owner/MSE12