Health, Safety and Environment Questionnaire
1.0 HSE Performance: Yes No
Description Year
2021
2017 2022
2018 2023
2019 2024
2020
1.1 Total Man-hours worked
1.2 Number of Lost Time Injury (LTI)
1.3 Lost Time Injury Frequency Rate
(LTIFR)
1.4 Number of Fatalities
1.5 Fatality Accident Rate (FAR)
NOTE:
a. Fatal Accident Rate (FAR)
The number of fatalities per 100,000,000 (100 million) man hours worked.
b. Lost Time Injury (LTI)
A fatality or lost work day case. The number of LTI is the sum of fatalities and
lost work day cases.
c. Lost Time Injury Frequency Rate (LTIFR)
The number of lost time injuries (fatalities + Lost workday cases) incidents per
1,000,000 man hours worked
d. Lost Work day case
Any work related injury other than a fatal injury which results in a person being
unfit for work on any day after the day of occurrence of the occupational injury.
2.0 Leadership and Commitment
Do you conduct Management review meetings to monitor and improve HSE
2.1
performance of your company? Please provide documentary evidence
Does your top management personally demonstrate commitment of HSE
2.2 (e.g. chairing HSE Management review meetings, site HSE visits, reward
and recognition programs etc)? Please state how.
Do you promote Positive HSE Culture (name a few programs that support
2.3
your statement)
Policies and Strategic Objectives: Does your company have Policies 1|Page
3.0
and objectives for. Please provide a copy of the same
3.1 Do you have Health, Safety & Environment (HSE) Policy
Is your company qualified to ISO: 14001 and OHSAS: 18001? Pl submit a
3.2
copy
Organization, responsibilities, Resources, Standards and
4.0
Documentation
HSE competence and Training of Managers / Supervisors. Please provide
4.1
training matrix
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? Provide training details.
4.2 Competence and General HSE Training
What arrangements does your company have to ensure new employees
have knowledge of basic work place hazards and safeguards to be taken,
safety norms to be followed etc. and to keep this knowledge up to date?
Provide evidence.
4.3 HSE Staff Qualifications and experience
4.3.1 Does your Site Safety Engineer has:
Degree in Engineering (Chemical / Mechanical / Electrical / Fire & Safety/
a)
Civil)?
b) Diploma in Industrial Safety
5 years’ Work experience as Safety supervisor of Chemical / Petrochemical
c)
/ Oil & Gas / Large EPC Projects
4.3.2 Are your site Safety Supervisors qualified in:
Diploma in Engineering (Chemical / Mechanical / Electrical/ Civil) or Science
a)
Graduate ( Chemistry / Mathematics / Physics)
b) Diploma in Industrial Safety
3 years’ work experience as safety supervisor in any Chemical /
c)
Petrochemical / Oil & Gas / Large EPC.
* Degree / Diploma through a correspondence course are not recognized.
4.4 Sub-contractors:
Do you assess your Sub-Contractors of their HSE Competence? Please
4.4.1
explain with evidence.
Do you spell out the standards you require your contractors to meet? If so,
4.4.2
please provide a sample copy.
4.4.3 Do you ensure these standards are met and verified? If yes, how?
4.5 HSE Manuals / Standards
4.5.1 Do you have a company HSE Manual? If yes please attach a copy
Do you have a site HSE Project Plan including audit and emergency
4.5.2
response drills etc?
Do you maintain a regulatory compliance register for all activities applicable?
4.5.3
If so, please provide a copy.
4.6 Risk Management
Do you have a process for Risk Assessment? Please share copy of the same
Do you follow a Job Safety Analysis (JSA) for identification, assessment,
4.6.1 2|Page
control and mitigation of Hazards and its Effects? Provide sample copy.
Do you follow MSDS system for warning on hazards and safe guards to be
4.6.2
followed before handling Chemicals/oil/Gas/ radioactive sources?
Do you provide PPE as per risk assessment to all the workers engaged by
4.6.3
you at the site? Provide list of PPE being issued to work force.
Do you have a system in place for identification, classification, minimization
4.6.4
and management of waste?
Do you ensure that plant and equipment used are correctly registered,
4.6.5 controlled and maintained in a safe working condition? Provide list of
equipment.
4.7 Road Safety Management
Do you comply with Motor Vehicle Acts & Rules 1989 for road safety? Please
4.7.1
share details on how you comply.
4.8 Implementation and Performance Monitoring
Did your company receive any HSE awards in the last three years? If so,
4.8.1
please provide copies of the same.
4.9 Occupational Health:
Do you have pre-employment and periodic medical examination program for
4.9.1
workers? Provide sample copy.
4.9.2 Do you maintain employees health record for audit purpose
Do you provide 24 hrs medical facility with qualified medical Paramedic /
4.9.3
doctor and an ambulance?
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