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Pre-Qualification Forms

CSMS

New Contracts

Data Bank

Pre-Qualification

Selection Risk Assessment

Qualification Phase: Select A Qualified Contractor

Contract Award

Pre-Job Activity Work In Progress Final Evaluation Contract Implementation Phase: Ensure Field Safe Work

Pre-Qualification

(CSMS) Guidelines

Appendix II.1. Form CSMS/PQ/01

PRE-QUALIFICATION

Date :

Project Period :

Job Title :

Contract No :

Work Location :

Contractor Name :

Address :

Assessed by: Approved by:

(Contract Originator) (Team Leader)

Appendix II.2. Form CSMS/PQ/02: Contractor HSE MS Questionnaires

Company Name:

Work Subject:

SECTION 1 – LEADERSHIP AND TOP MANAGEMENT COMMITMENT

1. Commitment to HSE through leadership

a) How are senior managers is top management personally involved in HSE management?

b) Provide evidence of commitment at all levels of the organization by:·

(i) Stating this year's company targets for HSE performance·

(ii) Describing how you ensure that your organization understands and is committed to deliver your company HSE targets

c) How do you promote a positive culture towards HSE matters?

d) Provide your current Organization chart

(CSMS) Guidelines

SECTION 2 – POLICY AND STRATEGIC OBJECTIVES

2.1. HSE Policy & Documents

a) Does your company have an HSE policy document that is applied?

(Yes/No) If yes, please attach.

b) Who has overall and final responsibility for HSE in your organization?

c) How do you ensure HSE Policy compliance and communication at site?

2.2. Availability of Policy Statements to Employees

How do you communicate your company's policy to your employees including any changes?

SECTION 3: ORGANIZATION, RESPONSIBILITY, RESOURCES, STANDARDS AND DOCUMENTATION

3.1. Organizations - Commitment and Communication

a) How is management involved in HSE activities, objective setting and monitoring?

b) What provision does your company make for HSE communication and meetings?

3.2. Competence and Training of Manager/Supervisors/Senior Site Staff/HSE Advisor

Have the managers and supervisors at all levels that will plan, monitor, oversee and carry out the work received formal HSE training in their responsibilities with respect to conducting work to HSE requirements? (Yes/No)

If yes, please attach the training matrix.

3.3. Competence and General HSE Training

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

b) What arrangements does your company have to ensure ALL employees, including sub contractors, also have knowledge of your HSE policies and practices?

(CSMS) Guidelines

SECTION 3: ORGANIZATION, RESPONSIBILITY, RESOURCES, STANDARDS AND DOCUMENTATION

3.4. Specialized Training

Have you identified areas of your company's operations where specialized training is required to deal with potential hazards? (Yes/No)

If Yes, please provide the list (e.g. radioactive, asbestos, explosive, diving, etc).

3.5. HSE Qualified Staff - Additional Training

Does your company have HSE specialist (related to your company's services) who can provide training for other employees? (Yes/No)

If Yes, please attach the curriculum vitae

3.6. Assessment of Suitability of Subcontractors

a) Do you employ sub-contractor(s) for the intended service? (Yes/No) If No, please go to the question 3.7.

Do you have sub-contractor(s) selection procedure in term of HSE?

b) How do you assess your sub-contractor(s) to ensure they comply with your company's HSE policy and standards?

SECTION 3: ORGANIZATION, RESPONSIBILITY, RESOURCES, STANDARDS AND DOCUMENTATION

3.7. Standards

a) What kind of HSE regulatory or industrial standards that your company refer to for the intended service?

b) How do you ensure these are met and verified?

SECTION 4: HAZARDS AND EFFECT MANAGEMENT

4.1. Hazards and Effect Management

Does your company have procedure for the identification, assessment, control and mitigation of hazards and effects? (Yes/No)

If Yes, please attach the index/table of content including the sub-index.

4.2. Exposures of the Workforce

What systems are in place to monitor the hazard's exposure of your workforce e.g. chemical or physical agents?

4.3. Handling of Potential Hazards

How is your workforce advised on potential hazards, e.g. chemicals, noise, radiation, etc., encountered in the course of their work?

(CSMS) Guidelines

SECTION 4 : HAZARDS AND EFFECT MANAGEMENT

4.4. Personnel Protective Equipment

a) What arrangements does your company have for provision and unkeep of protective equipment and clothing, both standards issue, and that required for specialized activities?

b) Do you provide appropriate personal protective equipment (PPE) for your employees?

(Yes/No)

Please provide a listing of the PPE for the scope of this work.

c) Do you provide training on how to use PPE? (Yes/No)

Explain the content of the training and any follow-up

d) Do you have a program to ensure that PPE is impacted and maintained?

4.5. Waste Management

a) What systems are place for identification, classification, minimization and management of waste?

b) Please provide the number of accidents resulting in environmental damage in the amount greater than $50,000 for the last 24 months. Attach copies of any governmental reports submitted.

c) Do you have procedures for waste disposal? (Yes/No)

d) Do you have procedures for spill reporting? (Yes/No)

e) Do you have procedures for spill clean up?(Yes/No)

f) Please provide details at any of your equipment related to environmental matters.

SECTION 4 : HAZARDS AND EFFECT MANAGEMENT

4.6. Industrial Hygiene

Do you have an industrial hygiene program? (Yes/No)

Please describe this process. If Yes, please provide the list.

4.7. Drugs and Alcohol

Do you have a drugs and alcohol policy in your organization? (Yes/No) If yes, please attach

SECTION 5: PLANNING AND PROCEDURES

5.1. HSE or Operations Manuals

a) Do you have HSE procedures? (Yes/No) If Yes, please attach the list of content

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

How do you ensure that plant and equipment used within your work environment, on-site, or at other locations by your employees are correctly registered, certified with regulatory requirement, inspected, controlled and maintained in a safe working condition?

5.3. Transport Safety Management and Maintenance

What arrangement does your company have for vehicle incidents prevention?

5.4. Lifting Operation Procedure (if applicable)

Do you have any procedures to control the work involved in lifting operation?

5.5. Maintenance Schedule of Lifting Operation Equipments (if applicable)

Do you have any inspection, testing, maintenance and certification programs and schedule for lifting equipments e.g. crane, forklift and rigging equipment?

5.6. Competency of Lifting Operation Personnel (if applicable)

Do you have any system to ensure that the lifting teams e.g. lifting equipment operators, signalmen and rigging personnel are competent?

(CSMS) Guidelines

SECTION 6: IMPLEMENTATION AND PERFORMANCE MONITORING

6.1. HSE Management and Performance Monitoring of Work Activities

a) What arrangement(s) does your company have for supervision and monitoring of HSE performance?

b) What arrangements does your company have for passing on any results and findings of this supervision and monitoring to your:

(i) Top/Base management (ii) Site employees

c) Has your company received any award for HSE performance achievement? (Yes/No)

6.2. Statutory Notifiable Incidents/Dangerous Occurrences, Improvement Requirement and Prohibition Notices

Has your company suffered any improvement requirement or prohibition notices on statutory notifiable incidents/dangerous occurrences 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? (Yes/No)

If yes, please give the number of occurrences and its short description.

6.3. HSE Performance Records

a) Please provide statistical details of your HSE performance over the past 3 years (if not recorded/applicable please mark N/R or N/A)

Total Number Frequency (incl. All contract & sub contract personnel) (based on OSHA)

 Fatalities

 Loss Time Incidents (LTI)

 Total Recordable Cases (e.g. Medical Treatment, Restricted Work, Transfer to Another Job, Unconsciousness)

b) How is health performance recorded?

c) How is environmental performance recorded?

SECTION 6: IMPLEMENTATION AND PERFORMANCE MONITORING

6.4. Incident Investigation and Reporting

a) Do you have a procedure for the investigation, reporting and follow-up of accidents, dangerous occurrences or occupational illnesses? (Yes/No) If yes, please attach

b) How are the findings following an investigation, or a relevant incident occurring elsewhere, communicated to your employees?

Please attach an example of investigation reports during the last 12 months.

SECTION 7: AUDIT AND REVIEW

a) Do you have a written procedure on HSE auditing? (Yes/No)

b) How does this procedure specify the standards for auditing, including schedule, coverage and the qualifications for auditors?

c) How is the effectiveness of audit verified and how does management report and follow up audits?

SECTION 8: EMERGENCY RESPONSE PROCEDURE

Do you have an emergency response plan? (Yes/No) If yes, please attach

SECTION 9: HSE MANAGEMENT - ADDITIONAL FEATURES Does your company hold association(s) membership? (Yes/No)

If yes, please provide the list

(CSMS) Guidelines Form CSMS/PQ/02

Appendix II.3. Form CSMS/PQ/03

PRE-QUALIFICATION TABLE TOP EVALUATION (PRIOR SITE VISIT)

Company : ___________________________

Evaluator : ___________________________

Date : ___________________________

Item

Number Item Description Verification Positive

Practices Gaps Score Site Visit

Remarks

Before After

Evaluated by:

………

Appendix II.4. Form CSMS/PQ/04:

PRE-QUALIFICATION EVALUATION CRITERIA

A B C D

Section 1: Leadership and Commitment

Commitment to HSE through leadership: Item 1 (a - d).

No commitment from

senior management HSE disciplines delegated to line managers – no direct involvement by senior management

Evidence of active senior management

involvement in HSE aspects

Evidence of a positive HSE culture in senior management and at all levels

Section 2: Policy and Strategic Objectives

HSE policy documents and availability: Items 2.1 and 2.2.

Policy statements exist but responsibility for HSE is unclear.

A policy statement exists with clear responsibility for HSE but not in a widely distributed document

HSE policy establishes responsibility for HSE in languages easily understood, but not widely distributed

Policy with clearly established responsibility and accountability; is distributed to all

employees; and is visible on notice boards

Section 3: Organization, Responsibilities, Resources, Standards and Documentation HSE communication and meeting programmes: Item 3.1 (a - b).

No management involvement or

commitment toward HSE activity

Management involvement and

commitment toward HSE in special occasion only, likewise for periodic HSE meetings.

Regular management involvement and commitment toward HSE. HSE meetings performed on a regular basis at management and supervisor level

Regular management involvement and commitment toward HSE. Regular HSE meetings performed and employees are assigned topics to discuss on a rotational basis

Staff HSE training: Item 3.2.

No HSE training

established HSE training established

but not implemented. HSE training established and implemented but only to a limited staff only.

HSE training established and fully implemented to all staff related to the work.

(CSMS) Guidelines

Page 55

PRE-QUALIFICATION EVALUATION CRITERIA

A B C D

Section 3: Organization, Responsibilities, Resources, Standards and Documentation (cont‟d)

Employee competency and HSE training: Item 3.3. (a - b).

No formal programme Formal program established to update employee knowledge on HSE.Verbal instructions on company procedures only for new employee.

Orientation booklet provided for new employees but no on-the- job orientation by supervisor

Formal program established and implemented for employee and new employee on HSE.

Update employee knowledge on HSE.

Employee handbook provided and supervisor outlines, explains and demonstrates new employee's job

Formal program established and implemented for employee and new

employee on HSE. Update employee knowledge on HSE. Employee handbook provided and supervisor outlines, explains and demonstrates new employee's job. With:

follow-up observation of the new employee's work is also included.

Supervisor has explained to him safe practices and emergency duties

Specialized training: Items 3.4 and 3.5.

No specialized HSE training

established Specialized HSE training established but not implemented.

Specialized HSE training established and

implemented.

Specialized HSE training established and

implemented on a regular basis. Retraining periods are established. Qualified HSE professional are employed.

Subcontractors: Item 3.6 (a - b).

No assessment program for

subcontractor established. Assessment program and standards for subcontractor are established, covering limited area only but not implemented yet,

Assessment program and standards for

subcontractor are established and implemented.

Assessment program and standards for subcontractor are established and fully implemented. Quality assurance for compliance in place.

HSE Performance Standards: Items 3.7 (a - b).

No HSE performance

standards available HSE performance standards established for limited purposes only or partial and in compliance with local industry regulatory standards only.

HSE performance

standards established and in compliance with local industry regulatory standards.

HSE performance standards established and in

compliance with local and global industry regulatory standards.

PRE-QUALIFICATION EVALUATION CRITERIA

A B C D

Section 4: Hazards and Effects Management

Hazards and Effects Assessment: Item 4.1.

Company's HSE system does not include hazards and effects assessment

Company's HSE system makes reference to the need to assess hazards and effects but has no comprehensive structure to carry this out

Company's HSE system includes methods for the assessment of major hazards and effects

Company's HSE system has a comprehensive set of methods for the assessment of all HSE hazards and effects and applies them to all of its contracts with

documentation

Exposure of the workforce: Item 4.2.

Company does not actively advise the workforce nor monitor exposure

Company advises the workforce of the major hazards that they are likely to be exposed to but only monitors exposure randomly

Company has formal methods for monitoring exposure to the major hazards

Company has a set of formal methods for monitoring exposure to all foreseeable hazards (linked to its hazards and effects assessment method) and applies them to all contracts

Potential Hazards (chemical, physical and biological hazards such as noise, radiation, vapors, fumes, temperature extremes etc.): Item 4.3.

Company makes no special provision for advising the workforce about properties of potential hazards

Company provides information to workforce in the workplace on properties of potential hazards but has no active follow-up

Company distributes information to individuals in the

workforce at start of their involvement on-site

Company maintains a database of the

properties of all potential hazards encountered in its contracts and has formal methods of information distribution to all personnel and trains its workforce in handling, etc.

(CSMS) Guidelines

Page 57

PRE-QUALIFICATION EVALUATION CRITERIA

A B C D

Section 4: Hazards and Effects Management (cont‟d)

Personal protective equipment: Item 4.4 (a – d)

Basic PPE provided to personnel but no corporate procedure for assessing individual needs

PPE requirements formally assessed but little effort made to ensure correct usage

PPE requirements formally assessed with spot checks on usage

Procedures in place to assess all PPE

requirements monitor and enforce usage and replacement needs.

Stock inventories monitored, kept above demand levels. Training in use provided where needed

Waste management: Item 4.5 (a – f) Company has no formal

methods for the control of waste

Company has general procedures for waste disposal

Company has procedures for the disposal of each of the main categories of site wastes but makes no provision for minimizing environmental impact

Company has a formal system for waste

management (including identification,

minimization and classification), which actively seeks to

minimize environmental impact

Industrial Hygiene Items 4.6 No Industrial Hygiene

procedure exists. Basic procedure exists

but is not enforced. A procedure exists and recognizes hazards but is not followed up.

A procedure exists which manages operations to minimize human health impacts providing a workplace free of recognized health Alcohol and Drugs Items 4 .7

No alcohol and drugs

procedure written An alcohol and drugs procedure statement exists but not in a widely distributed document

An alcohol and drugs procedure includes establishing responsibility and accountability, and widely distributed

Drugs procedure with clearly established responsibility, accountability, and disciplinary clause is distributed to all

employees; and is visible on notice boards

PRE-QUALIFICATION EVALUATION CRITERIA

A B C D

Section 5: Planning and Procedures

HSE or operations manuals: Item 5.1 (a – b) No HSE procedures /

manual is available Basic HSE

procedures/manual exist Contractor has written HSE procedures/manual to cover all hazardous operations

Contractor has

procedures to cover all HSE

precautions/manual, typical contractor HSE Plan requirements with a system of updating and dissemination to employees Equipment control and maintenance: Item 5.2

No defined programme to ensure control and maintenance of plant and / or equipment

Program relies on outside sources, i.e.

company inspections.

Supervisory inspection of equipment confined to worksite personnel only

A written programme outlining supervisory guidelines,

responsibilities,

frequency and follow-up is in effect

In addition to C, periodic inspections conducted by top management or by teams of specialists

Transport Safety Management: Item 5.3 No special attention paid

to transport safety as an area of hazardous activities

Importance of transport safety acknowledged but left to core business managers/supervisors to enact individually

Company has a general management strategy with some procedures for its component issues

Company has a complete strategy and set of plans and procedures covering vehicles, drivers and operations management

Lifting Operation Procedure: Item 5.4, (if applicable)

No manual/procedures/

guidelines/instructions for work control of lifting operations are available

Basic procedures for work control of lifting operations exist

Standard written procedures for lifting operations are available and implemented

A comprehensive system for work controls, including lifting operations is available and continually maintained to comply with local regulations and related international industrial standards.

(CSMS) Guidelines

Page 59

PRE-QUALIFICATION EVALUATION CRITERIA

A B C D

Maintenance Schedule of Lifting Operation Equipments: Item 5.5, (if applicable)

No inspection, testing,

maintenance or

certification programs for lifting equipment are available

Basic programs for inspection, testing, maintenance and certifications for lifting equipment exist

Standard programs for inspection, testing, maintenance and certifications for lifting equipment are available including color coding is implemented

A comprehensive system and organization is available to ensure that the program for

inspection, testing, maintenance and certifications of lifting operation equipments is properly implemented in accordance with the local regulations and related industrial standards.

Competency of Lifting Operation Personnel: Item 5.6, (if applicable) The lifting team displays

no evidence of clear assignments, training or competency assessments

Basic assignments, training, and

competency assessments for the lifting team exist

Roles and responsibilities of involved parties in lifting operations are clear. Formal training and certifications for key persons and competency assessment are available and implemented

In addition to C, the formal training and certifications for al related persons comply with the local

regulations;related industrial standards are maintained.

Section 6: Implementation and Performance Monitoring

Management and performance monitoring of work activities: Items 6.1 (a – c) No system for formally

monitoring HSE performance at all

Informal/incidental monitoring HSE performance only

Company has a system for monitoring HSE performance in key areas

Company has a comprehensive system for monitoring

performance in all areas with feedback to

employers for

improvement and has received awards for achievement

PRE-QUALIFICATION EVALUATION CRITERIA

A B C D

Section 6: Implementation and Performance Monitoring (cont‟d)

Statutory notifiable incidents, dangerous occurrences, improvement requirements and prohibition notices:

Items 6.2 More than one occurrence of major incident in last five years

One occurrence of a major incident in the last five years

Occurrences relate to

minor incident(s) only No occurrences in the last five years

HSE Performance records (Latest year injury rate comparison to contractor‟s three preceding years average):

Item 6.3 (a - c) Contractor supplied insufficient information to establish rate or rate increases

Rate is not improving Shows only minor rate

improvement Rate steadily improving by more than 20 per cent per year

Incident Investigation and reporting: Item 6.4 (a - b)

Procedure are available

but Findings not

generally communicated

Procedure are available and Findings

communicated to key personnel only via limited company internal memo or similar media

Procedure are available and Findings

communicated to all employees via specific company notice

As in C but with the addition of details of implication for improving HSE performance

(CSMS) Guidelines

Page 61

PRE-QUALIFICATION EVALUATION CRITERIA

A B C D

Section 7: Auditing and Review

Auditing: Item 7 (a - c)

Audit process is cursory only - HSE documents are not explicit about auditing

Company HSE documents include reference to auditing but there are no specific details about scheduling and coverage

Company HSE documents include details of how auditing is to be implemented with schedules/coverage for the key areas

As in C but additionally specifies management's role in audit and follow-up on action items

Section 8:

Emergency Response Procedure Emergency Response Procedure : Item 8

No written Emergency

Response. Basic procedures only. Emergency procedures written for major scenarios, e.g.

fires/explosions, H2S, evacuation, release of toxic or flammable

fires/explosions, H2S, evacuation, release of toxic or flammable

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