Filetype Excel XLSX | Posted on 15 Aug 2022 | 3 years ago
Authentication
digital resources
218x Filetype XLSX File size 0.03 MB Source: procurement.hcml.co.id
Sheet 1: Questionnaire - SK0074
| VHSE-PQ Questionnaire | |||
| Company: | |||
| Contact Person: | |||
| E-mail: | |||
| Phone Number: | |||
| Fax Number: | |||
| No. | VHSE PQ Questionnaire | Remarks | |
| 1. | Leadership & Commitment | ||
| 1.1 | HSE Leadership Commitment | ||
| a | How does Senior Manager directly involve in HSE Management to determine and supervise Company HSE Objectives? | ||
| b | Provide evidences of HSE Commitment in every organizations level. | ||
| c | How do you promote positive culture in solving HSE Problems? | ||
| 2. | HSE Policy & Strategic Objective | ||
| 2.1 | HSE Policy Document | ||
| a | Do you have HSE Policy document in language which is understood by employees? | ||
| b | Who holds the overall and final HSE responsibility in your Company? | ||
| c | Who is the most senior personnel in your organization who responsibles for exisiting implemented policy? | ||
| d | How do you socialize HSE Policy to your employee? Please explain the method. | ||
| e | How do you inform your employees regarding policy changes? | ||
| 2.2 | HSE Annual Objective | ||
| a | Do you have HSE Strategic Objective? | ||
| b | How do you inform your employees to understand Company HSE Objective? Please explain the method. | ||
| 3 | Organization, Responsibilities, Resources, Standard & Documentation | ||
| 3.1 | Organization Structure for HSE Management | ||
| a | How does your company structures affect HSE effective communication? | ||
| b | Does routine HSE meeting promote HSE understanding? | ||
| c | Do client and contractor conduct regular meeting to discuss and follow up interface situation? | ||
| d | What kind of regulations do your Company develop regarding HSE Communications meeting? Please provide organization structure. | ||
| 3.2 | HSE Training for Manager, Supervisor & important position for HSE | ||
| a | Do manager and supervisor in every organization levels, who plan, monitor, estimate and implement HSE related work, have received formal HSE training as per their responsibilities? | ||
| b | If yes, please explain. If in-house training has been implemented, please explain course material and duration, including refreshment training for long-term manager and supervisors. Please attach training matrix. | ||
| c | How do you identify Company operations area which need specific training? For example, training which is related to health hazard such as radiation, asbes and chemicals? | ||
| d | Please inform us related HSE Specialists in your Company Organization Structure. | ||
| e | How do you provide specific HSE Training to your HSE staff? | ||
| 3.3 | General HSE Training (for all related employees and parties) | ||
| a | What kind of regulations do you implement to ensure that all new employees have adequate and updated basic HSE knowledge in industry? | ||
| b | How do you ensure that employees and subcontractors have understood HSE Policy, Guideline & Requirements in your Company? Please explain. | ||
| c | How do you ensure that new employees and subcontractors have received instruction and information regarding potential work hazard? Please explain. | ||
| 3.4 | HSE Competency | ||
| a | Has your Company established competency system? If yes, please explain regarding scope and content of competency system. | ||
| b | How do you ensure that employees have adequate and updated HSE knowledge? If in house training is given, please provide course material. | ||
| 3.5 | Contractor HSE Management (Partner) | ||
| a | Has your Company already implemented system or process to manage Contractor? If yes, please explain the process or system. | ||
| b | How do you evaluate Contractor HSE Competency or Performance? | ||
| c | How do you explain standard that you require to be complied by your Contractor? | ||
| d | How do you ensure that required standards have been complied and checked? | ||
| Please mention list of your Subcontractors, if applicable. | |||
| 3.6 | HSE Regulations & Standards | ||
| a | How do you get information regarding updated HSE and industrial regulations that are applicable to your business? | ||
| b | Is there comprehensive structure to develop, renew and socialize HSE standards in your Company? | ||
| c | Do you have HSE Standards? Does your Company comply to OGP/Industrial Guideline or other recommended practices? Please explain! | ||
| 4 | Risk Management | ||
| 4.1 | Risk Assessment & Risk Control | ||
| a | How does your Company identify hazard, assess risk, control and mitigate impact to ALARP (As low as reasonably practicable)? | ||
| 4.2 | Health Hazard | ||
| a | Does your Company have specific policy and program related to specific health hazard such as drugs abuse, blood borne pathogens, malaria, etc. | ||
| b | What kind of health hazards (chemical, noise, radiation, vibration, etc.) which are related to your scope of work? Please explain how are those hazards identified, assessed and controlled? | ||
| c | What kind of systems do you have to control health hazards and monitor the control effectivity? Is routine monitoring conducted regularly as part of system? | ||
| 4.3 | Safety Hazard | ||
| a | What kind of safety hazard (mechanical guarding, working at height, lifting and handling, confined space, explosive atmosphere, etc.) which are related to your scope of work? | ||
| b | What kind of systems do you have to control health hazards and monitor the control effectivity? Is routine monitoring conducted regularly as part of system? | ||
| 4.4 | Logistics Hazard | ||
| a | What kind of logistic hazard (land, sea, air transportation, material handling, etc.) which are related to your scope of work? | ||
| b | What kind of systems do you have to control health hazards and monitor the control effectivity? Is routine monitoring conducted regularly as part of system? | ||
| 4.5 | Environmental Hazard | ||
| a | What kind of environmental hazard (spill, air emission, waste, etc.) which are related to your scope of work? | ||
| b | What kind of systems do you have to control health hazards and monitor the control effectivity? Is routine monitoring conducted regularly as part of system? | ||
| 4.6 | Security Hazard | ||
| a | What kind of security hazard (terrorism, kidnapping, thief, local population hostile, etc.) which are related to your scope of work? | ||
| b | What kind of systems do you have to control health hazards and monitor the control effectivity? Is routine monitoring conducted regularly as part of system? | ||
| 4.7 | Social Hazard | ||
| a | What kind of social hazard which are related to your scope of work? | ||
| b | What kind of systems do you have to control health hazards and monitor the control effectivity? Is routine monitoring conducted regularly as part of system? | ||
| 4.8 | Personnel Protective Equipment | ||
| a | How do you ensure procurement process and distribution process of adequate PPE to your employee? Both standards and specific PPE. | ||
| b | Do you provide suitable PPE to your employees? Please provide list for PPE provided. | ||
| c | Do you conduct training on how to wear PPE? Please provide course material and follow up. | ||
| d | Do you implement program to ensure tha PPE is adequately used and maintained? | ||
| 5 | Planning & Procedure | ||
| 5.1 | HSE Manual Operations | ||
| a | Does your Company HSE or Operations Manual comply to HSE regulations which specifically explained in HSE Guideline and Regulations and authorized by Company? For example scaffolding, lifting equipment, heavy equipment, pressure vessel, excavator, etc. | ||
| b | How do you ensure that guideline and procedures have been well consistently implemented in field with Company HSE Policy? | ||
| 5.2 | Infrastructure and Equipment Reliability | ||
| a | How do you ensure that infrastructure, plant and equipment used (in your working area, Client's area or others) have been certified, registered, controlled and maintained and available in good condition? | ||
| 5.3 | Management of Change | ||
| a | How do you manage changes and assess risk related to personnel, equipment, process and documentation? | ||
| 5.4 | Emergency Response Plan | ||
| a | How do you control your Emergency Response Plan? | ||
| b | What kind of emergency conditions have been discussed in your Emergency Response Plan? | ||
| 6 | HSE Performance Implementation & Monitoring | ||
| 6.1 | Active HSE Management System Implementation and Performance Monitoring | ||
| a | How do you control and monitor your HSE Performance? | ||
| b | How do you ensure implementation of HSE procedures in working area? For example, toolbox talks, HSE Meeting, Supervision & Observation, etc. | ||
| c | How do you monitor your employee HSE performance achievement? For example risk assessment, HSE Participation, etc. | ||
| d | What kind of active HSE Monitoring that has been implemented in your Company (For example, when there is no incident)? | ||
| e | How do you report and improve identified findings? | ||
| f | How do you communicate findings from active performance to relevant personnel? | ||
| 6.2 | HSE Performance Indicator | ||
| a | Please provide information related to incident statistic for the past 5 (five) years for: | ||
| Fatality Case | |||
| Lost Time Incident Case | |||
| Number of Lost Working Days due to Incident | |||
| Restricted Work Day | |||
| Medical Treatment Case | |||
| First Aid Case | |||
| Near miss | |||
| Fatal Accident Rate (per 100 million hours worked) | |||
| Lost Time Injury Frequecny (per 100 million hours worked) | |||
| Total Recordable Incident Rate (per 100 million hours worked) | |||
| Other specific HSE indicators based on activity | |||
| Please attach definition of above terms based on your Company's terminology in separate sheet. | |||
| 6.3 | HSE Performance monitoring | ||
| a | How do you monitor and record Health performance? | ||
| b | How do you monitor and record Safety performance? | ||
| c | How do you monitor and record Environment performance? | ||
| d | How do you report Near Miss case? What kind of near miss incident do you report? | ||
| e | How often do you monitor HSE Performance? Who conduct the monitoring? | ||
| f | How do you monitor and record Security performance? | ||
| g | Do you record Vehicle incident? | ||
| 6.4 | HSE Incident Investigation and Follow Up | ||
| a | What kind of HSE incidents that are investigated? | ||
| b | What process do you use to investigate HSE incident? | ||
| c | Who does HSE incident investigation? | ||
| d | How do you follow up incident investigation findings to ensure effective prevention? | ||
| e | How do you communicate incident lesson learned to all relevant personnel? | ||
| 6.5 | Mandatory Incidents to be reported as per Regulations and Non Compliance Records | ||
| a | Have you ever been required to correct or inform prohibition related to dangerous incident which is legally regulated by relevant National Agency, Authorized Agency in HSE, or other Law Enforcement Authority or have your ever been sued under HSE Regulations for the past 5 (five) years? | ||
| 7 | HSE Audit & Management Review | ||
| 7.1 | Audit | ||
| a | Do you have written policy regarding HSE Audit? | ||
| b | Who is involved in HSE Audit? How do you select Audit Team to ensure that they have specific expertise and independent from audited activity? What are auditor's qualifications that you require? | ||
| c | How do you schedule HSE Audit? What are HSE Audit scope? For example, compliance to regulations, supplier/contractor, HSE Management System implementation. | ||
| d | How does management follow up on audit findings and ensure effectivity of findings follow-up? | ||
| 7.2 | Management Review & Follow Up | ||
| a | Do you have written policy regarding HSE Management System? If yes, please attach the document. | ||
| b | How often do you review HSE Management System? Who involves in the process? | ||
| c | How do you identify controlling plan? How do you ensure that improvement strategy is well recorded and investigated? | ||
| 8 | HSE Management (Other achievements) | ||
| 8.1 | HSE Management System Certification | ||
| Please name HSE related certifications that you have from Certification Body | |||
| 8.2 | Association Membership | ||
| Please explain how do you participate in relevant industrial organization? | |||
| 8.3 | Additional Characteristic of HSE Management System | ||
| Does your Company (Global, Regional, Local) have specific characteristic that hasn't been explained in this questionnaire? | |||
| 9 | Company Specific Information | ||
| This section is not assessed. Company can request any specific information to evaluate Contractors. | |||
no reviews yet
Please Login to review.
