区域: 代表处：

项目编码: 项目名称：
稽查人员：
#

10
 分包商EHS管理稽查表
区域: 代表处：
项目编码: 项目名称：
稽查人员：
EHS稽查点
分包商是否给其塔工配备足够的个人安全防护用品（PPE），如：安全帽、安全鞋、全身安全绳、双安全
绳（带双挂钩）、定位安全绳等（塔工名单、PPE发放台账记录）？

分包商塔工是否拥有政府认可的（或华为认可的）第三方认证机构颁发的塔工证？

分包商电工是否有合法的电工证？

分包商是否任命EHS管理组织（EHS经理或EHS负责人），并定义其EHS管理职责？

分包商是否有EHS管理的指导文件（EHS指导手册、EHS管理程序文件、指导书等）？

分包商是否存有站点EHS审核报告以及对EHS不符合的整改报告？

分包商是否每月都有领导上站（有上站记录或照片）？

分包商是否给其作业队伍配备紧急救援的设备（急救箱等）？

分包商内部是否其所有作业人员和现场管理人员进行EHS培训和考试（有培训和考核记录）？

分包商在其公司内部对EHS是否进行宣传（宣传材料）、张贴EHS海报等？
稽查日期：
是/否 备注

否
 Checklist for Subcontractor EHS Management
Region: Central Sumatera Rep.Office：Pekanbaru
Project : Swap Telkomsel Project SUBCON NAME：PT.XERINDO
Checked by QHSE Tri Wahjuhono W Audit Office date:
# EHS Checking Items Y/N Remark

Whether subcontractor provides enough PPE (Personal Protective Equipment) to their riggers - Safety
1 Y
Helmet / Safety Shoes / Full-body harness / Double lanyard / Position lanyard?

Whether riggers working for subcontractors have been certified by 3rd parties (approved by local
2 Y
government or Huawei)?

3 Whether electricians working for subcontractor have been certified (legal certificate)? Y

Whether subcontractor has set up EHS management organization (documented with EHS manager or
4 Y
EHS responsible person), define their EHS management responsibility?

Whether subcontractor has EHS management documents (EHS Manual / EHS management procedure
5 Y
/ EHS working instruction)?

Whether subcontractor has documented with on-site EHS checking reports, corrective action reports for
6 N
noncompliance?

Whether subcontractor has arranged leadership (PM / GM) on-site audit by monthly basis (With audit
7 N
evidence)?

8 Whether subcontractor provides First Aid facilities to their crews? Y

Whether subcontractor has trained their operators and field managers and examined them (with training
9 N
record and examined result)?

10 Whether subcontractor has posted with EHS posters inside of their offices? Y
 EHS Indicator Score
Safe/Green 9 - 10
Warning/Yellow 6 - 8.5
Unsafe/Red 0 - 5.5
Uncoplete Checklist Deduction 0,5 point