IN THIS DOCUMENT THE FOLLOWING TOPICS ARE COVERED

Topic
 Purpose
 Accountability
 Scope
 Overview
 Health, Safety and Environmental Policy Statement
 Organisational Objectives
 Safety Audits
 Evaluate and reward performance
 PPE policy, Hazard Assessment for PPE, Selection of PPE, Training & Retraining
 Violations
 Safety Policy Review
 Inspection Checklist
 Corrective Action Plan Form
 MEWP Checklist
 Special Transportation Checklist
 Job Safety Analysis Form
 HSE monthly information system
 HSE performance review
 HIRA format and protocol
 Risk impact Register
 Incident , Accident reporting protocol
 Incident , Accident investigation protocol
 Training Module Monthly
 Induction Training
 Emergency Plan
 Contract Employment Policy
 Post contract HSE Evaluation for contractors
 HSE Audit Protocol
 Audit Scoring System.
PURPOSE The purpose of this policy is to establish the basic responsibilities for designing,
executing and monitoring the safety, health and environmental program applicable to IWLPL
and its subsidiaries/contractors.

ACCOUNTABILITY All IWLPL leadership and staff are accountable for their
specific safety, health and environmental responsibilities.

SCOPE This policy applies to all IWLPL leadership staff to include

the following: IWLPL President (CEO, COO, Vice President(s), Director of Operations, and
Human Resource Professionals) and all members of the Operation Management
department. In addition this policy applies to all IWLPL Support staff and contractors.

Our Health, Safety & Environment Policy is based on and supported by the following
eight Principles:

1. All injuries, occupational illnesses & environmental incidents are preventable

2. All operational exposures can be safeguarded
3. Safety & environmental assessment of all business processes is vital
4. Working safely is a condition of employment
5. Training all employees to work safely & environment friendly is essential
6. HSE Management audits are a must
7. Employee involvement is essential in all HSE issues
All deficiencies must be reported and corrected promptly.

Overview
Protection of people and the environment is a IWLPL core value. It is our vision to create a
culture that empowers employees, contractors and/or agents to drive this value into all global
operations and achieve excellence in Health, Safety, and Environmental (HSE) performance.
IWLPL deploys an integrated, enterprise-wide behaviour based HSE management system to
fulfil our mission and the expectations of our clients based on the following principles:
 We require all management and supervisory personnel to provide the leadership and
resources to inspire and empower our employees to take responsibility for their actions
and for their fellow employees to prevent injuries, illnesses, and adverse environmental
impacts, and create a safe, healthy, and environmentally-responsible workplace.
 We provide value to clients by tailoring IWLPL processes to customer needs and
requiring IWLPL employees, contractors and/or agents to deliver projects that identify
HSE requirements and commit to compliance with applicable HSE laws and
regulations, company standards, and external requirements.
 We aspire to continually improve our performance and influence others to redefine
world-class HSE excellence.
 We evaluate our physical work environment to verify safe work conditions and
practices are established, followed, and corrected as needed.
 We assess and continually improve our HSE program to achieve and maintain world-
class performance by setting and reviewing objectives and targets, reporting
 performance metrics, and routinely evaluating our program through internal and
external audits.
 We expect all employees, contractors and/or agents to embrace our HSE based culture,
share our core value for the protection of people and the environment, understand their
obligations, actively participate, take responsibility, and “walk the talk” on and off the
job.

HSE Policy Statement

IWLPL has identified Health, Safety and Environmental as core values of the enterprise.
Health, Safety and Environmental will be integrated into all appropriate business processes
in support of
our unwavering commitment to protecting our employees, contractors, agents, customers,
assets and the general public. Every IWLPL team member is held accountable for
performing their responsibilities in a safe and secure manner. Operating safely is a
cornerstone of maintaining our business
relationship. IWLPL will maintain a “zero tolerance” regarding the protection of physical
assets, personnel and intellectual capital.

Our approach
We ensure safe operations that protect people, the environment, communities and assets.
We manage our HSE program efficiently, and provide feedback to our location level
manager that supports
positive improvement. We believe that all accidents can be prevented.

We are committed to:

 Integrating HSE in how we do business
 Improving HSE performance in all our activities
 Demonstrating the importance of HSE through hands-on leadership and behaviour
 Openness in all HSE issues and active engagement with stakeholders.
How we work
 We take responsibility for our own and others’ safety and health.
 We work systematically to understand and manage risk.
 We provide employees, contractors and/or agents with necessary resources,
equipment and training to deliver according to designated responsibilities.
 We cooperate with our contractors and suppliers based on mutual respect.
 We stop unsafe acts and operations.
 We apply clean and efficient technologies to reduce the negative environmental
impact of existing operations.
 We aim for a safe and attractive working environment characterized by respect, trust
and cooperation.
 We monitor our people’s health in job-related risks.
 We establish work processes, goals and performance indicators to control measure
and improve them.
 We run HSE improvement processes based on audits and risk assessments.
 Set and Review
Organizational Objectives

Management by Objectives (MBO) starts with clearly defined strategic organizational

objectives, expressed in concise, easily understood Mission and/or Vision Statements.
These mission and/or vision statements should contain specific goals. Vague goals such as
"improving customer satisfaction" may mean little to team members; and they're also difficult
to measure. A better objective is to "reduce customer complaints by 90 percent."
This objective is exciting because it's challenging, and it's much easier to measure.

Safety Audits
Branch Managers can use the safety audit to help identify and correct regulatory problems and
compliance with internal policy, which can improve workplace safety, and help reduce
IWLPL ’ liability.
An audit can serve as an educational tool. It can increase employee awareness and
understanding of environmental and safety regulations. The audit process can also be an
opportunity to demonstrate IWLPL ’ commitment to compliance.
An audit can identify ways to improve the efficiency and cost- effectiveness of the compliance
program. Regulatory agencies and criminal prosecutors may view workplace audits
favourably. A thoroughly completed audit with proper follow-up can signal that IWLPL ’ is
making a good-faith effort to comply with applicable regulatory requirements.

IWLPL ’ Internal Audits

IWLPL ’ Health, Safety and Environmental (HSE) Audit Team performs formal audits at
selected branch locations. The Vice President of Operations leads an audit team process
comprised of operational and functional representatives selected by the Director of
Integration.
Audit Process

Each year IWLPL ’ policy sections and specific target areas of improvement (AOI) are
selected for possible auditing by the HSE Audit Team based on:

 each branch locations past safety, health, and environmental

performance, and
 each branch locations effectiveness at collision and injury
prevention efforts and activities, and
 each branch locations ability to properly manage the carrier
qualification process

An annual audit schedule is developed between the HSE Audit Team

and field operations management and outlines:
 which policy sections and/or AOI’s will be audited, and
 when the audits will occur.
Pre-Audit Process

Prior to the formal audit, the field HSE Audit Team conducts a pre- audit of the branch to
determine which policy sections or AOI’s require a full audit. This pre-audit is completed by:

 using site visits to assess areas of non-compliance;

 reviewing results of self-audits;
 reviewing the branches ability to properly manage the carrier qualification process
 interviewing employees and managers to assess the effectiveness of process
implementation;
 reviewing collision, injury, and environmental incident investigation and corrective
action plans; and
 conducting a review of the locations overall implementation of the IWLPL
Health, Safety and Environmental processes.

The pre-audit is used to determine which policy sections and/or AOI’s must be audited during
the formal audit process. If deemed appropriate by the Director of Integration, the results of
the pre-audit may be shared with the branch prior to the formal audit.

Formal Audit Process

After the pre-audit is completed and a determination is made regarding which policy sections
and/or AOI’s will receive a full audit, the field HSE Audit Team is responsible for:
 scheduling the format audit, and
 gathering any required information in preparation of the audit.

Formal audits expand on the requirements in each policy section and must include:

verification that IWLPL ’ safety, health, and environmental procedures, processes, and
policies are implemented, working, and will remain effective following the formal audit; and

 verification that branch management is adhering to IWLPL ’

carrier qualification procedures;
 observations made by the audit team during the formal audit;
and
 recommendations to correct deficiencies observed during the
auditing process.

Post Audit Process

Upon completion of the formal audit, the audit team meets with branch management to present
the results of the audit and communicate the post-audit responsibilities.
A copy of the final formal audit results are provided to the branch manager. Within 30 days,
the HSE Audit team must complete a corrective action plan to address deficiencies observed
during the audit. The corrective action plan must include:
 a detailed description of the actions planned to correct each
deficiency,
 a due date for each corrective action, and
 the name of the person responsible for implementing the
corrective action.

The Audit team is responsible for tracking each corrective action to completion and providing
regular updates to the Director of Integration and Vice President of Operations.

Evaluate and Reward Performance

Evaluation System

MBO is designed to improve performance at all levels of the organization. To ensure that this
happens, you must have a comprehensive evaluation system in place.

Give constructive, thorough feedback to all employees on their goals and on IWLPL ’ goals.

Remember the participative principle

When you present companywide results, you have another opportunity to link specific
individual and group achievements to corporate performance. Ultimately, this is what MBO is
all about and it explains how, when done right, it can spur companywide performance and
productivity.

Once your team members have met their goals, you can reward them in several ways.
• A simple "thank you" for a job done well will go a long way,
• you can highlight their achievements to the group, and
• you can compensate them strategically for the work that they do.
When you reward goal achievers, you send a clear message to everyone that goal attainment is
valued.

Repeat the Cycle

When reviewing these objectives and goals and creating new ones, ask for feedback from employees on what
went well and what could be improved, consider environmental factors, and take into account your team's past
performance.
 Personal Protective Equipment Policy
The purpose of the Personal Protective Equipment Policies is to protect the
employees of IWLPL from exposure to work place hazards and the risk of
injury through the use of personal protective equipment (PPE). PPE is not a
substitute for more effective control methods and its use will be considered only
when other means of protection against hazards are not adequate or feasible.

Personal protective equipment will be provided, used, and maintained when it

has been determined that its use is required to ensure the safety and health of
our employees and that such use will lessen the likelihood of occupational
injury and/or illness.

IWLPL will utilize Job Safety Analysis questionnaires to initially determine

which specific jobs will require the use of PPE and will conduct periodic
reviews to audit compliance and also identify areas where job requirements
have changed which may impact the type of PPE required

The IWLPL Personal Protective Equipment Policies includes:

 Responsibilities of supervisors and employees

 Hazard assessment and PPE selection
 Employee training
 Cleaning and Maintenance of PPE

PPE POLICY
Risk Management is responsible for the development, implementation, and administration
of IWLPL ’ PPE policies. This involves

Conducting workplace hazard assessments to determine the presence of hazards which

necessitate the use of PPE.
Selecting and purchasing PPE.
Reviewing, updating, and conducting PPE hazard assessments whenever
o a job changes

o new equipment is used

o there has been an accident

o a supervisor or employee requests it

o or at least every year

o Maintaining records on hazard assessments.

o Maintaining records on PPE assignments and training.

 o Providing training, guidance, and assistance to supervisors and
employees on the proper use, care, and cleaning of approved PPE.
o Periodically re-evaluating the suitability of previously selected PPE.

o Reviewing, updating, and evaluating the overall effectiveness of PPE use,

training, and policies.
Supervisors
Supervisors have the primary responsibility for implementing and enforcing PPE use and
policies in their work area. This involves

o Providing appropriate PPE and making it available to employees.

o Ensuring that employees are trained on the proper use, care, and cleaning
of PPE.
o Ensuring that PPE training certification and evaluation forms are signed.

o Ensuring that employees properly use and maintain their PPE, and follow
IWLPL PPE policies and rules.
o Notifying IWLPL management and the Vice President of Risk
Management when new hazards are introduced or when processes are
added or changed.
o Ensuring that defective or damaged PPE is immediately disposed of and
replaced.

Employees
The PPE user is responsible for following the requirements of the PPE policies. This
involves

o Properly wearing PPE as required.

o Attending required training sessions.

o Properly caring for, cleaning, maintaining, and inspecting PPE as

required.
o Following IWLPL PPE policies and rules.

o Informing the supervisor of the need to repair or replace PPE.

 Hazard Assessment for PPE

The Vice President of Risk Management in conjunction with Supervisors will

conduct a walk-through survey of each applicable work area to identify sources of
work hazards. Each survey will be documented using the Hazard Assessment
Certification Form, which identifies the work area surveyed, the person conducting
the survey, findings of potential hazards, and date of the survey. The Vice President
of Risk Management will keep the forms in the company business files.

The Vice President of Risk Management will conduct, review, and update the
hazard assessment for applicable PPE situations whenever

 a job changes
 new equipment or process is installed
 there has been an accident
 whenever a supervisor or employee requests it
 or at least every year
 Any new PPE requirements that are developed will be added into
IWLPL ’ PPE Policy.

Selection of PPE
Once the hazards of a workplace have been identified, Director of will
determine if the hazards can first be eliminated or reduced by methods other
than PPE, i.e., methods that do not rely on employee behavior. If such methods
are not adequate or feasible, then (Vice President of Risk Management or
designated person) will determine the suitability of the PPE presently available;
and as necessary, will select new or additional equipment which ensures a level
of protection greater than the minimum required to protect our employees from
the hazards. Care will be taken to recognize the possibility of multiple and
simultaneous exposure to a variety of hazards. Adequate protection against the
highest level of each of the hazards will be recommended for purchase.

All personal protective clothing and equipment will be of safe design and construction for
the work to be performed and will be maintained in a sanitary and reliable condition. Only
those items of protective clothing and equipment that meet IS and Factory Act standards.
Affected employees whose jobs require the use of PPE will be informed of the
PPE selection and will be provided PPE by IWLPL at no charge. Careful
consideration will be given to the comfort and proper fit of PPE in order to
ensure that the right size is selected and that it will be used.

Training
Any worker required to wear PPE will receive training in the proper use and care
of PPE before being allowed to perform work requiring the use of PPE. Periodic
retraining will be offered to PPE users as needed.
The training will include, but not necessarily be limited to, the following
 subjects:
 When PPE is necessary to be worn
 What PPE is necessary
 How to properly don, doff, adjust, and wear PPE
 The limitations of the PPE
 The proper care, maintenance, useful life, and disposal of the PPE

After the training, the employees will demonstrate that they understand how to
use PPE properly, or they will be retrained. Training of each employee will be
documented using the Personal Protective Equipment Training Documentation
and kept on file. The document certifies that the employee has received and
understood the required training on the specific PPE he/she will be using.
Retraining
The need for retraining will be indicated when
 an employee’s work habits or knowledge indicates a lack of the necessary
understanding, motivation, and skills required to use the PPE (i.e., uses PPE
improperly)
 new equipment is installed
 changes in the work place make previous training out-of-date
 changes in the types of PPE to be used make previous training out-of-date

Cleaning and Maintenance of PPE

It is important that all PPE be kept clean and properly maintained. Cleaning is
particularly important for eye and face protection where dirty or fogged lenses could
impair vision. Employees must inspect, clean, and maintain their PPE according to
the manufacturers’ instructions before and after each use. Supervisors are responsible
for ensuring that users properly maintain their PPE in good condition.

Personal protective equipment must not be shared between employees until it has been
properly cleaned and sanitized. PPE will be distributed for individual use whenever
possible.
If employees provide their own PPE, make sure that it is adequate for the work place
hazards, and that it is maintained in a clean and reliable condition.
Defective or damaged PPE will not be used and will be immediately discarded
and replaced.

NOTE: Defective equipment can be worse than no PPE at all. Employees would
avoid a hazardous situation if they knew they were not protected; but they would get
closer to the hazard if they erroneously believed they were protected, and therefore
would be at greater risk.
It is also important to ensure that contaminated PPE which cannot be decontaminated is disposed of in a
manner that protects employees from exposure to hazards.

IWLPL believes that a safety and health Accident Prevention Program is

 unenforceable without some type of disciplinary policy. Our company believes that
in order to maintain a safe and healthful workplace, the employees must be
cognizant and aware of all company, State, and Federal safety and health
regulations as they apply to the specific job duties required. The steps outlined in
the Disciplinary Policy will be applied to all safety and health violations.

Violations

 Non-Serious Safety Violations: A violation has direct

relationship to safety and health where the exposure is likely to
or does cause physical harm or equipment damage.
 Serious Safety Violations: If, in the judgment of management,
including on-site supervisors, the violation involves imminent
danger to his/her self or others, equipment damage or work
sabotage.

Discipline Action

 Non-Serious Safety Violations:

o A first time violation will be discussed orally between company
supervision and the employee. This will be done as soon as
possible.
o A second time offense will be followed up in written form and a
copy of this written documentation will be entered into the
employee’s personnel folder.
o A third time violation will result in time off or possible
termination, depending on the seriousness of the violation.

 Serious Safety Violations:

o An employee found to have a serious safety violation will be
terminated after a thorough investigation of the circumstances.
An employee may be suspended while this investigation is
conducted.
o A supervisor is responsible for physically inspecting the work
space of each employee. Noted concerns shall be addressed
immediately.

RESPONSIBILITIES FOR DESIGNING, EXECUTING AND MONITORING THE

IWLPL LOGISTICS CORE SAFETY RULES POLICY.
We are committed to:
• Improving and integrating the HSE Core Safety Rules Policy to reduce the risk of
and/or prevent accidents and identify safe work practices.
• Demonstrating the importance of the HSE Core Safety Rules Policy through hands-on
leadership and behaviour.
• Maintaining a safe work environment.
Rights & Responsibilities – We have the right and responsibility to perform our work safely.
Our training, skills, work experience, and personal judgment provide the foundation for
making safe decisions about work practices.
o Sufficient Time – Take sufficient time to perform job tasks safely.
o Alert & Attentive – Assure that you are alert and attentive when performing duties.
o Co-Workers Warned – Warn co-workers of unsafe practices and/or conditions.
o Safety Rules, Training Practices, Policies – Comply with company safety rules, training
practices and policies.
o Reporting – Make reports of incidents immediately to their supervisor.
o Horseplay – Conduct yourself in a way that supports a safe work environment – free of
horseplay, practical jokes and harassment.
o Medical Conditions – All employees are responsible to ensure their medical conditions
do not interfere with their ability to safely perform their duties. Employees with medical
conditions that may adversely affect their ability to work safely must inform their medical
practitioner of their job duties. The medical provider must determine that any prescribed
treatment including medication will not impair the employee from safely performing their job
duties. The employee must notify their physician/medical provider if prescribed treatment
and/or medication is affecting their ability to safely perform their job duties.
• Personal Protective Equipment and Clothing – Requirements
– Be familiar with and wear personal protective equipment and clothing as required by your
job. Any changes made in the recommended use or design of personal protective equipment or
clothing must be approved by the manufacturer. Training will be given to each employee
needing to wear PPE. When the workplace changes making the earlier training obsolete, the
type of PPE changes or when the employee demonstrates lack of use, improper use, or
insufficient skill or understanding, the employee(s) shall be retrained in the use of PPE. All
PPE training shall be documented. PPE must be provided, used and maintained in a sanitary
and reliable condition. Employee owned PPE is not allowed. When a hazard is identified
requiring PPE, a written hazard assessment is performed and signed. PPE will be fitted to
each affected employee. Employees shall not use defective or damaged PPE.
• Work Environment
o Housekeeping – Keep work stations and the inside and outside of buildings clean and
orderly at all times.
o Footing – Be alert to walkway conditions and adjust your actions to accommodate for
weather and time of day. Except in emergency, running is not permitted inthe performance of
duty.
o Skin Cleaning – Use company supplied hand creams and soaps for cleaning hands, arms
and face.
• Workplace Security – It is every employee’s responsibility to help keep our workplace
secure from unauthorized intruders. Every employee must comply with these security
precautions.
o After-hours access to the workplace is limited to those employees who need to work
late.
o If you are going to working past our usual closing time, please advise your supervisor.
o Employees are allowed to have an occasional visitor in the workplace, but workplace
visits should be the exception rather than the rule.
o If you are anticipating a visitor, please notify your supervisor. When your visitor
arrives, you will be notified.
• First Aid
o In the absence of medical assistance that is reasonably accessible in terms of time and
distance to the workplace, a person who has a valid certificate in first aid from the American
Red Cross or equivalent training that can be verified by documentary evidence may render
first aid assistance. Certified employees shall be identified for workplace locations.
o First aid supplies and kits are easily accessible at identified locations in each workplace.
Each first aid kit consists of appropriate items determined to be adequate for the workplace in
which they will be used and will be inspected and re-stocked to ensure the availability of
adequate first aid supplies monthly. Sinks and/or other equipment are available at each
workplace for quick drenching or flushing of eyes or body where the eyes or body of any
person may be exposed to injurious corrosive materials.
o Should an injured employee need to get to a hospital or doctor and is not in a condition
to drive themselves without endangering themselves or others, a manager or other available
employee shall call in request of an ambulance.
• Hazard Communication
o Employees shall be provided with information and training on the Hazard
Communication policy upon changes to the Hazard Communication policy or, at a minimum,
annually.
o A written Hazard Communication policy will be developed, implemented & maintained
at each workplace. The policy will include a list of hazardous chemicals at each workplace.
o Employees will be informed of the hazards of non- routine tasks by their supervisors.
o A written Hazard Communication policy will be developed, implemented & maintained
at each multi- employer and/or multi work site. The policy will identify the specific hazards of
performing tasks at these sites.
o Labels and other forms of warnings shall be maintained to ensure employees can be
aware of impending hazards.
• Material Safety Data Sheets (MSDSs) must be obtained for each chemical at the
workplace. MSDSs will be maintained in a readily accessible location to employees.

Branch Name Branch Code Date

Inspector’s Name Inspectors Title

A-Adequate at time of inspection, N-Needs Attention, NA-Not Applicable A N NA

PERIMETER CONTROL Check if entire section is not applicable:
1. Are fencing, gates and barriers in good repair (no holes, fencing in contact
with ground or ground rail, equipped with barbed wire to prevent climbing) ?
2. Are gates properly secured and functional?
3. Is the perimeter adequately lighted (able to read a newspaper at arms length)?
4. Do landscape features provide places for potential intruders to hide?
VEHICLE PARKING & TRAFFIC FLOW Check if entire section is not applicable:
1. Has a traffic flow pattern been established and followed by all drivers?
2. Are entry and exit points clearly identified?
3. Do visitors, employees, tractors and trailers have separate parking areas?
4. Are parking areas monitored by closed circuit television (CCTV) cameras?
5. Are all vehicles properly parked?
VEHICLE SECUREMENT Check if entire section is not applicable:
1. Are trucks and tractors secured with the keys removed?
2. Are unattended trailers secured by means of king pin or glad-hand locks?
3. Are vehicle keys stored in a locked cabinet or in a locked room?
4. Are keys for king pin and glad hand locks properly secured?
DOORS, WINDOWS AND OTHER OPENINGS Check if entire section is not applicable:
1. Are all exterior doors at least 1 ¾ - inch solid wood, metal clad or metal?
2. Are all exterior doors properly equipped with cylinder locks or dead bolts?
3. Are windows protected with locking devices, metal bars, mesh or other means?
4. Are openings to the roof securely fastened or locked from the inside?
5. Are exterior roof access points properly secured?
6. Are loading dock doors closed when not in use?
ENTRANCES & EXITS Check if entire section is not applicable:
1. Are all exterior doors closed, properly locked and secured?
2. Are all interior doors properly secured?
ACCESS CONTROL Check if entire section is not applicable:
1. Are access control processes and equipment adequate to control employees,
visitors and contractors?
2. Are employee, visitor and contractor badges properly displayed?
3. Are visitor and contractor registers available and in use?
4. Are visitors and contractors properly escorted and supervised while on-site?
5. Are driver movements through the facility restricted?
ALARM SYSTEMS Check if entire section is not applicable:
1. Are alarm system components in proper working order?
a. Door and window contacts?
b. Motion sensors?
d. Monitoring panel?
PARTS STORAGE ROOMS Check if entire section is not applicable:
1. Is access to parts storage rooms restricted?
2. Is parts storage room properly secured?
3. Are parts inventoried and reconciled monthly?
RENTAL COUNTERS Check if entire section is not applicable:
1. Do rental counters face the entrance door?
2. Do employees have a good view of approaching individuals?
3. Are exit doors equipped with tape to identify a person’s height?
4. Are cash and valuables locked and secured when unattended?
5. Are rental cash deposits made and reconciled daily?
6. Do employees have a readily accessible exit other than the customer entrance?
HIGH-VALUE STORAGE AREAS Check if entire section is not applicable:
1. Are high value items stored in a separate, lockable cage or room?
2. Are high value storage areas properly secured?
3. Are high value storage areas monitored by CCTV surveillance?
 CORRECTIVE ACTION PLAN
Complete the information below and return this form by due date to: Return completed form within 7 days from
the date of Audit Summary Report.

Date Mailed

Street Address City State Zip Code

Division Code Branch Code Location Address – Street City State Zip
Code
Division Manager Name (Print) Telephone Number
( ) -
Branch Manager Name (Print) Telephone Number
( ) -
Carrier Qualifications Manager Name (Print) Telephone Number
( ) -

Item Estimated Date

Numbe Description of Corrective Action Required Completion Complete Initial
r Date d
MOBILE ELEVATED WORK PLATFORM CHECKLIST

Mobile Elevated Work Platform Provider Company Name Vendor Address Date

Form Completed By Form Completed By Title

A-Acceptable, N-Not Acceptable, NA-Not Applicable A N NA

Mobile Elevated Work Platform Operations Check if entire section is not applicable:
1. Is there a Mobile elevated Work Platform (MEWP) instruction manual from
the manugacturer that includes electrical, hydraulic and pneumatic
diagrams?
2. Does the manual include basket evacuation procedurein the event of
structural failure?
3. Is there an attachment point in accordance with 29 CFR 1910.502 Supart M
that guarantees a stable connection while personnel is on the MEWP?
4. Is there a point to securely attach the descent equipment? What is the
maximum number of persons allowed?
5. Is there direct communication between the crane operator on the
basket employee?
6. Is there an anemometer?
7. Are there diagrams of loads, scopes and allowed limits?
8. Are there points to securely attach the emergency descent equipment
in accordance with 29 CFR 1910.5902 Subpart M
9. Are there controls on the work platform?
10. Is there an emergency stop device? (Not required for MEWPs for which
controls are mechanically attached to power circuit distrbutors (priority
manual control)
11. Are there priority emergency devices that, in the event of primary power failure,
return the work platform to a position from which it is safe to descend andthat
frees the platform from possible obstruction.

SPECIAL TRANSPORTATION CHECKLIST

Special Transportation Provider Company Name Vendor Address Date

Form Completed By Form Completed By Title

A-Acceptable, N-Not Acceptable, NA-Not Applicable A N NA

Special Transportatoin Operations Check if entire section is not applicable:
1. Is it equipped with the necessary emergency equipment (vest,
extinguisher, etc.)?
2. Does the user company guarantee road safety during transport (lead car,
lighted signs, government signs, etc.)?
3. Are there communication devices between the engine cabin and the
lead vehicle?
4. Arethere entry records for the purchase of auxiliary hoisting and lashing
devices that include their manufacturing year? Attach a copy of the purchase
records.
5. Are chocks used?
6. Is there a preventative maintenance program according to the manufacturer
of transportation vehicles
7. Does your company maintain a register lifting and rigging equipment
and specialized transport tooling?
Job Safety Analysis Form
Event:
Effective Date: / / Number of Pages: of
Department:

Prepared By: Date: / /

Reviewed By: Date: / /
Approved By: Date: / /

1. Equipment Operated:

2. Environmental Conditions:
Inside Outside Cold Heat Wet Dust Vapors /
Mist Noise Vibration Other

3. Primary Job Functions & Position:

Lifting Grasping Pushin Sitting Reaching Bending
g
Kneeling Standing Pulling Squatting Other

4. Physical Demands:
(Continuously = 100% ‐ 67%; Frequently = 66% ‐ 34%; Occasionally = 33% ‐ 1% Not
Applicable = 0%)

Standing Pulling Kneeling

Walking Climbing Reaching

Sitting Stooping Carrying ( lbs. distance)

Pushing Bending
5. Potential Hazards: Controlled By

Impact PPE Procedure Training

Guards Chemical Contact PPE

Procedure Training

Guards

Caught on or Between PPE Procedure Training Guards

Fall or Slip PPE Procedure Training Guards

Over Exertion PPE Procedure Training Guards

Cumulative Trauma PPE Procedure Training Guards

Other PPE Procedure Training Guards

6. List of Specific
Hazards:

7. List of
Chemicals:

8. PPE:
Eye Face Head
Clothing Hand Other
Foot Respiratory Other
HSE & Sustainability Monthly Information System

SBU : UNIT: Month:

Health & Safety
data
Cumulati
Direct Indirect
Categor Indicat ve for the Remark
employe personn
y or year s
e el
HS01 Number of Employees
HS02 Man Hours Worked
HS03 Fatalities
HS04 Loss Time Injury(LTI)
HS05 Injury Frequency Rate(IFR)
HS06 Lost days
HS07 Injury Severity Rate(ISR)
HS07 First Aid Case
HS08 Near Miss
HS 09 Property Damage Case
HS 10 Spillage of Oil
HS 10 HSE training conducted (man-
hrs)
Environment
Data:
For the Cumulative
Categor Indicat Month for the year Remark
y or s
ENV01 Water Consumption
ENV02 Waste Water Discharged
ENV03 HSD consumption in MT
ENV04 LDO consumption in FT
ENV 05 FO consumption in MT
ENV06 Gas(LPG, Natural gas) consumption in
MT
ENV07 Hazardous waste Generated in MT
ENV08 Hazardous waste disposed in MT
ENV09 Non Hazardous waste generated in MT
ENV10 Non Hazardous waste disposed in MT
ENV11 Electricity consumption from Grid in
MWH

Specify if any special event like Mock Drill, Specific HSE audit, Health Camp,
safety promotional events organized in the month:
HSE performance to be reviewed at the beginning of any

business review . Attached format to be used for reviewing &

monitoring HSE performance:

HSE PERFORMANCE
REVIEW
UNI SB reporting
T: U: Manager

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec FY-13

Man Hours Worked

Leading Indicators
1 HSE Training(man
Days)
2 HSE Inspections
3 Safety Committee
Meetings
4 Tool Box Talk
5 Job Safety Analysis
6 Near Miss

Lagging Indicators
1 Fatality
2 Loss Time Injury
3 First Aid Incidents
4 Loss days
5 IFR(Injury Frequency
Rate
6 ISR( Injury Severity
Rate)
7 Spill in Lts

Environmental
performance
1 Water intensity
2 Electrical intensity
3 Carbon Intensity
4 Waste generated
 Probability & Score
Frequency
Negligible 1
Low 2
Moderate 3
High 4
Definite 5

Severity Score
Minor 1
Moderate 2
High 3
Major 4
Catastrophic 5

Definite 5 5 10 15 20 25
High 4 4 8 12 16 20
Probability & Modera 3 3 6 9 12 15
Frequency te
Low 2 2 4 6 8 10
Negligib 1 1 2 3 4 5
le
1 2 3 4 5
Mino Moderat High Majo Catastroph
r e r ic
Severity
Risk Level Risk Priority

Negligible Tolerable

Low Medium Priority

Medium High Priority

High Immediate
Unit following Integrated Management System (IMS) can use a
combined Risk and Environment Aspect Impact register as follows:

HSE RISK / IMPACT

REGISTER

Strength of existing control

ngineering Control/Admin
Elimination/substitution/E
Compliance to legislation

significant risk/ Impact

Additional Control for
D/I/R/NR/Abnormal

Residual risk/Impact
Risk/ Impact Rating
Existing Control
OHSAS/EMS

Likelihood

Control by
Concern

Severity
Activity

control
Sr No

Scorings to be decided based on the following guideline:

Likelihood Scoring
Definite 5
High 4
Moderate 3
Low 2
Unlikely 1

Severity Scoring
Environment Safety
Permanent Damage to Catastrophic/ 5
Environment Multiple fatality
Major Damage to Single Fatality 4
environment
Moderate damage to LTI( Loss time 3
environment injury)
Low damage to MTC ( Medical 2
environment treatment Case)
Negligible damage First Aid 1

Strength of existing Control Scoring

Absence of control 5
Not reliable control 3
Available & effective control 1

Compliance to legislation Scoring

Not meeting legislation 5
Complied/ Not covered under any 1
legislation
 Reporting of Accidents, Incidents, corrective and preventive action

1.0 Purpose
To ensure that all HSE accidents and incidents are reported, investigated
and actions taken so as to prevent their re-occurrence

2.0 Scope
All operation sites, facilities & offices of IWLPL.

3.0 Definitions

1. Accident: Any event which results in harm to personnel, damage to

property, production loss or causes damage to the environment.
2. Company Employee: Any person employed directly by the company
including those on contract.
3. Contractor Personnel: Any person employed by a Contractor or
Contractor’s Sub- Contractor(s) who are directly involved in execution
of prescribed work under contract with the Company. Workers in
fabrication yards of contractors or any other party located at any of the
BL sites come under this category. Fabrication yards of contractors / third
party not located in BL site premises shall not come under this category.
4. Environment: Surroundings and conditions in which an organisation
operates, or which it may affect, including all living systems, and other
biodiversity.
5. Environmental Effect: The direct or indirect effect, of an organisation’s
activity, products or services to the environment.
6. Fatality: Any work injury resulting in death of the individual irrespective
of the intervening period. Fatalities arising, for example, from natural
causes, suicide, or inexplicable personal behaviour shall be excluded
from this category.
7. Fire: Fire includes unintentional fire of any magnitude and unintentional
electric arc. All fires regardless of whether the fire was extinguished by
an extinguishing medium or self extinguished shall be reported as fires.
Fires with no visible flame
e.g. oil soaked insulation, pyrophoric fires, smoldering in coke/sulphur
piles or other self ignitable materials etc. are also included in this
category. The size and extent of damage shall not determine whether it
shall be classified as fire or not. Grass fires in the plant areas shall also
be included as they pose potential problems to the plant. However, fires
shall be classified as ‘Process /Plant Areas’ or ‘Non- Process /Non-Plant
Areas’.
Fires are further classified into ‘Major Fires’ and ‘Minor Fires’ as below.
8. First Aid Case (FAC): Work related injury that requires one time
treatment and subsequent observation (for example minor scratches,
burns, cuts, which do not ordinarily require medical care) and does not
 result in a Medical Treatment Case (MTC).
9. Hazard: Potential to cause harm, including ill health or injury; damage
to property, plant or the environment;
10. Immediate Cause: Is the direct reason why an incident has occurred. It
can encompass unsafe conditions (which are not under the control of the
person in the workplace), as well as unsafe acts (which are under a
person's control).
11. Incident: Incident includes ‘Accident and Near Miss’; An Incident is an
event or a chain of events that has caused, or could have caused fatalities,
injuries, and/or damage to assets, the environment, or third parties.
12. Job Factor: Any circumstance that may cause or contribute to the
development of an unsafe condition.
13. Lost Time Injury (LTI): Any work related injury which results in a
person being unfit for work for a period of 48 hours or more immediately
following the occurrence of the occupational injury (as per the Indian
Factories Act,1948) “The period of 48 hours” includes rest days, weekend
days, leave days, public holidays or days after ceasing employment.
14. Medical Treatment Case (MTC): Medical treatment case is not LTI but
requiring medical treatment from a professional physician or qualified
medical person and MTC case is more than a First Aid.
As a guide a "yes" answer to any of the following questions (due to
work related injury) would be a medical treatment case:
i. Treatment of infection?
ii. Antiseptic during second or subsequent visits to medical personnel?
iii. Treatment for second or third degree burns?
iv. Application of sutures (stitches)?
v. Application of butterfly adhesive dressing?
vi. Removal of foreign body embedded in the eye?
vii. Complicated removal of foreign bodies from a wound?
viii. Use of Prescription medications?
ix. Cutting away of dead skin (surgical debridement)?
x. Application of heat therapy during second or subsequent visits?
xi. Positive X-ray diagnosis (fractures, broken bones, etc.)?
xii. Admission to a hospital for treatment (more than observation)?
15. Loss of Consciousness: If one loses consciousness as a result of a work-
related injury, even for a short period, the case must be considered as an
MTC.
16. Near Miss: A ‘Near Miss’ is an unplanned event, which under slightly
different circumstances could have resulted in harm.
17. Risk: Product of the chance that a specified undesired event will occur
and severity of the consequences of the event.
18. Spills/ leaks: Any loss of containment of hazardous, flammable or toxic
gas, liquid or solid. There is no difference between a leak and a spill. The
type of containment shall not determine whether to report or not - A spill
even in a bounded area on concrete floor shall be reported even though
 there is no environmental impact. Spills are classified into ‘Major Spills
and ‘Minor Spills’ as below.
a. Major Spill: A spill of 500 litres / kg or more & needs to be reported.
b. Minor Spill: A spill less than 500 litres / kg but more than 5 litres /
kg, needs to be recorded for investigation
19. Release / seepage reaching outside plant boundary: Accidental release
of liquid hydrocarbons, contaminated / saline water or effluent which can
cause negative impact on company reputation should be considered as
spills.
20. Work Related Activity: A work related activity is an activity in a work
environment, which is or ought to be subject to management controls. All
incidents that occur in work related activities are reportable.
Responsibilities
Site Manager
a. Initiating the investigation of reported incidents
b. Ensuring that accident / incidents are reported within BL, as required
c. Ensuring the implementation of any corrective and / or preventative measures

HSE representative
a. Coordination of accident and incident reporting and investigation
b. Maintenance of accident and incident records

Employees
All employees have a responsibility to report accidents and incidents
occurrences to the Site Manager or HSE Representative.
Unit Head has the overall responsibility to ensure implementation of this Table – 1
(TABLE – 1) Reporting of Incidents (in Format I)
Repor Responsibility Report to Time Line
t
Fatal, Serious C&MD, D(HR&CA), Immediate
Unit/Establishme
Accidents, Major Fire Director (I/C), SBU Head,
nt Head
1 or any incident RHR (Head)
resulting in disruption and Sr Manager (HSE)
of Operation for more All relevant Statutory Immediate
Unit HR head Authorities
than
2 days
LTI (Loss Time Injury). C&MD, Director (I/C), SBU Within 24 hrs
Work related injury Unit Head Head, RHR (Head) and
which results in a Sr Manager (HSE)
2
person being unfit for Factory Inspector After 48 hrs
work for a period of 48 of the
Unit HR head
hours or more accident but
within 72
hrs
 Fire/Spillage Director (I/C), SBU Head Within 24 hrs
3 (Greater than 200 Unit Head and Sr Manager (HSE)
lts) / Toxic
release
Incident leading to Director (I/C), SBU Head, Within 24 hrs
4 property damage of Unit Head Sr Manager (HSE)
more
than INR 20,000/-
High potential near SBU head & Sr Manager SHE Within 24 hrs
5 miss (event which Unit Head
could have
lead to major accident)
(TABLE – 1) Reporting of Incident Investigation (in Format II)
Investigation Report in C&MD, D(HR&CA), Within 7
1 case of fatality & Unit Head Director days of the
serious accident (I/C), SBU Head, RHR incident
(Head) and Sr Manager
(HSE)
Investigation Report Director (I/C), SBU Head, Within 7
2 for all other incidents Unit Head RHR (Head) and Sr days of the
reported Manager incident
(HSE)
 Annexure- A1

Initial Incident Notification: Form No:

INITIAL INCIDENT NOTIFICATION REPORT

Classification of Incident (Type of Incident - Tick more than one if appropriate):

Near Miss: First Aid Medical Treatment

Case:
Case:
Lost Time Injury: Fatality: HIPO incident:

Oil Spill: Chemical

Spill: Fire / Explosion:
Name of the company: Date & Time of Incident: Site/Location/Area/Pla
(BL / Contractor): Date: nt:
(dd/mm/yyyy)
Time: (hh:mm)
Event Potential Category (Low / Medium / High):
Level of Analysis (Summary or Detailed):
Brief Description of Incident:

Sex Years of
Name of Injured M/F Age Experien Designation
ce:

Location Status / Immediate Actions Taken:

Name of Reporter: Position:

Name of Supervisor: Position:

Signature of Unit Head:

 Annexure- A2

Summary Analysis Report/ Investigation Report Form No:

SUMMARY INCIDENT ANALYSIS

Reference (Incident Report Date & Time of Plant/Location of
no.): Incident: Incident:
Type of Incident:
Near Miss: First Aid Case: Loss Time Injury

Minor Oil /Chemical Minor Fire / Othe rs including

spill: explosion minor traffic
accidents
No. of Persons involved Name of Contractor: Employee /
Contractor:

Incident Details:

Immediate causes:

Basic causes & Root causes ( where applicable):

Target
Sr. No. Corrective Action Responsibility Completion
Date

Prepared by: Approved by:

Name: Name:
Designation: Designation:

GUIDE WORDS FOR INVESTIGATIONS

 Events Immediate Causes Basic Underlying Causes
1. Falls from height (from Unsafe Acts Personal Factors
different levels); 1. Operating equipment 1. Lack of knowledge/experience;
2. Falls from the same level without authority; 2. Lack of relevant skills;
(trips & slips); 2. Lack of planning; 3. Stress;
3. Struck by; 3. Lack of warning/failure to 4. Improper motivation;
4. Exposure to sharp & observe warning; 5. Abuse/improper use of
sudden sound; 4. Inappropriate tools/equip;
5. Long term exposure to speed/mistiming; 6. Memory failure;
sound; 5. Bypassing or removing 7. Change of task
6. Exposure to variations in safety devices; conditions/environment;
pressure (other that sound); 6. Using faulty 8. Pre existing personal condition;
7. Repetitive movement with tools/equipment; 9. Lack of capability (physical,
low muscle loading; 7. Lack of or inappropriate mental etc);
8. Overstress, PPE; 10. Time pressures
overexertion, overload; 8. Failure to secure/improper (actual/perceived);
9. Other muscular stress; loading;
10. Working in cramped 9. Incorrect lifting methods; Job Factors
conditions; 10. Incorrect position for 1. Inadequate
11. Contact or exposure to task; Leadership/Supervision/Standar d
electricity; 11. Not following setting;
12. Contact or exposure to heat procedures; 2. Lack of training;
& cold; 12. Inattention / poor 3. Inadequate engineering;
13. Single contact with judgments /decision 4. Inadequate purchasing;
chemical substance making;
(excludes insects and spider 5. Lack of Maintenance/or wear and
13. Working on operating tear;
bites & stings); equipment;
14. Contact with, or exposure to,
6. Lack of routine inspections or
14. Impaired ability; hazard Identification;
biological factors; 15. Horseplay /Taking
15. Exposure to mental stress 7. Incorrect equipment;
shortcuts;
factors; 8. Inadequate tools/equipment;
16. Unspecified events; 9. Inadequate work standards or
Unsafe Conditions
procedures;
17. Caught in between; 1. Inadequate or defective
18. Excessive or irregular
10. Confusing/out of date or procedures
guards/barriers or safety
with missing steps;
hours of work; devices;
11. Lack of employee input to
19. Breach of site Rules or 2. Unprotected height;
procedure development;
Standards; 3. Inadequate or incorrect
20. Environmental event; isolations;
12. Ineffective communication;
21. Spills (hydrocarbon, 4. Damaged Tools/Equip;
chemical, other); 5. Congested workplace;
22. Gas leak; 6. Lack of warning system;
23. Other Environmental 7. Inadequately controlled
Event; Fire and explosion
24. Event leading to asset hazards;
damage /Production loss; 8. Poor housekeeping;
9. Poorly controlled
chemical, electrical or
radiation hazards;
10. Inadequately controlled
 Events Immediate Causes Basic Underlying Causes
25. Fire & explosion; temperature extremes;
26. Event leading to 11. Adverse
reputation weather
damage; conditions;
12. Noisy workplace;
13. Inadequate ventilation;
14. Inadequate
/excessive light;
15. Inadequate or
defective PPE;

Training Modules for HSE Awareness

Module Training Title Target Remarks
No. Group
Safety Leadership All executives Once in every 3
M1 MONTHS
Training
Hazard Identification & All executives at operational Sites & Once in every
M2 risk assessment offices 3 MONTHS
Techniques of root Cause All executives at operational Sites & Once in every 3
M3 analysis offices MONTHS
Emergency Management All executives at operational sites & Once in every
M4 two MONTHS
offices
Work at Height Executives, & supervisors & workmen at Every MONTH
S1 Operational sites & offices
Working at Confined Executives, supervisors & related Every MONTH
S2 spaces workmen at Operational sites & offices
Electrical Safety & energy Executives, supervisors & related Every MONTH
S3 Isolation workmen at Operational sites & offices
Use of Personal Protective Executives, supervisors & workmen at Every MONTH
S4 equipments Operational sites & offices
Safety in Excavation work Executives, supervisors & related Every MONTH
S5 workmen at Operational sites & offices
Safety in Lifting Executives, & supervisors & Crane Every MONTH
S6 Operations drivers & riggers at Operational sites
Safety In Hot work Executives, supervisors & related Every MONTH
S7 workmen at Operational sites & offices
Waste Management Executives, &supervisors & workmen at Every MONTH
E1 Operational sites & offices
Environment Management Executives, &supervisors at Operational Every MONTH
E2 System sites
 Induction Training
All new employees & contractors are to be told about the following as a
minimum.
i. Security access/ egress control
ii. General hazard and risk associated with the site activities
iii. Requirements for first aid and welfare and how statistics are collected
iv. HSE legal requirements and those standards imposed by BL site
v. Work related significant risks and/ or environmental impacts and their
personal contributions to safe and environmentally improved site
vi. HSE policy and general site rules
vii. Permit system
viii. Emergency plans and procedures
ix. Disciplinary procedures

Emergency Plan (Insert Site Name) – Appendix 1

Emergency Plan

1.0 Introduction

1.1 This plan has been prepared to provide information and guidance for
responses to emergency situations. This plan is not, nor is it intended to be,
a substitute for good common sense, which must prevail in any given
emergency situation.

2.0 Scope

2.1 Types of Emergencies

This plan is intended to cover any potential emergency that may occur at the
(insert location/project) site including:
i. Serious Work Accident: A serious accident is any accident that involves
either serious injury requiring urgent medical aid, or involves entrapped
persons whose health or safety is in immediate danger.
ii. Non-Work Medical Emergency: A medical emergency is any situation
where a person through illness requires urgent evacuation to intensive
or specialist medical care.
iii. Fire Emergency: Is any unwanted occurrence of fire that cannot be
quickly brought under control by use of a hand held fire extinguisher.
iv. Environmental Emergency: An environmental emergency is any
situation where there is a serious risk to the environment, employees or
the public due to spill or leak of a hazardous substance.
v. Bomb Threat: Any received bomb threat will be regarded as an
emergency.
 vi. Major Gas Leak: Any gas emission or leak either onsite or on
neighbouring sites

3.0 Communications
The site has set up suitable arrangements for contact with the site medical
staff, fire crew and emergency response team:

(Insert site Emergency Contact

Numbers) Site Contacts Internal
Phone External Phone EMERGENCY
PHONE
Security
BL
Reception
Site Nurse
BL Site Manager
BL HSE
Representative
etc.…
Off Site Contacts Phone
Ambulance Fire Station Police
Station
Local Hospital Emergency
Department Customer
Government Authorities Local
Doctor
etc.….

Responsibilities

A Trained Emergency response team is set up as described below.

(Insert emergency organization and responsibilities; this will generally

include the following
• The person raising the Alarm
• The Emergency Communication Co-ordinator e.g. Security Guard
• The Emergency Response Team
• The Site Nurse

5.0 Evacuation Arrangements

The Site has made the following arrangements in case of evacuation:
i. Responsibilities as per the clause 4.
ii. Muster points have allocated and are indicated on the attached
site plan. (provide the site plan)
iii. An alarm has been installed (if more than one alarm is present state
sound of alarm if different for each type of emergency e.g. gas leak,
 fire)
iv. An Evacuation Notice has been appended to the site notice boards
v. Simulation Exercises shall be conducted every (define intervals). (If
alarm is also periodically tested also state time, day etc)

6.0 Containment

6.1 Spill kits are available at locations shown on the attached site plan for
chemical/oil spills and include the following items:
a. Oil/chemical absorbent material (mats, booms, sand etc)
b. Hand pump
c. Electric pump
d. Empty drums
e. Chemical resistant gloves
f. Chemical resistant overalls
g. Chemical resistant calf length boots
h. Chemical resistant face shield
i. Respirators with cartridges suitable for chemical mist
j. Hazard warning tape

6.2 Spill kits shall be inspected weekly to ensure that the inventory of the kit is
as it should be and to ensure that the location of the spill kit is appropriate to
the site activities such as storage, offloading and use of materials. Outfalls
and interceptor pits shall be inspected daily as part of the daily site inspection
system.

7.0 Emergencies

7.1 Medical
Contact the site medical staff and if casualty is in an obscure location or is
trapped alert emergency response team. Casualty must not be moved until
examined by site medical staff except where casualty is in further danger by
not being moved e.g., likely collapse of nearby structure etc. In case of
multiple casualties summon Statutory Emergency Services and where
applicable notify the Regulatory Authority.

7.2 Fire
Call for assistance from the trained Emergency Response team. If a minor
fire, try to extinguish using fire extinguisher but ensure escape route away
from the fire is available at all times. Hand the situation over to the
emergency response team on their arrival

7.3 Environmental
(i) Oil Spills
a) Call for assistance from the trained Emergency Response Team.
b) Use appropriate Personal Protective Equipment from the emergency
 spill kit and ensure oil cannot enter storm water drains, rivers or run
into the sea.
c) Bund area of spill as quickly as possible using sand, oil booms or
other suitable material.
d) Use hazard-warning tape to cordon off the area and establish as no
smoking, no source of ignition zone, position foam filled fire
extinguishers close to the area.
e) Arrange tanker if large spill or transfer to oil drums as soon as
possible. Soak up remaining oil with absorbent material and
excavate contaminated soil.
f) Treat used absorbent material and contaminated soil as hazardous
waste and dispose of through a licensed contractor to a licensed
facility.
g) Recovered oil should be considered for recycling.
h) At any time during this action that the emergency response team
arrives, hand over to that team informing them all that you know
about the incident and what you have done in preparation for their
arrival. Stay available for investigation purposes.

(ii) Chemical Spills

a) Call for the emergency response team and take only that action
required to prevent further damage only if certain of the chemical,
its toxicology and if you have appropriate PPE.

b) If there is a chemist on site seek immediate advise, if not refer to

material safety data sheet (MSDS) for information on safety
precautions and whether or not it is necessary to evacuate the area.
c) Wearing the correct personal protective equipment and at a safe
distance from the chemical try to divert flow path away from storm
water drains, rivers or sea.
d) If possible create a bund using sand, chemical booms or other
suitable material to contain the chemical spill.
e) Use hazard warning tape to cordon off the area and have fire truck
positioned close by and If a significant or if chemical has entered
storm water drain, river or sea contact the Statutory Emergency
Services and Environmental Agency.
f) Treat/neutralise chemical as advised by chemist or as stated on the
MSDS.
g) Arrange tanker if large spill or transfer too suitable drums as soon as
possible. Soak up remaining spillage with absorbent material and
excavate contaminated soil.
h) Treat waste including absorbent material and excavated soil as
hazardous and dispose of through licensed contractor to licensed
facility.
7.4 Bomb Threats
Terrorist threat / Bomb alert. (Try and obtain as much information as possible)
a) If a bomb, its exact location and time of detonation.
b) What demands are being made
c) Make a note of any background noise on the phone
d) Make a note of sex and approximate age of the caller
e) If possible try and have someone else listen in on the call.
f) Once the connection has been broken do not hang up the phone.
g) Make a written record of the above including time of call and time
of termination.
h) Contact the police.
i) Evacuate the site unless instructed otherwise by the caller or the police

7.5 Major Gas Leak

Depending upon the size, nature, location and type of gas involved, it may
be necessary to evacuate all personnel from the site as the first response.
Should the Emergency Commander take this course of action the Evacuation
siren should be sounded and the site evacuated. Consideration will need to
be given immediately to ensuring that personnel are moved to a safe distance
up wind of the leak.

7.6 Natural Disasters (As applicable)

(Include information as necessary for the site, see example for earthquake:
If inside a building stay inside, take cover under a sturdy piece of furniture
such as a table or desk or crouch up against an internal wall and cover your
head with your arms. If on a structure such as the boiler get as close to a
major structural item as possible or under a vessel there may be a danger
of falling objects such as partially secured secondary steel work, pipes, pipe
supports, scaffolding etc, (the structure should have been designed to
withstand an earthquake) crouch down and keep your hard hat in position. If
outside stay outside, move away from buildings, structures and overhead
power lines.)
Questionnaire for HSE Pre-Qualifications of contractors:
CONTRACTOR EMPLOYMENT POLICY
Contactor
Details
Company Name
Contact Person for HSE
Name
Telephone Number
E-Mail Address

Response Evidence Weightage

Questio Yes No Required at if
n
bidding Stage complied
1 Do you have a signed and dated HSE Attach HSE Policy 1
Policy?
2 Do you confirm that you will comply with None 1
BL HSE Policy in as much as it is applicable
to your scope
of work?
3 Do you have a Health and Safety System Provide 3
certified by an accredited body to a Current
recognized Certificate
standard? (Eg : OHSAS 18001)
4 Do you have an Environmental Management Provide 3
System Certified by an accredited body Current
to a recognized standard? (Eg : ISO Certificate
14001 )
5 Have you identified, documented and None 3
maintained your Health and Safety risk
assessment of your activities?
6 Have you identified, documented and None 3
maintained your Environmental Impact
Assessment of your activities?
7 If you use subcontractors, will you assess None 2
them
in terms of HSE?
 Response Evidence Weightage
Question Yes No Required at if
bidding Stage complied
8 Have you produced project/contract HSE plans None 2
for recently completed work?
9 Is HSE Covered in your company’s Provide Current Org 2
organization Chart.
chart?
10 Have HSE roles and responsibilities been None 2
defined
in your company?
11 Have your employees received documented None 2
HSE training appropriate to the task they will
undertake?
12 Do you identify and monitor compliance None 2
with HSE Legislation?
13 Do you carry out regular medical None 1
examination for your employees?
14 Is your company free from any charges or None 1
notices served by the regulatory authorities in
relation to HSE in the last 3 years?
15 Do you have any procedure of reporting HSE None 2
Incident and investigation?

Please provide your accident data for

Period
the current year and the last 2 calendar Curre Current
Current Year Average
years Note: this must include the data nt Year -
-1 (Three years
of any Year 2
contractors working for your organization. average)
16 Number of Fatalities
17 Number of Environmental Incidents reported
to
Pollution Control Board
18 Number of accidents with 2 or more days lost
time.( LTI)
19 Man Days Lost
20 Total Hours Worked

I confirm that the above information is correct and that further evidence to support this will be
provided to
BL on request.
Name Position Company Date Signature
 POST CONTRACT HSE EVALUATION
Answer
Question (Yes / Remark
No) s
The contractor demonstrated the application of an effective and
1 robust HSE management system.
The contractor did not cause any additional cost or delays to the
2 project through poor HSE performance.
The contractor prepared suitable and sufficient HSE risk
3
assessments
and method statements in a capable, proactive and timely
manner.
4 The contractor proactively reported on HSE Events and
Deviations.
The contractor's workforce fulfilled their HSE roles and
5 responsibilities.
The contractor's own/subcontracted workforce demonstrated the
6 required level of competency.
The contractor demonstrated knowledge of and proactively
7
ensured
compliance with HSE legislation.
All goods/materials/equipment/substances supplied by the
8 contractor were compliant with the HSE requirements.
The contractor ensured that appropriate and timely medical
9 examinations were performed for his own/subcontracted
workforce.
The contractor proactively demonstrated housekeeping and
10 cleanliness.
The contractor demonstrated compliance with the IWLPL
11 Contractors General Terms and Conditions.
12 The contractor demonstrated control of high risk activities
13 Number of accidents with 1 or more days lost time
14 Fatalities during the Contract
15 Man Day Lost
16 Man Hours Worked

Based on the overall HSE performance of the Contractor, the Contractor:

1. Can be re deployed for future assignments.
2. Needs extensive training & Counseling before reappointing
3. Cannot be considered for future assignments.

Sign of the Evaluator/Contract manager Sign of the Unit/

Project Head
 BL's HSE AUDIT PROTOCOL –
Annexure A
Score
s
1 2 3 4

Excellent & Best

Maintained at
awareness/ no

below BL std
Maintained

Final Score
Sr

per BL std
Them Points to be

Remarks
initiative

Practice
N

Lack of
e audited
o

Leadership and
1
management Commitment
Leadership and management
2
Commitment
Leadership and management
3 Commitment
Leadership and management
4 Commitment
Leadership and management
5 Commitment
6 Risks and Impacts Analysis
7 Risks and Impacts Analysis
8 Risks and Impacts Analysis
9 Regulation Monitoring
10 Regulation Monitoring
HSE MANAGEMENT
An HSE co-ordinator has been appointed at each site, or the responsibility has been
clearly assigned to a certain person and documented.
HSE roles and responsibilities of the Operational managers have been cascaded down
through the organization and documented.
The site’s management team has been given documented HSE training within the past 3
years.
A management review on HSE KPIs is held and documented at least once a year
Site, Unit or Project Management team members to do documented Safety Observation
Visits
The site has identified all of its routine and non routine activities requiring risk
assessment
For each activity, the site has identified environmental aspects/impacts generated
during normal, abnormal and emergency conditions
Identified significant risks should be controlled through appropriate procedures and
work-
instructions.
All applicable legal requirements are identified & documented
A regular documented compliance analysis of all applicable regulations is done.
 HSE Objectives to be framed for each year & targets have been defined for each of
11 Objectives and Targets these objectives

All investments associated with accident prevention must be identified and cost of
12 Cost Control treatment &
compensation to be documented.
 BL's HSE AUDIT PROTOCOL –
Annexure A
Score
s
1 2 3 4

Excellent & Best

Maintained at
awareness/ no

below BL std
Maintained

Final Score
Sr

per BL std
Them Points to be

Remarks
initiative

Practice
N

Lack of
e audited
o

HSE MANAGEMENT
All the site personnel including contractors are made aware of the site’s HSE policy,
13 Training relevant health and safety hazards and risk Assessments, environmental aspects and
associated impacts and applicable HSE objectives and targets set by the management,
A process has been established that ensures that all new employees and sub-contractors
14 Training are
identified and trained upon arrival at the site. All trainings to be documented.
All HSE topics (policy, objectives, results, assessments, reviews, reports, etc.) shall be a
15 Communication subject
of regular information. (such as team briefings or “tool box talks” for example).
16 Communication HSE posting is visible and understandable,
HSE communication involves as a minimum:
communication of HSE rules to visitors to the site,
appropriate involvement of workers in hazard identification, appraising on
17 Communication MSDS of all chemicals used in premises, risk Assessments and determination of
controls, appropriate involvement of workers in incident investigation,
involvement of workers in the development and review of objectives,
HSE roles and responsibilities are clearly defined and communicated accordingly
Accident and Incident Reporting
18 and The analysis of all the incidents is conducted annually.
Analysis
Accident and Incident Reporting Each accident with & without Lost time injury are recorded , investigated & reported as
19 and per
Analysis reporting protocol.
 Accident and Incident Reporting A process is in place to ensure that near misses are recorded & high potential near misses
20 and are
Analysis investigated.
Equipment and Installation
21 Compliance The site has identified equipment types and installations being subject to regulatory
controls;
22 Emergency Preparedness Procedure for alarm and evacuation are trained and known by employees.
 BL's HSE AUDIT PROTOCOL –
Annexure A
Score
s
1 2 3 4

Excellent & Best

Maintained at
awareness/ no

below BL std
Maintained

Final Score
Sr

per BL std
Them Points to be

Remarks
initiative

Practice
N

Lack of
e audited
o

23 Emergency Preparedness
24 Emergency Preparedness
25 Emergency Preparedness
26 Emergency Preparedness
27 Emergency Preparedness
28 Housekeeping
29 Housekeeping
30 Planned HSE Inspection
31 Planned HSE Inspection
32 Document and data control
33 Document and data control
34 Document and data control
35 Document and data control
36 Document and data control
HSE MANAGEMENT
Emergency equipment is tested and controlled periodically (at least once a year).Mock
Drills
are conducted at least 3 times a year.
Site Emergency team members (first aid & fire fighters) & important contact numbers
are
displayed at strategic locations.
Tie up with external hospitals, for immediate treatment in case of serious accidents.
Adequate safety shower & eye wash stations are in place
Adequate First aid box are available & contents are inspected frequently
The site has established a daily cleaning program and the work area is tided after each
shift;
All the walkways, driveways, workstation, lay-down areas, storage area, loading and
unloading
area are properly marked;
Site carry our daily safety inspection by a checklist & proactively address the HSE
deviations.
Inspection carried out by executives of various departments including Unit heads &
documented.
Register of periodical regulatory monitoring and controls are maintained.( Pressure
Vessels ,
Cranes , Slings etc)
Safety Organisation & safety committee reports of each month to be documented.
First aid & Near Miss reports are maintained.
Analysis of all Emissions.( Air , water etc)
Hazardous waste disposal agreements with authorised vendors
37 Document and data control
38 Document and data control
39 Document and data control
40 Document and data control
• fire License
• work accident reports,( Lost time accidents)
• employer insurance certificates,
• raw data (energy consumption, water, etc..), Management programs taken in HSE for
continual improvements.
 BL's HSE AUDIT PROTOCOL –
Annexure A
Score
s
1 2 3 4

Excellent & Best

Maintained at
awareness/ no

below BL std
Maintained

Final Score
Sr

per BL std
Them Points to be

Remarks
initiative

Practice
N

Lack of
e audited
o

41 Document and data control
42 Document and data control
Contractors and Building site
43 management
Contractors and Building site
44 management
Contractors and Building site
45 management
FINAL SCORE ON HSE MANAGEMENT
HSE MANAGEMENT
• operating permits, ( Consent to operate, Hazardous waste authorisation, Factory
License ,
approved drawing of the factory plan, License of explosives & petroleum products etc)
Submission of form -5 & Form -4 within due dates to PCB as per Environment
Protection rules
1986.
Contractor HSE performance considered in selection of contractor.
Scheduled regular inspections are done of contractors working on sit & documented
Contract clearly specifies our HSE requirements .Reward & Penalty clause incorporated
in
contract Documents for all contracts.
 BL's HSE AUDIT PROTOCOL – Annexure A
Score
s
1 2 3 4

Maintained at per
Maintained below

Excellent & Best

awareness/ no
Sr

Final Score
Them Points to be

Remarks
N

initiative

Practice
e audited

Lack of

BL std
BL std
o

HEALTH &
SAFETY
The site has identified workshops and processes required to carry out regulatory exposure
1 Industrial Hygiene
monitoring
and/or which are considered to have potential for high risk exposures according to risk
assessment.
· the immediate control measures of the personnel have been implemented in case of exposures
2 Industrial Hygiene greater than these standards;
· Medical check-ups as legally required for all relevant employees have been:
3 Medical Surveillance 1. planned, and/or
2. Completed.
4 Medical Surveillance Pre employment medical records of the contract staff are also in place.
Training on confined space hazards have been conducted to supervisors & people exposed to
5 Confined Spaces
confined spaces.
All confined spaces in the site are identified & confined space PTW (Permit to work) are issued
6 Confined Spaces
for all
work in confined spaces.
Oxygen level & LEL (lower explosive limits) are continuously monitored & maintained when
7 Confined Spaces
someone
enters inside confined space. Oxygen level should never be less than 19.5 %.
A suitable resource of trained and competent individuals have been appointed (in some cases
8 Electrical Safety
sub-
contracted) to carry out electrical activities.
 · All electrical staff are appropriately trained, have a formal statement of their competencies
and knowledge of the extent of their personal authority to carry out the required electrical
9 Electrical Safety
tasks, at their competency level. Those carrying out operations, maintenance, testing and
commissioning works on
the systems, equipment, must be competent and have knowledge of general electrical hazards.
All critical electrical equipments like Relays, Circuit breakers, tripping devices are tested &
10 Electrical Safety
certified by
an competent authority at least once a year.
11 Electrical Safety Entire earthing system to be checked & earth pits are tested once a year & documented.
Trained and formally authorized person approves the isolation prior to work starting through
12 Lockout Tagout
Permit to
Work system
 BL's HSE AUDIT PROTOCOL – Annexure A
Score
s
1 2 3 4

Maintained at per
Maintained below

Excellent & Best

awareness/ no
Sr

Final Score
Them Points to be

Remarks
N

initiative

Practice
e audited

Lack of

BL std
BL std
o

HEALTH &
SAFETY
13 Portable Equipment All site’s portable equipments have been identified, recorded in a register.
All portable tools to have fiber body & double insulation . No temporary joints are allowed in
14 Portable Equipment
the connected cable.
15 Control of Site Vehicles The risks associated to vehicles on site are included in the risks analysis;
All vehicles operating on or entering the site are registered or logged into the site & visually
16 Control of Site Vehicles
examined by security.
17 Control of Site Vehicles pedestrian routes are segregated from vehicle routes;
18 Control of Site Vehicles loading and equipment manoeuvre areas are identified;
19 Control of Site Vehicles emergency routes are maintained for emergency vehicles and evacuation;
Sufficient sanitary facilities such as toilets, showers & washing facilities, safe drinking water
20 General Well Being
etc. are
available on site.
21 Permit to Work System Permits are issued for all non routine activities.
22 Permit to Work System Permit to work procedure is complied.
23 Permit to Work System All permit issuers are trained on the PTW system & hazard identification.
24 Fall prevention Permit to work system is followed for all work above 6 feet high.
25 Fall prevention People working at height are trained on the associated hazards of working at height.
26 Fall prevention Helmets & Full body safety harnesses with double lanyard are used at all point of time.
27 Fall prevention Ms tubular scaffoldings are used for accessing heights.
28 Fall prevention Wherever possible safety net needs to be installed while people are exposed to heights.
29 Fall prevention All Ladders to have hand rails are only used for accessing heights & temporary work.
30 Fall prevention All work at heights are supervised continuously
31 Excavation Any excavation below 1.5 meter deep should undergo permit to work
 BL's HSE AUDIT PROTOCOL – Annexure A
Score
s
1 2 3 4

Maintained at per
Maintained below

Excellent & Best

awareness/ no
Sr

Final Score
Them Points to be

Remarks
N

initiative

Practice
e audited

Lack of

BL std
BL std
o

HEALTH &
SAFETY
32 Excavation People involved in excavation & trained in the associated hazards & documented.
33 Lifting Operations All lifting accessories & equipments are tested as per the legal requirements.
34 Lifting Operations All crane operators & riggers have undergone training on safe lifting operations.
35 Lifting Operations Working below suspended load is strictly prohibited
36 Lifting Operations Reverse alarm in all the lifting equipments are operational.
37 Machine guarding All dangerous machinery parts & rotating parts are guarded
If rotating parts are protected with wire–mesh guards the wire mesh openings are not larger
38 Machine guarding
than ½ inch
39 Machine guarding System in place to regularly check the guards and interlocks.
40 Personal Protective equipments PPE matrix of the site is in place
41 Personal Protective equipments People are provided with the PPE required by them
42 Personal Protective equipments PPE compliance tracking system is in place.
43 Gas Cylinders & air receivers All cylinders are kept in standing condition & chained
44 Gas Cylinders & air receivers Empty & filled cylinders are segregated.
45 Gas Cylinders & air receivers Flash back arrestors are installed in cylinders
46 Gas Cylinders & air receivers Air receivers are tested & labeled on the body as per statutoru requirements
47 Gas Cylinders & air receivers valid certificates of the safety valves are kept at site
FINAL SCORE ON HEALTH & SAFETY
 BL's HSE AUDIT PROTOCOL –
Annexure A
Score
s
1 2 3 4

Lack of awareness/

Maintained at per
Maintained below

Excellent & Best

no initiative

Final Score
S Them Points to be

Remarks
r

Practice
e audited
N
o

BL

BL
std

1 Waste
2 Waste
3 Waste
4 Soil and Groundwater
5 Water Supply
6 Water Supply
7 Energy Consumption
8 Energy Consumption
9 Energy Consumption
10 Greenhouse Effect Gas
11 Greenhouse Effect Gas
Underground Storage Tank &
12 Piping
std
ENVIRONEMENT
All the types and the nature of wastes generated at the site have been identified &
documented in
Form- 3.
Waste transfer& disposal documentations are maintained as per Form -13.
· regulatory compliance for the disposal of the waste can be proven;
· the storage areas of Chemicals & Petroleum products are subject to planned inspections in
order
to ensure their good management sound secondary containment.
· The site has knowledge of the source or sources of the water that it uses (local city supply
system,
pumping from the water table etc.);
· the site has quantitative data of its water consumption for each of its means of supply;
· the site has quantitative data on various types of energy consumption and for each of its
means of supply;
· an annual report on its consumption has been drawn up.
· the site has defined a program for the reduction of energy consumption (objectives and
targets);
· the site identifies all the activities that generate greenhouse gases;
· the site identifies the sources of the emissions of these gases;
The site has located (on a map if possible) all of its underground storage tanks, reservoirs and
piping
 present on the site;

Underground Storage Tank & · for each of the tanks, reservoirs and piping subject to regulatory testing, the test results
13
Piping file is up- to-date.
FINAL SCORE ON ENVIRONMENT