Appendix B: HSE Checklist for Low risk or Minor Contracts
Contract Holder Name: Contracting Company:
Contract Number:
Contract Holder shall ensure that the Contractor is fully aware of and understands the following statement:
“Contractor shall operate, and shall cause all sub-contractors and Contractor Personnel to operate, with the utmost care for the health and safety of Contractor Personnel, Company personnel and third parties, and for the environment, and in accordance with the Company's health, safety and environmental regulations (the HSE Specification) in force at the Effective Date, or as subsequently amended by the Company, and the Contractor shall exercise the strongest discipline in this regard.”
Contract Holder shall ensure that there is a formal HSE monitoring plan for all contracts. Contract holder shall ensure that the Contractor is fully aware and understands the importance of the quality and frequency of the performance monitoring.
Item No. / Contract Holder Action / Required for Contract?Coastal Interior / If Required, Action Completed?
Pre-execution of Contract:
1 / PDO 5555 Emergency number/procedure explained (PR1065) / MANDATORY / MANDATORY / NO
2 / Permit To Work requirements explained (PR1172) / MANDATORY / MANDATORY / NO
3 / Personnel Medically fit (reference SP1230) / MANDATORY / MANDATORY / NO
4 / Reportability of HSE incidents explained (PR1418) / MANDATORY / MANDATORY / NO
5 / PDO Road Journey Management Procedures explained (SP2000) / Not required / MANDATORY / NO
6 / Vehicle(s) meet PDO standards (SP2000) / Not required / MANDATORY / NO
7 / Area Coordinator briefed about interior visit / Not required / NO / NO
8 / HSE workshop with contractor completed / NO / NO / NO
9 / Identification of Hazards & Effects completed for Contract Scope of Work / NO / NO / NO
10 / Life Saving Rules included in HSE site induction / MANDATORY / MANDATORY / NO
11 / HSE Commencement Certificate signed / NO / NO / NO
12 / HSE Training requirements explained (SP1157) / NO / NO / NO
13 / HSE Training commenced / NO / NO / NO
During Execution of Contract:
14 / Contractor working practices monitored by Company Site Rep. / NO / NO / NO
15 / HSE Training completed / NO / NO / NO
Post-execution of Contract:
16 / Site Restoration Certificate Issued / NO / NO / NO
17 / Contract HSE Report filed / NO / NO / NO
All Mandatory and Contract Requirements completed
Signed: ______Date:Contract Holder
Signed: ------Date:HSE Advisor
All Mandatory and Contract HSE Requirements explained and understood.
Signed:______Date: Contractor
Monday, October 12, 2015 - LOW Risk or Minor Contract