HSE Performance Evaluation Summary Site Name
Date
WBS Name
HSE Incharge
Man Power
No. of Exec Engineers
No. of HSE Staffs Sl No.
Description of Item
Max. Marks
A
Administrative
300
1
Commitment & Involvement
80
2
Compliance of PTW
50
3
Credibility System
50
4
Incident Record
20
5
Training
40
6
Sub-contractor Management
20
7
Action tracking system (ATS)
15
8
Reward & Reprimand
25
B
Field
700
9
House Keeping
100
10
Personal Protective Equipment (PPE)
50
11
Material Handling
100
12
Electrical
30
13
Welding, Gas Cutting and Grinding
50
14
Confined Space
30
15
Fire Protection
30
16
Traffic
35
17
Work at Height
150
18
Welfare
30
19
Emergency Response Plan
30
20
HSE Communication and Awareness
35
21
Chemical Hazard
30
Page 1
Mark Obtained
Percentage
HSE Performance Evaluation Checklist S.No.
Description of Item
Max. Marks.
A
Administrative
1
Commitment & involvement Weather JSA is reviewed/ discussed during meetings? Whether safe work method discussed before start of new activity? Whether WBS carried out walk around? Whether Gang Safety Leader concept implemented effectively at site?
80
Compliances of PTW Permit to Work requirements identified and followed? (check permit to work and activity specific permit requirements) Regular STA conducted? Are engineers participating in STA? Credibility System Weekly HSE trend of UA/UC is tracked and reviewed weekly? Whether WBS review engineers score on daily basis? Whether weekly meeting is conducted by WBS with his team for credibility system review? HSE Staff are mapped with Execution staff and continuity of daily credible report open observation are closely tracked Incident Record Are recommendations noted during incident investigation being implemented? Check compliance status.
50
1.1 1.2 1.3 1.5 2 2.1 2.2 2.3 3 3.1 3.2 3.3 3.4 3.5 4 4.1 4.2 5 5.1 5.2 5.3 5.4 6 6.1 6.2 6.3 6.4 7 7.1 8 8.1 8.2 8.3 8.4
Lesson learnt from past incident are communicated to all? Training Compliances of following trainings Material handling training Scaffolding training Signal man training Skill specific training for Grinder/ Gascutter/ Welder Sub-contractor Management Are Sub Contractors being audited? Whether sub-contractor supervisor meeting conducted or not? Whether sub-contractor scores are reviewed? Whether efficient process of trade validation inplace? Action tracking system (ATS) ATS is being monitored and There is no ATS pending more than a week Reward & Reprimand Whether zero tolerance rule system implemented? Whether counseling booths are inplace? Records of counseling is Maintained? Records of employee HSE-related discipline are maintained (e.g., verbal / written warning, retraining, or termination). Workers motivational program is being conducted on weekly basis (2% worker awarded /month)
300 20 20 20 20
20 20 10 50 10 15 10 10 5 20 10 10 40 10 10 10 10 20 5 5 5 5 15 15 25 5 5 5 10
Mark Obtained
Remarks / Action
B 9 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 10 10.1 10.2 11 11.1 11.2 11.3 11.4 11.5 11.6 11.7 12 12.1
Field House Keeping Whether Scrap Bins are provided , used and regularly emptied? Whether elevated areas are maintained clear of debris, material, tools, etc., where such items could fall to areas below? Are Passageways / Walkways clean and free of trash and debris? Is the house keeping crew identified and placed for all areas? Is there any schedule for mass house keeping? Are protruding nails or other sharp objects being removed or bent? Is the access and work areas being maintained and kept clear of obstacles (hoses, cables, equipment's, material etc.)? House Keeping inside sub-contractor stores Personal Protective Equipment (PPE) Do the workmen use mandatory and job specific PPEs? Compliance level of Safety Goggles by staff and workmen. Material Handling Whether WBS ensuring that all cranes, Hydras and lifting tools& tackles are color coded & inspected? Counter weight swing area is properly barricadded Nobody working under suspended load during lifting whether authorized signalman engaged with each crane and Hydras Chain pulley block is not used for horizontal pulling softner are provided for sharp edge to prevent sling damages Proper support provided for structural members, equipment, pipes etc. Electrical Has the ELCB installed , numbered and inspected to protect against the leakage current? Check any random ELCB?
Are underground cables properly routed at required depth and route markers are 12.2 provided to identify the availability of the under ground cables? Are power cables properly routed 12.3 /suspended overhead so that they do not pose a tripping hazard? 13 Welding, Gas Cutting and Grinding Cylinders are not exposed to sunlight and 13.1 proper system for keeping it in upright position is made during handling and use. Gas cutting hose is without any crack or damage and laid properly. Check if hose is 13.2 routed properly so that it does not create tripping hazard. Usage of Fire blanket effectivly during hot 13.3 work at higher elevation Is gas cutting set provided with flash back 13.4 arrestor, crimped type clamps ,soap solution etc.? Is cylinder storage clearly identified and 13.5 maintained for fuel gas and oxygen? 14 Confined Space
700 100 10 20 10 10 20 10 10 10 50 40 10 100 20 20 20 10 5 5 20 30 10
10
10 50 15
10 10 5 10 30
Whether confined space identified & displayed? Are confined space procedure requirements 14.2 implemented? Whether confined space entry permit is filled? Check record. 14.1
14.3 14.4 15 15.1 15.2 15.3 16 16.1 16.2 16.3 16.4 16.5 17 17.1 17.2 17.3 17.4 17.5 17.6
17.7 18 18.1 18.2 18.3 18.4 19 19.1 19.2 19.3 20
Is the work performed under the competent supervision? Are all workmen/hole watcher trained? Record available? Fire Protection Are fire extinguishers periodically inspected? Are personnel trained for fire fighting? Whether combustible waste controlled? Traffic Considering size of the area/unit are sufficient numbers of parking areas identified and vehicles parked only at designated parking area? Are wheel choke provided on parked vehicle? Adequate passages available for vehicle movement? Are traffic instructions and signage displayed, communicated and followed? Are pedestrian paths separated and maintained from the vehicle routes and same are being used. Work at Height Is a fall protection plan, including rescue arrangements, prepared and available at work location. Is the scaffold erected and checked using scaffold checklist and certified by Competent person? Fall protection in the form of Personal Fall Arrest Systems (PFAS), safety nets, life lines etc. is provided and used? Whether the erection and dismantling of scaffold is done by trained persons under supervision? Whether workers working on approved and certified scaffold having green tag? Falling objects (tools, plate, pipes etc.) protection measures such as safety net, tool bags, tool lanyards, barricade etc. Are provided? Whether floor openings are properly guarded or are covered with a secured cover and properly labelled? Welfare Are adequate numbers of urinals, toilet, drinking water facilities available at site? Are urinals, toilet, drinking water facilities are cleaned and serviced on periodic basis? Are sufficient numbers of rest sheds with proper sitting arrangements provided at site? Are First aid boxes available at site? Is it properly maintained and required First Aid supplies are available? Emergency Response Plan Are Emergency contact numbers and evacuation routes posted around workplace and offices? Emergency responders training and drill conducted. Check records. Are emergency escape routes maintained in all work places? HSE Communication and Awareness
10 10 5 5 30 5 5 20 35 10 10 5 5 5 150 20 30 20 20 20 20
20 30 10 5 5 10 30 10 10 10 35
Relevant HSE instructions/caution boards/Chemical Hazard information 20.1 posters / tags etc. displayed at strategic locations? Organization of HSE awareness campaigns 20.2 and workers and management participation. Are HSE awareness /promotional posters, 20.3 symbols used as required to warn employees where potential hazards exist? 21 Chemical Hazard Chemical containers, including waste 21.1 containers, in good condition, clean, closed securely, and labelled properly. Chemicals stored at separate place in an 21.2 orderly manner and segregated by hazard class. Materials are identified clearly and dangers 21.3 are known (MSDS available)? 21.4 Hazard communication to the concerned? Total Marks :
10 10 15 30 10 5 10 5 1000