The

ENTRANTS WILL BE REQUIRED TO:

Answer 12 Key Performance Questions PART I - (ORGANIZATION PROFILE), PART- II (LAGGING INDICATORS) and PART III - (Declaration of Award Entry)

PART I

Organisation Profile
1. Please provide a brief description of your business profile (maximum one page) and your organisations structure. 2 Key Performance Questions: Evaluation of your HSE performance shall be done based on the following Key Performance Questions (KPQs). Please provide a brief description of the activities carried out under the each KPQ with supporting documents. 2.1 HSE Leadership and Administration 2.1.1 HSE Policy 2.1.2 Senior and Middle Management participation in HSE 2.1.3 Individual responsibility in HSE 2.1.4 Integration of HSE into business planning process 2.1.5 HSE committee and representatives 2.1.6 Regulation, codes and standard compliance 2.2 HSE Communication 2.2.1 Employee HSE orientation / induction Program 2.2.2 Internal communication ( HSE information within the company) 2.2.3 External communication ( HSE issues to community and external agencies) 2.3 HSE Training 2.3.1 Training need analysis 2.3.2 Knowledge and skill training 2.3.3 Workers HSE Training 2.3.4 Training evaluation and record keeping 2.4 Health & Hygiene control 2.4.1 Periodic health monitoring of workers and record keeping 2.4.2 Health hazard identification and control 2.4.3 Hygiene of the work place and camps 2.5 Hazard/ Incident /Accident reporting , investigation and analysis 2.5.1 Reporting & Investigation of Accidents / Incidents 2.5.2 Behaviour Based Safety process in place

2.5.3 Near miss reporting 2.5.4 Hazard identification and reporting 2.5.5 Implementation of recommendations 2.5.6 Communication of lesson leant from accidents/incidents/near miss 2.5.7 Record keeping 2.6 Emergency Preparedness 2.6.1 Emergency roles and responsibilities identified 2.6.2 Emergency drill 2.6.3 Emergency communication 2.6.4 Lesson leant system from emergency drill 2.7 HSE Promotion 2.7.1 Individual award and recognition 2.7.2 Group award and recognition 2.7.3 Housekeeping promotion 2.7.4 Off the job safety promotion 2.8 HSE management of sub contractor & Employees 2.8.1 Pre employment evaluation of employees 2.8.2 Sub contractors selection process based on HSE credential 2.8.3 Management of sub contractors 2.9 Companys HSE Achievements 2.9.1 OHSAS 18001 or ISO 14001 certification 2.9.2 Inclusion on clients preferred contractor list 2.9.3 Results from proprietary external audit scheme 2.9.4 Any other recognized award winner 2.10 Inspection & Audits 2.10.1 2.10.2 2.10.3 2.10.4 2.10.5 Internal audits External audits Planned inspections Proactive and preventive measures to control loss Follow up for audit and inspection report

2.11 Environmental management 2.11.1 2.11.2 Effluent, Air Emissions & Waste Management Any initiative to improve environment

2.12 Other HSE related highlights

E-mail : contact@asse-hseawards.com Chapter Website: www.assekuwait.org

Fatalities:

Points of Reference
Medical Treatment Only Case (MTOC):
All MTOC is a work related case for which Medical treatment is give, but that does not result in a RWC or LWC.

Fatal Cases are those work related injuries / illness that result in death. Number of days lost for each Fatal Case shall be 180 days.

LWC Injuries:
If an Employee is unable to work on his next scheduled shift because of a work related injury / illness, Precedence at the site does not constitute work.

Loss Damage Incidents:

Loss Damage incidents which result a loss amounting more than US $ 10,000/-

Restricted work day cases (RWDC):

RWDCs are injuries which are severe enough to prevent a person from performing normal duties, but not so severe that lighter duties cannot be performed.

Motor Vehicle Incidents (MVI):

An undesired occurrence of event involving a motor vehicle that result in Loss Damage of Vehicle, property amounting over US$ 1000/- or and, resulting in Fatality / LWC injury. MVI Covers A motor vehicle owned. Leased or rental that is assigned to its company Employee.

Lost Time Injury

Frequency Rate
Lost Time

Total number of (Fatal + LWC) injury Total man-hours worked by all employees Total days away from work (Fatal + LWC)

X 200000

Total recordable incident rate

Total recordable Incidents (Fatal + LWC + RWDC + MTOC) Total man-hours worked by all employees Total Motor Vehicle incident Total Kilometers Driven

X 200000

X = Accident Severity Total man-hours worked by all employees

200000

(MVIFR)

X 1,000,000

Guidelines for Registration:

Completed application with attachments must reach ASSE Kuwait Chapter office latest by 21 April 2012.
Application Packets must contain: 1. Each entry application covers organizations individual site or Business unit. 2. Answer all Key Performance Questions and Incident data for preceding three years. 3. Submission shall be secured with completed entry form, KPQ answers and supporting documents, all into one rigid A4 box folder. 4. Registration Fee payment, drawn in favor of Kuwait Society of Engineers Account No. 0600077532001, Payable at Al-Ahli Bank of Kuwait, Head Office, Kuwait Application Packet along with attachments must be submitted to: Executive Officer Chapter Operations American Society of Safety Engineers - Kuwait Chapter Kuwait Society of Engineers Complex, Bneid Alghar, Near Safir International Hotel P.O. Box 4047, Safat-13041, Kuwait Tel: +965 22445588 Ext 311, Mob: +965 66846040 Fax: +965 22428148 E-mail: contact@asse-hseawards.com Chapter Website: www.assekuwait.org o o o The identity of each applicant is kept confidential. Only award recipients will be recognized and publicized. Submittals must be written in English. During the process of evaluation, if there is any change in the addresses or any other details of communication, please provide the updated information to the contact details to contact@asse-hseawards.com This Award program does not bear the responsibility for non-receipt/late receipt of any material sent. o o o o Keep a copy of your submittal for your reference. Submittals, once received will not be returned. Wherever it is required necessary supporting documents are to be attached along with the Submittals. References to supporting evidence shall be clearly made in the narrative text. Define all the abbreviations.

PART II

Lagging Indicators
Accident/Incidents History
For your organisation give the number of each of the following. If not applicable insert 0 or NIL DO NOT LEAVE BLANK. Data provided is subject to verification if need be.

Section 2.1
2009 2010 2011

Fatalities Lost Work Case injuries (LWC) Restricted Work Day Cases (RWDC) Medical Treatment Only Case (MTOC) Loss Damage Incidents Total recordable incident rate (TRIR) Motor Vehicle Incidents ( MVI) Total man hours worked Section 2.2
Accident Frequency Rate 2009 2010 2011

Accident Frequency Rate Section 2.3

Accident Severity Rate 2009 2010 2011

Accident Severity Rate Section 2.4 Motor Vehicle Incident Frequency Rate ( MVIFR)
2009 2010 2011

Motor Vehicle Incident Frequency Rate ( MVIFR)

Conditions:
o o o By submitting an application to this award, applicant agrees for publication of the results. Applicants may be asked at any time during the review process to substantiate the claims made in the submission. If submission requirements are not met or the information is found to be incomplete, untrue or misleading, the submittal will be removed from the review process. o The Evaluation Panel has the sole right and discretion to reject entries that do not meet the submission requirements. The decision of the adjudication panel shall be final and binding. All applications require full payment of the appropriate entry fee, as shown. Non-payment of the relevant entry fee will invalidate the application.

o o

PART - III

Application. No

Application Form (Declaration)

Please provide Organization/Company Information
Organization/Company Name Award Category Applied for ( Tick the relevant column)

    

ENGINEERING & CONSTRUCTION MANUFACTURING OIL & GAS FACILITY & MAINTENANCE SECTOR

Postal Address Postal/Zip Code City State/Province Country Contact Person Name Job Title e-mail Phone with country code Cell Phone Fax with country code The following signatures attest to the completeness and accuracy of this entry, which is submitted to the ASSE - Kuwait Chapter for ASSE GCC HSE Excellence Award 2012 in good faith.

Registration Fee
Registration fee of US $ 300 or equivalent in Kuwaiti Dinars ( KD 100/) shall accompany the award application. This registration fees is non refundable. The Registration fees should be in the form of

Managing Director (or equivalent)

Name: Signature: Job Title: Date:

Cheque / Cash / Bank Transfer

Health Safety & Environment Head

Name: Signature: Job Title: Date:

In case of cheque or bank transfer please draw in favor of Kuwait Society of Engineers Account No. 0600077532001, IBAN # kw86abkk 0000 0000 0060 0077 5320 01, Payable at Al-Ahli Bank of Kuwait, Head Office, Kuwait

Applications along with attachments must be submitted to:

Executive Officer Chapter Operations

American Society of Safety Engineers - Kuwait Chapter Kuwait Society of Engineers Complex, Bneid Alghar, Near Safir International Hotel P.O. Box 4047, Safat-13041, Kuwait Tel : +965 22445588 Ext 311, Mob: +965 66846040 Fax : +965 22428148

Last day of registration for the application