CSMS Rev5 PHE ONWJ Forms Checklist Final 2011 (Bag 2)

New Contracts
Qulification Phase: Select A Qualified Contractor
Pre-Qualification
Selection
Risk Assessment
CSMS
Contract Award
Data Bank
Contract Implementation Phase: Ensure Field Safe Work
Pre-Job Activity
Work In Progress
Final Evaluation
CSMS
Forms and
Checklists
Rev-5: 2011
Contractor Health, Safety, and

Environmental Management System
INDEX
Appendix I. Risk Assessment Forms ....................................................................................... 35
APPENDIX I.1. FORM CSMS/RA/01 ......................................................................................... 36
APPENDIX I.2. FORM CSMS/RA/02 ......................................................................................... 42
Appendix II. Pre-Qualification Forms .................................................................................... 43

APPENDIX II.1. FORM CSMS/PQ/01: ....................................................................................... 43
APPENDIX II.2. FORM CSMS/PQ/02: ...................................................................................... 44
Appendix III. Selection Forms ............................................................................................... 65

APPENDIX III.1. FORM CSMS/SL/01: ....................................................................................... 65
Appendix IV. Pre-Job Activity Form ....................................................................................... 81

APPENDIX IV.1. FORM CSMS/PJA/01: ..................................................................................... 84
APPENDIX IV.2. FORM CSMS/PJA/02: ..................................................................................... 85
Appendix V. Work In Progress (WIP) Forms ........................................................................... 81

APPENDIX V.1. FORM CSMS/WIP/01: ...................................................................................... 89
APPENDIX V.4. FORM CSMS/WIP/04: .................................................................................... 101
APPENDIX V.5. FORM CSMS/WIP/05: .................................................................................... 103
Appendix VI. Final Evaluation Form ...................................................................................... 93

APPENDIX VI.1. FORM CSMS/FE/01: ..................................................................................... 104
Appendix I. Risk Assessment Forms
Risk Assessment
New Contracts
Qulification Phase: Select A Qualified Contractor
Pre-Qualification
Selection
Risk Assessment
CSMS
Contract Award
Pre-Job Activity
Work In Progress
Final Evaluation
Data
Bank
Contractor Health, Safety and Environmental Management System

(CSMS) Guidelines
Appendix I.1. Form CSMS/RA/01
No
Risk Area
Risk Exposure
What
(Impact Severity x Likelihood) L/M/H

People
Nature of work
Work location
Materials/equipm
ent used
Potential for
exposure to work
site hazards
Potential
exposure to
hazards for all
personnel
Simultaneous
work by different
contractors
Work duration
Potential incident
consequences
Contractor
experience
10
Exposure to
negative publicity
Assets
Page 35
CUSTODIAN: SAFETY TEAM LEADER
PAPER COPIES ARE UNCONTROLLED
THE CONTROLLED VERSION OF THIS DOCUMENT IS ON THE ELECTRONIC FILE AT HSE DEPARTMENT
Environment
Reputation
Remarks

(CSMS) Guidelines
DEFINITION OF CONSEQUENCES SEVERITY OF IMPACT
Consequences
HEALTH AND
SAFETY
Severity Level
F
LOW
MEDIUM
HIGH
Potential
Severity
Impact
Slight Injury or
Health Effect
Definition
- First aid
- No effect on work performance
Minor Injury or
Health Effect
- Medical treatment case

- Restricted work case
- LTI (a few days)
- Agents capable of minor health effects which are
reversible (No hospitalization)
Major Injury or
Health Effect
- Prolonged LTI
- Agents capable of moderate health effects which are
reversible but with hospitalization
Permanent
Disability
- Accident/ illness resulting permanent disability

- Agents capable of irreversible effects without loss of life
but with serious disability and prolonged hospitalization
1-2 Fatalities
- Accident/ illness resulting up to 2 fatalities

- Outbreak within facility leading to potential shutdown of
facility
- Agents capable of irreversible effects leading to death
3 Fatalities
- Accident / illness resulting more than 3 fatalities

- Outbreak to neighbourhood
- Agents with the potential to cause multiple fatalities eg.
chemicals with acute toxic effects
Page 36

(CSMS) Guidelines
Page 37

(CSMS) Guidelines
Page 38

(CSMS) Guidelines
Page 39

(CSMS) Guidelines
DEFINITION OF LIKELIHOOD
LIKELIHOOD
DEFINITION
Quantifification
Rare or never heard of in the industry
<10-6per year
Heard of in the industry
10-6 to 10-4 per year
Low (L)
Has occurred on PHE ONWJ up to once in 100 years
10-4 to 10-2 per year
Medium (M)
Has occurred on PHE ONWJ during its lifetime up to

once per year OR conditions may allow the event to occur
on PHE ONWJ during its lifetime up to once per year
10-2 to 1 per year
High (H)
Has occurred more than once per year on PHE ONWJ

OR event can reasonably be expected to occur more than
once per year on PHE ONWJ
>1 per year
Almost Impossible (AI)

Very Low (VL)
Page 40

(CSMS) Guidelines
RULE OF THUMB IN DEFINING THE RISK EXPOSURE
LIKELIHOOD
Almost
Impossible
Very Low
Low
Medium
High
IMPACT SEVERITY
Page 41

(CSMS) Guidelines
Appendix I.2. Form CSMS/RA/02
RISK ASSESSMENT RESUME
Date
Project Period :
Job Title
Contract No
Work Location
Risk Category
Explanation
L (Low)
M (Medium)
H (High)
Assessed by:
Approved by:
(Contract Originator)
(Team Leader)
Page 42
Contractor Safety, Health and Environmental Management System

(CSMS) Guidelines
Appendix II. Pre-Qualification Forms
Pre-Qualification
New Contracts
Qualification Phase: Select A Qualified Contractor
Pre-Qualification
Selection
Risk Assessment
Contract Award
Data Bank
Pre-Job Activity
Work In Progress
CSMS
Final Evaluation

(CSMS) Guidelines
Appendix II.1. Form CSMS/PQ/01
PRE-QUALIFICATION
Date
Project Period
Job Title
Contract No
Work Location
Contractor Name
Address
Assessed by:
Approved by:
(Team Leader)
Page 43

(CSMS) Guidelines
Appendix II.2. Form CSMS/PQ/02: Contractor HSE MS Questionnaires
Company Name:
Work Subject:
SECTION 1 LEADERSHIP AND TOP MANAGEMENT COMMITMENT

1. Commitment to HSE through leadership
a) How are senior managers is top management personally involved in HSE management?
b) Provide evidence of commitment at all levels of the organization by:

(i) Stating this year's company targets for HSE performance
(ii) Describing how you ensure that your organization understands and is committed
to deliver your company HSE targets
c) How do you promote a positive culture towards HSE matters?
d) Provide your current Organization chart
Page 44

(CSMS) Guidelines
SECTION 2 POLICY AND STRATEGIC OBJECTIVES

2.1. HSE Policy & Documents
a) Does your company have an HSE policy document that is applied?

(Yes/No) If yes, please attach.
b) Who has overall and final responsibility for HSE in your organization?
c) How do you ensure HSE Policy compliance and communication at site?
2.2. Availability of Policy Statements to Employees
How do you communicate your company's policy to your employees including any changes?
Page 45

(CSMS) Guidelines
SECTION 3: ORGANIZATION, RESPONSIBILITY, RESOURCES, STANDARDS AND

DOCUMENTATION
3.1. Organizations - Commitment and Communication
a) How is management involved in HSE activities, objective setting and monitoring?
b) What provision does your company make for HSE communication and meetings?
3.2. Competence and Training of Manager/Supervisors/Senior Site Staff/HSE Advisor
Have the managers and supervisors at all levels that will plan, monitor, oversee and carry out the
work received formal HSE training in their responsibilities with respect to conducting work to HSE
requirements? (Yes/No)
If yes, please attach the training matrix.
3.3. Competence and General HSE Training
a) What arrangements does your company have to ensure employees have knowledge of basic
industrial HSE, and to keep this knowledge up to date?
b) What arrangements does your company have to ensure ALL employees, including sub
contractors, also have knowledge of your HSE policies and practices?
Page 46

(CSMS) Guidelines
SECTION 3: ORGANIZATION, RESPONSIBILITY, RESOURCES,

STANDARDS AND DOCUMENTATION
3.4. Specialized Training
Have you identified areas of your company's operations where specialized training is required to
deal with potential hazards? (Yes/No)
If Yes, please provide the list (e.g. radioactive, asbestos, explosive, diving, etc).
3.5. HSE Qualified Staff - Additional Training
Does your company have HSE specialist (related to your company's services) who can provide
training for other employees? (Yes/No)
If Yes, please attach the curriculum vitae

3.6. Assessment of Suitability of Subcontractors
a) Do you employ sub-contractor(s) for the intended service? (Yes/No)

If No, please go to the question 3.7.
Do you have sub-contractor(s) selection procedure in term of HSE?
b) How do you assess your sub-contractor(s) to ensure they comply with your company's HSE
policy and standards?
Page 47

(CSMS) Guidelines
SECTION 3: ORGANIZATION, RESPONSIBILITY, RESOURCES,

3.7. Standards
a) What kind of HSE regulatory or industrial standards that your company refer to for the
intended service?
b) How do you ensure these are met and verified?
SECTION 4: HAZARDS AND EFFECT MANAGEMENT

4.1. Hazards and Effect Management
Does your company have procedure for the identification, assessment, control and mitigation of
hazards and effects? (Yes/No)
If Yes, please attach the index/table of content including the sub-index.
4.2. Exposures of the Workforce
What systems are in place to monitor the hazard's exposure of your workforce e.g. chemical or
physical agents?
4.3. Handling of Potential Hazards
How is your workforce advised on potential hazards, e.g. chemicals, noise, radiation, etc.,
encountered in the course of their work?
Page 48

(CSMS) Guidelines
SECTION 4 : HAZARDS AND EFFECT MANAGEMENT

4.4. Personnel Protective Equipment
a) What arrangements does your company have for provision and unkeep of protective
equipment and clothing, both standards issue, and that required for specialized activities?
b) Do you provide appropriate personal protective equipment (PPE) for your employees?
(Yes/No)
Please provide a listing of the PPE for the scope of this work.
c) Do you provide training on how to use PPE? (Yes/No)
Explain the content of the training and any follow-up
d) Do you have a program to ensure that PPE is impacted and maintained?
4.5. Waste Management
a) What systems are place for identification, classification, minimization and management of
waste?
b) Please provide the number of accidents resulting in environmental damage in the amount
greater than $50,000 for the last 24 months. Attach copies of any governmental reports
submitted.
c) Do you have procedures for waste disposal? (Yes/No)
d) Do you have procedures for spill reporting? (Yes/No)
e) Do you have procedures for spill clean up?(Yes/No)
f) Please provide details at any of your equipment related to environmental matters.
Page 49

(CSMS) Guidelines
SECTION 4 : HAZARDS AND EFFECT MANAGEMENT

4.6. Industrial Hygiene
Do you have an industrial hygiene program? (Yes/No)
Please describe this process. If Yes, please provide the list.

4.7. Drugs and Alcohol
Do you have a drugs and alcohol policy in your organization? (Yes/No) If yes, please attach
SECTION 5: PLANNING AND PROCEDURES

5.1. HSE or Operations Manuals
a) Do you have HSE procedures? (Yes/No) If Yes, please attach the list of content
b) How do you ensure that the working practices and procedures used by your employees on-site
are consistently in accordance with your HSE policy objectives and arrangements?
5.2. Equipment Control and Maintenance
How do you ensure that plant and equipment used within your work environment, on-site, or at
other locations by your employees are correctly registered, certified with regulatory requirement,
inspected, controlled and maintained in a safe working condition?
5.3. Transport Safety Management and Maintenance
What arrangement does your company have for vehicle incidents prevention?
5.4. Lifting Operation Procedure (if applicable)
Do you have any procedures to control the work involved in lifting operation?
5.5. Maintenance Schedule of Lifting Operation Equipments (if applicable)
Do you have any inspection, testing, maintenance and certification programs and schedule for
lifting equipments e.g. crane, forklift and rigging equipment?
5.6. Competency of Lifting Operation Personnel (if applicable)
Do you have any system to ensure that the lifting teams e.g. lifting equipment operators,
signalmen and rigging personnel are competent?
Page 50

(CSMS) Guidelines
SECTION 6: IMPLEMENTATION AND PERFORMANCE MONITORING

6.1. HSE Management and Performance Monitoring of Work Activities
a) What arrangement(s) does your company have for supervision and monitoring of HSE
performance?
b) What arrangements does your company have for passing on any results and findings of this
supervision and monitoring to your:
(i) Top/Base management
(ii) Site employees
c) Has your company received any award for HSE performance achievement? (Yes/No)
6.2. Statutory Notifiable Incidents/Dangerous Occurrences, Improvement Requirement and Prohibition
Notices
Has your company suffered any improvement requirement or prohibition notices on statutory
notifiable incidents/dangerous occurrences by the relevant national body, regulatory body for
HSE or other enforcing authority or been prosecuted under any HSE legislation in the last five
years? (Yes/No)
If yes, please give the number of occurrences and its short description.
6.3. HSE Performance Records
a) Please provide statistical details of your HSE performance over the past 3 years (if not
recorded/applicable please mark N/R or N/A)
Total Number
Frequency
(incl. All contract & sub contract personnel)
(based on OSHA)
Fatalities
Loss Time Incidents (LTI)
Total Recordable Cases (e.g. Medical Treatment, Restricted Work, Transfer to Another Job,
Unconsciousness)
b) How is health performance recorded?

c) How is environmental performance recorded?
Page 51

(CSMS) Guidelines
SECTION 6: IMPLEMENTATION AND PERFORMANCE MONITORING

6.4. Incident Investigation and Reporting
a) Do you have a procedure for the investigation, reporting and follow-up of accidents,
dangerous occurrences or occupational illnesses? (Yes/No) If yes, please attach
b) How are the findings following an investigation, or a relevant incident occurring elsewhere,
communicated to your employees?
Please attach an example of investigation reports during the last 12 months.
SECTION 7: AUDIT AND REVIEW

a) Do you have a written procedure on HSE auditing? (Yes/No)
b) How does this procedure specify the standards for auditing, including schedule, coverage and
the qualifications for auditors?
c) How is the effectiveness of audit verified and how does management report and follow up
audits?
SECTION 8: EMERGENCY RESPONSE PROCEDURE

Do you have an emergency response plan? (Yes/No) If yes, please attach
SECTION 9: HSE MANAGEMENT - ADDITIONAL FEATURES

Does your company hold association(s) membership? (Yes/No)
If yes, please provide the list
Page 52

(CSMS) Guidelines
Form CSMS/PQ/02
Appendix II.3. Form CSMS/PQ/03
PRE-QUALIFICATION TABLE TOP EVALUATION

(PRIOR SITE VISIT)
Company
: ___________________________
Evaluator
: ___________________________
Date
: ___________________________
Item
Number
Item Description
Verification
Positive
Practices
Evaluated by:
Page 53
Gaps
Score
Before
After
Site Visit
Remarks

(CSMS) Guidelines
Appendix II.4. Form CSMS/PQ/04:
PRE-QUALIFICATION EVALUATION CRITERIA

A
Section 1: Leadership and Commitment

Commitment to HSE through leadership: Item 1 (a - d).
No commitment from
senior management
HSE disciplines
delegated to line
managers no direct
involvement by senior
management
Evidence of active senior

management
involvement in HSE
aspects
Evidence of a positive
HSE culture in senior
management and at all
levels
Section 2: Policy and Strategic Objectives

HSE policy documents and availability: Items 2.1 and 2.2.
Policy statements exist
but responsibility for HSE
is unclear.
A policy statement exists

with clear responsibility
for HSE but not in a
widely distributed
document
HSE policy establishes

responsibility for HSE in
languages easily
understood, but not
widely distributed
Policy with clearly

established responsibility
and accountability; is
distributed to all
employees; and is visible
on notice boards
Section 3: Organization, Responsibilities, Resources, Standards and Documentation

HSE communication and meeting programmes: Item 3.1 (a - b).
No management
involvement or
commitment toward HSE
activity
Management
involvement and
commitment toward HSE
in special occasion only,
likewise for periodic HSE
meetings.
Regular management
involvement and
commitment toward
HSE. HSE meetings
performed on a regular
basis at management
and supervisor level
Regular management
involvement and
commitment toward
HSE. Regular HSE
meetings performed and
employees are assigned
topics to discuss on a
rotational basis
HSE training established

and implemented but
only to a limited staff
only.

and fully implemented to
all staff related to the
work.
Staff HSE training: Item 3.2.

No HSE training
established

but not implemented.
Page 54

(CSMS) Guidelines
A
Section 3: Organization, Responsibilities, Resources, Standards and Documentation (contd)

Employee competency and HSE training: Item 3.3. (a - b).
No formal programme
Formal program
established to update
employee knowledge on
HSE.Verbal instructions
on company procedures
only for new employee.
Orientation booklet
provided for new
employees but no onthe- job orientation by
supervisor
Formal program
established and
implemented for
employee and new
employee on HSE.
Update employee
knowledge on HSE.
Employee handbook
provided and supervisor
outlines, explains and
demonstrates new
employee's job
Formal program
established and
implemented for
employee and new
employee on HSE. Update
employee knowledge on
HSE. Employee handbook
provided and supervisor
outlines, explains and
demonstrates new
employee's job. With:
follow-up observation of
the new employee's work
is also included.
Supervisor has explained
to him safe practices and
emergency duties
Specialized HSE training

established and
implemented.

established and
implemented on a regular
basis. Retraining periods are
established. Qualified HSE
professional are employed.
Assessment program and

standards for
subcontractor are
established and
implemented.

standards for subcontractor
are established and fully
implemented. Quality
assurance for compliance in
place.
HSE performance
standards established and
in compliance with local
industry regulatory
standards.
HSE performance standards

established and in
compliance with local and
global industry regulatory
standards.
Specialized training: Items 3.4 and 3.5.

No specialized HSE training
established

established but not
implemented.
Subcontractors: Item 3.6 (a - b).

No assessment program for
subcontractor established.

standards for subcontractor
are established, covering
limited area only but not
implemented yet,
HSE Performance Standards: Items 3.7 (a - b).

No HSE performance
standards available
HSE performance standards

established for limited
purposes only or partial
and in compliance with
local industry regulatory
standards only.
Page 55

(CSMS) Guidelines
A
Company's HSE system

includes methods for the
assessment of major
hazards and effects

has a comprehensive set
of methods for the
assessment of all HSE
hazards and effects and
applies them to all of its
contracts with
documentation
Company has formal

methods for monitoring
exposure to the major
hazards
Company has a set of

formal methods for
monitoring exposure to
all foreseeable hazards
(linked to its hazards and
effects assessment
method) and applies
them to all contracts
Section 4: Hazards and Effects Management

Hazards and Effects Assessment: Item 4.1.
does not include hazards
and effects assessment

makes reference to the
need to assess hazards
and effects but has no
comprehensive structure
to carry this out
Exposure of the workforce: Item 4.2.

Company does not
actively advise the
workforce nor monitor
exposure
Company advises the

workforce of the major
hazards that they are
likely to be exposed to
but only monitors
exposure randomly
Potential Hazards (chemical, physical and biological hazards such as noise, radiation, vapors,
fumes, temperature extremes etc.): Item 4.3.
Company makes no
special provision for
advising the workforce
about properties of
potential hazards
Company provides
information to workforce
in the workplace on
properties of potential
hazards but has no
active follow-up
Company distributes
information to
individuals in the
workforce at start of their
involvement on-site
Page 56
Company maintains a
database of the
properties of all potential
hazards encountered in
its contracts and has
formal methods of
information distribution
to all personnel and
trains its workforce in
handling, etc.

(CSMS) Guidelines
A
Section 4: Hazards and Effects Management (contd)

Personal protective equipment: Item 4.4 (a d)
Basic PPE provided to
personnel but no
corporate procedure for
assessing individual
needs
PPE requirements
formally assessed but
little effort made to
ensure correct usage
PPE requirements
formally assessed with
spot checks on usage
Procedures in place to
assess all PPE
requirements monitor
and enforce usage and
replacement needs.
Stock inventories
monitored, kept above
demand levels. Training
in use provided where
needed
Company has
procedures for the
disposal of each of the
main categories of site
wastes but makes no
provision for minimizing
environmental impact
Company has a formal

system for waste
management (including
identification,
minimization and
classification), which
actively seeks to
minimize environmental
impact
A procedure exists and

recognizes hazards but is
not followed up.
A procedure exists which

manages operations to
minimize human health
impacts providing a
workplace free of
recognized health
An alcohol and drugs

procedure includes
establishing responsibility
and accountability, and
widely distributed
Drugs procedure with

clearly established
responsibility,
accountability, and
disciplinary clause is
distributed to all
employees; and is visible
on notice boards
Waste management: Item 4.5 (a f)

Company has no formal
methods for the control
of waste
Company has general

procedures for waste
disposal
Industrial Hygiene Items 4.6

No Industrial Hygiene
procedure exists.
Basic procedure exists

but is not enforced.
Alcohol and Drugs Items 4 .7

No alcohol and drugs
procedure written
An alcohol and drugs

procedure statement
exists but not in a widely
distributed document
Page 57

(CSMS) Guidelines
A
Contractor has written

HSE procedures/manual
to cover all hazardous
operations
Contractor has
procedures to cover all
HSE
precautions/manual,
typical contractor HSE
Plan requirements with a
system of updating and
dissemination to
employees
A written programme
outlining supervisory
guidelines,
responsibilities,
frequency and follow-up
is in effect
In addition to C, periodic
inspections conducted by
top management or by
teams of specialists
Company has a general

management strategy
with some procedures for
its component issues
Company has a
complete strategy and
set of plans and
procedures covering
vehicles, drivers and
operations management
Section 5: Planning and Procedures

HSE or operations manuals: Item 5.1 (a b)
No HSE procedures /
manual is available
Basic HSE
procedures/manual exist
Equipment control and maintenance: Item 5.2

No defined programme
to ensure control and
maintenance of plant
and / or equipment
Program relies on
outside sources, i.e.
company inspections.
Supervisory inspection of
equipment confined to
worksite personnel only
Transport Safety Management: Item 5.3

No special attention paid
to transport safety as an
area of hazardous
activities
Importance of transport
safety acknowledged but
left to core business
managers/supervisors to
enact individually
Lifting Operation Procedure: Item 5.4, (if applicable)

No manual/procedures/
guidelines/instructions
for work control of lifting
operations are available
Basic procedures for

work control of lifting
operations exist
Standard written
procedures for lifting
operations are available
and implemented
Page 58
A comprehensive system
for work controls,
including lifting
operations is available
and continually
maintained to comply
with local regulations
and related international
industrial standards.

(CSMS) Guidelines
A
Maintenance Schedule of Lifting Operation Equipments: Item 5.5, (if applicable)

No inspection, testing,
maintenance or
certification programs for
lifting equipment are
available
Basic programs for

inspection, testing,
maintenance and
certifications for lifting
equipment exist
Standard programs for

maintenance and
certifications for lifting
equipment are available
including color coding is
implemented
A comprehensive system
and organization is
available to ensure that
the program for
maintenance and
certifications of lifting
operation equipments is
properly implemented in
accordance with the
local regulations and
related industrial
standards.
Competency of Lifting Operation Personnel: Item 5.6, (if applicable)

The lifting team displays
no evidence of clear
assignments, training or
competency assessments
Basic assignments,
training, and
competency assessments
for the lifting team exist
Roles and responsibilities

of involved parties in
lifting operations are
clear. Formal training
and certifications for key
persons and competency
assessment are available
and implemented
In addition to C, the
formal training and
certifications for al
related persons comply
with the local
regulations;related
industrial standards are
maintained.
Section 6: Implementation and Performance Monitoring

Management and performance monitoring of work activities: Items 6.1 (a c)
No system for formally
monitoring HSE
performance at all
Informal/incidental
monitoring HSE
performance only
Company has a system

for monitoring HSE
performance in key
areas
Page 59
Company has a
comprehensive system
for monitoring
performance in all areas
with feedback to
employers for
improvement and has
received awards for
achievement

(CSMS) Guidelines
A
Section 6: Implementation and Performance Monitoring (contd)

Statutory notifiable incidents, dangerous occurrences, improvement requirements and prohibition notices:
Items 6.2
More than one
occurrence of major
incident in last five years
One occurrence of a
major incident in the last
five years
Occurrences relate to
minor incident(s) only
No occurrences in the
last five years
HSE Performance records (Latest year injury rate comparison to contractors three preceding years average):
Item 6.3 (a - c)
Contractor supplied
insufficient information to
establish rate or rate
increases
Rate is not improving
Shows only minor rate

improvement
Rate steadily improving

by more than 20 per
cent per year
Incident Investigation and reporting: Item 6.4 (a - b)

Procedure are available
but Findings not
generally communicated

and Findings
communicated to key
personnel only via
limited company internal
memo or similar media

and Findings
communicated to all
employees via specific
company notice
Page 60
As in C but with the

addition of details of
implication for improving
HSE performance

(CSMS) Guidelines
A
Company HSE
documents include
details of how auditing is
to be implemented with
schedules/coverage for
the key areas
As in C but additionally
specifies management's
role in audit and followup on action items
Emergency procedures
written for major
scenarios, e.g.
fires/explosions, H2S,
evacuation, release of
toxic or flammable
materials and medical
emergencies. No
requirements established
for drill frequencies.
Emergency procedures
written for major
scenarios, e.g.
fires/explosions, H2S,
evacuation, release of
toxic or flammable
materials and medical
emergencies. Procedures
documented in an
Emergency Procedures
Manual, which is widely
distributed. Frequency of
conducting drills
established.
Company is a member
of at least one HSE
association
Company is an active
participant in at least
one HSE association
Section 7: Auditing and Review

Auditing: Item 7 (a - c)
Audit process is cursory
only - HSE documents
are not explicit about
auditing
Company HSE
documents include
reference to auditing but
there are no specific
details about scheduling
and coverage
Section 8: Emergency Response Procedure
Emergency Response Procedure : Item 8
No written Emergency
Basic procedures only.
Response.
Section 9: HSE Management - Additional Features

Membership of Associations: Item 9
No memberships
Company has
Membership of at least
one association but with
no prominence given to
HSE
Page 61

(CSMS) Guidelines
Appendix II.5. Form CSMS/PQ/05:
PRE-QUALIFICATION SCORING SHEET

Contractor
Address
Date
Contractor Safety Contract
Phone
: ______________________________________________
: ______________________________________________
: ______________________________________________
: ______________________________________________________
: ______________________________________________
Circle the number, which best represents this evaluation based on the criteria for rating purposes attached.
SECTION 1 LEADERSHIP AND COMMITMENT
12
SUBTOTAL
SECTION 2 POLICY AND STRATEGIC OBJECTIVES
SECTION2 ITEM 2 .1
SECTION2 ITEM 2 .2
Subtotal
Factor
X1
0
12
12
Subtotal
SECTION 3 ORGANIZATION, RESPONSIBILITY, RESOURCES,
X1/2
SECTION 3 ITEM 3 .1 (A B)
12
SECTION 3 ITEM 3 .2
12
SECTION 3 ITEM 3 .3 (A - B)
12
SECTION 3 ITEM 3 .4
12
SECTION 3 ITEM 3.5
12
12
12
Subtotal
SECTION 4 HAZARDS AND EFFECT MANAGEMENT
X1/7
SECTION 4 ITEM 4 .1
12
SECTION 4 ITEM 4 .2
12
SECTION 4 ITEM 4 .3
12
SECTION 4 ITEM 4 .4 (A D)
12
SECTION 4 ITEM 4 .5 (A F)
12
SECTION 4 ITEM 4 .6
12
SECTION 4 ITEM 4 .7
12
SUBTOTAL
TOTAL (SECT 1-SECT 4)
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SUBTOTAL (SECT 1 SECT 4)

A
SECTION 5 ITEM 5 .1) (A - B)
12
SECTION 5 ITEM 5 .2
12
SECTION 5 ITEM 5 .3
12
SECTION 5 ITEM 5 .4, (IF APPLICABLE)
12
12
12
Subtotal
Factor
SECTION 5 PLANNING AND PROCEDURE
SUBTOTAL IF LIFTING OPERATION IS NOT APPLICABLE
X1/3
SUBTOTAL IF LIFTING OPERATION IS APPLICABLE
X1/6
SECTION 6 IMPLEMENTATION AND PERFORMANCE MONITORING

SECTION 6 ITEM 6 .1 (A C)
12
SECTION 6 ITEM 6 .2
12
SECTION 6 ITEM 6 3 (A C)
12
12
SUBTOTAL
SECTION 7 AUDIT AND REVIEW
X1/4
0
10
SUBTOTAL
SECTION 8 EMERGENCY RESPONSE PROCEDURE
X1
0
10
SUBTOTAL
SECTION 9 HSE MANAGEMENT ADDITIONAL FEATURES
X1
0
SUBTOTAL
TOTAL RATING (SECT 1 SECT 9)
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X1
Total

(CSMS) Guidelines
SUMMARY
The numerical values below are the weighted ratings calculated above. The total represents the overall
score for the Contractor.
TOTAL RATING
_____________*)
EVALUATED BY:
NAME
TITLE
DATE
NAME
TITLE
DATE
*) FOR A BIDDER TO QUALIFY AS ACCEPTABLE, THE TOTAL RATING MUST BE EQUAL OR MORE
THAN 64.0 IF INSUFFICIENT NUMBERS OF BIDDERs ARE QUALIFIED, SELECTION SHALL BE
MADE FROM THE FIVE BIDDERS HAVING THE HIGHEST TOTAL RATING, PROVIDED THAT THE
PRIMARY FACTORS THEREOF MUST BE THE HIGHEST RELATIVE TO THE OTHER BIDDERS
PRIMARY FACTORS.
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Appendix III. Selection Forms
Selection
New Contracts
Pre-Qualification
Selection
Risk Assessment
Contract
Award
Data Bank
Pre-Job Activity
Work In Progress
CSMS
Final Evaluation

(CSMS) Guidelines
Appendix III.1. Form CSMS/SL/01
SELECTION
Date
Project Period
Job Title
Contract No
Work Location
:
:
Contractor Name :
Address
Assessed by:
Approved by:
(Team Leader)
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Appendix III.2. Form CSMS/SL/02:
EXAMPLE OF EXHIBIT H
HEALTH, SAFETY, AND ENVIRONMENT
(Attached and part of Contract No.______________)
1.
COMPANYS COMMITMENT TO HSE PERFORMANCE

COMPANY's policy is to manage all operations in a manner that protects the environment and
the health and safety of employees, customers, contractors, and the public.
Our goal is simply stated no incident.
To accomplish this, CONTRACTOR shall take all necessary precautions for the safety and health
of all personnel and environmental protection at the Worksite. All activities must comply with
COMPANYs applicable HSE Policies and Standards as listed in Attachment No.1 to Exhibit H
and all applicable Government laws, rules and regulations while working at any COMPANY's
premises. CONTRACTOR shall ensure that its subcontractors also comply with the abovementioned HSE requirements.
2.
CONTRACTORS HEALTH, SAFETY AND ENVIRONMENTAL (HSE) PLAN

CONTRACTOR shall establish and implement a HSE Plan designed to minimize the risk of injury
or illness to CONTRACTOR's Personnel from any physical, chemical, biological, ergonomics,
psychosocial and other hazards present at any COMPANYs premises, and to minimize the
potential of loss of or damage to the environment and any property.
HSE Plan shall be submitted within 14 days after Contracts Effective Date or refer to Performance
Schedule Exhibit.
CONTRACTOR's HSE Plan shall, where applicable, be based on COMPANY's HSE policies, rules
and procedures and include, at a minimum:
2.1.
Leadership and commitment

This describes a commitment to HSE issues through senior management personal style of
leadership and employees at all levels in the organization.
2.2.
Policy and strategic objectives

This describes a confirmation of the existence of a formalized policy that has reference to
importance of HSE.
2.3.
Organization, responsibilities, resources, standards and documentation
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This describes an organizational system explaining the set of practices in addressing HSE
issues.
2.4.
Hazard and Effect management

This describes an established scheme to clearly address hazard and effect management.
2.5.
Planning and procedures

This describes an existence of, documented, review and updated plan and procedures
that covers HSE issues within business.
2.6.
Implementation and performance monitoring

This describes a procedure established for HSE system implementation and performance
measure.
2.7.
Auditing and review

This describes an existence of methodology for audit of HSE contract operations.
Detailed CONTRACTORs HSE Plan shall refer to:

PHE ONWJ HSSE Plan Minimum Requirements Guideline
Note for User:
User should ensure the above attachments are provided to CONTRACTOR as part of Exhibit H.
Those attachments can be obtained from HSE Department.
3.
CONTRACTOR SAFETY, HEALTH AND ENVIRONMENTAL MANAGEMENT SYSTEM (CSMS)

REQUIREMENT
In line with the Contractor Safety, Health and Environmental Management System (CSMS)
Guidelines, CONTRACTOR shall understand, comply with and implement all procedures during
period of the Contract. This CSMS Guidelines is a control mechanism and summarized in
checklist format as attached in this exhibit. CONTRACTOR must complete all checklists in
parallel with the relevant stages in the Work. As of effective date of this Contract and during the
Contract Implementation in the Field, CONTRACTOR shall constitute the following steps:
3.1.
Pre-Job Activity
Prior to mobilization personnel and/or equipment, CONTRACTORs and COMPANYs
Representatives and other related parties shall conduct a meeting to communicate work
implementation including but not limited to review the COMPANYs and Contractor
HSEMS, HSE Plan, risk assessment, interface plan, KPIs, emergency procedure, accident
& incident reporting, peoples competencies, readiness of equipment and tools, pre-job
inspection and audit requirement and review the Conditional Acceptance, if any, that was
obtained during the Pre-Qualification and/or Selection Process. The similar meeting shall
also be conducted upon CONTRACTORs arrival at the worksite. CONTRACTORs and
COMPANYs Representatives must complete the Pre Job Activity Checklist.
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3.2.
Work In Progress
CONTRACTORs and COMPANYs Representatives shall conduct Interim Evaluation on a
regular basis to closely monitor and evaluate the Work In Progress. The schedule of this
Interim Evaluation shall be determined and agreed upon by CONTRACTORs and
COMPANYs Representatives considering the Work time period and the risks associated
with the Work. COMPANY has the right to inspect and review progress of the Work at
any time. During the interim evaluation CONTRACTORs and COMPANYs
Representative must complete the checklist which consists of HSE Inspection, HSE
Program and Interim Evaluation Checklists.
3.3.
Final Evaluation
At the end of the Work, a Final Evaluation Checklist as the attachment in the Exhibit H:
Health, Safety and Environment, shall be filled out. The Final Evaluation shall be based
on HSE contractual obligations, Pre Job Activities Reports, Interim Evaluation Reports,
corrective action during interim evaluations and final KPIs figures. This Checklist shall be
communicated and agreed on.
The Final Evaluation Reports will be used for future Pre Qualification and Selection
Process. COMPANY shall have the right to suspend or terminate the Contract if in
COMPANYs opinion CONTRACTOR do not comply with the above steps including, but
not limited to, follow-up to Conditional Acceptance and/or complete the specific
requirements which was obtained during Pre-Qualification and/or Selection Process, do
not follow-up corrective actions required during interim evaluation. In the event of
suspension of the Contract, penalty as set forth in Exhibit D, Performance Schedule, will
be applied and will be continued until CONTRACTOR fulfill all requirements needed.
CONTRACTOR may develop an additional checklist to fit a specific requirement if such
requirement is not included in the guidelines and this additional checklist is subject to
COMPANYs approval.
4.
HSE SPECIFICATION REQUIREMENT

CONTRACTOR shall refer to Exhibit B: Scope of Work for detail HSE Specification Requirement
such as Personal Protective Equipment (PPE), Medical Check-Up Standard, CONTRACTORs OnSite Safety Officer, etc. in accordance to, including but not limited to PPE Specification List.
Note for User:
User should consult to HSE Department in developing this HSE Specification requirement.
5.
HSE PERFORMANCE INDICATOR

HSE Performance indicator shall refer to Exhibit of Contractor Performance Management.
The HSE performance indicator should include provision for COMPANY to suspend the work if
the CONTRACTOR does not observe the HSE criteria spelled out in the contract HSE Plan, and in
particular at mobilization, to withhold permission to start execution and hold payments until a
satisfactory pre-job audit has been achieved.
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Appendix III.3. Form CSMS/SL/03: HSE Plan Guideline for Major and Small Work
HSE Plan Guideline for Small Contracts

HSE Plan Definition Guideline
When the contracted activities are covered by a contractor HSE Management System (e.g. in line with the E&P
Forum or other guidelines on HSE Management System), including HSE Cases for contracted installations, the
HSE Plan should only address those issues that are unique for the contract under consideration. It shall focus on
contract specific risks and the management of controls to eliminate reduces or mitigates these risks. Other
contract-specific issues that may be addressed in the Plan are:
organisation and personnel for the project
project specific procedures
project audit and review Plan
compliance with local rules and legislation
etc.
Table 1. Checklist for HSE Plan

Checklist items
Leadership and
commitment
Senior management should reinforce the importance of HSE at all levels in the
organisation and should be seen to be setting a personal example.
Policy
and
Strategic
Objectives
Contractor has a policy that makes reference to the importance of HSE. It is

formalised by the Chief Executives or the Managers signature.
Organisation,
Responsibilities,
Resources,
Standards and
Documentation
A focal point in the organisation for HSE. Simple procedure for distributing
information on HSE issues to the workforce.
A procedure for determining/enacting HSE training. Provision for obtaining HSE
advice should this be outside the capability of the contractors personnel.
A procedure for ensuring any subcontractor adheres to same HSE standards.
Simple advice on the importance of the links with client (or third party)
emergency services on contracts.
Typical agenda for any HSE items in meetings and how to ensure they are
covered effectively.
A statement of how HSE competence is assessed for personnel with HSE-critical
activities to perform.
Statement of requirements for employees to indicate that they have the necessary
appreciation of the HSE issues in the contractors business activities. This should
include reference to potential client HSE introduction sessions and HSE training.
Such training could include items from the following list (as relevant to the
contract):
Hazards identification
Road safety
First-aid
Permit to work
Risk assessment
Security
Basic HSE rules
Occupational health
Environmental protection
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Table 1 Checklist for HSE Plan (cont.)
Checklist items
Hazards and
Effects
Management
HSE targets set in clear quantifiable terms.

A system in place to assess workplace hazards.
Planning and
Procedures
Contractor has a document with procedures/rules covering the

HSE issues in his business activities with a method for review and
update.
Basic HSE precautions to be observed in the workplace
HSE hazards of equipment used, tasks and operations
encountered in his business
PTW system
Communications with supervisory personnel on site
outlines the activities of his business
identifies those areas that are HSE-critical
finds a method how individual contract scopes can be simply
appraised to determine where the attention to HSE issues
need to be focused
identifies how to determine PPE requirements
identifies a simple set of steps for road transport
management
Implementatio
n and
Performance
Monitoring
Contractor has a procedure for recording incident, for

advising legislative bodies where necessary and for making
annual reviews of performance.
Auditing and
Review
Contractor has a method for the management to carry out

audits of his contract operations.
Contractor has a procedure for investigating incidents.
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Small Contract Typical HSE Plan Performance
This provides guidance for a set of headings for a typical HSE Plan for use on small contracts. The list of
headings should be determined individually for the contract concerned.
Table. 2 Small contract typical HSE Plan Performance

Item
General
Company
Project
Contract Title/Number
Contractor details
Site location
Company Contract Holder/Representative(s)
Company Representative(s)
Contract Manager/contractor Representative(s)
Hazard assessment
Contract scope description
Expected hazards identified (including adjacent operations, etc.)
Procedures to be followed for hazard control (list documents or
describe details here)
Access/escape provisions (alarms, muster stations, etc.)
Emergency service provisions (including first-aid, nearest
medical treatment, emergency phone numbers, etc.)
Competence standards for contractors personnel
Standards for contractors equipment
Training requirements (including site HSE induction)
Job/services description
Contractors personnel assigned
Contractors equipment/consumables/services assigned
Companys personnel assigned
Companys equipment/consumables/services assigned
Subcontractors details
Responsibilities/interfaces defined
PPE and any special HSE equipment to be used
Working hours/job duration
Site description/limits
PTW provisions applicable
Conditions for suspending work (e.g. weather, adjacent site
operations, etc.)
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(CSMS) Guidelines
HSE Plan Guideline for Major Contract
HSE Plan Definition Guideline
When the contracted activities are covered by a contractor HSE Management System (e.g. in line with the E&P Forum or
other similar guidelines on HSE Management System), including HSE Cases for contracted installations, the HSE Plan should
only address those issues that are unique for the contract under consideration. It should focus on contract specific risks and
the management of controls to eliminate, reduce or mitigate these risks. Other contract specific issues that may be
addressed in the Plan are:
organisation and personnel for the project
project specific procedures
project audit and review Plan
compliance with local rules and legislation
The checklist in Section 1 to 7 can be used to check the HSE plans for the project specific issues, but can also be used to
assess the HSE Management System if this has not been certified or assessed in any other manner.
When the contractor does not have an HSE Management System, the HSE Plan should be developed in line with the
principles of the E&P Forum guidelines for HSE Management System or other comparable guidelines. The HSE Plan should
follow principal headings with an expansion into key checklist items given on the following pages under respective headings.
The detail included in the tender should be in keeping with the complexity of the contract and should additionally include
prompts for specific action plans, target dates and action parties.
HSE Management System

Section 1 Leadership and commitment
Leadership and Commitment
Section 2 Policy and strategic objectives
HSE Policy Statement
Section 3 Organisation, responsibilities, resources, standards and documentation
HSE Organisation
HSE Professionals resources.
Subcontractors
HSE Communications
HSE meeting programme
HSE promotion and awareness
HSE competence requirements
Employee orientation programme
HSE training
HSE legislation
HSE standard
Section 4 Evaluation and risk management
Methods and procedures for hazards and effects management
Assessment of exposure of the workforce to hazards, effects and PPE requirements
Material and data sheets for safe handling of chemicals
Methods and procedures for waste management
Section 5 Planning and procedures
HSE procedures
Emergency response procedures
HSE equipment and inspection
Occupational health
Environmental
Road safety
Section 6 Implementation and performance monitoring
HSE performance general
Incident reporting and investigation
Section 7 Auditing and review
HSE auditing
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Section 1 Leadership and Commitment

Checklist items
Leadership and Commitment
Commitment to
Senior management should engender commitment to HSE issues at all levels
HSE aspects
through their personal style of leadership and management. Key elements
through
include:
leadership
Visible expressions of commitment by senior people
HSE matters should be placed high on personal and collective.
All senior managers should set a personal example to others.
Checked
They should be, and seen to be actively involved in HSE matters, e.g.
attendance at HSE meetings, investigation of HSE, audits and reviews, etc.
A feedback system should be established to encourage and facilitate
employee feedback on HSE matters
A positive culture should be promoted at all levels
Procedures and standards should be endorsed and implemented at the
local level.
Section 2 Policy and Strategic Objectives

Checklist items
HSE Policy Statement
General
Content
Written HSE policy
Dated and signed by Chief Executive
Policy statements:
specific to individual parts of the contract (e.g. locations/sites/plants)
consistent with company guidelines
clear, concise and motivating
Importance of HSE as a contract objective.

Incidents and injuries are unacceptable.
HSE established as a line management responsibility.
Everyone is responsible for their own and their colleagues HSE at work.
Distribution/
availability
HSE policy distributed to all concerned, i.e.

handed to each employee by their line manager when issued
all new employees handed a copy by their line manager
displayed on notice boards at each company on the contract (including
subcontractors, suppliers and agents)
available to company and contractor employees in their working
languages)
Familirization
Policy and its implementation when issued discussed by line managers with
each employee.
Section 3 Organisation, Responsibilities, Resources, Standards and Documentation

HSE Organisation
Key personnel
Personnel responsible for the implementation of HSE objectives clearly

identified in an organisation chart.
Responsibility adequately covered during all phases of the contract.
Job descriptions in place showing each team members HSE
competencies, responsibilities and function.
Organisation clearly shows position of HSE professionals
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HSE Organisation (contd)

Contract
objectives/
accountability
Defined to meet health, safety and environmental objectives as well as

those of time, cost and quality.
Accountability for HSE success and equally of any failure clearly stated.
Focal point within the team structure ensuring that all HSE matters have
been identified.
Designated team leader to produce HSE objectives, tasks and targets for
the contract.
Targets, etc. to be realistic and consistent .
Establish procedures for distribution, reporting and reviewing HSE issues.
Manning/
communication
s
Manpower level to be defined correctly so as not to compromise HSE .

Effective means to communicate HSE issues to the company, contractor
and subcontractors.
Organisation staffed by competent personnel with sufficient appreciation
of HSE where necessary with specific training in the issues involved.
Establish procedures for distribution, reporting and reviewing HSE issues
involved.
Corporate
structure/
responsibility
Companys expectations on HSE management to be communicated in

depth.
Access of contractors line management to their corporate management
structure on HSE issues to be defined.
Level of handling project HSE issues by the contractor corporate structure
(middle or senior management or board level).
In the contractors corporate organisation, individuals charged with
responsibility for HSE at middle senior manager or board member level
Access to specialist HSE advice for line management e.g.
Provision and employement of HSE documentation for small
contracts.
Employment of HSE specialist for large contracts.
HSE Professionals
Job definition
Reporting/
follow-up
Role of the contractors HSE advisers well defined
Job definition drafted.
Reporting relationship with line management.

Direct access to the Chief Executive.
Does line management follow-up on advice offered.
HSE department
Contractors HSE department involved in:

preparing and monitoring departmental action plans
formulation and suitability of HSE rules
planned inspections and audits together with line management
promotional material
HSE training
subcontractor assessment
training and auditing
health risk assessment, health performance monitoring and health
surveillance
environmental monitoring
supporting incident investigation by line management
Guidance given by the contractors HSE management in preparing and
implementing:
operating and emergency plans manuals
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Training for fire fighting teams, first-aiders etc.
emergency drills and exercises
protective equipment and rescue
maintained contact and liaison with government departments
Subcontractor
Management
Identification
Coverage/
awareness
To be well integrated and identified in contract HSE Plans.

Have own plans if carrying out a large portion of the work.
HSE Plans to be vetted for suitability by main contractor.
Main contractor to communicate that subcontractor subject to the same
rigorous HSE standards as main contractor.
Subcontractors to be identified at this stage of the project.
Maintenance of approved subcontractor lists where HSE has been
considered.
Set up appropriate lines of communication to handle HSE issues, e.g.
such items as:
direct access to emergency services
nearest hospital
helicopter availability
air ambulance, etc.
Authorisation and implementation procedures fully understood
Emergency services: those organisations that would be expected to
provide support in a major incident aware of requirements briefed as to
their likely role.
Emergency
communication
Appropriate for incidents envisaged.
Strengthened, duplicated or backed up by other means.
HSE Meeting Programme

Scheduling
Contractor to establish a regular schedule for HSE meetings.
Define responsible management person for scheduling such meetings.
Procedure to maintain records of personnel attendance of personnel

attendance.
Management
participation
Managers seen to be involved by employees in:

HSE activities, objective setting and monitoring
taking action and providing resources to support their stated policies and
objectives
Follow-up
actions
Where action is agreed, is it seen to be carried out?
Communication
Results of HSE activities, both successful and less successful, openly

communicated to all employees.
Meeting programme consistent with the rest of the management structure

to communicate effectively HSE issues.
Meetings recorded clearly and consistently.
Structured to include health, safety and environment items.
Where action is not agreed, is it explained why?
HSE Promotion and Awareness

Techniques
Appropriate communications techniques used to make the personnel

aware of HSE issues.
How this is to be implemented, e.g.
personal contact
interactive video
notice-boards
newsletters (suitable for large sites)
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bulletins
posters, etc.
Performance
HSE performance boards (e.g. at worksite gates).
Promotional
methods
Possibilities include:
Part of business
HSE activities seen as an intrinsic part or running an efficient business rather

than a costly and time-consuming extra.
small give-aways with the HSE message

competitions
suggestion schemes
HSE Competence Requirements

Fitness for work
Confirmation of medical fitness from a recognised and approved medical

facility of all proposed employees for contract.
HSE Orientation Programme

Approach
New employees
Accountability
On-the-job orientation for supervisory staff.

Established procedure in relation to follow-up of all new employees at the
worksite.
Adequately trained and confident of their own abilities.
Coached to improve their work practices rather than blamed for mistakes.
Employees know they are accountable for HSE performance.
Aware that their HSE performances part of the contractors appraisal and
reward system.
Know that flagrant or frequent breaks of published HSE rules will result in
disciplinary action.
Procedures
Required for new employee orientation consistent with existing company

guidelines.
Re-appraisal
Programme subject to appraisal and review.
HSE Training
Contract
standards
Statement on the current standard of workforce and training requirements to

meet contract standard.
Established
training
programme
Including:
HSE management
Job procedures
Road safety
Health (first-aid health hazards, medical services, alcohol and drugs,
health promotion, use of PPE)
Auditing
Incident investigation and reporting
Supervisory development
Environmental protection
Supervisory
training
Supervisory development training promotes man-management skills and

communication skills.
Formalised
programme
Course content
Specialised
Records kept of employees who have been through the programme.

Employees trained before starting work.
Training covers those joining as a contract is being implemented.
Effective system for establishing the need for and the content of training
courses.
Determining course effectiveness and relevance of training assessed.
Relevant training given to personnel prior to the execution or hazardous
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training
operations.
Training gained through course attendance supplemented by on-the-job
training as necessary.
Records kept of attendees of the training courses and qualifications
gained by employees.
Emergency
training
Training covers the actions to be implemented and the employees

responsibilities in an emergency.
HSE content in
other courses
HSE included in:

induction courses
craft training
supervisory training
line management training
auditing techniques
HSE Legislation
Coverage
HSE Plan to include:

a comprehensive list of applicable legislation
government, national and international codes
company regulations, codes and standards
contractors identification of regulations, codes and standards
Definition of the legislation, codes, standards, etc. reflecting the
companys previous experience.
For contracts carried out i separate countries:
different legislation requirements
company assistance for foreign contractors
HSE Standards
Availability
Control/
authorisation
Coverage
Contractor in possession of HSE manual/set of standards.

Identifying minimum criteria for achievement during contract
implementation.
Available in writing to all users in consistent, concise and clear form.
Users involved in the development.
Standards in line with company requirements.
Controlled documents
Updated regularly
Approval level indicated
Procedure for obtaining deviations from standards
Responsibility for authorization
Standards in line with company requirements
Clear reference to national and international standards.
Setting minimum requirements on health, safety and environmental
issues.
Section 4 Evaluation and Risk Management

Checklist items
Methods and Procedures for Hazards and Effects Management
Coverage
Company assessment used as a starting point with additional hazards
identified by the contractor.
Contractors assessment carried out in accordance with his formal
methods and procedures.
Analysis techniques used in preliminary form where appropriate.
Contract covers all parts of the contract with assessments for the specific
scope and location of the contract.
Experience and
Contractor able to use material from previous similar projects and
awareness
demonstrate awareness from past experience.
Coverage
Contractor develops assessment of the scope and degree of exposure of
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workforce to hazards from the hazards and effects management process.
Handling of Chemicals
Coverage
Contractor demonstrates availability and distribution of guidance/information

on the safe handling of chemicals, likely to be encountered in the contract,
and proposals for confirming adherence to guidance during contract.
Hazards and Effects Management and The Assessment of PPE Requirements

Hazard
assessment/PPE
requirements
PPE instruction/
training
All processes identified that PPE requirement.

Procedure in place for recording, follow-up inspection and
replacement/re-certification of PPE and ensuring adequacy of stock.
Schedule and criteria for renewing PPE.
Responsibility for payment.
Requirements identified for all personnel.
Instruction and training in its use provided where needed .
Procedure for checking its use specified.
Section 5 Planning and Procedures

Checklist items
HSE Procedures
Availability/
control
Deviations
Omissions
Permit to work
(PTW).
Training/
qualification
Training standards and qualifications set for personnel allowed to implement

procedures.
Written procedures available to cover hazardous operations on HSE.

Include HSE precautions to be taken.
Consistent with company guidelines.
Controlled documents.
Appropriate level.
Coverage: include health and environment.
Written procedures:
familiar to all employees including subcontractors
available in their working language
contents related to individual job descriptions
Procedure for obtaining.
Responsibility and level.
Recording of authorised deviations.
Identify whether there are any areas where procedures for hazardous
operations are not drafted.
Commitment to prepare.
System in place.
If the contractors own system is utilised, is it consistent with industry norms
and in line with company guidelines?
Emergency Response Procedures

Coverage
Identification of potential major emergency scenarios, and procedures to

use in such scenarios, e.g.
fire
abandon rig/location
storm
oil/chemical, spill
aircraft incident
emergency communications
Medevac
blow-out
diving emergency
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Awareness
Potential use of company guidelines
By employees of procedures
Plans
search and rescue (SAR)

explosions
H2S
well control
man overboard
evacuation
terrorism
Orientation
Schedule of drills and testing
Medical contingency Plan included
Review frequency
Responsibility of employees for own and colleagues HSE
Monitoring mechanism
Drills to be carried out without warning
Contingency plans allowed for in emergency situations.

Recovery procedures in place to be activated in event of emergency
scenarios.
Drills to be held to demonstrate preparedness for response.
HSE Equipment and Inspection

HSE equipment
List drawn up of all HSE equipment to be used on the project.
Identified by type, capacity and reference to standards.
Requirements identified for each item of HSE equipment, including:
Critical items
for HSE
inspection
Schedule
registry
classification
licensing
survey
test certification
List drawn up of critical items of equipment that must be the subject of an

HSE inspection.
Procedure established for carrying out HSE inspection of equipment
(covering health, safety and environmental aspects to be reviewed).
Procedure established for checking standards where tools have been
provided personally by tradesmen.
HSE equipment inspection schedule established for the duration of the
project.
Inspection frequency clearly identified for critical items of plant.
Occupational Health
Facilities
available
Facilities defined as part of contract

identify health hazards
assess health hazards
Control hazards, e.g. engineering controls, procedural controls, PPE,
vaccinations, etc.
maintain emergency procedures
Appropriate for the site conditions.
Welfare programme meets the needs of isolated sites.
Local medical facilities evaluated in detail to assess:
range and quality of equipment and supplies
hygiene standards
administration procedures and standards
transportation and communication
Page 79

(CSMS) Guidelines
Staffing
Sufficient for day-to-day needs and consistent with relevant health

programmes.
Adequate provision for supply of drugs, antidotes, etc.
Availability of adequately trained, experienced staff.
Access to medical treatment facilities (if external).
Contingency,
plans
Defined for possible incidents beyond capability of site facilities.
Accommodatio
n and catering
facilities
Where provided, facilities to meet normally accepted standards of hygiene

at site location.
Facilities to be operated in line with government hygiene regulations and
to meet company guidelines.
Rules in force to maintain cleanliness of site and other facilities.
Promotional material available to assist in maintaining standards.
Appropriate for the contractors workforce in terms of:
Language.
clarity, etc.
Promotion
Hygiene and
housekeeping
Procedures on on-site cleanliness and maintenance.
Environmental
Awareness
Workforce aware of requirement to protect the environment whilst executing

contract
Control
Aims
Monitoring/
restoration
Audits
Identify potential environmental hazards.

Develop procedures for handling materials and performing operations
that may damage the environment.
Contingency plans.
Focus for the environmental protection team.
At what level
Line management responsibility for environmental protection defined as
well as other job objectives.
Development and enhancement of environmental impact statements for
the contract.
Environmental monitoring to gauge the impact of operations.
Plans appropriate and sufficiently detailed.
Recovery and restoration of site after contract completion.
Environmental audits of operations during the contract.
Carried out by experienced individuals or companies.
Road Safety
Drivers:
Competence
and selection
Assess physical, mental and psychological capability

Character and background
Qualities and experience, medical examination, document checks, driving
tests
Special skills such as terrain and climatic experience and first-aid
knowledge
Driving Permits
Should record personal and employment details, types of vehicle licensed

to drive and types of cargo licensed to carry.
Driver induction
Local area characteristics and regulations
Driver training
This should test vehicle operation and use, operating conditions (terrain,
climate), off-loading and positioning, emergency situations, and vehicle
inspection.
Page 80

(CSMS) Guidelines
Driver
Improvement
Techniques should identify deficiencies; analyses cause and select

appropriate retraining.
Selection
Ensure correct type, capacity and size for facilities

Good manoeuvrabiliy and serviceability
Vehicle
specification
The job description should be clearly defined before the vehicle is chosen,
to ensure work operations do not exceed the manufacturers specifications
Passenger
Is the vehicle designed to carry passengers?

Design of vehicle and load limits
Freight
Vehicle
maintenance
Segregation, positioning and securing of freight

Conducted on a regular basis
Procedures
Ensure procedures are in place for all transport operations.

Monitor and review mechanisms in place.
Emergency
service
In place and tested
Section 6 Implementation and Performance Monitoring

Checklist items
HSE Performance General
Measurement
Proposed plan to measure performance, i.e.
performance indicators
progress against targets,
HSE initiatives/incentive schemes,
achievement of milestones,
numbers and types of training courses
numbers and results of audits
clearance of action items
Use will be made of reactive statistical indicators, e.g.

Lost Time Injury Frequency/Total Recordable Incident Rate
Numbers of first-aid and minor injuries.
material losses
vehicle incidents
spillages
occupational illnesses
sickness absenteeism
Feedback/
analysis
Comparison of
performance
Availability and use of performance records.

Feedback/review/discussion at HSE meetings.
Presentation and distribution to employees.
Comparison of performance:
With other similar contrack work
Frequency specified
Involvement of company personnel
Incident Investigation
Coverage
Reporting procedure for the contract

Covering not only injuries to and time lost by personnel but also:
Health incidents (diseases, exposures to hazardous substances, near
Page 81
Checked

(CSMS) Guidelines
Methods
misses, etc.)
environmental incidents (spilages, releases, contamination, etc.)
other safety incidents (safety equipment failures, loss of capital
equipment)
material loss
Incident investigation method established to determine and correct
causes.
Incidents first reported to the direct supervisor.
Methods to be used for collecting incident statistics.
Section 7 Audit and Review

Checklist items
HSE Auditing
Availability
Established HSE procedure outlining responsibilities, frequency, methods and

follow-up.
Scope
Compliance with the HSE Plan including:
Coverage
Effectiveness
Follow-up
HSE Manajement
technical personnel HSE
subcontractor
occupational health
unsafe acts
audit training
environmental
own activities and those of his subcontractors
Schedule for full contract duration.

Involvement of personnel in audit teams from outside the location.
Carried out by a wide cross-section of the workforce including company
and subcontractor personnel.
Involvement of the contractors corporate management in review of
findings.
Intention to publish findings.
Discussion with personnel on contract and HSE meetings,
Lessons used to improve operations across the contract.
Any numerical treatment made of findings.
Frequency of review of implementation progress.
Rejections of audit findings properly authorised and documented.
Page 82
Checked

(CSMS) Guidelines
Appendix III.4. Form CSMS/SL/04: Site Verification Result
Date:
Inspector:
Contract No:
Contract Title:
VERIFICATION RESULT
Evaluated Items
Min.
Req. as in the
selection criteria
Verification
Result
SUMMARY & RECOMMENDATION
Verified by:
Page 83
Remarks

(CSMS) Guidelines
Appendix IV. Pre-Job Activity Form
Pre-Job Activity
New Contracts
Pre-Qualification
Selection
Risk Assessment
Contract
Award
Data Bank
Pre-Job Activity
Work In Progress
CSMS
Final Evaluation

(CSMS) Guidelines
Appendix IV.1. Form CSMS/PJA/01
COMPANY ACCEPTANCE
PRE-JOB ACTIVITY
Date
Project Period :
Job Title
Contract No
Work Location
Contractor Name
Address
Recommendation
GO/NO GO *to Mobilization Phase.
Contractor Reps: _________________ PHE ONWJ Reps: ___________________

(Name/Date)
(Name/Date)
*): Select based on assessment
Page 84

(CSMS) Guidelines
Appendix IV.2. Form CSMS/PJA/02
PRE-JOB ACTIVITY CHECKLIST

No
ITEM
YES
NO
PREMOBILIZATION
I. Work Plan
1.1
Has the HSE KPI been set up and agreed

by PHE ONWJ and Contractors (such as
safety observation, management visit,
audit, reward and diciplinary action)
1.2
Has the contractor's equipment, related to

the job to be performed and pass
inspected? (Evident of readiness the
equipment, tools and its safety devices
attached, verification by certificate,
maintenance history, functional check and
test).
1.3
Are safe execution procedures for critical

activities are written, reviewed approved
and familirization with the contractor
workforce before the work begins?
1.4
Is he/she contractor's competent person as

the HSE representative available?
1.5
Is contractors designated person for HSE

inspector and auditor?
1.6
Minimum requirement to work at site full

filled (evident of the workforce fitness for
work by appropriate medical check up
record and mandatory applicable HSE
training sea survival, etc).
1.7
Has the HSE plan been developed,

approved and include in the execution
program (or project schedule), following
minimum contain:
1.7.1. HSE Induction of new employees?
1.7.2. HSE meetings, promotion and
communication?
Page 85
N/A
REMARKS

(CSMS) Guidelines
1.7.3. Risk Assessment?

1.7.4. Safe work execution procedures?
1.7.5. HSE inspections and audit?
1.7.6. Control of Work and or Permit to
Work System?
1.7.7. Supervisor and employees safety
behavior observation?
1.7.8. Emergency drills?
1.7.9. Accident reporting and
Investigation?
1.8
Does the Contractor have rewards

programs for an effort to reduce
occupational injuries, illnesses and
environmental damages?
1.9
Does the Contractor have disciplinary

action programs in case of noncompliance?
II. Potential Hazards

2.1
Does the Contractor provide a system for

potential hazard identification and control
or
mitigation
and
verify
their
implementation
2.2
Does this contracted work have writen risk

assessment in place and tracking the
control measure action closure status?
III.
Emergency Response Plans and Procedures
3.1
Do they have emergency respon

procedure specific to the scope of
contracted work?
3.2
Are the Contractor's employees aware of

their role in an emergency?
Page 86

(CSMS) Guidelines
3.3
Is Contractors Contact Person and

telephone numbers available during
emergency? posted through the site and
communication tested?
IV
HSE Training
4.1
Does the contractor's having evidence that

all the workers are competence to perform
the work (CV, Training, Certification, etc.)?
4.2
Is there any a HSE training plan for

contractors employees and management
relevant with scope of work?
V
5.1
Contractors Management Commitment

Have all HSE issues been communicated
to the Contractors upper management
(example: approval Risk Assessment, HSE
plan, Audit status, closure action progress,
etc)
Mobilization
6.1
6.2
6.3
Do you have tools/check list to measure

your readiness progress before
mobilization staff and equipment?
Do you consider that they are ready to
execute the work (evidence contractors
management approval)
Did you conduct HSE site orientation
program and scope induction to all
involved personil before mobilization to
site?.
Page 87

(CSMS) Guidelines
Appendix V. Work In Progress (WIP) Forms
Work In Progress
New Contracts
Pre-Qualification
Selection
Risk Assessment
Contract
Award
Data Bank
Pre-Job Activity
Work In Progress
CSMS
Final Evaluation

(CSMS) Guidelines
COMPANY ACCEPTANCE
WORK IN PROGRESS
Date
Project Period :
Job Title
Contract No
Work Location
Contractor Name
Address
Contractor Reps: _________________ PHE ONWJ Reps: _________________

(Name/Date)
(Name/Date)
Page 88

(CSMS) Guidelines
Appendix V.1. Form CSMS/WIP/01:
OFFICE AND FIELD WORK IN PROGRESS EVALUATION CRITERIA

A
SECTION 1- PEOPLE
1
How does the standard of competence and completeness certification/documents required from the
supervisor/leader on location.
Incompetent and
incomplete documents
All competent and

complete documents
Work plan and scope of

work available but not
aligned.
Work plan provided but

not agreed with scope of
work.
Provided work plan

agreeable with scope of
work.
HSSE KPI not updated

and not agreed by
contractor
HSSE KPI agreed by

owner company and
Contractors but not
updated.
Has been update and

agreed by Owner
Company and
Contractors
Less than 50% skilled to

do their work
An average skilled to
perform the work.
Its all very skilled at

doing the work.
How does the skills of crew /technician in performing work on location.

Unskilled
competent to do the job

and document
completeness > 50%
How does the skills of supervisor /leader in performing work on location.

Unskilled

and document
completeness < 50%
Has the HSSE KPI been update and agreed by Owner Company and Contractors
They havent HSSE KPI
All competent and

complete documents
Has the Contractors provide the work plan agreeable with scope of work
Not Provided work
plan and scope of
work

and document
completeness > 50%
How does the standards of competence and completeness certification/documents required from the
crew/technician on location.
Incompetent and

and document
completeness < 50%

do their work
perform the work.

doing the work.
How does the HSSE behavior of all Contractors personnel.

Always repeat the
mistakes
Often must be reminded

and sometimes repeat a
mistake.
Sometimes need to be
reminded and not repeat
the mistake.
Page 89
Always show the habit of

safe behavior.

(CSMS) Guidelines
Have minimum requirement work force fitness for work at site full filled
Not document
supported (medical
checkup and
Mandatory HSSE
Training)
Active, meet as KPI
Very active more than KPI

per person.
Occasional
Active, every morning in

general but not prior job
execution.
Very active, tool box talk

performed prior job
execution
Occasional cannot be
contacted/communicate
d.
Communication with the

field / IOM is fluently and
easily accessible, but still
often not responsive to
follow up action.
Very responsive to followup action and coordinate

at site.
Is number and competency of Crew complying with the work required on site?
Number and
competency of crew
not sufficient.
13
Occasional, less than

target in KPI
How does responsive the Project Management Team (PMT)/Contractor Project Manager.
Difficult to contact/to
communicate
12
Full filled with document

by appropriate medical
checkup record and
mandatory applicable
HSE training (Sea
Survival, etc)
How does the participation of all personnel in implementing Safety meeting (tool box talk).
Not active
11
Full filled but not

documented.
How does the participation of all personnel in implementing STOP (Safety Observation Program).
Not active
10
Support document only

Sea survival training.
Number of crew
sufficient but not
competent.
Competence of Crew
comply with work but the
number of crew not
enough.
Number and competence

of crew always comply
and consistent with work
required.
Have all HSSE issues been communicated to the contractors upper management
Never
HSSE issues
communicated only
management at site
verbally.
HSSE issues
communicated only
middle management at
site and written to upper
management without
approval upper
management.
Page 90
Contractors upper
management
communicated and
coordinates all HSSE
issues, such as: approve
risk assessment and
mitigation, HSSE plan,
follow up
recommendation.

(CSMS) Guidelines
SECTION 2- PLANT
14
How is the completeness PPE for personnel

Most of the personnel
have not received a
complete PPE.
15
18
19
Each personnel already

get a complete PPE follow
a standard including
stock availability
guarantee the back up
and can be replaced.
Occasional borrow a
standard equipment
Complete accordance
with the required service,
no mitigation the backup
/ backup equipment
Always a complete
accordance with the
required services,
including mitigation the
backup equipment
How to order equipment from site if any defective equipment for replacement
unsatisfied
17
All personnel receive a

complete PPE follow a
standard but there is no
guarantee of availability
of back up, or be
Replaced.
How is the availability of standard equipment / regular tool

Never used a standard
equipment
16
Some personnel have

not received a complete
PPE (less than 10%).
Often not satisfied
Occasional there is a
discrepancy of required.
Always arrived on time as

required at site.
How does maintenance of equipment implementation.

Visually not feasible,
not perform
maintenance and data
is not available
Visually good, there was

no maintenance and
inspection, including no
pre-use check list.
Visually good, performed

maintenance and
routine maintenance and
inspection, but the
inspection, completed
documents are
document use pre-use
incomplete.
check list
Accommodation, Kitchen, Sanitary System, and Food Material storage appropriate
Uncontrolled all
accommodation,
kitchen and food
material store.
All accommodation,
kitchen and food
material storage not
clean, sanitary system
uncontrolled.
All accommodation,
kitchen and food material
storage keep clean,
sanitary system
uncontrolled.
All accommodation,
storage keep clean and
tidy, sanitary system keep
appropriate control.
The contractors have

housekeeping program
verbally without procedure
or guideline

such as: procedure
familiarization,
implementation and
assessment.
Has the Contractors Housekeeping Program

The contractors
havent housekeeping
program.

Page 91

(CSMS) Guidelines
SECTION 3 - PROCESS
20
How does the implementation of Standard Operating Procedure (SOP).

There is no procedure
on site and not
implemented
21
23
All leader/supervisor
already training SSOW
(PA) but the certification is
invalid and covered with a
dispensation.
already trained SSOW
(PA) with valid certificate.
Training matrix available Training matrix available

Training matrix not
by contractors, but not
implemented and
implemented and
available and not
documented
documented to
documented
management.
How does the implementation of Control Of Work (COW)
procedure.
Training matrix available

by contractors,
implemented and
documented to all level
Procedure implemented
including competency
personal, but audit and
analyst not performed.
personal, audit and
analyst.
Procedure approve but

not implemented
How does the Risk Assessment process and its implementation.

Risk assessment
occasional implemented
including competency of
personal, and no
assesment.
How does the Permit To Work process and its implementation
No method of risk
assessment.
25
Some of
leader/supervisor trained
SSOW (PA)
Is there any a HSE training plan implemented for contractors employees, include provide training for its
managers and supervisor to ensure that they are capable?
No procedure
available
24
There is Procedure on
site, approve by
management
familiarization to work
force and implement by
all crew.
How is the Training Safe System Of Work (SOW) performed

not train SSOW (PA)
22
There is procedure on
There is procedure on site
site but not implemented. but implementation not
consistently
No procedure or
method available
Risk assessment method

available but not
implemented.

not implemented
Page 92
Risk assessment
implemented including
competency of personal,
and assessment.
personal, audit and
analyst.

(CSMS) Guidelines
26
How does the HSE induction for new employees

No plan to induction
program
27
The program perform by

Company and
Contractors on periodic
basis, recommendations
not follow up by
contractors

Company and
follow up by Contractors
and documented
Contractors have
program reward and
consequences, but not
implemented.
Contractors implement
consequences
(Punishment) programs
without reward to reduce
injuries, illnesses and
environmental damage.
rewards and
consequences programs
for an effort to reduce
occupational injuries,
illnesses and
environmental damage
Have safe execution procedures for critical activities relevant scope of works been written, reviewed,
approved and familiarized to contractors workforce.
Safe execution
procedure not
provided by
contractors
30
The program performs

by Company and
Contractors
occasionally.
Does the contractors implement rewards and consequences programs for an effort to reduce occupational
injuries, illnesses and environmental damage
No program reward
and consequences.
29
Perform with appropriate

material to all new
employee coverage all
hazard and activities
Does the contractor conduct HSE inspections and audits together on periodic basis
No program
inspections and audit.
28
Perform with verbally

material to all new
employee but not inform
all hazard and activities
Contractors provide safe

execution procedures for
critical activities relevant
scope of works been
written, but not reviewed
and approved by
management.

scope of works been
written, reviewed,
approved, but not
familiarized to Contractors
workforce.

scope of works been
written, reviewed,
approved and
familiarized to
Contractors workforce.
Has the HSE plan been implemented in the execution phase (or project schedule)
Contractors havent
HSE plan.
contractors have HSE

plan during PJA only not
in execution phase
Contractors have HSE

plan in the execution
phase.
Page 93
Contractors implemented
HSE plan in the execution
phase.

(CSMS) Guidelines
31
Is the contractor has Emergency Respond Plan.

Contractors not
provided Emergency
Respond Plan
Procedure.
32
Contractor has
Emergency Respond Plan
not approved procedure.
Contractor has Emergency

Respond Plan Approved
Procedure, review and
familiarization to ERT, but
never exercise/tested
Contractor has
Approved Procedure,
review and familiarization
to ERT including
exercise/tested
Are Contractors Emergency telephone numbers posted throughout the site and tested.
No Contractor
Emergency telephone
numbers.
Contractor Emergency
telephone numbers not
posted.
telephone numbers posted
throughout the site, but
not tested
Page 94
telephone numbers
posted throughout the site
and tested

(CSMS) Guidelines
OFFICE AND FIELD WORK IN PROGRESS SCORING SHEET

Contractor
: ______________________________________________
Address
: ______________________________________________
Date
: ______________________________________________
A
SECTION 1 ITEM 1
12
SECTION 1 ITEM 2
12
SECTION 1 ITEM 3
12
SECTION 1 ITEM 4
12
SECTION 1 ITEM 5
12
SECTION 1 ITEM 6
12
SECTION 1 ITEM 7
12
SECTION 1 ITEM 8
12
SECTION 1 ITEM 9
12
SECTION 1 ITEM 10
12
SECTION 1 ITEM 11
12
SECTION 1 ITEM 12
12
SECTION 1 ITEM 13
Subtotal
12
Subtotal
Factor
SECTION 1 PEOPLE
X1/13
SECTION 2 PLANT
SECTION 2 ITEM 14
12
SECTION 2 ITEM 15
12
SECTION 2 ITEM 16
12
SECTION 2 ITEM 17
12
SECTION 2 ITEM 18
12
SECTION 2 ITEM 19
SUBTOTAL
12
Page 95
X1/6
Total

(CSMS) Guidelines
SECTION 3 PROCESS
SECTION 3 ITEM 20
12
SECTION 3 ITEM 21
12
SECTION 3 ITEM 22
12
SECTION 3 ITEM 23
12
SECTION 3 ITEM 24
12
SECTION 3 ITEM 25
12
SECTION 3 ITEM 26
12
SECTION 3 ITEM 27
12
SECTION 3 ITEM 28
12
SECTION 3 ITEM 29
12
SECTION 3 ITEM 30
12
SECTION 3 ITEM 31
12
SECTION 3 ITEM 32
Subtotal
12
X1/13
SUMMARY
The numerical values below are the weighted ratings calculated above including contribute from field values.
The total represents the overall score for the Contractor. This score only for performance control of
Contractor field and office implementation.
TOTAL RATING
_____________*)
EVALUATED BY:
NAME
TITLE
DATE
NAME
TITLE
DATE
Page 96

(CSMS) Guidelines
FIELD WORK IN PROGRESS EVALUATION CRITERIA

A
SECTION 1 PEOPLE
1
Incompetent and

aligned.

work.
Provided work plan

work.

do their work
perform the work.

doing the work.

do their work
perform the work.

doing the work.

mistake.
the mistake.

safe behavior.
Not active
All competent and

complete documents

Always repeat the
mistakes

and document
completeness > 50%

Unskilled

and document
completeness < 50%

Unskilled
All competent and

complete documents
Not Provided work
plan and scope of
work

and document
completeness > 50%
Incompetent and

and document
completeness < 50%

target in KPI
Active, meet as KPI

per person.
Page 97

(CSMS) Guidelines
Not active
Occasional

execution.

performed prior job
execution
Is number and competency of Crew complying with the work required on site
Number and
competency of crew
not sufficient.
Number of crew
sufficient but not
competent.
Competence of Crew
number of crew not
enough.

required.

of back up, or be
Replaced.

stock availability
SECTION 2 - PLANT
10

have not received a
complete PPE.
11

Never used standard
equipment.
12
13
14
Some personnel have

Occasional borrow
standard equipment.
Complete accordance
no mitigation the back up
/ backup equipment.
Always a complete
accordance with the
required services,
backup equipment.

not perform
is not available

no maintenance and
pre-use check list.

maintenance and
inspection, but the
documents are
incomplete.
check list
Uncontrolled all
accommodation,
kitchen and food
material store.
All accommodation,
kitchen and food
uncontrolled.
All accommodation,
storage keep clean,
sanitary system
uncontrolled.
Has the Contractors House keeping Program
Page 98
All accommodation,

(CSMS) Guidelines
The contractors
havent house keeping
program.

house keeping program

or guideline

such as: procedure
familiarization,
implementation and
assessment.
SECTION 3 - PROCESS
15

There is no procedure
on site and not
implemented
16

not implemented
already trained SSOW
(PA) with valid certificate.
Risk assessment
personal, and no
assesment.
No procedure or
method available
20
already training SSOW
(PA) but the certification is
invalid and covered with a
dispensation.
personal, audit and
analyst.

No method of risk
assessment.
19
Some of
leader/supervisor trained
SSOW (PA)
How does the implementation of Control Of Work (COW) procedure.

No procedure
available
18
There is Procedure on
site, approve by
management
familiarization to work
force and implement by
all crew.

not train SSOW (PA)
17
There is procedure on
site but not implemented. but implementation not
consistently

available but not
implemented.

not implemented
Risk assessment
and assessment.
personal, audit and
analyst.
Page 99

(CSMS) Guidelines
No program
21

Company and
and documented

in execution phase

phase.
phase.

Contractor has
Approved Procedure,
to ERT including
exercise/tested.

Contractors not
provided Emergency
Respond Plan
Procedure.
23

Company and
not follow up by
contractors
Has the HSE plan been implemented in the execution phase (or project schedule)
Contractors havent
HSE plan.
22

by Company and
Contractors
occasionally.
Contractor has
No Contractor
Emergency telephone
numbers.
posted.
not tested
Page 100
telephone numbers
and tested

(CSMS) Guidelines
FIELD WORK IN PROGRESS SCORING SHEET

Contractor
: ______________________________________________
Address
: ______________________________________________
Date
: ______________________________________________
SECTION 1 ITEM 1
12
SECTION 1 ITEM 2
12
SECTION 1 ITEM 3
12
SECTION 1 ITEM 4
12
SECTION 1 ITEM 5
12
SECTION 1 ITEM 6
12
SECTION 1 ITEM 7
12
SECTION 1 ITEM 8
12
SECTION 1 ITEM 9
12
Subtotal
Factor
SECTION 1 PEOPLE
Subtotal
X1/9
SECTION 2 PLANT
SECTION 2 ITEM 10
12
SECTION 2 ITEM 11
12
SECTION 2 ITEM 12
12
SECTION 2 ITEM 13
12
SECTION 2 ITEM 14
12
SUBTOTAL
X1/5
SECTION 3 PROCESS
SECTION 3 ITEM 15
12
SECTION 3 ITEM 16
12
SECTION 3 ITEM 17
12
Page 101
Total

(CSMS) Guidelines
SECTION 3 ITEM 18
12
SECTION 3 ITEM 19
12
SECTION 3 ITEM 20
12
SECTION 3 ITEM 21
12
SECTION 3 ITEM 22
12
SECTION 3 ITEM 23
12
X1/9
Subtotal
SUMMARY
The numerical values below are the weighted ratings calculated from field only. This score only for performance
control of Contractor field implementation as contribute data to Form CSMS/WIP/01:
The contract holder should compile the Field and Office score.
TOTAL RATING
_____________*)
EVALUATED BY:
NAME
TITLE
DATE
NAME
TITLE
DATE
Page 102

(CSMS) Guidelines
WORK IN PROGRESS INTERIM REPORT

(Office and Field)
No.
Descriptions
Improvement
needed
COMMENTS
Section 1 - People
1.
2.
3.
Section 2 - Plant
1.
2.
3.
Section 3 - Process
1.
2.
3.
Contractor Reps:
___________________________
Name/Title
HSE PERFORMANCE
1. No of First Aids :_______
2. No of Recordable Cases
:____
3. No of Lost Workday Cases
:_____
4. No of Equipment Damage Incidents :______

5. No of Spills / non-Compliance Cases
:_____
___________________________
Signature/Date
PHE ONWJ Reps:
___________________________
Name/Title
___________________________
Signature/Date
Page 103
Contractor Health, Safety, and Environmental Management System

(CSMS) Guidelines
Appendix VI. Final Evaluation Form
Final Evaluation
New Contracts
Pre-Qualification
Selection
Risk Assessment
Contract
Award
Data Bank
Pre-Job Activity
Work In Progress
CSMS
Final Evaluation

(CSMS) Guidelines
Appendix VI.1. Form CSMS/FE/01:
FINAL EVALUATION
Date
Project Period :
Job Title
Contract No
Work Location
Contractor Name
Address
Contractor Reps: _________________ PHE ONWJ Reps: ___________________

(Name/Date)
(Name/Date)
Page 104

(CSMS) Guidelines
FINAL EVALUATION CRITERIA

A
SECTION 1- PEOPLE
1
Incompetent and
All competent and

complete documents

aligned.

work.
Provided work plan

work.
HSSE KPI not updated

and not agreed by
contractor
HSSE KPI agreed by

owner company and
Contractors but not
updated.
Has been update and

agreed by Owner
Company and
Contractors

do their work
perform the work.

doing the work.

Unskilled

and document
completeness > 50%

Unskilled

and document
completeness < 50%
Has the HSSE KPI been update and agreed by Owner Company and Contractors
They havent HSSE KPI
All competent and

complete documents
Not Provided work
plan and scope of
work

and document
completeness > 50%
Incompetent and

and document
completeness < 50%

do their work
perform the work.
Page 105

doing the work.

(CSMS) Guidelines
Always repeat the

mistakes
8
Full filled with document

by appropriate medical
checkup record and
mandatory applicable
HSE training (Sea
Survival, etc)

target in KPI
Active, meet as KPI

per person.
Occasional

execution.

performed prior job
execution
Occasional cannot be
contacted/communicate
Communication with the

field / IOM is fluently and
easily accessible, but still
often not responsive to
follow up action.
Very responsive to followup action and coordinate

at site.
Is number and competency of Crew complying with the work required on site?
Number and
competency of crew
not sufficient.
13
Full filled but not

documented.
How does responsive the Project Management Team (PMT)/Contractor Project Manager.
Difficult to contact/to
communicate
12
Support document only

Sea survival training.
Not active
11

safe behavior.
Not active
10
the mistake.
Have minimum requirement work force fitness for work at site full filled
Not document
supported (medical
checkup and
Mandatory HSSE
Training)

mistake.
Number of crew
sufficient but not
competent.
Competence of Crew
number of crew not
enough.
Have all HSSE issues been communicated to the contractors upper management
Page 106

required.

(CSMS) Guidelines
Never
HSSE issues
communicated only
management at site
verbally.
HSSE issues
communicated only
middle management at
site and written to upper
management without
approval upper
management.
Contractors upper
management
communicated and
coordinates all HSSE
issues, such as: approve
risk assessment and
mitigation, HSSE plan,
follow up
recommendation.

of back up, or be
Replaced.

stock availability
SECTION 2- PLANT
14

have not received a
complete PPE.
15

Never used a standard
equipment
16
Complete accordance
no mitigation the backup
/ backup equipment
Often not satisfied
Occasional there is a
discrepancy of required.
Always a complete
accordance with the
required services,
backup equipment
Always arrived on time as
required at site.

not perform
is not available
18
Occasional borrow a
standard equipment
How to order equipment from site if any defective equipment for replacement
unsatisfied
17
Some personnel have


no maintenance and
pre-use check list.

maintenance and
inspection, but the
documents are
incomplete.
check list
Page 107

(CSMS) Guidelines
Uncontrolled all
accommodation,
kitchen and food
material store.
19
All accommodation,
kitchen and food
uncontrolled.
All accommodation,
storage keep clean,
sanitary system
uncontrolled.
All accommodation,

or guideline

such as: procedure
familiarization,
implementation and
assessment.
Has the Contractors Housekeeping Program

The contractors
havent housekeeping
program.

SECTION 3 - PROCESS
20

There is no procedure on
site and not implemented
21
There is Procedure on site,

approve by management
familiarization to work force
and implement by all crew.
Some of leader/supervisor
trained SSOW (PA)
All leader/supervisor already

training SSOW (PA) but the
certification is invalid and
covered with a dispensation.
All leader/supervisor already

trained SSOW (PA) with
valid certificate.
Is there any a HSE training plan implemented for contractors employees, include provide training for its
managers and supervisor to ensure that they are capable?
implemented and
documented to
management.
How does the implementation of Control Of Work (COW) procedure.

by contractors,
implemented and
documented to all level
personal, audit and
analyst.
Training matrix not

available and not
documented
23

but implementation not
consistently

All leader/supervisor not
train SSOW (PA)
22

No procedure
available

implemented and
documented

not implemented
Page 108

(CSMS) Guidelines
24

Risk assessment
personal, and no
assesment.
No method of risk
assessment.
25
No procedure or
method available
26
personal, audit and
analyst.

material to all new
employee but not inform
all hazard and activities

material to all new
employee coverage all
hazard and activities
Perform with verbally

by Company and
Contractors
occasionally.

Company and
not follow up by
contractors

Company and
and documented
Does the contractors implement rewards and consequences programs for an effort to reduce occupational
injuries, illnesses and environmental damage
No program reward
and consequences.
29
No program
28

not implemented
Risk assessment
and assessment.
How does the HSE induction for new employees

No plan to induction
program
27

available but not
implemented.
Contractors have
program reward and
consequences, but not
implemented.
consequences
(Punishment) programs
without reward to reduce
injuries, illnesses and
environmental damage.
rewards and
consequences programs
for an effort to reduce
occupational injuries,
illnesses and
environmental damage
Have safe execution procedures for critical activities relevant scope of works been written, reviewed,
approved and familiarized to contractors workforce.
Page 109

(CSMS) Guidelines
Safe execution
procedure not
provided by
contractors
30
31
32

scope of works been
written, but not reviewed
and approved by
management.

scope of works been
written, reviewed,
approved, but not
familiarized to Contractors
Has the HSE plan been implemented in the execution workforce.
phase (or project schedule)

scope of works been
written, reviewed,
approved and
familiarized to
Contractors workforce.
Contractors havent
HSE plan.

in execution phase

phase.
phase.
Contractors not
provided Emergency
Respond Plan
Procedure.

Contractor has
Approved Procedure,
to ERT including
exercise/tested
Contractor has
No Contractor
Emergency telephone
numbers.
posted.
not tested
Page 110
telephone numbers
and tested

(CSMS) Guidelines
FINAL EVALUATION SCORING SHEET

Contractor
: ______________________________________________
Address
: ______________________________________________
Date
: ______________________________________________
A
SECTION 1 ITEM 1
12
SECTION 1 ITEM 2
12
SECTION 1 ITEM 3
12
SECTION 1 ITEM 4
12
SECTION 1 ITEM 5
12
SECTION 1 ITEM 6
12
SECTION 1 ITEM 7
12
SECTION 1 ITEM 8
12
SECTION 1 ITEM 9
12
SECTION 1 ITEM 10
12
SECTION 1 ITEM 11
12
SECTION 1 ITEM 12
12
SECTION 1 ITEM 13
12
Subtotal
Factor
SECTION 1 PEOPLE
Subtotal
X1/13
SECTION 2 PLANT
SECTION 2 ITEM 14
12
SECTION 2 ITEM 15
12
SECTION 2 ITEM 16
12
SECTION 2 ITEM 17
12
SECTION 2 ITEM 18
12
SECTION 2 ITEM 19
12
SUBTOTAL
SECTION 3 PROCESS
Page 111
X1/6
Total

(CSMS) Guidelines
SECTION 3 ITEM 20
12
SECTION 3 ITEM 21
12
SECTION 3 ITEM 22
12
SECTION 3 ITEM 23
12
SECTION 3 ITEM 24
12
SECTION 3 ITEM 25
12
SECTION 3 ITEM 26
12
SECTION 3 ITEM 27
12
SECTION 3 ITEM 28
12
SECTION 3 ITEM 29
12
SECTION 3 ITEM 30
12
SECTION 3 ITEM 31
12
SECTION 3 ITEM 32
12
Subtotal
X1/13
SUMMARY
The numerical values below are the weighted ratings calculated above. The total represents the overall score for
the Contractor.
TOTAL RATING
_____________*)
EVALUATED BY:
NAME
TITLE
DATE
NAME
TITLE
DATE
Page 112

(CSMS) Guidelines
FINAL EVALUATION RESULT SHEET

No.
ITEM
Improvement
needed
COMMENTS
Section 1 - People
1.
2.
3.
Section 2 - Plant
1.
2.
3.
Section 3 - Process
1.
2.
3.
Contractor Reps:
___________________________
Name/Title
HSE PERFORMANCE
1. No of First Aids :_______
2. No of Recordable Cases
:____
3. No of Lost Time Incident Cases
:_____
4. No of Equipment Damage Incidents :______

5. No of Spills / non-Compliance Cases
:_____
___________________________
Signature/Date
PHE ONWJ Reps:
___________________________
Name/Title
___________________________
Signature/Date
Page 113

CSMS Rev5 PHE ONWJ Forms Checklist Final 2011 (Bag 2)

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New Contracts

Qulification Phase: Select A Qualified Contractor

Contractor Health, Safety, and

Appendix II. Pre-Qualification Forms .................................................................................... 43

Appendix III. Selection Forms ............................................................................................... 65

Appendix IV. Pre-Job Activity Form ....................................................................................... 81

Appendix V. Work In Progress (WIP) Forms ........................................................................... 81

Appendix VI. Final Evaluation Form ...................................................................................... 93

Appendix I. Risk Assessment Forms

Contract Implementation Phase: Ensure Field Safe Work

Contractor Health, Safety and Environmental Management System

Appendix I.1. Form CSMS/RA/01

(Impact Severity x Likelihood) L/M/H

Contractor Health, Safety and Environmental Management System

- Medical treatment case

- Accident/ illness resulting permanent disability

- Accident/ illness resulting up to 2 fatalities

- Accident / illness resulting more than 3 fatalities

Contractor Health, Safety and Environmental Management System

Contractor Health, Safety and Environmental Management System

DEFINITION OF CONSEQUENCES SEVERITY OF IMPACT

Contractor Health, Safety and Environmental Management System

DEFINITION OF CONSEQUENCES SEVERITY OF IMPACT

Contractor Health, Safety and Environmental Management System

Rare or never heard of in the industry

Heard of in the industry

10-6 to 10-4 per year

Has occurred on PHE ONWJ up to once in 100 years

10-4 to 10-2 per year

Has occurred on PHE ONWJ during its lifetime up to

10-2 to 1 per year

Has occurred more than once per year on PHE ONWJ

>1 per year

Almost Impossible (AI)

Contractor Health, Safety and Environmental Management System

RULE OF THUMB IN DEFINING THE RISK EXPOSURE

Contractor Health, Safety and Environmental Management System

Appendix I.2. Form CSMS/RA/02

RISK ASSESSMENT RESUME

Contractor Safety, Health and Environmental Management System

Appendix II. Pre-Qualification Forms

Contract Implementation Phase: Ensure Field Safe Work

Contractor Safety, Health and Environmental Management System

Appendix II.1. Form CSMS/PQ/01

Contractor Safety, Health and Environmental Management System

SECTION 1 LEADERSHIP AND TOP MANAGEMENT COMMITMENT

b) Provide evidence of commitment at all levels of the organization by:

c) How do you promote a positive culture towards HSE matters?

d) Provide your current Organization chart

Contractor Safety, Health and Environmental Management System

SECTION 2 POLICY AND STRATEGIC OBJECTIVES

a) Does your company have an HSE policy document that is applied?

c) How do you ensure HSE Policy compliance and communication at site?

2.2. Availability of Policy Statements to Employees

Contractor Safety, Health and Environmental Management System

SECTION 3: ORGANIZATION, RESPONSIBILITY, RESOURCES, STANDARDS AND

a) How is management involved in HSE activities, objective setting and monitoring?

3.2. Competence and Training of Manager/Supervisors/Senior Site Staff/HSE Advisor

3.3. Competence and General HSE Training

Contractor Safety, Health and Environmental Management System

SECTION 3: ORGANIZATION, RESPONSIBILITY, RESOURCES,

3.5. HSE Qualified Staff - Additional Training

If Yes, please attach the curriculum vitae

a) Do you employ sub-contractor(s) for the intended service? (Yes/No)