emcoqatar.netemcoqatar.net/files/qms/_HSE_Reporting_Formats.pdf · Personal Injury . Spillage ....

Rev.-03, 25/03/2014

SF/FR-01

ENGINEERING MAINTENANCE COMPANY

Tel: 44359181 – Fax: 44359188, P. O. Box: 24125 - Doha, Qatar

INCIDENT REPORT Types of incident: Personal Injury Spillage Property Damage

Project Name :

Job No. : Name of the injured /exposed person :

Staff/Card No. :

Category :

Nature of Injury: First Aid Case Restricted Work Case MTC LTI

Type of Injury: Minor Major

Location of Incident :

Date & Time of Incident :

Description of the Incident :

Activity Performed :

Relevant Risk Assessment & EAIA & Ref. No. :

Control measures that were not followed / not available in the Risk Assessment & EAIA: 1. 2. 3. 4. 5. Action taken to prevent similar accidents in future

:

Name & Card No of Witness :

_____________ Site Engineer _____________

Project Manager

Distribution: 1. GM 2. MR 3. Admin officer 4. Commercial 5. Site File

Rev. 02, 25/03/2014 Page-1 of 2

SF/FR-02



INCIDENT INVESTIGATION REPORT

1. Types of incident :

Personal injury

Spillage

Property Damage

2. Name of injured / exposed person : ……………………………………………………………………………………

3. Staff/ Card No. : …………………………………… Job No.: ……………………………............

4. Nature of Injury : First Aid Case Restricted Work Case MTC LTI

5. Type of Injury : Minor Major

6. Quantity of spillage : …………………..(Liters)

7. Incident Date : ……………………………… Incident Time: ……………………….

8. Description of Incident : (Attach sketch and additional sheets, if necessary)

9. What are the root causes of this incident?

10. Recommendations.

SF/FR-02

Rev.-01, 25/03/2014 Page 2 of 2

SUBSTANDARD ACTIONS SUBSTANDARD CONDITIONS1. Operating equipment without authority 1. Inadequate guards or barriers

2. Failure to warn 2. Inadequate or improper protective equipment

3. Failure to secure 3. Defective tools, equipment or materials

4. Operating at improper speed 4. Congestion or restricted action

5. Making safety devices inoperable 5. In adequate warning system

6. Removing safety devices 6. Fire and explosion hazards

7. Using defective equipment 7. Poor house keeping, disorder

8. Using equipment improperly 8. Hazardous equipment conditions, gases, dusts, smokes,

9. Failing to use personal protective equipment properly fumes, vapors

10. Improper handling of materials 9. Noise exposures

11. Improper positioning of task 10. Radiations

12. Servicing equipment while in operation 11. High or low temperature exposure

13. Horseplay 12. Inadequate or excess illumination

14. Under influence of drugs 13. Inadequate ventilation

15. Disregarding of rules/ regulations

PERSONAL FACTORS JOB FACTORS ENVIRONMENT TYPE OF CONTACT CONTACT WITH

1. Inadequate capability 1. Inadequate leadership/ Lack of inspection 1. Struck against 1. Electricity

2. Lack of knowledge supervision Lack of containment 2. Struck by 2. Heat

3. Lack of skill 2. Inadequate engineering High Noise/ Vibration 3. Caught in 3. Cold

4. Stress 3. Inadequate purchasing Uncontrolled emission or 4. Caught on 4. Radiation

5. Improper motivation 4. Inadequate maintenance Discharge 5. Caught between 5. Caustics

5. Inadequate tools/ equipment 6. Slip 6. Noise

6. Inadequate work standards 7. Fall in same level 7. Toxic or noxious substances

7. Wear and tear 8. fall to below

8. Abuse or misuse 9. Overexertion/ Exposed to chemical, fumes etc.

ATTRIBUTE THE INVESTIGATION FINDINGS TO HSR PROCEDURES (WHICHEVER APPLICABLE)

QHSE/MREV-01 QHSE/CVMI-09 QHSE/PMDA-15 QHSE/TBT-22 QHSE/HK-28

QHSE/PUR-02 QHSE/CNP-10 QHSE/CCP-17 QHSE/IRI-23 QHSE/LOR-29

QHSE/VSA-03 QHSE/CPA-11 QHSE/INS-18 QHSE/DSV-24 QHSE/MOC-30

QHSE/WH-04 QHSE/CR-12 QHSE/HIRA-19 QHSE/PTW-25 QHSE/WM-31

QHSE/DDC-06 QHSE/IAUD-13 QHSE/EAIA-20 QHSE/PPE-26 QHSE/MMM-32

QHSE/EVM-08 QHSE/CTA-14 QHSE/JM-21 QHSE/PCH-27 QHSE/EPR-33

WHAT REMEDIAL ACTIONS HAVE BEEN TAKEN TO PREVENT RECURRENCE?

…………………………………………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………………………………………………

SITE ENGINEER PROJECT ENGINEER/ MANAGER

NAME: SIGN: NAME: SIGN:

COMMENTS ON REMEDIAL ACTIONS TAKEN:

…………………………………………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………………………………………………

SITE MANAGER/SUPT./HEAD OF DEPT. NAME:………………………………………………………………………………SING:…………………………DATE:………………….NOTE: ATTACH SKETCH & ADDITIONAL DETAILS IF NECESSARY

DISTRIBUTION: 1. GM, 2. MR-QHSEMS 3. Admin officer/HR 4. Site file

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TENGINEERING MAINTENANCE COMPANY

Tel: 44359181 - Fax: 44359188, P.O.Box: 24125 - Doha, Qatar

INCIDENT INVESTIGATION REPORTIMMEDIATE CAUSES: WHAT SUBSTANDARD ACTIONS AND CONDITIONS CAUSED OR COULD HAVE CAUSED THE EVENT

BASIC CAUSES: WHAT SPECIFIC PERSONAL OR JOB FACTORS CAUSED OR COULD CAUSE THIS EVENT? CHECK

Rev.01, 25/03/2013 Page 1 of 2

SF/FR-02A



VEHICLE ACCIDENT INVESTIGATION REPORT 1. Location of accident : ………………………………………………………………………………

2. Date of accident : ……………………………… Time of accident ………………………….

3. Name of the driver : ……………………………… ……… …………S/C# ……………………

4. How long has driver been driving vehicle? Years:……………………….. Months:………………….

5. List the dates of all vehicle accidents by this driver in the past two years:

……………………………………………………………… ………………………………………………………………

6. Description of Accident (Describe what happened- who was involved-where-when- why –how)

……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ………………………………………………………………………………………………………………

7. The Cause of the Accident:(also complete page 2 What did our driver or any other employee do or fail to do, that contributed to this accident? ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ………………………………………………………………………………………………………………

8. Did driver’s physical condition (hearing, eye defects, sickness, lack of sleep) cause or contributed in any way to the accident?

Yes No If Yes, then write in details:......................................................................................................................... ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ………………………………………………………………………………………………………………

9. Did a vehicle’s condition, preventive maintenance, etc. Contribute in any way to the accident occurrence or to the resulting damage or injury? Explain: ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ………………………………………………………………………………………………………………

10. Corrective Action Taken : What is being done to prevent a re -occurrence? (Be specific. List definite steps taken. Avoid vague or meaningless answers such as “Told driver to be more careful,” etc.) ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ………………………………………………………………………………………………………………

Site in charge Project Manager Name: Sign: Name: Sign:

Distribution 1. GM 2. MR-QHSEMS 3. Manager- Plant & Assets 4. Admin officer 5. Commercial 6. Site file

SF/FR-02A

SUBSTANDARD ACTIONS SUBSTANDARD CONDITIONS1. Failure to observe clearance 1. Defective brakes

2. Failure to signal intentions 2. Defective personal protection (seatbelts)

3. Failure to yield right of way 3. Defective turn signals

4. Speed too fast for the conditions 4. Inoperative lights

5. Improper backing (reversing) 5. Defective tires

6. Improper parking 6. Bad weather or road conditions

7. Improper passing (overtaking) 7. Poor road illumination

8. Improper turning 8. Unsecured load or loaded improperly

9. Operating equipment without authority 9. Vehicle over loaded

10. Unsafe act of others

11. Driving under the influence of alcohol or drug

12. Insufficient visibility

13. Operating beyond vehicle capacity (overload)

14. Operating without proper license

15. Reckless driving

PERSONAL FACTORS JOB FACTORS TYPE OF CONTACT

1. Inadequate capability 1. Equipment/ vehicle modified 1. Hit on frontal vehicle

2. Lack of knowledge 2. Interior hazard in side vehicle 2. Hit by following vehicle

3. Lack of skill / training 3. Inadequate maintenance 3. Hit on rear vehicle or structure while reversing

4. Fatigue 4. Inadequate inspection 4. Hit on either side

5 Distraction 7 Wear and tear

ENGINEERING MAINTENANCE COMPANYTel: 44359181 - Fax: 44359188, P.O.Box: 24125 - Doha, Qatar

VEHICLE ACCIDENT INVESTIGATION REPORTC

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IMMEDIATE CAUSES: WHAT SUBSTANDARD ACTIONS AND CONDITIONS CAUSED OR COULD HAVE CAUSED THE EVENT

BASIC CAUSES: WHAT SPECIFIC PERSONAL OR JOB FACTORS CAUSED OR COULD CAUSE THIS EVENT? CHECK

5. Distraction 7. Wear and tear

6. Improper motivation 8. Abuse or misuse

ATTRIBUTE THE INVESTIGATION FINDINGS TO HSR PROCEDURES (WHICHEVER APPLICABLE)

WP-1. Audit WP-7. Journey Mgmt. WP-13. PTW WP-19. House Keeping WP-25. NC, CA & PA

WP-2. Inspections WP-8. TBT WP-14. Waste Mgmt. WP-20. Legal Requirement WP-26. Monitoring &

WP-3. Nearmiss/ suggestion WP-9. Incident Rept & invstn. WP-15. PPE WP-21. External Comm. measurement

WP-4. Training WP-10. Safety Violation WP-16. Pest & Hygiene WP-22. Mgmt of Change

WP-5. Doc. Mgmt. WP-11. HSE Meeting WP-17. Mgmt Review WP-23. Control of Doc & Record

WP-6. Risk Assessment WP-12. Sub-Contr. Mgmt. WP-18. ERP WP-24. EAI Assessment

WHAT REMEDIAL ACTIONS HAVE BEEN TAKEN TO PREVENT RECURRENCE?

…………………………………………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………………………………………………

SITE ENGINEER PROJECT ENGINEER/ MANAGER

NAME: SIGN: NAME: SIGN:

COMMENTS ON REMEDIAL ACTIONS TAKEN:

…………………………………………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………………………………………………

SITE MANAGER/SUPT./HEAD OF DEPT. NAME:………………………………………………………………………………SING:…………………………DATE:………………….NOTE: ATTACH SKETCH & ADDITIONAL DETAILS IF NECESSARY

DISTRIBUTION: 1. GM, 2. MR-QHSEMS 3. Admin officer 4. Site file

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Rev.-01, 25/03/2013 Page 2 of 2

Rev.01, 30.11.2011

SF/FR-03 ENGINEERING MAINTENANCE COMPANY


FIRST AID REGISTER

Details of the injured:

Name :

Staff/Card No. :

Category :

Details of the incident

Date :

Time :

Exact location :

Part of body injured :

Brief description of the incident (Mention what the injured was doing, the equipment, material he was handling at the time of incident etc.)

:

Date & time of returning back to work :

Category of the incident

First aid at site only : Yes/ No

Requiring outside medical attention : Yes/ No

Involving restricted work* : Yes/ No

Involving lost man days** : Yes/ No

Number of days lost due to restricted work/ absence

:

Prepared by:

Name : Signature:

* The injured could return back to work (to a restricted work activity) after the medical attention. ** The injured could not return back to work after the medical attention.

ENGINEERING MAINTENANCE COMPANY Tel. : 44359181 – Fax :44359188, P.O. Box : 24125 – Doha, Qatar

MINUTES OF HSE MEETING

Rev. 01, 25/03/2013 Page 1 of 2

SF/FR-04

HSE Meeting Number: Name of the site:

Member Present Distribution of the minutes

1. 1. 2. 2. 3. 3. 4. 4. 5. 6. 7. Date: Place: Recorded by:

Time: Signature:

S. No. DESCRIPTION ACTION

1 Purpose and objectives of the meeting:

2 Minutes approval of previous meeting:

3 General:

4 House keeping & Waste disposal:

5 Welfare measures:

6 Near miss and suggestions received:

7 Accident / incidences (including Spillage) / FA case:

8 Scaffolding and ladder:

9 Electrical safety:

10 PTW issues: Hot Work: LOTO: Excavation: Confined space:


MINUTES OF HSE MEETING

Rev. 01, 25/03/2013 Page 2 of 2

SF/FR-04

11 HSE Inspections:

12 HSE Induction and Toolbox talks:

13 Fire prevention:

14 Emergency preparedness:

15 Lifting machinery/tackles/hoists:

16 Journey management:

17 HSE Training and awareness sessions:

18 Risk Assessments & Aspect /Impact Assessment:

19 Sub contractors:

20 Scope for possible improvements in HSE:

21 Legal issues:

22 HSE audit, if any:

23 PPE’s:

24 HSE Programs:

25 Any other issue:

26 Next meeting:


HSE TOOLBOX TALK MEETING

Rev.: 01, 25/03/2013

SF/FR-05

Name of the site: Date:

Topic:

S. No. Name Signature

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20. Conducted by Name & Designation : Signature: 1.

2.

ENGINEERING MAINTENANCE COMPANYTel: 44359181 - Fax: 44359188, P.O.Box: 24125 - Doha, Qatar SF/FR-06

Months

Fata

l Inc

iden

t (F

I)

Tota

l Rep

orta

ble

Inci

dent

(TR

I)

Num

ber o

f Los

t Ti

me

Inci

dent

(LTI

)

Tota

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day

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st d

ue to

LTI

Num

ber o

f M

edic

al

Trea

tmen

t Cas

es

(MTC

)

Num

ber o

f R

estr

icte

d W

orkd

ays

Cas

es

(RW

C)

Num

ber o

f R

estr

icte

d W

orkd

ays

Num

ber o

f fire

in

cide

nt

Num

ber o

f pr

oper

ty d

amag

e ca

se

Num

ber o

f Ve

hicl

e A

ccid

ent

Firs

t Aid

Cas

e (F

AC

)

No.

of N

ear m

iss

happ

ened

dur

ing

the

mon

th

Tota

l Man

pow

er

(incl

udin

g St

affs

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Tota

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Wor

ked

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(in

clud

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Ove

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any)

Num

ber o

f ve

hicl

es

avai

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e

Tota

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's

Driv

en d

urin

g th

e m

onth

January

February

March

April

May

June

July

August

September

October

November

December

Total

Months

No.

of H

SE

Mee

ting

hel

d

No.

of A

-1 w

ork

plac

e In

spec

tion

C

ompl

eted

No.

of H

SE

Insp

ectio

ns

com

plet

ed

No

of

Cor

rect

ive

Act

ions

(CA

) ra

ised

dur

ing

the

mon

th

No.

of

Cor

rect

ive

Act

ions

Clo

sed

out d

urin

g m

onth

No.

of H

SE

Impr

ovem

ent

Slip

s is

sued

du

ring

the

mon

th

No.

of H

SE

Sugg

estio

n R

epor

ted

No.

of N

ear

mis

s R

epor

ted

No.

of H

SE

Inte

rnal

/ Ex

tern

al a

udit

cond

ucte

d

No.

of

HSE

tr

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ng

Con

duct

ed

durin

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onth

No.

of T

oolb

ox

talk

Con

duct

ed

No.

of

Empl

oyee

s at

tend

ed H

SE

Trai

ning

No.

of M

ock

drill

con

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ed

No.

of b

asic

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st a

ider

(s)

avai

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si

te

No.

of b

asic

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hter

(s)

avai

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e

No

of

tool

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uipm

ent

/tool

boxe

s in

spec

ted

January

February

March

April

May

June

July

August

September

October

November

December

Total

No.

of n

ew

empl

oyee

s gi

ven

site

sa

fety

in

duct

ion

Proactive KPI's

Name of the project: Job#

Sign

ifica

nt

Envi

ronm

enta

l ca

ses

(Spi

llage

, Em

issi

on,

disc

harg

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Reactive KPI's

HSE MONTHLY PERFORMANCE REPORT

Rev.:0, 25/03/2013



Journey Management Register Project: Vehicle No.: Name of the driver: Month/Year:

Date of travel

Details of Journey Follow up actions during and until the safe

arrival of the vehicle at the other end

Sign. of the driver

Starting Timing Starting Location End Location

Expected time of reaching the

destination

Actual time of reaching the destination

Note: This format to be filled while undertaking travel in desert roads (Under off road condition)/ while traveling more than 100 KM’s between 9:00 pm to 5:00 am

hasmu

Typewritten Text

Rev.:0, 11/06/2008

Severity (S)

Probability (P)

Risk Rating (S x P)

Risk Level

Severity (S)

Probability (P)

Risk Rating (S x P)

Risk Level

Risk rating before control measures

Hazard

Control measures to be used Risk rating after control measures

Risk Assessment SheetRef.No.:

Activity:

Harm

Issued by Approved by Risk assessment carried Negligible 1 Very rare 1 out by risk assessment Minor 2 Remote 2 committeeReportable 3 Occasional 3 Risk RatingMajor 4 Regular 4 1 - 7 = LowFatality 5 Frequent 5 8- 16 = Medium Revision date: Multi-fatal 6 Almost certain 6 17-36 = High

Severity (S)Revision No.:

Probability (P)

Rev.01, 30.11.2011

SF/FR-8A

Environmental Aspects Environmental Impacts

Activity, product or service that can interact with the

environment

Any change to the environment, whether adverse or beneficial, wholly or partially resulting from any EMCO’s environmental aspects.(Depletion of natural Resources, Air, Water,Land, Local nuisance, Flora, fauna, Human Ill Health)

Impa

ct

Rat

ing

Freq

uenc

y

Seve

rity

Reg

ulat

ion

Qua

ntity

Impa

ct R

atin

g

Impa

ct L

evel

B

A

B

A

ENVIRONMENTAL ASPECTS/IMPACTS ASSESSMENT REGISERActivity: Ref.No.:

Activity under consideration Control measures Applicable Legal / Other

requirements

Impact Evaluation

B

A

B

A

B

A

Issued by Approved by Regulation Impact LevelNo Regulation 1 1 1 Low 1 Rev. No.

MR HSEMS GM Controlled by organization objectives & programs 2 2 2 Moderate 2Guided by national/Iinternational best management practices 3 3 3 Large 3 Date:Regulated by Laws 4 Serious 4 4 Very Large 4

B=

SignificantContinuous

No Impact Improbable Insignificant

Minor InfrequentLess than or equal to 72

Impact Rating before apply control measures A= Impact rating after applied control measures

Moderate Frequent Above 72

Severity Frequency Quantity

G:\DEPTS\HSE\Documents\QHSE_WORD FORMAT\QHSE DOC\HSE Formats\SF-FR-8A Rev. no.: 01, 12.08.2013 SF-FR-08APage 1 of 1

IMS/NCR - 09

Rev-3 Dtd: 15/12/2013

Project Name/Job No :………………………………………….

Name of Auditor(s)/Observer :……………………… Auditee (s)/Site Incharge : ………………

Brief Description of Non Conformity Observation : Major Minor

Attribute to ISO 9001/ISO 14001 OHSAS 18001/Legal & Other requirements/Work Procedures:………………

Potential problem Normal

Audit Feed Back: (Attach detailed feedback report wherever applicable)

Proposed Immediate Action : Target Date

Proposed Corrective Action : Target Date

Proposed Preventive Action : (Required Only for potential problem)Target Date

Auditor : ACKNOWLEDGED BY :Date : Date :Verification of Corrective /Preventive Action

Verified and Closed

Auditor Management Representative

Root Cause(s):

Action By

Action By

Non Conformance Report NCR No.:

Date:

Action By


IMS Internal Audit Checklist

Rev.:03, 15/12/2013 Page 1 of 9

IMS/IAUD-10

SECTION –A (HEALTH, SAFETY & ENVIRONMENT)

Name of the site audited :

Job number : Audit Ref No. :

Site In-charge :

Engineer (S)/ Supervisor(s) :

Technicians audited :

Date of Audit :

S. No. PR

OC

. R

EF.

CHECKS COMMENTS

1

QH

SE/I

AU

D-1

3 Verify the status of implementation of the previous audit in the same place / same person (if any)

Are all th e recommendations including NCR’s from the previous audit complied within given time and NCR’s closed?

2

QH

SE/I

NS-

18

Scaffolding, ladder, power tools and construction machinery inspection of the actual condition of the said accessory and the reported condition in the inspection records have to be verified.

Discuss with the authorized inspectors to find out any problems they are facing.

Check the status of fire extinguishers and first aid box.

Check the status of A1 workplace inspection checklist implementation and is verified by project manager.

Check the status of A2 Camp inspection checklist implementation and is verified by administrative officer.

Is the project engineer, who does the monthly inspection (A1), is checking the legal and contractual requirements also as a part of inspection?



Rev.:03, 15/12/2013 Page 2 of 9

IMS/IAUD-10

Conduct a through site inspection to

verify legal compliance, and the compliance with our HSEMS.

3

QH

SE/C

CP-

17

How many suggestion/ near miss cards the site has generated?

What is the status of those reports?

Talk to the contributors how do they feel about it?

Are the suggestions/near misses given earlier (elsewhere in the company) being communicated to the site and are they following the same

Are the supervisors committed to this? Has the site received any communication

about HSE matter from outside the company (Clients, neighbours, consultants, co-contractors, local authorities etc)

Talk to so me of them if possible and obtain their feedback.

How the site is handling such communications?

Has the site made any efforts to communicate our HSE requirements to outsiders, whatever required?

4

QH

SE/C

TA

-14

Is there new/transferred employees given site safety induction? Verify at least two employee’s induction records.

Is there enough number of trained Fire fighters First aider Authorized Equipment Inspector Authorized PTW personnel available

Are the supervisor/engineers identifying the training needs of their employees and sending them for training? Verify the last training (in-house/external) attended by the employees.



Rev.:03, 15/12/2013 Page 3 of 9

IMS/IAUD-10

Is the training effectiveness being evaluated after 60 days of training?

Check the awareness and knowledge level of EMCO HSEMS at various levels of persons at random and comment.

5

QH

SE/D

DC

-05

Verify the availability of the following documents: 1. QHSE Manual and procedure 2. Near miss/suggestion cards 3. Tool box talk records 4. Accident report / investigation

reports 5. First aid register 6. Monthly HSE performance report 7. Legal requirements 8. Material Safety Data Sheet 9. Third party inspection certificates of

lifting equipments & loose gears 10. Calibration certificate of measuring

instruments 11. OH&S Risk assessment and

Environmental Aspect & Impact assessment sheets.

12. Closed permits 13. Inspection records 14. Minutes of HSE monitoring

meetings. Check the c ompleteness of the re cord

and its authenticity.

6

QH

SE/H

IRA

-19 Has the si te separated the relevant risk

assessment sheets for th eir day-to-day reference?

Have they studied the scop e of work completely to find out whether a ny additional risk assessments will be required?



Rev.:03, 15/12/2013 Page 4 of 9

IMS/IAUD-10

7

QH

SE/J

M-2

1

In there a ny movement of v ehicle goes through the desert roads involved in the execution of the contract. If so, verify the journey management register (SF/FR-07).

Are the v ehicles provided with all the accessories as per the above work procedure?

Does the driver inspecting vehicle as per SF/CH-21?

Are the vehicles being sent for regular maintenance as per manufacturer recommendation?

Have the dri ver attended the tra ining "Defensive Driving"?

8

QH

SE/T

BT

-22

Check toolbox talk records

Verify the efficiency of the toolbox talks with cross section of people

Is there any group meeting conducted before start of any new activity or af ter occurrence of any near miss/ incident. Verify the records.

9

QH

SE/I

RI-

23

How many incidents/near miss/ first aid cases been reported? Check and verify the investigation and action taken report.

Check the availability & inspection of first aid box as per the Qatar Labour law 14/2001- article 104 or Part 1 .2.4 section-11 of QCS-2010

Check the contents of fi rst aid bo x. Watch for signs of usage.

Check the a vailability of trained first aider & fire fighter. Verify their competency certificate.

Talk to t he trained first aider and fire fighter.



Rev.:03, 15/12/2013 Page 5 of 9

IMS/IAUD-10

10

QH

SE/D

SV-2

4

Check the availability of HSE improvement slip with site staffs.

Check the implementation of HSE improvement slip.

Check how many HSE improvement slips was issued in the last month. Is the summary of HSE improvement slip forwarded to MR? verify SF/FR-18

Ask the s upervisors about how do they handle HSE violation at site

Verify the same with employees

11

QH

SE/M

MM

-32

Check the minutes of monthly HSE monitoring meeting and verify the implementation of the points discussed.

Are all the p oints as prescribed un der SF/FR-04 being followed in conducting the meeting?

What is the average tim e taken for the meeting?

12

QH

SE/V

SA-0

3 Are there subcontractors working?

If so, what is their awareness about HSE Management System?

Are they aware of the specific Q HSE requirements related to the scope of work?

13

QH

SE/P

TW

-25

Check enough number of trained PTW cardholders available to the site? Check their authorization cards and validity date.

Check site following EMCO/Client permit to work system? Verify at least two current (if any) for compliance to the PTW requirements and the availability of resources for the compliance.

Closing out / renewal of the work permit being followed? Verify at least two closed permit.



Rev.:03, 15/12/2013 Page 6 of 9

IMS/IAUD-10

14

QH

SE/W

M-3

1

Are the enough numbers of skip b oxes, dustbins available at work site/ site offices to handle the wastage properly?

Are the w astage being, collected, segregated and dispo sed at regular interval by our own arrangements/ third party? Verify the disposal record.

15

QH

SE/P

PE-2

6

Verify the physical condition of the Personal protective equip ments worn by the workers at least three persons.

Talk to the employees to check the awareness and find ou t any suitability problem about Personal protective equipments.

Check site having adequate stock of personal protective equipment for their day-to-day use and issue record s maintained.

16*

QH

SE/P

UR

-02

Is the LPO for chemicals to be purchased mentioned the requirement of Material Safety Data Sheet (MSDS)?

Is the LPO for the lifting gears to be purchased mentioned the requirement of Third Party Valid Inspection certificate?

Is the vendor/subcontractor QHSE prequalification questionnaire (SF/FR-Q01) filled and submitted by the subcontractor contractor?

Are all the subcontractor approved by the management as per the QF/FR-Q01

17

QH

SE/P

CH

-27

Check all the rooms, toilet facilities & dining facilities being cleaned a nd disinfected everyday and verify the records.

Check the pest control plan available. Check when last pest control was carried out.

Check the name of the pesticide, quantities of the pesticides and Material Safety Data Sheet (MSDS) submitted by the pesticide contractor?



Rev.:03, 15/12/2013 Page 7 of 9

IMS/IAUD-10

18

QH

SE/E

PR-3

3

Check there emergency response plane available, communicated & displayed in common location.

Check there eno ugh numbers of poster, stickers, signboards, Spill Kits and notice boards are displayed at site?

Are the names and contact number of first aider & fire fighter and emergency telephone numbers displayed?

When was the last Mock drill conducted? Verify the records.

Talk to the employees to check the awareness level about emergency response plan

19

QH

SE/H

K-2

8

Are the employees doing house keeping at site as a part of their daily job on daily basis?

Are the enough numbers of dust collector (skip box, dust bins) available at worksite/office?

Are the skip boxes being emptied on regular basis?

Verify the house keeping standard in the workshop, stores, dining facility, offices and Lay down areas.

20

QH

SE/L

OR

-29

Check the status of implementation of applicable legal requirement (Qatar Labour law-14/2004 Part-10 Article-99, 100, 101, 102, 103, 104, 105 ,106, QCS-2010 Section-11, Qatar Law No. 30 of 2002 Environmental protection and other requirement such as client and prepare status report of compliance.

21

QH

SE/E

AIA

-20

Are all the activities being carried out at the time of inspection covered by existing environment aspect/impact assessment sheet?{ List out the activities inspected and the rel evant EAI assessment ref nos}

Are the control measures being followed?



Rev.:03, 15/12/2013 Page 8 of 9

IMS/IAUD-10

22

QH

SE/M

OC

-30

Are new/transferred employees given HSE induction before allowing them to work? (Check the employee attendance register/daily sheet f or new/transferred e mployees a nd interview them

Are inspection checklists, risk assessments available for new/transferred machineries? (Check gate pass /entry register)

Is MSDS available for new chemicals and it communicated to all concerned?

If there is an y revision in the procedures, is it updated and communicated to all concerned?

Is a method statement available for any change in process (work methods) or new methods and is it updated in the risk assessment?

23

HSE

Pro

gram

s &

Obj

ectiv

es

Are the site staffs aware of the current HSE programmes?

What is the status of implementation of the current HSE programs? Check records,

Are the HSE programmes / objectives displayed in the site?

What is the awareness at the level of technicians?

24

HSE

Pol

icy

Is the HSE p olicy displayed at conspicuous location?

Are the people aware of the existence of the HSE policy?

What is the awareness and commitment to the contents of the policy?

What is the awareness at the level of technicians?

Sign: Auditor

Sign: Auditee

Date: Date: * Note: S. No. 16 is applicable to purchase department only.



Rev.:03, 15/12/2013 Page 9 of 9

IMS/IAUD-10

SECTION –B (Quality Management System) Name of the site/department audited : Job number :

Site In-charge : Date of Audit : Audit Ref No. :

1. Procedure Reference QHSE/EC-07 from 5.2 to 5.3.6 for Construction Project and from 5.4.0 to 5.5.25 for Maintenance project. 2. Procedure Reference QHSE/EVM-08 from 5.1 to 5.14 for vehicle maintenance workshop 3. Procedure Reference QHSE/TWC-06 from 5.0 to 5.47 for Estimation 4. Procedure Reference QHSE/CTA-14 from 5.0 to 5.2.14 for HR & Admin 5. Procedure Reference QHSE/PUR-02 from 5.0 to 5.45, QHSE/VSA-03 from 5.0 to 5.2.7, QHSE/WH-04 from 5.0 to 5.3.7 for

Purchase & warehouse Note: Verify all the above procedures wherever applicable

S. No.

PROCEDURE REF. CHECKS COMMENTS

Auditor :……………………. Auditee:…………………….


HSEMS- Attendance Sheet

Rev.:01, 25/03/2013

SF/FR-11

Subject :

Venue :

Date :

S. No. Name S/C No. Signature

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

Feed back from the participants


CONTRACT REVIEW (To be filled up after award of contract)

Rev.:01, 25.09.2013

SF/FR-12

Job No. ……………………….. Contract Value: ………………………………

Start Date ……………………...... Completion Date …………………………........

Mobilization Date ………………………. Manpower required YES NO

Brief Scope of Work ……………………………………………………………………………………

……………………………………………………………………………………

……………………………………………………………………………………

All EMCO’s an d Customers HSE requirements are completely specified in the contract agreement.

YES NO

All Deviation from tender/quotation related to HSE are reviewed and resolved with the customer.

YES NO

Brief Scope of Sub-Contract Work (if any)

…………………………………………………………………………………….

…………………………………………………………………………………….

Sub-Contract works- QHSE/VSA-03 made part of the inquiry to sub-contractors.

YES NO

EMCO has the capability to meet the contract requirements completely to cover HSE matters

YES NO

(mention id any constraints/ cautions to be taken)

……………………………………………………………………………………

……………………………………………………………………………………

Project Manager/ Engineer assigned for this project

……………………………………………………………………………………

……………………………………………………………………………………

Remarks

……………………………………………………………………………………

Reviewed By ………………………. Approved By ………………………………..

Date ………………………. Date ………………………………..

SF/FR-13

ENGINEERING MAINTENANCE COMPANYTel.: 44359181 - Fax : 44359188, P.O.Box:24125 - Doha, Qatar.

Audit Ref No: Job # AUDITEE

RESPONSIBLE AUDIT SCOPE AUDIT DATES TEAM LEADER/ AUDITOR Remarks

DEPARTMENTS / DIVISION & LOCATIONS

Ref:

Date :

Signature of the Management Representative : …………………………………………………………

Date :

hasmu

Typewritten Text

Rev.:01,25/03/2013

hasmu

Typewritten Text

INTERNAL IMS AUDIT SCHEDULE

hasmu

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hasmu

Typewritten Text

IMS/ARC-14

Location : ……………………………………………………………………. Audit Ref. No.: ……………………..

Audit Team Leader

Audit Team Members

Name of the auditee(S)

Action Required Date

……………………..

……………………..

………………...…..

Response to Audit Report (If any)

…………………………………………..(AUDIT TEAM LEADER)DATE:

Distribution of the internal IMS audit report:1) Genral Manager 2) All Committee members 3) Management Representative

Rev.-02, 15.12.2013

: …………………………………………………………………………………………………...…………

: …………………………………………………………………………………………………………….…

………………………………………………………………………………………………………...……..

: ……………………………………………………………………………………………………...………

ENGINEERING MAINTENANCE COMPANYTel: 44359181 - Fax: 44359188, P.O.Box: 24125 - Doha, Qatar

IMS (ISO 9001/ISO 14001/OHSAS 18001) AUDIT REPORT

3) …………………………………………………………………………………………………………………………………...…..….

Summary of Audit Results (e.g. any major system non conformities may be in the form of absence of documents or failure in compliance with the procedures)

1) …………………………………………………………………………………………………………………………………......…….

2) ………………………………………………………………………………………………………………………………….……….

………………………………………………………………………………………………………...……..

Audited Areas/Departments/Divisions

1) ………………………………………………………………………………………………………………………………...………...

2) …………………………………………………………………………………………………………………………………….…..….

………………………

………………………

………………………

3) …………………………………………………………………………………………………………………………………...……….

Action By

1) ……………………………………………………………………………………

2) ……………………………………………………………………………………

…………………………………………………………………………………………………………………………………….………..

…………………………………………………………………………………………………………………………………….………..

(ACKNOWLEDGED BY)DATE

……………………………………………..

3) ……………………………………………………………………………………

SF/FR-15

DEPARTMENTS / DIVISION & LOCATIONS AUDITEE RESPONSIBLE FREQENCY JAN FEB MAR APR MAYUN JUL AUG SEP OCT NOV DEC REMARKS

Prepared By Approved By

Management Representative General Manager

Signature: Signature:

Date: Date: Rev.No.: 01, 25/03/2013

ENGINEERING MAINTENANCE COMPANYTel.: 44359181 - Fax : 44359188, P.O.Box:24125 - Doha, Qatar.

hasmu

Typewritten Text

INTERNAL IMS AUDIT PLAN

BE ALERT DO NOT GET HURT

Ref. No.: SF/FR‐16

Near Miss Card (For Reporting Observation)

Location of Near Miss: Date:

Near Miss related to: Health & Safety Environment Quality

Near Miss (Hazard) Description (Please write what you observed, You may write in any language):

Were you able to rectify the situation? Yes/No. If yes what was the action taken?

If No, what is the action suggested?

Reviewer comments:

Name :…………………………………………………………………………………………………….. Mobile/Tel.No.: …………………………..

S/C No.:…………………………… Project /Location:…………………………………………………………………………………………………

Date:……………………………….. Remarks:……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………. …………………………………………………………………………………………………………………………….

Job No.#............................ Rev.:01, 25/03/2013

TEAM UP TO WIN FOR QHSE

Ref. No.: SF/FR‐17

Suggestion Card

Suggestion related to: Health & Safety Environment Quality

Problem description (Please write what you observed, You may write in any language):

What is your suggestion to eliminate the problem?

Reviewer comments:

Name :…………………………………………………………………………………………………….. Mobile/Tel.No.: …………………………..

S/C No.:…………………………… Project /Location:…………………………………………………………………………………………………

Date:……………………………….. Remarks:……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..……………………………………………………………………………………………………………………………..

Job No.#............................ Rev.: 02, 25/09/2013

SF / FR /18

Name of the Project: …………………………………………………………………………………………………… Month …………………………….

S.No. Card No. Name of the Violator Date of IssueHSE

Improvement Slip No.

Description of violation Issued by

ENGINEERING MAINTENANCE COMPANY Tel.: 44359181 - Fax : 44359188, P.O.Box:24125 - Doha, Qatar

HSE Improvement Slip Issue Summary

Note: NIL reports are also to be specified

Rev.: 01, 25/03/2013

SF/FR/19

ENGINEERING MAINTENANCE COMPANY Tele.: 44359181 – Fax : 44359188, P.O. Box 24125 – Doha, Qatar

Fire Fighting Equipment Register

Name of the Premises: __________________________________________

Sl No.

Details of the Equipment Location of Equipment Remarks Description Tag Number Capacity Service due date

Note : This register is to be maintained in each site/facility by the in-charge.

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Rev.: 0, 11/06/2008


VEHICLE ACCIDENT REPORT

Rev. 02, 25.03.2013

SF/FR-20

Location of Accident

Date & Time of Accident

Job No.

Circumstances & Description of the Accident

Spillage of fuel/oil due to accident Yes

No

Quantity of spillage (Litres)

Vehicle No. Vehicle Type

Vehicle Details

Name of the Driver Staff number

Driving License No. Issue Date Expiry Date

Name of the persons injured (if any)

Nature and extent of damage to the vehicle

Draw a sketch how the accident was happened?

Action Taken

___________________

Site in charge

___________________

Project Manager

___________________ Department Manager

Date:________________ Date:________________ Date:________________

Distribution: 1. GM 2. MR (HSE MS) 3. Admin Officer 4. Manager-Plant & Assets/ 5. Commercial 6. Site file

HEALTH, SAFETY ENVIRONMENT TRAINING MATRIX SF/FR 21

Rev-02 Date:25/03/2014

COURSES

1 HSE Induction x x x x x x x x x x x x x x x x On joining & on transfer 1 In-house2 OHSAS Awareness (OHSAS 18001 2007) x x x x x x x x x x x x x x x x On Joining the company 2 In-house3 HSE management x x x x 1 4 In-house4 Personal Protective Equipment x x x x x x x x x x x 2 2 In-house5 OH&S Risk and Environmental Aspect/Impact Assessment x x x x x 1 2 In-house6 Fire Safety 3 6 3rd party7 Electrical Safety x x x x x x x x x 1 2 In-house8 Lifting equipments & Material handling x x 1 4 In-house / 3rd party9 Warehouse/Store Safety x 1 2 In-house

10 Work at Height x x x x x x x x x 1 2 In-house / 3rd party11 Office Safety x x x x 2 1 In-house12 Scaffolding Safety x x x x x x x x x x 1 2 In-house / 3rd party13 Ladder Safety x x x 1 1 In-house14 First Aid 3 6 3rd party15 H2S Awareness 1 2 In-house16 Usage of Power tools x x x x x x x x x 1 1 In-house17 Defensive driving training 1 4 In-house18 Environmental Awareness (ISO 14001 2004) x x x x x x x x x x x x x x 2 2 In-house19 Occupational Health & hygiene x x x x x x x x x x x x x 2 2 In-house20 Working in Hot Environment (Heat Stress) x x x x x x x x x x x x x x 1 1 In-house21 Compressed Gas Cylinders x x x x x 1 1 In-house22 Welding Safety x x 1 1 In-house23 Confined Space Entry x x x x x x x x x x 1 2 In-house24 Usage of Abrasive wheel x x x x x x x 1 1 In-house25 Equipment inspection training x x x x x x x x x x 1 2 In-house26 Permit To Work System x x 1 2 In-house27 Manual Handling x x x x x x x x 1 1 In-house28 Behavior Based Safety x x x x 1 In-house29 OHSAS 18001 & ISO 14001 Internal Audit x x 2 6 In-house / 3rd party30 Trenching & Excavation x x x 1 2 In-house31 Noise x x x 2 1 In-house32 Life Saving Rules (Oil & Gas field) x x x x x x x x x x x x x x x x 1 1 In-house33 H2S/BA (RASGAS) 2 3rd party34 PTW (RASGAS) 2 3rd party35 SAFETY/FIREWATCH(RASGAS) 2 3rd party36 FOOD HANDLING x 2 In-house

Training hours per year 16 4 27 44 42 4 7 24 23 26 22 24 21 22 19 20 2 77

Site in-charge to nominate based on site activities

Sl No

Man

ager

Off

ice

Staf

f

Sr E

ngin

eers

Site

Eng

inee

rs

Supe

rvis

ors

Off

ice

Ass

t

Driv

ers

Mas

ons

Kitc

hen

staf

f

Freq(Yrs)

Stor

e K

eepe

rs

Pain

ters

A/C

Tec

hnic

ians

Elec

trici

ans

Wel

ders

Duc

t Fab

ricat

ors Type of Training

Based on Project requirementDept. Manager to nominate

Dept. Manager to nominate

Nomination shall be done by the site incharge.

Nomination shall be done by the site incharge.Personnel working in locations prone to H2S hazard

Plum

bers

Car

pent

ers

Dur

atio

n in

hou

rs

Site in-charge to nominate technicians

Site in-charge to nominateSite in-charge to nominate

Dept. Manager to nominate

All Drivers & Staffs,Technicians who are all driving

All Senior Technicians

Name of Program :

Venue : Training Date :

Name & Signature of Trainer :

Name & Signature of Trainee : Employee No.:

Personal Action Plan :

Training Objectives that I have learnt from this program that I would like to implement in my day to day activity

1

2

3

Evaluaton Date : ____________________________

EVALUATON OF TRAINING EFFECTIVENESS

QF/TRG‐02&SF/FR‐22

Effectiveness of Training on job [after 60 days]

(Some Progress)

Justification for Assessment:

Signature : ___________________________ Name :

Designation :

Excellent(5)

Demonstrated)

Superior

(Good Progress) (CompetencyPoor (1)

(No Progress)Fair (2) Good (3) Very Good (4)

demonstrated)

Supervisor / Site Incharge

[Signature]

Entered in System Date : _____________________

Level of Implementaton

Self

(Very well

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Rev.: 01, 30/11/2011

EMCO QATARTel: 44359181, Fax: 44359188, P .O. Box : 24125, Doha, Qatar

SF/FR-23

PROJECT NAME :……………………………….. Date :

JOB NO :…………………………………………

AUDITEE : ……………………………………….. Audit Ref. :

SL NO DESCRIPTION OF REQUIREMENT COMPLIANCE STATUS ACTION REQUIRED TARGET DATE STATUS

HSE OBSERVATION REPORT

Rev.: 02, 25/03/2013

AUDITOR . DATE : ACKNOWLEDGED BY DATE:

Rev.: 02, 25/03/2013


MOCK DRILL REPORT

SF/FR-24

NAME OF THE SITE/CAMP:

JOB NUMBER: Date:

CONDUCTED BY WITNESSED BY

MOCK DRILL SENARIO:

EMERGENCY RESPONSE TEAM

S. NO. FIRST AIDERS FIRE FIGHTERS / SPILL CONTROL TEAM

S.NO. OBSERVATION OF MOCK DRILL DETAILS

1 Location of assembly point

2 Fire alarm activation Method.

3 Time- Siren activated Time Siren reset

4 Time taken for Assembling and headcount

5 No. of company personnel at site/camp

6 No. of Sub-Contractor Personnel at site/camp

7 No. of personnel at assembly point

8 Head count done by

9 Head count reported to

Observations /Feedback: (Detail any specific observation /feedback as a result of the drill) Recommendation(s) (Corrective measures against observations/Feedback:

RESULT OF MOCKDRILL:

Satisfactory Not Satisfactory

Prepared By: Name: Signature:

Copy to: MR (QHSEMS) / HR Rev.no.: 2, 25.03.2014

SF/FR-25

No.

of U

C/U

A re

ctif

ied

No.

of U

C re

ctif

ied

Act

ion

take

n on

poi

nts

of th

e m

eetin

gs

No.

of T

BT c

ondu

cted

by

him

Stat

us o

f Com

plia

nce

of H

SE

audi

t rec

omm

enda

tions

Num

ber o

f mea

suri

ng

inst

rum

ent w

ithou

t val

id

calib

ratio

n ce

rtif

icat

e in

his

ar

ea

S.No ENGINEERS

1

2

3

4

5

1

2

3

4

5

6

7

11

No.

of N

CR

's fr

om H

SE

audi

t, if

any

No.

of s

afet

y tr

aini

ng

atte

nded

No.

of U

C/U

A o

bser

ved

in

his

area

by

Safe

ty O

ffic

er

No.

of U

C/U

A re

mar

ks b

y cl

ient

/con

sulta

nt

No.

of S

afet

y Im

prov

emen

ts

slip

Issu

ed

Part

icip

atio

n in

Saf

ety

Mee

tings

No.

of s

ugge

stio

n/ne

ar m

iss

fr

om h

is a

rea

No.

of A

ccid

ents

in h

is a

rea

of re

spon

sibi

lity

SUPERVISORS

Distribution: 1. GM; 2. MR HSEMS

Prepared by: Safety OfficerApproved by: Project Manager

Name of the Staff

For the month:

EMCOTel: 44359181, Fax: 44359188, P O Box: 24125, Doha, Qatar

MONTHLY STAFF SAFETY PERFORMANCE MONITORING REPORTName of the Site :

Remarks

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Typewritten Text

Rev.: 1, 25/03/2013

SAFE SUPERVISOR EVALUATION FORM

Note: Attach necessary supporting documents Rev.:0, 25/03/2013

For the month of: Name: Designation:

S/C # Job#

Project Name:

S. No. Evaluation guideline Scores to

be awarded

Number of Observations Score Obtained

1. No. of unsafe conditions identified by safety officer

-10 /UC notified

2. No of unsafe conditions rectified 5 /UC rectified

3. Number of safety improvement slips issued by supervisor/foreman 5 /slip

4. No of safety improvement slip issued by safety officer in his area - 5 /slip

5. Non participating in safety meeting -10 /Meeting

6. Action taken on the points discussed in the safety meeting 5/Action

7. Number of TBT conducted 5 /Topic

8. Number of suggestion / near miss reported by him

10 /Sugg,NM

9. Number of suggestion / near miss reported by workmen 3 /Sugg,NM

10. No of NCRs in safety audit his area -5 /NCR

11. Closing of NCRs 4/NCR

12. No of Trainings attended by him 5 /training

13. No of Trainings attended by his workmen 10 /person

14. Number of measuring instruments found without valid calibration certificate in his area

-10 /instruments

15. Number of tools/equipments inspected based on checklist under his control

3 /tools &equipts.

Total

Prepared by: Approved by: Name: Name:

Signature Signature

SF/FR-26

SF/FR-27

Note: Attach necessary supporting documents Rev.:0, 25/03/2013

Nomination form Safe Employee for the month of……………….

Name: Staff Card #

Designation: Job #

Name of the Project:

S. No. Check Points

1. Has he attended duty on all working day of the month?

2. Has he received any safety improvement slip during the month?

3. Has he generated suggestion / near miss report during the month?

4. Has he attended all the toolbox talk meeting during the month?

5. Has he received any safety complaint from the client during the month?

6. Has he met with any incident during the month?

7.

Have you anything extra about nominee to report? Write in few words.

Nominated by: Approved By: Name Name:

Signature Signature:

SF/FR-28

S C Q S O

First Aid Box ChecklistYear: Location:

S.No. Contents Expiry Date Qty Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Remarks

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

2727

28

29

30

Inspected by:Inspected by:

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Typewritten Text

Rev.: 0, 25/03/2013

EMCOTel:44359181, Fax:44359188, PO Box:24125, Doha, Qatar

SF/FR-29

Brief Description Source Date of receipt

Received by (Project/Dept) Remarks

External Communication Log

Rev.:0, 25/03/2013

EMCOTel: 44359181, Fax:44359188, PO Box: 24125, Doha, Qatar

SF/FR-30

Name of the site/camp:

Month Total Fuel Consumption (liters) No. of Vehicle Fuel Consume / Vehicle (Liters) Remarks

January

February

March

April

FUEL CONSUMPTION RECORDYear:

May

June

July

August

September

October

November

December

hasmu

Typewritten Text

Rev.:0, 25/03/2013

EMCOTel: 44359181, Fax:44359188, PO Box: 24125, Doha, Qatar

SF/FR-31

Name of the site/camp: Year:

Recorded byA4 Size A3 Size Sign:

January

February

March

April

May

PAPER CONSUMPTION RECORD

Total numbers of paper reams comsumedMonth Remarks

June

July

August

September

October

November

December

hasmu

Typewritten Text

Rev.: 0, 25/03/2013

EMCOTel: 44359181, Fax: 44359188, PO Box: 24125, Doha, Qatar

SF/FR-32

S.No. Location of Facilities Electricity No. Units consumed

Occupancy strength Amount (Qr.) Remarks

List of Electricity bills to be paid for the Month of :

Page 1 of 1

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Typewritten Text

Rev.:0, 25/03/2013

Rev.: 0, 25.03.2013



Safety Equipment Register Project: Job No.: Month/Year:

S. No. Name of the safety equipment

Tag Number / Identification

Number

Calibration date

Calibration due on Remarks


Tel.: 44359181 - Fax : 44359188, P.O.Box:24125 - Doha, Qatar

SF/FR-34

NOISE MEASUREMENT

Location

Date of survey

Survey carried out by

Other persons present

Source of Noise

Details of Sound level meter

Date of calibration

Location Time Distance from the source (m)

Noise Level (dBA) Remarks

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ENGINEERING MAINTENANCE COMPANYTel.:44359181 - Fax : 44359188, P.O.Box:24125 - Doha, Qatar

SF/FR-35

Rev. no.: 0, 15.12.2013

S. No.Date of

Suggestion reported

Name S/C# Job Number Descritpion of Suggestion Site In charge Review & Comments Status of implementation Remarks

Suggestion Card Register

ENGINEERING MAINTENANCE COMPANYTel.:44359181 - Fax : 44359188, P.O.Box:24125 - Doha, Qatar

SF/FR-35A

Rev. no.: 0, 15.12.2013

S. No.Date of

Suggestion reported

Name S/C# Job Number Descritpion of Suggestion Site In charge Review & Comments Status of implementation Remarks

Near Miss Card Register


Tel : +974-44359181 - Fax : +974-44359188 - P.O BOX : 24125 - DOHA - QATAR

MASTER REGISTER FOR HAZARDOUS MATERIALS FOR SITE

Project Name: Job No: Location:

Sl No Name of hazardous Material Type

(G/P/L/S/A) Location Date

Brought In

Qty Quantity used for the Month

Quantity Balance

Copy of MSDS

Available YES/NO

Remarks

Note: - G-Gas, P-Powder, L-Liquid, S-Solid, A- Aerosol Updated by Verified by

Name : Name :

Sign & Date : Sign & Date :

SF/FR-36

Rev-0, 15.06.2014


Tel : +974-44359181 - Fax : +974-44359188 - P.O BOX : 24125 - DOHA - QATAR

MASTER REGISTER FOR HAZARDOUS MATERIALS FOR HO

Project Name: Job No: Location:

Sl No

Name of hazardous Material

Type (G/P/L/S)

Chemical Available Sites Copy of MSDS

Available YES/NO

Remarks Job Number

Note: - G-Gas, P-Powder, L-Liquid, S-Solid, A- Aerosol

Updated by Verified by

Name : Name :

Sign & Date : Sign & Date :

SF/FR-37

Rev-0, 15.06.2014

SF/FR ‐Q 01

Yes ( if yes Attach the document)

If NO ( Are You Ready To Follow

EMCO HSE Procedures)

1Does your organization hold a recognized quality managementcertification?

2 Does your organization have a written quality policy?

3 Is there a company quality manual or plan?

4

Is there a tool and calibration program which includes; all tools andtooling which require calibration, frequency and due date of calibration,

DESCRIPTION OF REQUIREMENTS

STATUS

A. QUALITY MANAGEMENT SYSTEM

SL NO

QHSE VENDOR PREQUALIFICATION QUESTIONNAIRE

This questionnaire forms is the part of EMCO vendor evaluation process and to be completed by contractors/vendors and submitted with their tender/quote offer. The objective of the questionnaire is to provide an overview of the status of the contractors/vendors QHSE management system. Contractors/vendors will be required to verify their responses to the questionnaire by providing evidence of their ability and capacity in relevant matters.

NAME OF VENDOR/SUB CONTRACTOR :

TENDER/QUOTE REFERENCE # : VENDOR CODE :

4personal tools, and a system to prevent the use of tools out ofcalibration?

5Is there a documented, methodical and systematic approach to correctiveprocesses to meet the specified requirement?

6 Is there project organization charts?

1 Does your organization have a written health and safety policy?

2Does the company have any H&S management system certified by arecognized independent authority?

3 Is there a company H&S management system manual or plan?

4 Are HSE responsibilities clearly identified for all levels of staff?

1Has the company prepared safe operating procedures or work methodstatements of specific safety or environmental management instructionsrelevant to its operations?

2 Does the company have any permit-to-work systems?

3Are there procedures for maintaining, inspecting and assessing thehazards of plant operated/owned by the company?

4Are there procedures for identifying, assessing and controlling risksassociated with specific task?

C. H & S PRACTICES OR WORK METHOD STATEMENTS AND PROCEDURES

B. H & S POLICY AND MANAGEMENT

Rev.No.:0Date: 06/05/2013 Page1/2

SF/FR ‐Q 01

QHSE VENDOR PREQUALIFICATION QUESTIONNAIRE

Yes ( if yes Attach the document)

If NO ( Are You Ready To Follow

EMCO HSE Procedures)

1 Does your organization have a risk assessment process?

2Does your organization apply a risk assessment to each new type /process / machinery / area of work?

1 Is there a documented Accident/incident investigation procedure?

2 Does your organization keep statistics of accidents / incidents?

1 Does your organization train staff in Health and Safety?

2Does your organization train staff in Health and Safety according to theirparticular job?

3 Does your organization keep HSE training records?

D. RISK ASSESSMENT

E. ACCIDENT/ INCIDENT

F. HSE TRAINING

SL NO DESCRIPTION OF REQUIREMENTS

STATUS

1 Does your organization have a HSE Inspection procedure?

1 Does your organization have a written environment policy?

2Does your organisation hold a recognised environment managementsystem certification?

3Does your organization apply an environment aspect impact assessmentto each new type / process / machinery / area of work?

4 Are there procedures for waste management system?

POSITION:

NAME: POSITION:

NAME: POSITION:

NAME OF EVALUATOR:

SIGNATURE: DATE ………. /………. /……….

For EMCO OFFICE USE ONLY

REVIEWED BY

The information provided in this questionnaire is an accurate summary of the company’s QHSE management

G. HSE INSPECTION

H. ENVIRONMENT MANAGEMENT SYSTEM

SIGNATURE:

APPROVED BY

SIGNATURE:

DATE ………. /………. /……….

DATE ………. /………. /……….

Rev.No.:0Date: 06/05/2013 Page2/2

HOT WORK PERMIT Permit number :__________ Section – I Location of the hot work Description of the work Approximate duration of work Name of the work-in-charge

: : : :

------------------------------------ ---------------------------------------------------------------------- ----------------------------------------------------------------------- From ________ To_______ On ________ (Date)

Section – II (Request for the Permit)(Tick relevant ones)

• The area immediately below the work spot has been cleared of flammable materials

• Proper fire fighting equipment has been placed at site (fire extinguisher)

• Wet gunny bag/fire resistant cloth has been kept to control falling sparks.

• Flash back arrestor has been installed in the gas cylinder

• Gas cylinder and fittings are free from any leakage

• Gas cylinders are kept vertical and prevented from toppling

• Operators are in possession of the PPE specified for the job

• Pressurized lines, which could be affected by hot work, depressurized

Any other precautions ______________________________________________________ Work shall be carried out only after complying the precautions given in section II and on the reverse of this permit. (Approving authority shall check the adequacy of safety requirements mentioned in Sec II) The permit is valid upto _____________ Hrs on _______________ Name of designated approving authority: _____________________ Signature : _______________________________

Section – IV (Permit close out) The work is completed and the area has been cleared. / Renewal of permit requested for an additional period of _______________________________. Work-in-charge Approving Authority Sign : ________________________ Sign:________________________ Date & Time:__________________ Date & Time:_________________ (To be returned to the designated approving authority after the completion of work) Section – V (Revalidation Details) Sign below in appropriate column to revalidate. SAT SUN MON TUE WED THU FRI Sign & Date Work-in-charge

Sign & Date Approving Authority

Distribution: Original : Place of work

First copy: Approving Authority

SF/PTW-1

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(Following conditions apply while taking up hot work as per the details indicated in this permit) Safety Appliances: (tick relevant ones) Safety Helmet Safety Harness(belt) Safety Shoes Apron Goggles Face shield Any other (Specify) Other safety requirements to be arranged: (tick relevant ones) Ventilation Lighting Scaffolding Ladder Fire watcher (Standby) Area barrication Any other (Specify)

1. Ensure that the working platform of the scaffolding is : • Fully boarded • Handrails and toe boards are fixed • Proper access to the work place in the form of ladder is available. • Stability of the scaffolding is good

2. Do not cut diesel barrel, adhesive container, paint/ thinner drums, and containers of grouting compound or any other flammable containers using gas-welding torch or with welding holder.

3. Do not use cigarette lighter to start the flame in the torch; use approved spark lighters only. 4. Post a fire watcher wherever the fire hazard is very high. 5. Inform the safety officer specifically, if the hot work is to be performed in a confined space. 6. Public safety is most important.

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CONFINED SPACE ENTRY PERMIT Permit number: __________

Section – I Location of the work Reason for entry Approximate duration of work Name of the work-in-charge

: : : :

------------------------------------ ----------------------------------------------------------- From ________ To_______ On ________ (Date)

(Tick relevant ones) 1. Has the area been fenced / cordoned off?

2. Has proper illumination been arranged ?

3. Have traffic diversion signs (flashers at night) been kept?

4. Have all concerned persons been informed ?

5. Has gas test been done to check the absence of flammable gases?

6. Is there enough ventilation?

7. Have low voltage & flameproof lighting been arranged ?

8. Have necessary safety appliances been provided ?

9. Will there be a stand-by (Buddy) outside the manhole ?

10. Is the confined space checked for oxygen deficiency ?

11. If any toxic gases are anticipated, has it been checked ?

12. Any other precautions taken ?

All the workman involved in this activity have been adequately briefed about the safety requirements of the job today. Signature of the work-in-charge : Date & Time Section – II To be filled in by Site-in-charge (Designated approving authority)

Section II. To be filled in by Site-In-Charge (Designated approving authority). I have checked personally that the above precautions have been taken. I authorize Mr._______________________ to send … …number of workmen inside the confined space. Signature :_______________ Name :_______________ Designation :_______________ Date & Time:________________ Section – III Permit completion (To be filled by work-in-charge, who opened the manhole The manhole cover / grill has been placed back in position properly at_________ (hrs.) on _______(Date) after the work was completed and safety arrangements have been removed and the area is cleared. Signature :_________________ Name :_________________ Designation :_________________ Date: _____________

This permit is meant for underground sump tank and sewage tank entries. Concentration of H2S shall be restricted to less than 10 PPM Percentage of O2 should not be less than 20%. Distribution: Original : Place of work


SF/PTW-2

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ELECTRICAL ISOLATION PERMIT Permit number :__________ Section - I Location of the work Description of the work Approximate duration of work Name of the work-in-charge

: : : :

From ________ To_______ On ________ (Date)

(Tick relevant ones) 1. Power supply switched off?

2. Has proper illumination been arranged?

3. Fuses removed / circuit breaker raked out? *

4. Isolator switch locked ? *

5. Earthing available ?

6. Necessary safety appliances provided ?

7. Stand-by (Buddy) provided?

8. Caution boards installed ?

Any other precautions:______________________________ All the above precautions have been checked and found okay. Said work can be taken up safely in the vicinity. It is a safe practice to confirm positive isolation before starting the work. Work-in-charge Approving Authority Sign : ________________________ Sign:________________________ Date & Time:__________________ Date & Time:_________________ Section – II Permit close out (To be filled by work-in-charge after the work is completed)

The said shutdown job is complete and the equipment is safe for re-energizing.

Work-in-charge Approving Authority Sign : ________________________ Sign:________________________ Date & Time:__________________ Date & Time:_________________ (To be returned to the designated approving authority after the completion of work) This permit is to be obtained while working on or near live Electro-mechanical equipment. Permit must be obtained before beginning of the work. * The key / fuse should be held by the person who is actually performing the work. Section – III (Revalidation Details) Sign below in appropriate column to revalidate. SAT SUN MON TUE WED THU FRI Sign & Date Work-in-charge




SF/PTW-3

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EXCAVATION PERMIT Permit number :__________ Section – I Location of the work (Attach sketch wherever possible) Description of the work Approximate duration of work Name of the work-in-charge

: : :

------------------------------------ ---------------------------------------------------------------------- From ________ To_______ On ________ (Date)

Section – II (Request for the Permit) (Tick relevant ones)

• Are the services (cables, pipelines etc.) are located / marked?

• Whether the existence of underground cables were identified by using cable detector?

• Is Clearance from local authorities/ clients obtained.?

• Is Pilot trench required?(only by hand tools)

• Is Shoring / sloping required.?

• Are the Caution boards/Traffic signs/Flasher lights placed ?

• Is Barricades/Handrails required?

• Is Ladder (access to the pit) required / Cross over required?

• All workmen are in possession of the PPE specified for the job?

Any other precautions:______________________________ I request for a excavation permit for the above-mentioned location. I have personally inspected the work place to ensure that the precautions mentioned above have been complied with. I will undertake to brief all workmen involved in the excavation activity about the hazards involved and precautionary measures. Signature of work-in-charge__________________________ Date & Time _____________________ Section – III (Permit Approval) (Clients approval shall be obtained wherever required)

Work shall be carried out only after complying the precautions given in sec tion II of t his permit. (Approving authority shall check the adequacy of safety requirements mentioned in Sec II) The permit is valid up to _____________ Hrs on _______________ Name of designated approving authority : _____________________ Signature : ____________________________ Date & Time ______________________

Section – IV (Permit close out) The work is completed and the area has been cleared. / Renewal of permit requested for an additional period of _______________________________. Work-in-charge Approving Authority Sign : ________________________ Sign:________________________ Date & Time:__________________ Date & Time:_________________ (To be returned to the designated approving authority after the completion of work) Section – V (Revalidation Details) Sign below in appropriate column to revalidate. SAT SUN MON TUE WED THU FRI Sign & Date Work-in-charge




SF/PTW-4

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