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Template Hse Audit Questionnair: Rev. A Page 1 of 8
Template Hse Audit Questionnair: Rev. A Page 1 of 8
Template Hse Audit Questionnair: Rev. A Page 1 of 8
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Page 1 of 8
Company name:.
Company address:
Company activities:
Company workforce:
% part-time staff:
No. near-accidents
E-TPL-17-0-6, Rev. D
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TEMPLATE Rev. A
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E-TPL-17-0-6, Rev. D
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TEMPLATE Rev. A
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Check the box that matches your answer YES NO REASONS / OBSERVATIONS
2 HSE MANAGEMENT
2.1 Do you have a formalized HSE Policy? ☐ ☐ Attach a copy of the letter of commitment by the Management
2.2 Do you periodically check that those at the company are Date of most recent evaluation:
☐ ☐
aware of and understand the HSE policy? Specify comments:
2.5 Have you appointed an HSE Supervisor attached to the Name of the HSE Supervisor:
☐ ☐
Management? How long position has existed::
E-TPL-17-0-6, Rev. D
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TEMPLATE Rev. A
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3.1 Do you have an HSE manual? ☐ ☐ Attach a copy of the HSE manual -
Reference:
3.2.11 Emergency intervention (first aid)? ☐ ☐
Number of first-aid workers:
E-TPL-17-0-6, Rev. D
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TEMPLATE Rev. A
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4 PROTECTIVE EQUIPMENT
4.1 Have you identified the individual protective equipment ☐ ☐ Attach a copy of the equipment list:
that is essential for your employees?
4.2 Have you identified the collective protective equipment ☐ ☐ Attach a copy of the equipment list:
that is essential for your employees?
4.3 Do you have written instructions for using work site ☐ ☐ Attach a copy of instructions:
equipment/tools?
4.4 Do you periodically train your employees on how to ☐ ☐ Date of the latest and the next exercise:
wear individual and collective protective equipment?
E-TPL-17-0-6, Rev. D
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TEMPLATE Rev. A
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5 SUPERVISION OF SUBCONTRACTORS
E-TPL-17-0-6, Rev. D
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TEMPLATE Rev. A
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7 SHOP SURVEY
E-TPL-17-0-6, Rev. D
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TEMPLATE Rev. A
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E-TPL-17-0-6, Rev. D