Guideline HSEQ requirements in supplier management

Attachment 2.3 HSE Pre-Qualification Questionnaire.

ITT Ref.:104053 – Casing and Tubular Running Services for Block 30

HSE Prequalification Questionnaire

In order to promote and provide assurance of high health, safety and environmental standards in business, please supply the following information and any relevant supporting
documentation according to the table in the work sheet attachments. Responses should ideally apply to the work you undertake in the country in which the service is requested.

Please ensure that all questions are adequately addressed with all requested documents and examples submitted. In case the answer is partial, a description shall be provided
as to explain partial compliance .

The completed questionnaire should be checked and signed as complete and verified by an appropriate level of management authority.

No. Questions related to HSE management system yes no partial description, if required
1 Policies and Management Systems

1.1 Does your company have a written health, safety and environmental policy? X

1.2 Do you have an QHSE Management System? (ISO's 9001, 14001, 45001) X
if yes please specify the certificates

1.3 Are policies, standards and procedures communicated to all your employees? X

1.4 Have you implemented the IOPG life-saving rules? X

2 Leadership, Roles & Responsibilities

2.1 Is HSE integrated into your company’s organization? X

2.2 Who has the responsibility in your company for?

a) Development of HSE policy? QHSE Manager and Senior Management
b) Providing specialist HSE advice? QHSE Manager and Senior Management
c) Inspecting workplaces? QHSE Supervisors
d) Auditing compliance to HSE policy? Multidisciplinary Audit Team
e) Final responsibility for HSE matters? Senior Management

2.3 Wich job descriptions have clearly defined HSE responsibilities? All Job Descriptions in the organization have HSE responsibilities.

3 Risk Management

3.1 Do you identify hazards and assess risks in your workplace? X

3.2 Have you documented and implemented safe working practices or procedures?
X

How are identified risks and safe working practices communicated to your
3.3
employees? X

3.4 Do you have objectives and programs on specific environmental risks?

X

4 Training and Competency

4.1 Does your company have a competence assurance process in place? X

4.2 Does your company have a formal HSE induction course? X

4.3 What other HSE training is provided to your employees? Firefighting, First Aids, RCA, Emergency Brigades, among others.

5 Operational Control

If you plan to bring hazardous substances to the worksite what controls and
5.1
procedures do you have in place to manage this? We don't work with hazardous substances.

Are arrangements for providing your employees with personal protective

5.2
equipment in place? X

5.3 Are non-conformances identified and reported?

X
6 Contractor Management

Does your company have a contractor management process or system in

6.1
place? X

6.2 Do you ensure that contractors meet the set requirements? X

7 Incident Reporting, Investigation and HSE KPIs

7.1 Do you have an incident reporting and incident investigation procedure? X

7.2 Do you have a hazard or near-miss reporting system? X

           
Please provide the following statistics for your company over the last 5 years
7.3 (including contractors).                  
Enter the numbers separated by ";", eg. 250;230;210;260;300:
2021 2020 2019 2018            
i) Average number of employees 79 48 50 48            
ii) Fatality Rate (Fatalities / 100 Million working hours) 0 0 0 0            
iii) Lost time injuries frequency (LTIF = LTI / 1 Million working hours) 0 0 0 0            
iv)Total recordable injuries rate (TRIR = TRI / 1 Million working hours) 0 0 0 0
v) Number of HiPo 0 0 0 0
vi) Number of environmental incidents 0 0 0 0

7.4 Do you have an emission reporting and energy management system? X

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Guideline HSEQ requirements in supplier management
Appendix A
11/26/2020

Attachments to HSE Pre-qualification questionaire

Please attach the requested attachments according to your supplier/contractor categorisation (1 / 2 / 3).

Your categorisation

Description of Procurement category

Supplier
Attachments to the Pre-Qualification Questionaire
1
HSE policy
Code of Conduct x
Organizational chart
Certificates (if available) x
HSE Risk assessment example(s)
HSE Risk assessment for specific job (….........................................)
HSE Plan (example, for comparabel activities)
Waste Management
Environmental Protection Plan
References of high risk activities
Self assessment (for example supported by industry organisation)
Safety culture improvement example(s)
Audit report
HSE KPI in place
Training and Competence Plan
Job description example(s)
Incident reporting procedure
Incident investigation procedure
Near-miss reporting procedure
Safe working practices example(s)
Substance abuse management
Health Management Plan
Stop-work policy
HSE report (last year)
Overview of Contractors involved in activities
Description of main HSE Risks and mitigation measures
Other, please specify.

x mandatory attachments

supplier
contractor

1
2
3
 Procurement category risk profil

Supplier 1

Supplier Contractor

2 1 2 3

x x x
x x x
x x
x x x x
x x
x
x
x
x
x x
x
x

x x
x

x x x
 x x
x x
x
x x