CONTRACTOR HSE ASSURANCE CHECKLIST FOR DEMOBILISATION

Legend:
Y – YES
N – NO
NA – Not Applicable

CHECK ITEM FINDINGS Y / N / NA REQUIRED ACTION CLASSIFICATION

DE-MOBILISATION PHASE (DOCUMENT REVIEW, INTERVIEW)
1 HSE risk associated with de- Refer PTW List Y Please refer
mobilization has been assessed attachment :
Appendix 13 PTW
with implementation of controls list.
to minimize the risks.
2 The HSE plan has been updated As per approved Y Please refer
/ de-mobilization plan has been HSE plan attachment :
Appendix 14 PGB-
developed to address de- EPM-CORIO-PM-
mobilization risk, mitigation and HSE-4001_Rev 0
activities. These may include:

 Emergency response
 Site restoration
 Waste management and
disposal
 Verification/monitoring
activities
3 Deliverables have been Document Y
handover to the Contract submitted as per
PSI.
Owner. This may include the
following:

 Documentation e.g. process

safety information, marked
up P & IDs, procedures, etc.
 Completed handover
checklists
 Pre-activity Safety Review
and checklist
 Incident investigation
reports
 Training for start-
up/operations
 Suggestions for
improvement

Internal
CHECK ITEM FINDINGS Y / N / NA REQUIRED ACTION CLASSIFICATION
4 Contractor Performance N/A
Evaluation assessment has been
completed.
5 Closed out report has been Refer HSE CLOSE Y Please refer
developed and should OUT REPORT attachment :
Appendix 15 PGB-
incorporate the following: EPM-CORIO-PM-
HCR-2001 Rev 0
 Assess the effectiveness of
the contractor’s HSE Plan
 Identify those areas not
anticipated in the plan, how
they were resolved and the
future approach to be taken
 Highlight successful positive
aspects that should be
adopted for future
contracts
 Provide a concise analysis of
the contractor’s HSE
performance for discussion
with the contractor’s
management as a means of
improvement. The
performance should include
the following:
a. Actual HSE performance
vs agreed targets e.g. LTI,
MTC, FAR, spills, etc.
b. Non-compliance to the
agreed HSE plan e.g. HSE
manpower, HSE inspection
and assurances, equipment
reliability, etc.
 Provide information on the
contractor for owner
bidders’ list to identify
actions needed in
assessments for future
tenders.

Internal
CHECK ITEM FINDINGS Y / N / NA REQUIRED ACTION CLASSIFICATION
DE-MOBILISATION PHASE (SITE COMPLIANCE ASSESSMENT)
6 Inspection & acceptance of Y
work site have been completed.

Prepared Endorsed by:

by:

Signature:
Name: NAZRIN AMREE BIN SHOKERI Signature: Name:
Designation: SAFETY AND HEALTH OFFICER Designation:

Internal