INTERNAL QSE AUDIT

Company

REPORT NR. ____________

Office

Date Place

Type of Audit Annual Additional

AUDITOR’S COMMENTS

NCs Raised Observations

Name of Lead Auditor Name of other Auditor(s)

Lead Auditor Signature

CP 4 - Form 02 Rev.8 September/2019 Copy: SMS Dept. – e-Binder

Periodicity : Annual & Additional Page 1 of 12
 Personnel Involved
N.
Name Position
1
2
3
4
5
6

Reference
Check List Yes No N/A
ISM 9001 14001
OBJECTIVES AND POLICY
Has the Company defined and documented the scope of its Environmental Management
4.1 Policy ?
1.4.1 A copy of the Company’s Quality - Safety & Environmental Policy describing how
5.3 4.2
2.2 objectives are achieved, implemented and maintained is available on board.
Does the EMS include commitment:
1) To comply with all legal requirements and other applicable requirements concerning the
4.2 environmental aspects?
2) To continual improvement and pollution prevention ?
Was the EMS communicated to all persons working in the Company either on board and
4.2 ashore? Was the EM Policy made available to the public ? If YES state how…………
4.3.1 Were the environmental direct and indirect significant aspects been identified?
Does the EMS contain procedures to take into account the future changes in applicable
4.3.2 legislation? State how the Company is kept updated on new environmental related
legislations…………………….
1.2 5.4 4.3.3 QSE Objectives are understood by the personnel involved in the Management System
The Company QSE Policy is prominently posted around the offices
2 All Office staffs involved in the QSE Management System are aware of the Company
Policy.
4.3.3 Had the Company, in their EMS, set a time frame within which the Company expects to
achieve environmental targets and objectives ?
1.4.6 The QSE policy is reviewed at regular intervals.
COMPANY RESPONSIBILITIES AND AUTHORITY
3.1 The Owner has reported to the Administration and to the Society the entity responsible for
the operation of the ships and its full style and contacts details (Phone, Fax, Email etc)
5.4.1 4.3.3 Responsibility, authority and interrelation of key persons managing, performing and
verifying work relating and affecting the SQE are defined and documented
4.4.1 Are the human resources specialized/skilled to achieve EMS objectives and targets?
3.2
An updated Company organizational chart is available
The updated telephone numbers of the D.P.A(s). and their back up are available to the
interested persons ashore and on board
The following activities are outsourced to:
...............................................................................................................................................
.................................................................................................... ………………………....
4.1 4.4.6
The Company maintains the subcontracted activities under control (specify the system
adopted)
............................................................................................................................................
5.1 5.5 4.3.3 Responsibility and authority of Masters, Chief Engineers and other shipboard key persons
are defined and documented
4 A procedure has been established to provide the DPA(s) the possibility to ask for
resources and shore based support to the Company’s management
DESIGNATED PERSON ASHORE AND MANAGEMENT REPRESENTATIVE
Formal DPA appointment letter is available and signed by the top management
The Organisation of the Company ensure direct access to the highest management
The continuous availability of the DPAs is ensured.
4 The results of safety and antipollution audits and inspections are reported to the DPA.
Requests from ships for resources and shore based support are supervised by the DPAs
Sufficient information are provided to the Office of the Deputy Commissioner of Maritime
Affairs to enable immediate contact at all times between the Administration and the
Company designated person or persons. ***LIBERIA REQUIREMENT*****
Top management has formally appointed a management representative for maintaining
and implementing both the Quality and Environmental Management System
5.5.2 4.4.1
The responsibility of the MR have been defined and they are in accordance with the ISO
9001 and 14001 standards

CP 4 - Form 02 Rev.8 September/2019 Copy: SMS Dept. – e-Binder

Periodicity : Annual & Additional Page 2 of 12
MASTER’S RESPONSIBILITY AND AUTHORITY
The Master’s role in the implementation of the QSE policy of the Company is clearly
defined.
Documentation of the specific duties delegated to the Officers under the Master’s
command are provided to the Master by the Company.
Appropriate orders and instructions are issued (standing orders, night orders, etc.)
5 5.5.2 4.4.1 The Master reviews the QSE Management System and reports to the Company any
deficiency (e.g.: the review is made during safety meetings)
The Company shore based management system allows for the Master’s overriding
authority and responsibility
The crew is motivated (e.g. by means of meetings with the crew, instruction of the
crewmembers at embarkation, etc.).
Reference
Check List Yes No N/A
ISM 9001 14001
MASTER’S RESPONSIBILITY AND AUTHORITY – Cont’d
The Master’s role in the implementation of the safety and environmental protection policy
of the Company is clearly defined.
The Master takes into account the customer’s expectations (e.g. charterers expectations)
MANDATORY REQUIREMENTS
The management system complies with the latest mandatory requirements and take into
1.2.3 account all applicable codes, guidelines and standards.
7.2.1 4.3.2 Copy of applicable rules, regulations and codes are available on board and checked on
regular basis. (SOLAS, MARPOL, STCW 95, COLREGS and Flag & Port states
requirements etc. Last revision )
RESOURCES AND PERSONNEL
6 6.1 4.4.1 Sufficient Resources are available for implementing the QSE management system
The company ensures that all managed ships are manned with seafarers that are
qualified, certified and medically fit. Valid Certificates, endorsements and medical
examination reports.
6.2 6.1 4.4.2
Criteria are fixed to ensure that seafarers are qualified (Curriculum Vitae, evaluation,
interview and appraisal system), certified (certificates required by STCW) and medically fit
(periodical medical examination and at embarkation)
A common working language and effective communication has been established and
6.3 QSE documentation written in such a language
6.6.2 Training needs for all relevant personnel on board are identified
4.4.2
Procedures for environmental awareness and competence training are implemented.
The Office Key Staff and Senior ships officers are fully conversant with the QSE
6.1.2 6.2.2 4.4.2 Management system. They are suitably qualified and skilled to achieve QE targets and
objectives.
Adequate support has been given to Master (by the Company) so that he can safely
6.1.3 perform his duties
Hand-over procedures have been adequately implemented and relevant report compiled.
Hand over procedures complies with RLM-108, 10.295 (Liberia Req.)
6.3 Familiarization has been given to joining personnel (ratings and officers) upon
embarkation
Specific familiarization questionnaires (crew / officers) have been compiled and filed

6.4 6.2.2 4.4.2 The company ensures that senior officers have adequate understanding of relevant rules,
regulations, codes and guidelines
6 Information, appraisal and qualification records of shipboard and shore-based personnel
are available
Each person employed on board and ashore is fit for duty.
Drug and alcohol policy has been established and appropriate tests carried out
The joining crew members have the necessary training and proper seafarer’s
6
identification including licenses, special qualification certificates, seafarer’s Identification
6.2.2 4.4.2 and Record books as required by International Conventions, Liberian Maritime Law, the
Liberian Maritime regulations and the specifics of the publication “Requirements for
Merchant Marine Personnel Certification”, RLM-118.
6.3 Vessel and duties introduction and familiarisation training in accordance with the STCW
Code for on-coming officers and crew are documented.
Familiarisation procedures are available (e.g. overlapping, tutorial training, written handing
6.3 6.2.2 4.4.2 over procedures for Masters and Chief Engineers, briefing at embarkation concerning
safety and operational aspects
Adequate understanding of rules and codes for the personnel involved in the Company
6.4 QSE is ensured. Any training required in support of the SMS is identified (from appraisal
charts, new technologies or engines, new rules)
Training needs for shore-based personnel have been identified by each head of
4.4.2 department
6.2.2 Training plan for shore-based personnel has been established and approved
Training effectiveness has been ascertained and documented when required

CP 4 - Form 02 Rev.8 September/2019 Copy: SMS Dept. – e-Binder

Periodicity : Annual & Additional Page 3 of 12
 Training course certificates have been achieved and enclosed to the personal file of the
concerned office staff.
DEVELOPMENT OF PLANS FOR SHIPBOARD OPERATIONS
5.4.2
7 7.1 4.4.6 Procedures, plans and instructions, including check lists established by the Company
have been maintained and used when required.
7.5
The company ensures that enclosed spaces entries and other work permits are used and
relevant procedures implemented across the fleet
Procedures to ensure that Flag State safety inspections are conducted are available
within the QSE management system documentation.
EMERGENCY PREPAREDNESS
8.1 Potential emergency shipboard situations have been established by the company and
included in the contingency plan
8.2 Procedures to deal with potential emergency shipboard situations (environmental, health
4.4.7
8.3 and safety) been tested by conducting required drills and exercises
Reference
Check List Yes No N/A
ISM 9001 14001
EMERGENCY PREPAREDNESS – Cont’d
8.2 4.4.7 Drills and exercises programme, established by the company have been well
implemented (drill schedule)
The updated and approved Shipboard Oil Pollution Emergency Plan (SOPEP) (or Vessel
Response Plan - VRP) is available
A worst case scenario Table Top Exercise has been carried out at least once a year
The identification of the emergency situations is made from previous experience and from
analysis of accidents and near misses
Office evacuation plan is available and prominently posted
8.3 4.4.3
Office evacuation drill has been carried out at regular intervals
4.4.3 Has the Company decided whether to communicate externally their significant
environmental aspects and has the Company documented such decision?
ON BOARD MEETINGS
On-board Monthly QSE Committee meetings have been reviewed by the DPA and
appropriate response provided to managed vessels
Copy of each meeting minute is collected and archived in the office
CARGO OPERATIONS
7.1 Procedures and Instructions concerning safe cargo handling and pollution prevention
5.1.4 4.4.6 such as hold preparation, cargo specifications, loading/discharging plans, reporting and
7.5
waste management, etc. have been provided to all managed vessels.
4.3.1 New identified environmental aspects and related impacts are communicated to all
interested parties including ships
8.3 Ships’ performances are monitored in order to ensure that Charterers’ expectations are
satisfied (rates, speed, etc)
REPORT AND ANALYSIS OF NON CONFORMITIES, ACCIDENTS AND HAZARDOUS OCCURENCES
Procedures for reporting accidents and incidents are available and well implemented by
the company. (Report - Investigation – Analysis – Root Causes – Corrective & Preventive
actions)
Procedures for reporting and investigating accidents are in compliance with the Flag state
9.1 requirements (Liberia – Panama and Malta).
The provisions of Article IX and Article X of RLM-260, “Rules for Marine Investigations
and Hearings” are incorporated in the Company SMS.
Accidents and Near Misses have been reported to DPA and appropriate investigation has
been carried out
Lessons learnt from accidents and significant near misses have been shared among the
9.2 fleet and used to prevent hazardous occurrences
Appropriate procedures ensuring that non-conformities are reported to the DPA or to Q&E
9.1 8.3 Manager (as appropriate) and investigated are established and implemented within the
4.5.3 shore offices and across the fleet.
9.2 8.5.2 Procedures for implementing corrective and preventive actions have been implemented
8.5.3 The effectiveness of corrective actions is reviewed when required
A documented procedure and related responsibilities and authorities for dealing with
8.3 nonconforming product has been established and implemented by the company.
MAINTENANCE OF THE SHIP AND EQUIPMENT
The maintenance system includes systematic plans and actions designed to address all
6.3
10 those items and systems covered by class and statutory survey and ensure that the
7.1 4.4.6 Vessel’s condition is satisfactorily maintained at all times.
11
7.5.1
Maintenance problems are promptly reported by ships to the Technical Department

CP 4 - Form 02 Rev.8 September/2019 Copy: SMS Dept. – e-Binder

Periodicity : Annual & Additional Page 4 of 12
 Periodicity of ships’ inspections is in accordance with the procedures
Date of last ship’s inspections:
1) …………………………. 2)……………………………....................

Copy of the inspection reports or lists of non-conformities are available and

properly filed
Communications relating to corrective actions taken have been forwarded to the
Company
Critical equipment are identified as per established procedures.
Stand-by arrangements, equipment and systems are periodically tested and records
available
Intervals for maintenance and inspections are established and observed.

Reference
Check List Yes No N/A
ISM 9001 14001
MAINTENANCE OF THE SHIP AND EQUIPMENT – Cont’d
Management of critical systems and tasks covers refrigerating plants (with CFC),
4.4.6
incinerators, oil-water separators, detergents and hazardous waste etc.
4.5.1
Maintenance activities are associated with the identified significant environmental aspects
Flag State or PSC Deficiencies are treated as Non Conformity and rectified as quickly as
possible.
The inspection and maintenance records, including those available in the computerized
PMS are up-to-date and properly filed
The maintenance is carried out in accordance with the manufacturers’ requirements in
running hours
The analyses of lube oil (main/aux engines, sterntube), water and fuel oil are regularly
carried out; the relevant reports are available.
Technical Department Response on lube oil / water analysis has been provided when
required
Drydock and repair list is maintained and updated for each managed vessel
Records of all ships’ purchase orders/requests are maintained
The documentation relevant to spare parts and material provided and to be provided to
managed ships is properly filed at technical department.
7.4.1 Non-conformity reports are issued by ships against goods or materials supplied which do
not meet specified requirements. Appropriate actions are taken by the company
10 4.4.6 Procedures relevant to purchasing and environmental processes have been correctly
implemented by purchasing dept staff.
10.2 7.6 4.5.1 Monitoring and measuring equipment have been calibrated and verified at specified
intervals against national or international measurement standards
4.5.2 Has the Company established procedures to periodically evaluate compliance with
applicable legal and other requirements and is there evidence available?
DOCUMENTATION AND RECORDS
The updated QSE Management System documents (SMS and Quality Manuals,
Company’s QSE Procedures, etc.) are available as specified by the relevant distribution
11 4.2.3 4.4.5 lists. Said documents are maintained updated.
Procedures for controlling the documentation and ensuring that latest version is available
at all locations have been correctly implemented
4.2.3 Service documents are appropriately filed
7 4.2.1 4.4.4 Periodical flash reports and bulletins are issued and properly distributed
4.4.4 Does the EMS documentation include a description of the EMS scope, objectives and
targets? Are documents and records required by the standard available?
11.2.3 Obsolete QSE Documentation is promptly removed or marked
4.2.3 4.4.5 The SMM – CP – Quality Manual and other QSE controlled documentation is written in
11.3
plain English and understood by all personnel involved.
A copy of all ships’ statutory and service certificates are available and properly filed
A procedure for managing Condition of Class is used and there are no expired COC
Mandatory rules (including flag state circulars), regulations and other document or
external origin are available.
11 4.2 4.4.5 Documents of external origin are controlled at specified intervals
Technical manuals, drawings, user’s manuals (together with the relevant lists) are
available
Copy of ship’s manuals, documents and instructions (e.g.: Stability and loading manuals,
Cargo Securing Manual, Grain loading manual (if applicable), Shipboard oil pollution
emergency plans, etc.) are available

CP 4 - Form 02 Rev.8 September/2019 Copy: SMS Dept. – e-Binder

Periodicity : Annual & Additional Page 5 of 12
 The Circular letters are properly filed and an updated index is available
10.2.4 Operational records, registrations and documentation, including forms and checklists,
4.2.4 4.5.4
11.1 are available and maintained and filed according to the procedures.
System and Service records are appropriately compiled and filed (as per QUA 4.3)
Liberia - Panama - Malta A copy of the most recent Nautical Inspection reports made by the relevant Flag
Requirement Administration.
COMPANY VERIFICATION, REVIEW AND EVALUATION
Internal audits are conducted by the Company according to established procedures and
by taking into consideration the annual audit plan
12 8.2.2 4.5.4 Date of last ship’s audits:
1)………. 2) ……….

Reference
Check List Yes No N/A
ISM 9001 14001
COMPANY VERIFICATION, REVIEW AND EVALUATION – Cont’d
12 Master’s reviews have been analysed and taken into consideration for the improvement of
the QSE management system. Company response should be provided.
Management review has been carried out on regular basis and in accordance with the
12.2 5.6 4.6 ISM code and ISO 9001-14001 Standards an reviewed by the top management.
Management review reports and supporting documents are available
Key Performance Indicators have been established and monitored.
8.1 4.5.1
KPIs have been analysed and appropriate targets established
8.2.1 Performance of the QSE system has been measured and information relating to customer
perception have been monitored
12 8.2.2 4.5.3 Has the Company established implemented and maintained procedures to deal with
actual and potential Non Conformities and to take corrective and preventive actions?
Date of last office audit::
1) Technical Department ………………………2) Operations Department……………………
3)………………………………………………….4) ………………………………………………
12 8.2.2 4.5.4
5)………………………………………………….6) ………………………………………………

Audits have been carried out by qualified auditors

4.5.6 The QSE management system audits are performed at regular intervals and on the basis
of a check list
Both for the audit report and for requiring corrective action, appropriate forms are
foreseen
12 8.2.2 4.5.4 Company’s audits reports or list of non-conformities are available
Is there any non-conformity not closed out?
12.5 8.2.2 4.5.4 Communication from the ship’s command to the Company, when non-conformities have
been corrected, are available
The report of the last QSE audit reports and relevant list of non-conformities
are available
The corrective actions taken to close-out the non-conformities have been reviewed by the
Class auditor(s) and are considered effective.
OPERATIONS
Appropriate and written voyage instructions have been provided to the ships, agents and
OPE
suppliers
02
Voyage instructions and information are appropriately filed
OPE Bunker suppliers have been selected and evaluated as per established procedures
03
OPERATIONS – Cont’d
Bunker procedures have been fully implemented. These include :
- Responsibilities;
- Planning:
- Ordering and negotiation;
- Choice of suppliers;
- Order’s confirmation;
- Delivery;
- Settlement of invoices;
- Administration;
- Claims;
- Filing of documentation.
Bunker specification are checked and monitored as required

CP 4 - Form 02 Rev.8 September/2019 Copy: SMS Dept. – e-Binder

Periodicity : Annual & Additional Page 6 of 12
 Port Disbursement Accounts are appropriately handled
Port Agents have been selected and evaluated as per established procedures
DA procedures and relevant instructions have been implemented. Including:
- Submission of accounts
- Handling time
OPE
04 - Checking of disbursement accounts
- Checking of Rates and Offers
- Disputes
- Payment initiating
- Filing of documents
Agents’ service is appropriately monitored
Freight and hire settlement related procedures and practices have been implemented by
the personnel involved. These include:
- Freight calculations
- Invoices and Payments
OPE
- Disputes
05
- Hire
- Hire statements, off-hire periods
- Disputes
- Filing of documents
OPE Procedures concerning to the administration of Bill of Ladings, including responsibilities,
06 cargo delivery and filing system have been observed and implemented.
OPE Financial transactions relevant to inward and outward invoices have been managed as
07 per procedures established by the company.
Cargo claims have been properly handled.
Verify:
OPE a) Responsibility;
7.2
08 b) Adherence to Cargo claims procedures;
c) Management of actual claims;
d) Filing of documentation.
OPE Procedures concerning to the final evaluation of service, including performance of
contractors and suppliers, corrective actions and filing of documents have been observed
09
by the personnel involved.
Surveyors used for ship’s inspection have been appropriately selected
Vessels to be chartered have been appropriately identified and selected
Required information have been exchanged with the Owners and Masters as appropriate
OPE
Appropriate instructions have been issued and forwarded to the ship / managers
10
Ship inspections have been arranged as per company procedures
Ship’s performance has been adequately monitored
Documents and records concerning to ship inspection have been properly filed

Take Time Talks

To be completed by internal auditor in order to assist all personnel engaging in a health and safety
conversation, reinforcing positive and where necessary addressing ‘at risk’ behaviours when
observed. Take Time Talks can be conducted in any work location, at any time. Following five key
steps as follows:

1.Observe behaviour during an activity.

2.Safely stop activity, introduce self and ask the participant to explain the task and associated risks process.
3.Commend positive behaviours and discuss ‘at risk’ behaviours.
4.Get commitment to work safely.
5.Thank the participant and action findings and provide feedback.

NAME OF PERSONNEL:

Personnel Involved
Name Position

CP 4 - Form 02 Rev.8 September/2019 Copy: SMS Dept. – e-Binder

Periodicity : Annual & Additional Page 7 of 12
ADDITIONAL AUDITOR’S REMARKS

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

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

PLANNED TASK OBSERVATION CHECKLIST ENSURING CORRECTNESS AND FOLLOWING OF

ACTIVITY AS DOCUMENTED IN TASK BASED WORK INSTRUCTIONS AND PROCEDURE

SAFE UNSAFE N/A

Environment / Working Conditions
• Housekeeping
• Toxic Atmosphere
• Work Plans/Procedures Available
• Condition of Tools & Equipment
• Hazard Warnings
• Safety Devices in Place
Behaviours
• Using PPE
• Procedures Followed
• Communicating
• Proximity to Other Workers
• Work Pace
• Horseplay
• Focus on Work / Distraction
• Balance, Traction, Grip
• Pre-Task Planning / Permits
• Recognizing Change
Body Mechanics
• Reaching / Extending
• Lifting / Bending
• Repetitive Motion
• Standing / Sitting
• Comfortable
Line of Fire
• Body Position
• Energy Sources
• Lock Out
• Guards & Barriers
• Engineering Controls
• Workplace Design / Condition
• Congested Work Area
Tools & Equipment
• Pre-Job Inspection
• Correct For Task
• Safe Use
Employee Competency Check
• Knowledge / Trained / Certificate
• Skill / Experience
Management / Supervisory
• Training / Coaching
• Worker / Supervisor Competency
• Procedures Available, Adequate,

CP 4 - Form 02 Rev.8 September/2019 Copy: SMS Dept. – e-Binder

Periodicity : Annual & Additional Page 8 of 12
 Understood

Personnel Involved
Name Position

PLANNED TASK OBSERVATION CHECKLIST ENSURING CORRECTNESS AND FOLLOWING OF

ACTIVITY AS DOCUMENTED IN TASK BASED WORK INSTRUCTIONS AND PROCEDURE

SAFE UNSAFE N/A

Environment / Working Conditions
• Housekeeping
• Toxic Atmosphere
• Work Plans/Procedures Available
• Condition of Tools & Equipment
• Hazard Warnings
• Safety Devices in Place
Behaviours
• Using PPE
• Procedures Followed
• Communicating
• Proximity to Other Workers
• Work Pace
• Horseplay
• Focus on Work / Distraction
• Balance, Traction, Grip
• Pre-Task Planning / Permits
• Recognizing Change
Body Mechanics
• Reaching / Extending
• Lifting / Bending
• Repetitive Motion
• Standing / Sitting
• Comfortable
Line of Fire
• Body Position
• Energy Sources
• Lock Out
• Guards & Barriers
• Engineering Controls
• Workplace Design / Condition
• Congested Work Area
Tools & Equipment
• Pre-Job Inspection
• Correct For Task
• Safe Use
Employee Competency Check
• Knowledge / Trained / Certificate
• Skill / Experience
Management / Supervisory
• Training / Coaching
• Worker / Supervisor Competency
• Procedures Available, Adequate,
Understood

CP 4 - Form 02 Rev.8 September/2019 Copy: SMS Dept. – e-Binder

Periodicity : Annual & Additional Page 9 of 12
 Personnel Involved
Name Position

PLANNED TASK OBSERVATION CHECKLIST ENSURING CORRECTNESS AND FOLLOWING OF

ACTIVITY AS DOCUMENTED IN TASK BASED WORK INSTRUCTIONS AND PROCEDURE

SAFE UNSAFE N/A

Environment / Working Conditions
• Housekeeping
• Toxic Atmosphere
• Work Plans/Procedures Available
• Condition of Tools & Equipment
• Hazard Warnings
• Safety Devices in Place
Behaviours
• Using PPE
• Procedures Followed
• Communicating
• Proximity to Other Workers
• Work Pace
• Horseplay
• Focus on Work / Distraction
• Balance, Traction, Grip
• Pre-Task Planning / Permits
• Recognizing Change
Body Mechanics
• Reaching / Extending
• Lifting / Bending
• Repetitive Motion
• Standing / Sitting
• Comfortable
Line of Fire
• Body Position
• Energy Sources
• Lock Out
• Guards & Barriers
• Engineering Controls
• Workplace Design / Condition
• Congested Work Area
Tools & Equipment
• Pre-Job Inspection
• Correct For Task
• Safe Use
Employee Competency Check
• Knowledge / Trained / Certificate
• Skill / Experience
Management / Supervisory
• Training / Coaching
• Worker / Supervisor Competency
• Procedures Available, Adequate,

CP 4 - Form 02 Rev.8 September/2019 Copy: SMS Dept. – e-Binder

Periodicity : Annual & Additional Page 10 of 12
 Understood

Personnel Involved
Name Position

PLANNED TASK OBSERVATION CHECKLIST ENSURING CORRECTNESS AND FOLLOWING OF

ACTIVITY AS DOCUMENTED IN TASK BASED WORK INSTRUCTIONS AND PROCEDURE

SAFE UNSAFE N/A

Environment / Working Conditions
• Housekeeping
• Toxic Atmosphere
• Work Plans/Procedures Available
• Condition of Tools & Equipment
• Hazard Warnings
• Safety Devices in Place
Behaviours
• Using PPE
• Procedures Followed
• Communicating
• Proximity to Other Workers
• Work Pace
• Horseplay
• Focus on Work / Distraction
• Balance, Traction, Grip
• Pre-Task Planning / Permits
• Recognizing Change
Body Mechanics
• Reaching / Extending
• Lifting / Bending
• Repetitive Motion
• Standing / Sitting
• Comfortable
Line of Fire
• Body Position
• Energy Sources
• Lock Out
• Guards & Barriers
• Engineering Controls
• Workplace Design / Condition
• Congested Work Area
Tools & Equipment
• Pre-Job Inspection
• Correct For Task
• Safe Use
Employee Competency Check
• Knowledge / Trained / Certificate
• Skill / Experience
Management / Supervisory
• Training / Coaching

CP 4 - Form 02 Rev.8 September/2019 Copy: SMS Dept. – e-Binder

Periodicity : Annual & Additional Page 11 of 12
 • Worker / Supervisor Competency
• Procedures Available, Adequate,
Understood

ADDITIONAL AUDITOR’S REMARKS

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

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

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

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

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

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

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

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

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

CP 4 - Form 02 Rev.8 September/2019 Copy: SMS Dept. – e-Binder

Periodicity : Annual & Additional Page 12 of 12