VENDOR / SUPPLIER QUESTIONNAIRE
ATTACHMENT H ASSESSMENT OF HSE MANAGEMENT SYSTEM
QF 20
Inquiry Reference
1/2
Vendor or main sub-vendor location:
Description of material / equipment:
Bidder is requested to submit its replies to this HSE questionnaire and provide the related document as identified in part 2. Following the replies to the questionnaire, Technip Energies will choose to revert to bidder with additional information to form a complete assessment of Bidder’s HSE management system and standard.
- Health, Safety and Environment Management System
1.1 Is you HSE management system certified?
If yes, under which code or standard (standard and year – e.g. ISO14001-2015). If no, please fill out the reason.
Yes
No
1.2 Do you record Environmental Consumptions (energy, water material) and Emissions (air, effluents,
Yes
solid wastes)
1.3 Do you have a written and signed HSE and security policy ?
1.4 Do you have a documented HSE management system (i.e. HSE plan or HSE manual …)
1.5 Do you have an up to date risk register for the works performed in your workshop
Please list the 5 highest risks in your workshop:
HEALTH
SAFETY
ENVIRONMENT
Yes
Yes
Yes
1.6 STOP THE WORK AUTHORITY - does you company have a stop the work policy allowing anyone
Yes
to stop the work should immediate danger appears?
1.7 Do you train visitors to HSE requirements and potential hazards in your facilities (HSE induction
Yes
program or other)?
No
No
No
No
No
No
1.8 Do you have a documented system in place to train your personnel in HSE matters (procedures,
matrix etc…)?
Yes
No
1.9 Do you have a system in place facilitate and encourage near miss, hazardous observations reporting? Yes
No
1.10 Please provide the name and the title of the person, in your workshop or company, in charge of
overseeing all HSE aspects and the reporting line to the management Position: Position:
Name: Name:
Reporting to -
-
Documentation to be submitted with the bid 2.1. A copy of OHSAS 18001, ISO45001 and ISO 14001 certificate(s) or equivalent for standard last revision 2.2. Risk register including: environmental aspects, chronic health exposure and accidental scenarios 2.3. Current HSE objectives and targets 2.4. HSE manual or HSE plan (preliminary for project if not existing) 2.5. Environmental consumption (energy, water material) and emissions (air, effluents, solid wastes) records. 2.6. HSE and security policies, including stop work authority policy. 2.7. HSE induction program and documented HSE training system/processes. 2.8. Evidence of system to facilitate and encourage near miss and hazardous observations reporting.
-
HSE Performance 3.1 Worked manhours
Worked Manhours
3.2 Lagging indicators
Fatalities (number of cases) Lost Time Injuries (number of cases) Restricted Work Cases (number of cases) Medical Treatments (number of cases) First Aids (number of cases)
QF 20- rev. 3 – March 2023
Year
Year -3
Year -2
Year -1
Current year
Year
Year -3
Year -2
Year -1
Current year
VENDOR / SUPPLIER QUESTIONNAIRE
ATTACHMENT H ASSESSMENT OF HSE MANAGEMENT SYSTEM
QF 20
Inquiry Reference
2/2
Near Misses (number of cases) Environment incidents related to air, soil, (ground)water, sea, fauna, flora, communities (number of cases) Oil and chemical spills (volume) LTIR (lost time injury rate) calculated on 200,000manhours TRIR (total recordable injury rate) calculated on 200,000manhours Severity rate calculated on 200,000manhours
3.3 Leading indicators
Year
Year -3
Year -2
Year -1
Current year
HSE visit of senior management (nb) HSE compliance review (nb of review) Carbon footprint assessments (nb) % of water reused (fabrication, housekeeping, gardering..) % of recycled waste % of first aiders HSE training hours HSE drills (nb) Inspections (incl. spill containment areas) External audits (nb) HSE awareness events (nb)
Notes: 1 Work-related incidents resulting in death, occupational illness and injuries associated with loss of consciousness, lost time, restricted
work, job transfer or medical treatment.
2 TRIR = (Total number of Recordable Cases) x 200 000 / Number of worked manhours 3 LTIR = (Total Lost Time Injury) x 200 000 / Number of worked manhours 4 Severity aret = (Number of days lost through injury (LTI)) x 200 000 / Number of worked manhours
- High risk factors - Will you of do your fabrication activities involve the following hazards: 4.1 Work with increased risk of fire or explosion (welding, spray painting, abrasive cutting, etc…) or
in an environment with potential for fire and explosion
4.2 Work at height with a height above 1.8m, where there is a risk for fall from height (no 100%
collective protection)
4.3 Work in enclosed / confined space not designed for human occupancy
4.4 Work with corrosive, toxic, inert gas, highly flammable or carcinogenic substances
4.5 Worked on live / energized equipment (fluids, mechanical force, pressure, electrical power)
4.6 Perform pneumatic pressure or tightness tests
4.7 Work involving ionizing radiations outside of dedicated radiation bunkers and that requires
definition of supervised and controlled areas
Written by: Name: Date: DD / MM / YYYY
Position:
Signature and stamp :
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
Requisition criticality rating:
Section reserved for Technip Energies
L
M
H Confidence level with bidder: H
M
L
Technip Energies experience on previous orders at this location:
Date: DD / MM / YYYY Name:
Signature:
Gaps identified and description of further risk assessment / audits or risk mitigation to be taken:
QF 20- rev. 3 – March 2023
Project: Q-32859 - NMDC - Ruwais Folder: RFQ Files