Health, Safety and Environment

HSEF1101.3 Contractor HSE

Questionnaire
Form Approved by: Manager Sustainability & Safety
Form Revision: 0 Date: 14
st
Feb 2013 Page 1 of 4
Form variations to suit user, system / software constraints, legal requirements or corporate requirements are permissible, as long as the
intent of the form is not compromised.



Date printed 08/03/2014



HSEF1101.3 Contractor HSE Questionnaire
This form is completed by the contractor / supplier representative when requested by Hydro Tasmania. The
information provided is used to evaluate the HSE management of the contractor / supplier company. The
completed form is retained on file by the Hydro Tasmania Representative.

CONTRACTING COMPANY DETAILS
Company name:
Company address: Phone:
Information provided by (name): Role:

Signature: Date:
Services offered:

CONTRACTOR HSE MANAGEMENT ASSESSMENT
Contractor to answer and provide comment. Where relevant, summary supporting evidence should be attached or
contact details provided for persons who can provide more details information. Hydro Tasmania will complete the Rating
section.

HSE Management Requirement Yes No Comments
Hydro
rating
1. Policy and management
1.1 Does your business have a WH&S and/or
Environmental management system audited by a
recognised independent authority?
If only safety certification is held, proceed directly to
section 5 of this form.
If environmental certification is held, skip section 5 of
this form.
If both safety and environmental certification are
held, proceed directly to section 6 of this form

1.2 Does your business have a health and safety policy?
If yes provide a signed and dated copy of policy.

1.3 Does your business have an environmental policy?
If yes provide a signed and dated copy of policy.

1.4 Is there a business WH&S management system manual
or plan?
If yes provide a copy of contents page(s).


Health, Safety and Environment
HSEF1101.3 Contractor HSE
Questionnaire
Form Approved by: Manager Sustainability & Safety
Form Revision: 0 Date: 14
st
Feb 2013 Page 2 of 4
Form variations to suit user, system / software constraints, legal requirements or corporate requirements are permissible, as long as the
intent of the form is not compromised.



Date printed 08/03/2014



HSE Management Requirement Yes No Comments
Hydro
rating
1.5 Is there a business environmental management system
manual or plan?
If yes provide a copy of contents page(s).

1.6 Are health and safety and environmental
responsibilities clearly identified for all levels of staff?
If yes provide details.

1.7 Are health, safety and environmental inductions and
training conducted in your business?
If yes, provide contact details for the person responsible
for arranging this training.

1.8 Are records maintained of all HSE training and
induction programs undertaken in your business?
If yes, provide copies of relevant training matrices.

2. Safe work practices and procedures
2.1 Has the company prepared safe operating procedures
or specific safety instructions relevant to its operations?
If yes, provide a summary listing of procedures or
instructions.

2.2 Does the business have all required health and safety
permits and approvals in relation to the proposed work?
If yes, provide a summary listing of permits.

2.3 Are there procedures for maintaining, inspecting and
assessing the hazards of plant operated/owned by the
business?
If yes, provide a list of the procedures.

2.4 Are there procedures for storing and handling
hazardous substances?
If yes, provide a list of the procedures.

2.5 Are there procedures for identifying, assessing and
controlling risks associated with manual handling?
If yes, provide a list of the procedures.

2.6 Is there an established process for the preparation of
job hazard analyses/ safe work method statements?
If yes, provide details and an example.

3. Health and safety workplace inspection
3.1 Are regular health and safety inspections at workplaces
undertaken?
If yes, provide details.

3.2 Are standard workplace inspection checklists used to
conduct health and safety inspections?
If yes, provide details or examples.


Health, Safety and Environment
HSEF1101.3 Contractor HSE
Questionnaire
Form Approved by: Manager Sustainability & Safety
Form Revision: 0 Date: 14
st
Feb 2013 Page 3 of 4
Form variations to suit user, system / software constraints, legal requirements or corporate requirements are permissible, as long as the
intent of the form is not compromised.



Date printed 08/03/2014



HSE Management Requirement Yes No Comments
Hydro
rating
3.3 Is there a procedure by which employees can report
hazards at workplaces?
If yes, provide details.

4. Health and safety consultation
4.1 Is there a workplace health and safety committee?
If no, provide a brief explanation.

4.2 Do you hold work group meetings related to WH&S
matters?
If yes, please provide details.

4.3 Are there employee-elected health and safety
representatives?

5. Environmental practices and procedures
5.1 Has the company identified the environmental aspects
and impacts relevant to its operations?
If yes, provide a summary listing or register.

5.2 Is the business aware of, or has it developed processes
for, the management of aboriginal and historic cultural
heritage?
If yes, provide details (e.g. heritage management plans)

5.2 Does the business have all required legal and
environmental permits and approvals in relation to the
proposed work?
If yes, provide a summary listing of permits.

5.3 Are there procedures for disposing of wastes, including
controlled substances?
If yes, provide details.

5.4 Is there an established process for the preparation of
environmental impact assessments and management
plans?
If yes, provide detail.

6. HSE performance monitoring
6.1 Is there a documented incident reporting and
investigation process?
If yes, provide a copy of a standard incident report form.

6.2 Has the business ever been convicted of an workplace
health and safety or environmental offence?
If yes, provide detail.

6.3 Does the business audit its health, safety and
environmental performance?
If yes, provide detail and an example audit report


Health, Safety and Environment
HSEF1101.3 Contractor HSE
Questionnaire
Form Approved by: Manager Sustainability & Safety
Form Revision: 0 Date: 14
st
Feb 2013 Page 4 of 4
Form variations to suit user, system / software constraints, legal requirements or corporate requirements are permissible, as long as the
intent of the form is not compromised.



Date printed 08/03/2014



HSE Management Requirement Yes No Comments
Hydro
rating
6.4 Is there a system for recording and analysing health,
safety and environmental performance statistics?
If yes, provide the following:

What are the number of workplace: Last reporting year 1 year previous 2 years previous
Fatalities
Lost time injuries
Medically treated injuries
Reportable safety incidents
Reportable environmental incidents
Fines or prosecutions


7. References
7.1 Provide at least three written references, or contact
details for referees, for work or a similar nature or similar
contract value to that proposed.

7.2 Provide copies of one safety and/or environmental
management plan developed and implemented by the
business for work of a similar nature.


HYDRO TASMANIA - EVALUATION RATING TABLE
ASSESSOR
Name:

Role:

Signature: Date:
RATING
F = Fail, does not meet Hydro
Tasmanias required standards
P = Pass, meets or exceeds Hydro
Tasmanias required standards