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HALLIBURTON COMPANY'S HEALTH, SAFETY AND ENVIRONMENTAL AUDIT PROGRAM

GHANA HEALTH
SITE SELF ASSESSMENT

LOCATION:

ADDRESS:

CITY: STATE / TERRITORY / PROVINCE: COUNTRY:

DIVISION: NWA: TELEPHONE NUMBER:

TYPE OF OPERATION(S) CONDUCTED AT THIS SITE:

NAME OF PERSON CONDUCTING ASSESSMENT: DATE:

WHEN COMPLETED, PLEASE PROCEED TO THE CHECKLIST BY SELECTING THE "CHECKLIST" TAB BELOW

This Site Self Assessment checklist is intended as an aid and a guideline only. It does not attempt to be the complete, definitive answer to all state, federal or other agency requ

This Site Self Assessment should be conducted in conjunction with the Halliburton Environmental Appendix, which is available on HALWORLD at the HSE Auditing Site or by
"LINK" below

THIS INFORMATION IS CURRENT AS OF SEPTEMBER 2012

SITE SELF ASSESSMENT CHECKLISTS AND APPENDICES


H, SAFETY AND ENVIRONMENTAL AUDIT PROGRAM
GHANA HEALTH
E SELF ASSESSMENT

HE CHECKLIST BY SELECTING THE "CHECKLIST" TAB BELOW

oes not attempt to be the complete, definitive answer to all state, federal or other agency requirements.

nvironmental Appendix, which is available on HALWORLD at the HSE Auditing Site or by selecting the
"LINK" below

IS CURRENT AS OF SEPTEMBER 2012

MENT CHECKLISTS AND APPENDICES


CATEGORY TOPIC A U N/A

Safety Medical Surveillance 10.1 In cases of illness due to the nature of a process or any other condition of work, the facility takes
10 measures for the medical supervision of employees as may be directed by a notice issued by

the Minister of Labour.

10.2 If there may be risk of injury to the health of persons employed in that process due to alteration
of a process, or the introduction of a new process, or new substance for use in a process, the

facility takes measures for the medical supervision of employees as may be directed by a notice
issued by the Minister of Labour.
10.3 If the facility employs or intends to employ young persons in work which may cause risk of injury
to their health, it takes measures for the medical supervision of employees as may be directed

by a notice issued by the Minister of Labour.

10.4 If there may be risk of injury to the health of employees from a substance or material brought to
the factory or shop to be used or handled in the factory or shop or from a change in the

conditions of work or any other conditions in the factory or shop, the facility takes measures for
the medical supervision of employees as may be directed by a notice issued by the Minister of
Labour.
10.5 When it recruits foreign employees, the facility notifies the vaccination Inspector prior to the
arrival of such employees in Ghana.

10.6 Before an employer engages an employee in any work, the employee undergoes pre-
employment examination that he/she is in good health and is medically fit for the work assigned

to the employee.

First Aid Provisions 10.7 The facility provides and maintains an adequate number of first aid boxes or cupboards of the
prescribed standard in a factory so as to be readily accessible.

10.8 The facility keeps a first aid box, only requisite items and materials for first aid in any first aid
box or cupboard.

10.9 The facility ensures that first aid boxes or cupboards have been placed under the charge of a
responsible person, who is, if possible, a person with knowledge of first aid and who is always

readily available during working hours.

10.10 The facility displays a notice stating the name of the person in charge of the first aid box or
cupboard in the premises so as to be easily seen and read by the persons employed to work in

the premises.
CATEGORY TOPIC A U N/A

Safety Accident/Illness 10.11 The facility reports occupational accidents and diseases which occur in the workplace as soon
10 Investigation, Record as practicable and not later than seven days from the date of their occurrence to the Chief

keeping & Reporting Labour Officer or the Inspector of Factories.

10.12 If a worker finds himself f or herself in any situation at the workplace which she or he has
reasonable cause to believe presents an imminent and serious danger to his or her life, safety

or health, the employer ensures that the worker immediately reports this fact to his or her
immediate supervisor and removes himself or herself from the situation.
10.13 If an accident in a factory, an office or a shop (a) causes the death of a person employed in that
place, or (b) disables a person employed for more than three days from earning full wages at

work at which that person was employed, the occupier sends a written notice of the accident, in
the prescribed form and containing the prescribed particulars, to the chief inspector or the
inspector for the district.
10.14 If the facility is a factory, office or shop, it reports in writing to the chief inspector or the inspector
for the district, in the prescribed form and containing the prescribed particulars any dangerous

occurrence occurring in a factory, an office or a shop, whether death or disablement is caused or
not.
10.15 If the facility is a factory, office or shop, it reports any case of an industrial disease occurring in a
factory or a shop in writing to the chief inspector or the inspector for the district, in the prescribed

form and containing the prescribed particulars.

General Workplace 10.16 the facility keeps the workplace, as well as the furniture, furnishings and fittings in that place, in
Requirements a clean state.

10.17 If the facility is a factory, an office or a shop, it ensures that accumulations of dirt and refuse are
removed daily from the floors and benches of workrooms, and from staircases and passages.

10.18 The facility ensures that the floor of an office, a shop or a workroom is cleaned at least once a
week by washing, sweeping or any other suitable and effective method.

10.19 If the facility is a factory, it ensures that the inside walls and partitions, and the ceilings or tops of
rooms, and walls, sides and tops of passages and staircases are (a) where they have a smooth

impervious surface, washed with hot water and soap or otherwise suitably cleaned at least once
in every twelve months; (b) where they are varnished or painted with oil paint,revarnished or
repainted at least once in every five years, and at least once in every twelve months be washed
10.20 The
with facility ensures
hot water that or
and soap workplaces
otherwiseare of thecleaned;
suitably minimumand required areaother
(c) in any and cases,
not overcrowded as
whitewashed
to cause risk or injury to the health of persons
or colour-washed at least once in every twelve months. working in that place, unless specifically

exempted.
CATEGORY TOPIC A U N/A

10.21 The facility provides and maintains safe means of access to every place at which a person has
at any time to work, and keeps and makes that place, so far as is reasonably practicable, safe

for a person working there.

Ventilation 10.22 The facility takes steps to prevent contamination of the workplaces by, and to protect the
workers from, toxic gases, noxious substances, vapour, dust, fumes, mists and other

substances or materials likely to cause risk to safety or health.

Safety 10.23 The facility provides effective and suitable measures to secure and maintain by the circulation of
10 fresh air in each workroom the adequate ventilation of the room.

10.24 If the factory process gives off dust, fumes or any other impurities of a character or to an extent
as is likely to be injurious or offensive to the persons employed, or a substantial quantity of dust

of any kind, the facility (a) takes practicable measures; and (b) where the nature of the process
makes it practicable, provides and maintains exhaust appliances, as near as possible to the
point of origin of the dust, fumes or the other impurities, so as to prevent them from entering the
Lighting 10.25 If
airthe
of facility is a factory, office or shop, it provides effective measures to secure and maintain
a workroom.
sufficient and suitable lighting, natural or artificial, in every part of a factory, an office or a shop in

which persons are working or passing.

Sanitary Provisions 10.26 The facility provides separate, sufficient and suitable toilet and washing facilities and adequate
facilities for the storage, changing, drying and cleansing from contamination of clothing for male

and female workers.

10.27 The facility ensures that adequate and suitable sanitary conveniences conveniently accessible
to persons employed are provided, maintained and kept clean in a factory, an office or a shop,

and effective provision shall be made for their lighting and ventilation.

10.28 The facility provides and maintains adequate and suitable accommodation for clothing not worn
during working hours at suitable places for the use of the persons employed in a factory, an

office or a shop.

Drinking Water 10.29 The facility provides and maintains an adequate supply of wholesome drinking water at suitable
points conveniently accessible to the persons employed in a factory, an office or a shop.

10.30 If the supply of drinking water is not piped, the facility (a)ensures that it is contained in suitable
vessels and renewed at least daily; and (b)takes practicable steps to preserve the water and

vessels from contamination.
CATEGORY TOPIC A U N/A

10.31 The facility ensures that a drinking water supply whether piped or not, is as directed by an
inspector, clearly marked, Drinking Water.

Rest Areas 10.32 If the facility is a factory, office or shop, where in a room of a factory or a shop poisonous
substances or otherwise harmful substances are used which may cause dust or fume, suitable

provisions are in place to have the meals.
CATEGORY TOPIC A U N/A

Safety General Ergonomic 10.33 If the facility employs worker who has,in the course of their work, reasonable opportunities for
10 Requirements sitting without detriment to their work, it provides and maintains for their use, at suitable places

conveniently accessible to them, suitable seating facilities sufficient to enable them to take
advantage of those opportunities.
10.34 If a substantial proportion of the work can properly be done sitting down, the facility (a) provides
and maintains for an employed person doing that work a seat of a suitable design, construction

and size, and the work, together with a footrest on which the feet can readily and comfortably be
supported if the employed person cannot do so without one; and (b) supports the seat
adequately and properly while in use for the purpose for which it is provided.
Manual Handling of 10.35 If the facility is a factory, office or shop, the facility ensures that an employee is not in the course
Loads / Back Injury of this work required to lift, carry or move a load so heavy as to be likely to cause injury to such

Prevention an employee.

Physical Hazards 10.36 If the facility is a factory, office or shop, it takes appropriate and practicable measures to reduce
as far as possible noise likely to affect the health of persons employed in a factory, an office or a

shop.

Ionizing Radiation 10.37 If the facility (a) manufactures or otherwise produces; (b) possesses or uses; (c) sells, disposes
of or leases, loans or deals with; (d) imports or exports; or (e) transports any irradiating device

or radioactive material, it holds a licence issued under the Radiation Protection Instrument.

10.38 If the facility has or uses an irradiating device or radioactive material, it has notified the Board in
writing of his intention to acquire, store, install or use the device or material specifying the

purpose for which it is required and the type of building or facility where the device or material is
to be stored, installed or used.
10.39 If the facility owns, purchases, manufactures, acquires, imports, sells or deals in, stores, uses,
disposes of or exports, any kind of irradiating device or radioactive material or any other source

of ionizing radiation, it holds a licence issued by the Board.

10.40 If there is any kind of irradiating device or radioactive material or any other source of ionizing
radiation, the employer appoints a person experienced in radiation health and safety measures

as a Radiation Safety Officer within the facility.

10.41 If there is any kind of irradiating device or radioactive material or any other source of ionizing
radiation, the Radiation Safety Officer ensures that any other instructions that may be issued

from time to time by the Board are implemented.

10.42 If there is any kind of irradiating device or radioactive material or any other source of ionizing
radiation, the Radiation Safety Officer ensures that all radiation workers employed within the

facility are given proper instruction on radiation safety measures and where annual exposure
exceed three-tenths of the dose equivalent limit, receive medical check-ups at least once every
six months.
CATEGORY TOPIC A U N/A

10.43 If there is any kind of irradiating device or radioactive material or any other source of ionizing
radiation, the Radiation Safety Officer ensures that exposure records are kept as prescribed in,

the code of practice for users Of ionizing radiation.

10.44 If there is any kind of irradiating device or radioactive material or any other source of ionizing
radiation, the Radiation Safety Officer ensures that all persons using or working the facility are

supplied with at least one monitoring device and any other protective accessories necessary to
carry out radiation procedures with the lowest possible risk.
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OBSERVATION PROBABILITY RATING POTENTIAL CONSEQUENCES RISK PRIORITY CODE

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RECOMMENDATION

Requires Action By the End of the Audit Period

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Requires Action By the End of the Audit Period

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Requires Action By the End of the Audit Period

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Requires Action By the End of the Audit Period

Requires Action By the End of the Audit Period

Requires Action By the End of the Audit Period

Requires Action By the End of the Audit Period

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Requires Action By the End of the Audit Period

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Requires Action By the End of the Audit Period


Requires Action By the End of the Audit Period

Requires Action By the End of the Audit Period

Requires Action By the End of the Audit Period

Requires Action By the End of the Audit Period


Date: Risk Factor: Location: A: U: N/A: Category Number: Sub Category: Checklist Topic: Category Title: Observation:

In cases of illness due to the nature of a process or any other cond


Safety
December 30, 1899 0 0 0 0 0 10 10.1 Medical Surveillance 0

If there may be risk of injury to the health of persons employed in

December 30, 1899 0 0 0 10.2 0

If the facility employs or intends to employ young persons in wor

December 30, 1899 0 0 0 10.3 0 0

If there may be risk of injury to the health of employees from a su

December 30, 1899 0 0 0 10.4 0 0

December 30, 1899 0 0 0 10.5 0 0

Before an employer engages an employee in any work, the emplo

December 30, 1899 0 0 0 10.6 0 0

December 30, 1899 0 0 0 10.7 The facility providesFirst Aid Provisions 0

The facility keeps a first aid box, only requisite items and materia

December 30, 1899 0 0 0 10.8 0 0

The facility ensures that first aid boxes or cupboards have been p

December 30, 1899 0 0 0 10.9 0 0

The facility displays a notice stating the name of the person in ch

December 30, 1899 0 0 0 10.10 0 0

The facility reports occupational accidents and diseases which oc


Safety
December 30, 1899 0 0 10 10.11 Accident/Illness Inve 0

December 30, 1899 0 0 0 10.12 0 0


Date: Risk Factor: Location: A: U: N/A: Category Number: Sub Category: Checklist Topic: Category Title: Observation:

If an accident in a factory, an office or a shop (a) causes the death

December 30, 1899 0 0 0 10.13 0 0

December 30, 1899 0 0 0 10.14 If the facility is a 0 0

If the facility is a factory, office or shop, it reports any case of an

December 30, 1899 0 0 0 10.15 0 0

December 30, 1899 0 0 0 10.16 the facility keeps theGeneral Workplace Re 0

If the facility is a factory, an office or a shop, it ensures that accum

December 30, 1899 0 0 0 10.17 0 0

The facility ensures that the floor of an office, a shop or a workro

December 30, 1899 0 0 0 10.18 0 0

If the facility is a factory, it ensures that the inside walls and parti

December 30, 1899 0 0 0 10.19 0 0

December 30, 1899 0 0 0 10.20 The facility ensures 0 0

The facility provides and maintains safe means of access to every

December 30, 1899 0 0 0 10.21 0 0

The facility takes steps to prevent contamination of the workplac

December 30, 1899 0 0 0 10.22 Ventilation 0

The facility provides effective and suitable measures to secure an


Safety
December 30, 1899 0 0 10 10.23 0 0

December 30, 1899 0 0 0 10.24 If the factory proces 0 0


Date: Risk Factor: Location: A: U: N/A: Category Number: Sub Category: Checklist Topic: Category Title: Observation:

If the facility is a factory, office or shop, it provides effective mea

December 30, 1899 0 0 0 10.25 Lighting 0

The facility provides separate, sufficient and suitable toilet and w

December 30, 1899 0 0 0 10.26 Sanitary Provisions 0

December 30, 1899 0 0 0 10.27 The facility ensures 0 0

The facility provides and maintains adequate and suitable accomm

December 30, 1899 0 0 0 10.28 0 0

December 30, 1899 0 0 0 10.29 The facility provide Drinking Water 0

If the supply of drinking water is not piped, the facility (a)ensures

December 30, 1899 0 0 0 10.30 0 0

The facility ensures that a drinking water supply whether piped o

December 30, 1899 0 0 0 10.31 0 0

If the facility is a factory, office or shop, where in a room of a fac

December 30, 1899 0 0 0 10.32 Rest Areas 0

If the facility employs worker who has,in the course of their work
Safety
December 30, 1899 0 0 10 10.33 General Ergonomic R 0

If a substantial proportion of the work can properly be done sittin

December 30, 1899 0 0 0 10.34 0 0


Date: Risk Factor: Location: A: U: N/A: Category Number: Sub Category: Checklist Topic: Category Title: Observation:

December 30, 1899 0 0 0 10.35 If the facility is a Manual Handling of Lo 0

If the facility is a factory, office or shop, it takes appropriate and

December 30, 1899 0 0 0 10.36 Physical Hazards 0

If the facility (a) manufactures or otherwise produces; (b) possess

December 30, 1899 0 0 0 10.37 Ionizing Radiation 0

If the facility has or uses an irradiating device or radioactive mate

December 30, 1899 0 0 0 10.38 0 0

If the facility owns, purchases, manufactures, acquires, imports, s

December 30, 1899 0 0 0 10.39 0 0

December 30, 1899 0 0 0 10.40 If there is any kind 0 0

December 30, 1899 0 0 0 10.41 If there is any kind 0 0

If there is any kind of irradiating device or radioactive material or

December 30, 1899 0 0 0 10.42 0 0


Date: Risk Factor: Location: A: U: N/A: Category Number: Sub Category: Checklist Topic: Category Title: Observation:

If there is any kind of irradiating device or radioactive material or

December 30, 1899 0 0 0 10.43 0 0

If there is any kind of irradiating device or radioactive material or

December 30, 1899 0 0 0 10.44 0 0


Code: Citation: Address: City: State / Territory / Province: Country: Division: NWA: Telephone Number:
Factories, Offices
and Shops Act,
1970 (Section
29(a)) 0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
29(b)) 0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
29(c)) 0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
29(d)) 0 0 0 0 0 0 0
Vaccination Act,
1919 (Section 9) 0 0 0 0 0 0 0
Labour
Regulations, LI
1833 (2007)
(Regulation 19(1))
0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
28(1)) 0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
28(2)) 0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
28(3)) 0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
28(4)) 0 0 0 0 0 0 0
Labor Act, 2003
(Section 120) ;
Labour
Regulations, LI
1833 (2007)
(Regulation 18(2))
0 0 0 0 0 0 0
Labor Act, 2003
(Section 119(1)) 0 0 0 0 0 0 0
Code: Citation: Address: City: State / Territory / Province: Country: Division: NWA: Telephone Number:
Factories, Offices
and Shops Act,
1970 (Section 10)
0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section 11)
0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section 12)
0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
13(1)) 0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
13(2)) 0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
13(3)) 0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
13(4)) 0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section 14)
0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
34(1)) 0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section 118)
0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section 15)
0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
23(1)) 0 0 0 0 0 0 0
Code: Citation: Address: City: State / Territory / Province: Country: Division: NWA: Telephone Number:
Factories, Offices
and Shops Act,
1970 (Section 17)
0 0 0 0 0 0 0
Labor Act, 2003
(Section 118(2)(f)) ;
Factories, Offices
and Shops Act,
1970 (Section 16)

0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
19(1)) 0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section 21)
0 0 0 0 0 0 0
Labor Act, 2003
(Section 118(2)
(h)) ;
Factories, Offices
and Shops Act,
1970 (Section 20)
0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
20(2)) 0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
20(3)) 0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Sect 24)
0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
22(1)) 0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section
22(2)) 0 0 0 0 0 0 0
Code: Citation: Address: City: State / Territory / Province: Country: Division: NWA: Telephone Number:
Factories, Offices
and Shops Act,
1970 (Section 27)
0 0 0 0 0 0 0
Factories, Offices
and Shops Act,
1970 (Section 26)
0 0 0 0 0 0 0
Radiation
Protection
Instrument (No.
1559 of 1993) (Part
II Section 1)
0 0 0 0 0 0 0
Radiation
Protection
Instrument (No.
1559 of 1993) (Part
II Section 7)
0 0 0 0 0 0 0
Radiation
Protection
Instrument (No.
1559 of 1993) (Part
II Section 9)
0 0 0 0 0 0 0
Radiation
Protection
Instrument (No.
1559 of 1993) (Part
III Section 11)
0 0 0 0 0 0 0
Radiation
Protection
Instrument (No.
1559 of 1993) (Part
III Section 11(e))
0 0 0 0 0 0 0
Radiation
Protection
Instrument (No.
1559 of 1993) (Part
III Section 11(b))
0 0 0 0 0 0 0
Code: Citation: Address: City: State / Territory / Province: Country: Division: NWA: Telephone Number:
Radiation
Protection
Instrument (No.
1559 of 1993) (Part
III Section 11(d))
0 0 0 0 0 0 0
Radiation
Protection
Instrument (No.
1559 of 1993) (Part
III Section 11(a))
0 0 0 0 0 0 0
Type of Operation(s) Conducted at This Site: Name of Person(s) Conducting This Assessment: Citation Quote: Citation II: Citation II Quote:

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
Type of Operation(s) Conducted at This Site: Name of Person(s) Conducting This Assessment: Citation Quote: Citation II: Citation II Quote:

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
Type of Operation(s) Conducted at This Site: Name of Person(s) Conducting This Assessment: Citation Quote: Citation II: Citation II Quote:

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
Type of Operation(s) Conducted at This Site: Name of Person(s) Conducting This Assessment: Citation Quote: Citation II: Citation II Quote:

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
Type of Operation(s) Conducted at This Site: Name of Person(s) Conducting This Assessment: Citation Quote: Citation II: Citation II Quote:

0 0

0 0
Risk Priority Code: Observation Number:

III 001

III 002

III 003

III 004

III 005

III 006

III 007

III 008

III 009

III 010

III 011

III 012
Risk Priority Code: Observation Number:

III 013

III 014

III 015

III 016

III 017

III 018

III 019

III 020

III 021

III 022

III 023

III 024
Risk Priority Code: Observation Number:

III 025

III 026

III 027

III 028

III 029

III 030

III 031

III 032

III 033

III 034
Risk Priority Code: Observation Number:

III 035

III 036

III 037

III 038

III 039

III 040

III 041

III 042
Risk Priority Code: Observation Number:

III 043

III 044

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