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Date : .
Project Period : .
Job Title : .
Contract No : .
Work Location : .
Contractors Name : .
Address : .
GRADING CRITERIA:
1. Equipment and/or conditions do not exist or are informal. Little awareness observed in
the workforce
2. Equipment and/or conditions have been defined and a plan is in place but compliance is
inconsistent.
3. Equipment and/or conditions required to meet the expectation are in place. Compliance
with processes and procedures is good.
4. Equipment and/or conditions required to meet the expectation are in place and
compliance is assured. Best in class performance is demonstrated.
Housekeeping - Rating 1 2 3 4
V. Hazard Communication
X. Compressed Gas
VII. Ladder
Ladder 1 2 3 4
XIII. Scaffolds
Scaffolds Rating 1 2 3 4
FORM-SAKA-CHSEMS-003
CONTRACTOR HSE MANAGEMENT
SYSTEM Rev. 1 10 Feb 2015
WORK IN PROGRESS Ref. Doc. GL-SAKA-HSE-002
(HSE INSPECTION CHECKLIST) Page 7 of 8
XIV. Excavations
Excavations Rating 1 2 3 4