CHECKSHEET FOR REVIEWING HSE PLANS

CONTRACT NO CONSULTANT

MAIN CONTRACTOR SUBCONTRACTOR

Please Note:- The check sheet is a guide and will help you evaluate and score the Plan. Each Section must
have a 70% pass mark to pass, any Section that fails to achieve 70% is an immediate rejection of the Plan.
However, any one area may deem the Plan rejected if it constitutes a serious failure in HSE requirements.
When reading the questions for a Plan and the Plan is for a continuous moving site i.e. OHL or a water main, please
consider the questions on this basis?
SECTION Max Score Comments
1 General 20
2 Implementation & Monitoring 20
3 Roles & Responsibility 10
4 Safety 10
5 Environment 10
6 Occupational Health & Welfare 10
7 Emergency Response 10
8 Miscellaneous 10
Total 100
ITEM SECTION 1 GENERAL YES NO COMMENTS
1.1 Does the Plan follow a logical sequence and have an adequate scope of work?
1.2 Is the Plan site specific? (does it cover the environment were the work will be undertaken)
1.3 Are the Risk Assessments appropriate for the scope of work?
1.4 Are the control measures adequate and documented?
1.5 Does the Plan give a Confidence factor of managing risks and hazards?
1.6 Is the Plan consistent throughout? (No inconsistencies within Job titles/responsibilities etc)
1.7 Does the Plan document say how the site will be secured and prevent trespass?
1.8 Does the Plan comply with ADWEA/Transco Procedures/Guidelines?
1.9 Does the Plan refer to the relevant Laws, Standards and Regulations?
1.10 Does the Plan describe (briefly) the programme for Project start up and completion?
Total (Max score 20 pass mark 14)

ITEM SECTION 2 IMPLEMENATTION & MONITORING THE PLAN YES N0 COMMENST

2.1 Does the Plan describe how the Plan will be implemented & communicate to staff on Site?
2.2 Does the Plan describe how the Plan will be monitored & enforced on Site?
2.3 Does the Plan contain a Site Plan showing
Fire extinguishers locations, Assembly Point locations and egress routes
HSE Notice Boards locations and contents
Location for First Aid Boxes, First Aid Room location
Location of EM vehicle, EM Telephone Numbers
Fist Aiders Telephone Numbers
2.4 Does the Plan contain a section describing how good performance will be recognised?
2.5 Is the Plan of a relevant size to be implemented (40-50 pages)
2.6 Does the Plan state who will do inspections and what and the process for these?
2.7 Does the Plan describe the normal mechanisms for communication to the workers?
2.8 Does the plan describe the interaction and communication with Subcontractors on Site?
2.9 Does the Plan describe who is responsible and how new employees will be inducted?
2.10 Does the Plan describe how it will make the Public aware of its operation?
Total (Max score 20 pass mark 14)

ITEM SECTION 3 ROLES & RESPONSIBILTY YES NO COMMENTS

3.1 Does the Plan state who is responsible for implementing it?
3.2 Are Roles & Responsibilities clearly defined?
3.3 Does it have a Project organisation chart with names and telephone numbers?
3.4 Does the Plan have a list of key staff and contact numbers?
3.5 Does the Plan make it clear who is responsible for and how Incidents are reported?
Total (Max score 10 pass mark 7)

ITEM SECTION 4 SAFETY YES NO COMMENTS

4.1 Does the Plan refer to how visitors will be controlled and the minimum PPE required?
4.2 Does the Plan describe the arrangements for PPE on the site for the workers?
4.3 Does the Plan describe a method of work for the high risk activities or refer to separate
method statements?
Working at Height & and in Excavations

GUIDE
Yes = 2 points No = 0 points
Any question that you think is not applicable, remove the question from the overall section score.
Version 3 03/02/2011 Form 1
 CHECKSHEET FOR REVIEWING HSE PLANS

Working in a Confined Space & heavy materials and equipment

Working with electricity, chemicals,
And any other major high risk activity associated with the project.
4.4 Does the Plan describe how vehicle transport will be managed on the site?
4.5 Does the Plan document how tools and equipment will be used and checked?
Total (Max score 10 pass mark 7)

ITEM SECTION 5 ENVIRONMENT YES NO COMMENTS

5.1 Does the Plan document how it will deal with environmental issues?
Noise, Dust, Waste, Land Protection, Nuisance
5.2 Does the Plan document what it will do with its waste & hazardous waste?
5.3 Does the Plan describe how materials will be stored and protected?
5.4 Does the Plan describe how it will manage general housekeeping?
5.5 Does the Plan describe how it will deal with protected sites?
Total (Max score 10 pass mark 7)

ITEM SECTION 6 OCCUPATIONAL HEALTH & WELFARE YES NO COMMENTS

6.1 Does the Plan contain the HSE issues for the Labour Camps?
6.2 Does the Plan describe adequately the Welfare provisions for workers?
Toilets, Access to drinking water
Kitchen provisions. showers
Cleaning arrangements, Transport arrangements
6.3 Does the Plan describe how workers will be screened to ensure they are fit to work?
6.4 Does the Plan refer to the MSDS date sheets and where they will be kept?
6.5 Does the Plan include regular breaks for workers in the summer?
Total (Max score 10 mark 7)

ITEM SECTION 7 EMERGENCY REPSONSE YES NO COMMENTS

7.1 Does the Plan contain Emergency Response Procedures?
For Fire, For Emergency evacuation of the site, For oil or chemical spill
7.2 Does the Plan list the First Aiders?
7.3 Does the Plan detail the nearest Hospital?
7.4 Does the Plan contain a list of Emergency Numbers?
7.5 Does the Plan identify the location of the First Aid Room & Fist Aid Boxes?
Total (Max score 10 mark 7)

ITEM SECTION 8 MISCELLANOUS YES NO COMMENTS

8.1 Does the Plan refer to how the workshop will be set up and controlled?
8.2 Does the Plan describe how they will ensure the competence of workers?
8.3 Are the HSE Site Inspection forms relevant and appropriate for the activities?
8.4 Does the Plan describe or refer to how to manage the change through the organization?
8.5 Does the Plan describe the potential consequences of the change?
Total (Max score 10 pass mark 7)

OVERALL COMMENTS
Completed By Date

GUIDE
Yes = 2 points No = 0 points
Any question that you think is not applicable, remove the question from the overall section score.
Version 3 03/02/2011 Form 1