(598295696) 08.0 Article 3.0 Section D - HSE(27012015)

Policy/Plan/Program: ID-G-BU-00000-00000-00362 Rev.7Contractor Health, Safety & Environmental Management System (C-HSE MS)C ono c o P h illi p s I ndon es i a P a g e 1 o f 9

Appendix D.1 - Contractor HSE PQ Questionnaires

COPI-HS-FR-00035 rev.4

Contractor HSE PQ Questionnaires

GENERAL INFORMATION

Company Name :

Address :

Telephone :

Fax :

Email :

Company core business :

Work experience in the :

current core business

Contact Person :

o Title :

o Telephone :

o Fax :

o Email :

SECTION 1 – LEADERSHIP AND COMMITMENT1. Com m i tm en t to H SE thr oug h l ead ershi p

a) How do senior managers as top management personally involved in HSE management?

b) Provide evidence of commitment at all levels of the organization by:

(i) Stating this year's company targets for HSE performance·

(ii) Describing how you ensure that your organization understands and is committed to deliver your company HSE targets

c) How do you promote a positive culture towards HSE matters?

d) Does your company have a HSE Management System? (Yes/No)

If yes, please attach.


Hints: (Please provide)

Provide evidence of Senior Management involvement in HSE matters (e.g. trip plan and report, safety messages, HSE meeting attendance list, etc), organization chart

SECTION 2 – POLICY AND STRATEGIC OBJECTIVES

2 .1 . H SE P olicy & Docum entsa) Does your company have an HSE policy document that is applied in this region? (Yes/No)


b) Who has overall and final responsibility for HSE in your organization?

c) How do you ensure HSE Policy compliance and communication at site?

2 .2 . A vai labil ity of P o licy Stat em en ts to Em ploy ees

How do you communicate your company's policy to your employees including any changes?


HSE policy

Evidence of communication (distribution list, display on bulletin board, email or letter announcement, etc)

SECTION 3: ORGANIZATION, RESPONSIBILITY, RESOURCES, STANDARDS AND DOCUMENTATION

3 .1 . Or ganiz a tions - Co m m i tm en t an d Co m m un icatio na) Provide your current Organization chart!

b) How is management involved in HSE activities, objective setting and monitoring?

c) What provision does your company make for HSE communication and meetings?


HSE meeting program and schedule at all level Evidence of implementation (minutes of meeting, attendance list, presentation material

3 .2 . Staff H SE Traini ng P rogram

Have the managers and supervisors at all levels that will plan, monitor, oversee and carry out the work received formal HSE training in their responsibilities with respect to conducting work to HSE requirements? (Yes/No)


HSE training program for staff

HSE Training matrix for staff (training matrix is training requirement for each position)

HSE training record for all staff related to the work3 .3 . Em ploy ee Com petence an d G en eral H SE Tr aining

a) What arrangements does your company have to ensure employees have knowledge of basic


industrial HSE, and to keep this knowledge up to date?

b) What arrangements does your company have to ensure ALL employees, including sub contractors, also have knowledge of your HSE policies and practices?


HSE training program for existing and new employee

Orientation materials (booklet, hand out, etc),

HSE Handbook (outlines, explains and demonstrates new employee's job)

Evidence follow up observation of new employees work3 .4 . Sp ecializ ed H SE Tr aining

Have you identified areas of your company's operations where specialized training is required to deal with potential hazards? (Yes/No)

If Yes, please provide the list (e.g. radioactive, asbestos, explosive, diving, etc).

3 .5 . H SE Qualified S taff

Does your company have HSE specialist (related to your company's services) who can provide training for other employees? (Yes/No)If Yes, please provide the curriculum vitae


HSE specialized training program, including retraining period (e.g. radioactive, asbestos, explosive, diving, etc)

List of qualified HSE professional employee

3 .6 . A ssessm en t of Sui t abili ty of Su bcon tract or s

a) Do you employ sub-contractor(s) for the intended service? (Yes/No)

If No, please go to the question 3.7.

Do you have sub-contractor(s) selection procedure in term of HSE?

b) How do you assess your sub-contractor(s) to ensure they comply with your company's HSE policy and standards?


Assessment program and standard for subcontractor

Records/reports of assessment (e.g. pre qualification) and performance monitoring (e.g. work in progress audit) results

3 .7 . H SE R egula tio ns a nd S tandar ds

a) What kind of HSE standards and regulations that your company refers to for the intended service?


b) How do you ensure these are met and verified?

c) How do you update the standard and its dissemination?


List of HSE regulations and standards and its references (e.g. local, global industry regulatory standard)

SECTION 4: HAZARDS AND EFFECT MANAGEMENT

4 .1 . H az ards an d Effect M anagem ent

Does your company have procedure for the identification, assessment, control and mitigation of hazards and effects? (Yes/No)

If Yes, please attach the index/table of content including the sub-index.


Hazards and effects management procedure/guideline

Sample of HSE hazards and effects management implementation (e.g. record of risk assessments: JSA, HAZID, HAZOP, HAZAN, QRA, etc)

4 .2 . Ex posu re of th e W o rk force

What systems are in place to monitor the hazard's exposure of your workforce e.g. chemical or physical agents?


Communication mechanism (e.g. email, orientation, notice board, safety sign, etc) to the workforce of the major hazards that they are likely to be exposed

Result/report of hazards exposure monitoring (Chemical, physical and biological hazards such as noise, radiation, vapors, fumes, temperature extremes etc.)

4 .3 . H andli ng of P ot en tial H az ards (chemical, physical and biological hazards such as noise, radiation, vapors, fumes, temperature extremes, etc.)

How is your workforce advised on potential hazards, e.g. chemicals, noise, radiation, etc., encountered in the course of their work?


Hazard Communication program (Chemical, physical and biological hazards such as noise, radiation, vapors, fumes, temperature extremes etc.)

Database of potential hazards properties (e.g. MSDS, etc)

4 .4 . P ers onnel P rot ecti ve Equi pm en t

a) What arrangements does your company have for provision and upkeep of protective equipment and clothing, both standards issue, and that required for specialized activities?

b) Do you provide appropriate personal protective equipment (PPE) for your employees? (Yes/No) Please provide a listing of the PPE for the scope of this work.


c) Do you provide training on how to use PPE? (Yes/No) Explain the content of the training and any follow-up

d) Do you have a program to ensure that PPE is impacted and maintained?


List of PPE as company standard

PPE procedure

PPE inspection records

PPE inventory and training records

4 .5 . W ast e M a nag em ent

a) What systems are place for identification, classification, minimization and management of waste3

b) How do you ensure these are incompliance with local regulation?

c) Please provide the number of accidents resulting in environmental damage in the amount greater than $50,000 for the last 24 months. Attach copies of any governmental reports submitted.

d) Do you have procedures for waste disposal? (Yes/No)

e) Do you have procedures for spill reporting? (Yes/No)

f) Do you have procedures for spill clean up?(Yes/No)

g) Please provide details at any of your equipment related to environmental matters.

h) Do you assign an expertise to coordinate the environmental and how to ensure his/her competencies?


Company waste management procedure/system

Evidence implementation of waste management system (waste identification/classification, waste matrix, waste manifest/record)

4 .6 . I ndus trial H y giene

a) Do you have an industrial hygiene program? (Yes/No) Please describe this process. If Yes, please provide the list.


b) How do you identify industrial heath/hygiene?

c) If you procure hazardous substance, please explain the process of documentation and its supervision


Industrial Hygiene program (e.g. Respiratory protection, noise protection, ergonomic, indoor air quality control, illumination control, house keeping, personal hygiene)

Evidence of health hazards identification (monitoring results, e.g.: noise measurement, illumination level, etc) and control mechanism (e.g. providing PPE, providing appropriate tools for manual handling, shift control duration, providing barriers, etc)

4 .7 . Dr ugs a nd A lcoh ol

Do you have a drugs and alcohol policy in your organization? (Yes/No) If yes, please attach


Drugs and alcohol policy

Evidence of communication (distribution list, display on bulletin board, email or letter announcement, etc)

Drugs and alcohol program (e.g. random check)

SECTION 5: PLANNING AND PROCEDURES

5 .1 . H SE and Operati on s P rocedur es / M anuals

a) Do you have HSE and Operations procedures manuals? (Yes/No) If Yes, please attach the list of content

b) How do you ensure that the working practices and procedures used by your employees on-site are consistently in accordance with your HSE policy objectives and arrangements?


HSE and Operations procedures manuals

HSE Document control procedure (e.g. system for updating and dissemination to employees)

5 .2 . Eq uip m ent Con trol and M ain tena nce

How do you ensure that plant and equipment used within your premises, on-site, or at other locations by your employees are correctly registered, certified with regulatory requirement, inspected, controlled and maintained in a safe working condition?


Equipment inspection/certification and maintenance program

Evidence of third party inspection/certification

Evidence of equipment inspection records (internal) and follow up


5 .3 . Trans por t Safety M anagem en t a nd M ain ten ance

What arrangement does your company have for vehicle incidents prevention?


Land transportation procedure

Evidence of implementation (e.g. drivers training, vehicle inspection and maintenance, vehicle incident prevention program, etc)

SECTION 6: IMPLEMENTATION AND PERFORMANCE MONITORING

6 .1 . H SE M anag em en t a nd P erfor m ance M o ni tor ing of W or k A ctivi ties

a) What arrangement(s) does your company have for supervision and monitoring of HSE performance?Please explain the criteria.

b) What arrangements does your company have for passing on any results and findings of thissupervision and monitoring to your:

(i) Base management

(ii) Site employees

c) Has your company received any award for HSE performance achievement? (Yes/No)


Company HSE performance monitoring system (e.g. procedure, man hours recording system, incidents count and analysis, HSE performance reward program, etc)

Evidence of HSE performance recognition from clients6 .2 . S tatu t ory N ot ifiab le I ncid en ts/ Dan ger ous Occurr ences, I m pr ovem en t R equi rem en t and P ro hi bit ion N o tices

Has your company suffered any improvement requirement or prohibition notices on statutory notifiable incidents/dangerous occurrences by the relevant national body, regulatory body for HSE or other enforcing authority or been prosecuted under any HSE legislation in the last five years? (Yes/No)

If yes, please give the number of occurrences and its short description.


Letter received from regulatory body regarding major incident in the last five years

Record of incident case occurred in your company6 .3 . H SE P erfor m ance R ecords

a) Please provide statistical details of your HSE performance over the past 3 years (if not recorded/applicable please mark N/R or N/A)

Total Number Frequency(incl. All contract & sub contract personnel) (based on OSHA)

• Fatalities• Days Away From Work Cases (DAFWC) or LTIs• Total Recordable Cases (e.g. Medical Treatment, Restricted Work, Transfer to Another Job,


Unconsciousness)

b) How is health performance recorded?

c) How is environmental performance recorded?


Injury rate (latest year injury rate comparison to contractor’s three preceding years average)with reference to national and or international standard (e.g. Depnaker, OSHA, ANSI, etc)

6 .4 . I ncid ent I nves ti gat ion a nd R epor ti ng

a) Do you have a procedure for the investigation, reporting and follow-up of accidents, dangerous occurrences or occupational illnesses? (Yes/No)


b) How are the findings following an investigation, or a relevant incident occurring elsewhere, communicated to your employees?Please attach an example of investigation reports during the last 12 months.

c) Do you report lesson learn of any near miss ?


Incident reporting and investigation procedure

Evidence of incident report and investigation result

Evidence of incident investigation result/finding sharing (e.g. root cause and lesson sharing using email, notice boards, etc)

Evidence of HSE performance improvement initiatives based on incident learning

SECTION 7: AUDIT AND REVIEW

a) Do you have a written policy on HSE auditing? (Yes/No)

b) How does this policy specify the standards for auditing, including schedule, coverage and the qualifications for auditors?

c) How is the effectiveness of audit verified and how does management report and follow up audits?



Audit procedure Audit program and implementation (schedule, coverage, audit team, report and follow up, etc)

SECTION 8: EMERGENCY RESPONSE PROCEDURE

Do you have an emergency response plan? (Yes/No).


How do you maintain readiness of the plan? And explain the command structure?


Emergency response plan/procedure Emergency response team structure Exercise program (schedule and report of drill and table top) Evidence of communication (e.g. distribution list, email or letter announcement, etc)

SECTION 9: HSE MANAGEMENT - ADDITIONAL FEATURESa) Does your company hold association(s) membership? (Yes/No)

If yes, please provide the list.

b) Is there any aspect of your HSE performance that you believe differentiates yourselves from yourcompetitors that not described elsewhere in your response to the

questionnaire? If yes, please explain.


List of association membership Certificate of association membership (e.g. KADIN, APINDO, IAKKI, AK3, BSC) Evidence of active participation in HSE association (e.g. attending association event, etc)

Policy/Plan/Program: ID-G-BU-00000-00000-00362 Rev.7Contractor Health, Safety & Environmental Management System (C-HSE MS)ConocoPhillips Indonesia

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Appendix D.2 - Contractor HSE PQ Evaluation Criteria

COPI-HS-FR-00084 Rev. 2

Contractor HSE PQ Evaluation Criteria

LEGEND:

= Mandatory = Medium (M) Risk = Significant (S) Risk = High (H) Risk

= M & S Risk = S & H Risk = M, S & H Risk

GRADING – CRITERIA:

A. Systems do not exist or are informal. Little awareness observed in the work force.B. Requirements have been defined and a plan is in place but compliance is inconsistent.C. Systems required to meet the expectation are in place. Compliance with processes and procedures

is good.D. Systems required to meet the expectation are in place and compliance is assured. Best in class

performance is demonstrated.

A B C D

Section 1: Leadership and Commitment

Commitment to HSE through leadership: Item 1(1)(a) – (d)

No commitment from senior management

HSE disciplines delegated to line managers – no direct involvement by senior management

Evidence of active senior management involvement in HSE aspects

Evidence of a positive HSE culture in senior management and at all levels

Section 2: Policy and Strategic Objectives

HSE policy, documents and availability of Policy Statements to Employees: Items 2(1)(a) – (c) and 2(2)

A policy statement exists but responsibility for HSE is unclear.

A policy statement exists with clear responsibility for HSE but not in a widely distributed document

HSE policy establishes responsibility for HSE in languages easily understood, but not widely distributed

Policy with clearly established responsibility and accountability; is distributed to all employees; and is visible on notice boards

Section 3: Organization, Responsibility, Resources, Standards and Documentation

Organizations - Commitment and Communication : Item 3(1)(a) - (c)

No management involvement or commitment toward HSE activity

Management involvement and commitment toward HSE in special occasion only, likewise for periodic HSE meetings.

Regular management involvement and commitment toward HSE. HSE meetings performed on a regular basis at management and supervisor level

Regular management involvement and commitment toward HSE. Regular HSE meetings performed and employees are assigned topics to discuss on a rotational basis

Staff HSE training Program: Item 3(2)


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A B C D

No HSE training established

HSE training established but not implemented.

HSE training established and implemented but only to a limited staff only.

HSE training established and fully implemented to all staff related to the work.

Employee Competence and General HSE Training : Item 3(3)(a) - (b)

No formal program Formal program established to update employee knowledge on HSE. Verbal instructions on company procedures only for new employee. Orientation booklet provided for new employees but no on-the- job orientation by supervisor

Formal program established and implemented for employee and new employee on HSE. Update employee knowledge on HSE. Employee handbook provided and supervisor outlines, explains and demonstrates new employee's job

Formal program established and implemented for employee and new employee on HSE. Update employee knowledge on HSE. Employee handbook provided and supervisor outlines, explains and demonstrates new employee's job. With: follow-up observation of the new employee's work is also included. Supervisor has explained to him safe practices and emergency duties

Specialized HSE Training and HSE Qualified Staff : Items 3(4) and 3(5)

No specialized HSEtraining established

Specialized HSE training established but not implemented.

Specialized HSE training established and implemented.

Specialized HSE training established and implemented on a regular basis. Retraining periods are established. Qualified HSE professional are employed.

Assessment of Suitability of Subcontractors : Item 3(6)(a) - (b)

No assessment program for subcontractor established.

Assessment program and standards for subcontractor are established, covering limited area only but not implemented yet,

Assessment program and standards for subcontractor are established and implemented.

Assessment program and standards for subcontractor are established and fully implemented. Quality assurance for compliance in place.

HSE Regulations and Standards: Item 3(7)(a) - (c)

No HSE regulations and standards available

HSE regulations and standards established for limited purposes only or partial and in compliance with local industry regulatory standards only.

HSE regulations and standards established and in compliance with local industry regulatory standards.

HSE regulations and standards established and in compliance with local and global industry regulatory standards.

Section 4: Hazards and Effects Management

Hazards and Effect Management: Item 4(1)


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A B C D

Company's HSE system does not include hazards and effects assessment

Company's HSE system makes reference to the need to assess hazards and effects but has no comprehensive structure to carry this out

Company's HSE system includes methods for the assessment of major hazards and effects

Company's HSE system has a comprehensive set of methods for the assessment of all HSE hazards and effects and applies them to all of its contracts with documentation

Exposure of the workforce: Item 4(2)

Company does not actively advise the workforce nor monitor exposure

Company advises the workforce of the major hazards that they are likely to be exposed to but only monitors exposure randomly

Company has formal methods for monitoring exposure to the major hazards

Company has a set of formal methods for monitoring exposure to all foreseeable hazards (linked to its hazards and effects assessment method) and applies them to all contracts

Handling of Potential Hazards (chemical, physical and biological hazards such as noise, radiation, vapors, fumes, temperature extremes, etc.) : Item 4(3)

Company makes no special provision for advising the workforce about properties of potential hazards

Company provides information to workforce in the workplace on properties of potential hazards but has no active follow-up

Company distributes information to individuals in the workforce at start of their involvement on- site

Company maintains a database of the properties of all potential hazards encountered in its contracts and has formal methods of information distribution to all personnel and trains its workforce in handling, etc.

Personal Protective Equipment: Item 4(4)(a) – (d)

Basic PPE provided to personnel but no corporate procedure for assessing individual needs

PPE requirements formally assessed but little effort made to ensure correct usage

PPE requirements formally assessed with spot checks on usage

Procedures in place to assess all PPE requirements monitor and enforce usage and replacement needs. Stock inventories monitored, kept above demand levels. Training in use provided where needed

Waste Management: Item 4(5)(a) – (h)

Company has no formal methods for the control of waste

Company has general procedures for waste disposal

Company has procedures for the disposal of each of the main categories of site wastes but makes no provision for minimizing environmental impact

Company has a formal system for waste management (including identification, minimization and classification), which actively seeks to minimize environmental impact

Industrial Hygiene : Item 4(6) (a) – (c)


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A B C D

No Industrial Hygiene program exists.

Basic industrial hygiene program exists but is not enforced.

A program exists and recognizes hazards but is not followed up.

A program exists which manages operations to minimize human health impacts providing a workplace free of recognized health

Drugs and Alcohol : Item 4(7)

No alcohol and drugs policy written

An alcohol and drugs policy statement exists but not in a widely distributed document

An alcohol and drugs policy includes establishing responsibility and accountability, and widely distributed

Drugs policy with clearly established responsibility, accountability, and disciplinary clause is distributed to all employees; and is visible on notice boards

Section 5: Planning and Procedures

HSE and Operations Procedures / Manuals : Item 5(1)(a) and (b)

No HSE andOperations procedures/ manuals is available

Basic HSE procedures /manuals exist

Contractor has written HSE and Operations procedures / manuals to cover all hazardous operations

Contractor has procedures to cover all HSE precautions / manual, typical contractor HSE Plan requirements with a system of updating and dissemination to employees

Equipment Control and Maintenance: Item 5(2)

No defined program to ensure control and maintenance of plant and / or equipment

Program relies on outside sources, i.e. company inspections. Supervisory inspection of equipment confined to worksite personnel only

A written program outlining supervisory guidelines, responsibilities, frequency and follow-up is in effect

In addition to C, periodic inspections conducted by top management or by teams of specialists

Transport Safety Management and Maintenance: Item 5(3)

No special attention paid to transport safety as an area of hazardous activities

Importance of transport safety acknowledged but left to core business managers/supervisors to enact individually

Company has a general management strategy with some procedures for its component issues

Company has a complete strategy and set of plans and procedures covering vehicles, drivers and operationsmanagement

Section 6: Implementation and Performance Monitoring

HSE Management and Performance Monitoring of Work Activities: Item 6(1)(a) – (c)


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A B C D

No system for formally monitoring HSE performance at all

Informal/incidental monitoring HSE performance only

Company has a system for monitoring HSE performance in key areas

Company has a comprehensive system for monitoring performance in all areas with feedback to employers for improvement and has received awards for achievement

Statutory notifiable incidents, dangerous occurrences, improvement requirements and prohibition notices: Items 6(2)

More than one occurrence of major incident in last five years

One occurrence of a major incident in the last five years

Occurrences relate to minor incident(s) only

No occurrences in the last five years

HSE Performance Records (Latest year injury rate comparison to contractor’s three preceding years average): Item 6(3)(a) – (c)

Contractor supplied insufficient information to establish rate or rate increases

Rate is not improving Shows only minor rate improvement

Rate steadily improving by more than 20 per cent per year

Incident Investigation and Reporting: Item 6(4)(a) - (c)

Procedure are available but Findings not generally communicated

Procedure are available and Findings communicated to key personnel only via limited company internal memo or similar media

Procedure are available and Findings communicated to all employees via specific company notice

As in C but with the addition of details of implication for improving HSE performance

Section 7: Audit and Review

Audit and Review : Item 7 (a) – (c)

Audit process is cursoryonly - HSE documents are not explicit about auditing

Company HSEdocuments include reference to auditing but there are no specific details about scheduling and coverage

Company HSEdocuments include details of how auditing is to be implemented withschedules/coverage for the key areas

As in C but additionallyspecifiesmanagement's role in audit and follow-up on action items

Section 8: Emergency Response Procedure

Emergency Response Procedure : Item 8

No written EmergencyResponse.

Basic procedures only. Emergency procedureswritten for major scenarios, e.g. fires/explosions, H2S, evacuation, release of toxic or flammable materials and medical emergencies. No requirements established for drill frequencies.

Emergency procedureswritten for major scenarios, e.g. fires/explosions, H2S, evacuation, release of toxic or flammable materials and medical emergencies. Proceduresdocumented in an Emergency Procedures Manual, which is widely distributed. Frequency of conducting drills established.


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A B C D

Section 9: HSE Management - Additional Features

Membership of Associations: Items 9(a) and (b)

No memberships Company hasMembership of at least one association but with no prominence given to HSE

Company is a memberof at least one HSEassociation

Company is an activeparticipant in at least one HSE association

Policy/Plan/Program:

Contractor Health, Safety & Environmental Management System (C-HSE MS)

ConocoPhillips Indonesia

Appendix D.4 - Contractor HSE PQ Evaluation Result

COPI-HS-FR-00067 Rev. 4

ID-G-BU-00000-00000-00362 Rev.7

Contractor HSE PQ Evaluation Result

Company Name:

Address:

Telephone:

Facsimile:

Email:

Contact Person:

Company Core Business

Work experience in the core business:

Circle the number, which best represents this evaluation based on the criteria for rating purposes attached.

A B C D Subtotal Factor Total

Section 1 – Leadership and Commitment 0 4 8 12Subtotal 0 1 0Section 2 – Policy and Strategic Objectives 0 4 8 12Subtotal 0 1 0

Section 3 – Organization, Responsibility, Resources,

Standards and Documentation

Item 3 (1) - Organizations - Commitment and

Communication0 4 8 12

Item 3 (2) - Staff HSE training Program 0 4 8 12Item 3 (3) -Employee Competence and General HSE

Training0 4 8 12

Item 3 (4) and 3 (5) - Specialized HSE Training and HSE

Qualified Staff0 4 8 12

Item 3 (6) - Assessment of Suitability of Subcontractors 0 4 8 12

Item 3 (7) - HSE Regulations and Standards 0 4 8 12

Subtotal 0 1/6 0.00Section 4 – Hazards and Effect ManagementItem 4 (1) - Hazards and Effect Management 0 4 8 12Item 4 (2) - Exposure of the workforce 0 4 8 12Item 4 (3) - Handling of Potential Hazards 0 4 8 12Item 4 (4) - Personal Protective Equipment 0 4 8 12Item 4 (5) - Waste Management 0 4 8 12Item 4 (6) - Industrial Hygiene 0 4 8 12Item 4 (7) - Drugs and Alcohol 0 4 8 12Subtotal 0 1/7 0.00Section 5 – Planning and ProceduresItem 5 (1) - HSE and Operations Procedures / Manuals 0 4 8 12Item 5 (2) - Equipment Control and Maintenance 0 4 8 12Item 5 (3) - Transport Safety Management and

Maintenance0 4 8 12

Subtotal 0 1/3 0.00Section 6 – Implementation and PerformanceItem 6 (1) - HSE Management and Performance

Monitoring of Work Activities0 4 8 12

Item 6 (2) - Statutory notifiable incidents, dangerous

occurrences, improvement requirements and prohibition

notices

0 4 8 12

Item 6 (3) - HSE Performance Records 0 4 8 12Item 6 (4) - Incident Investigation and Reporting 0 4 8 12

Subtotal 0 1/4 0.00Section 7 – Audit and Review 0 3 7 10Subtotal 0 1 0

Section 8 – Emergency Response Procedure 0 3 7 10

Subtotal 0 1 0

Section 9 – HSE Management – Additional Features 0 2 5 8

Subtotal 0 1 0

Total Scoring (Sect 1 – Sect 9) 0.00

Evaluation Date:

Validation Date:

For a bidder to qualify as acceptable, the minimum passing score must be equal or more than 65.2 4 for high risk work, 54.1 0 for

significant risk work, and 46.4 8 for medium risk work. The evaluation result is valid for 2 year. This validity can be revoked at any time if

the contactors fail to perform or due to other justifiable reasons such as contractor make any significant or noticeable changes. Your

commitment to HSE is highly appreciated.

EVALUATED BY: ACKNOWLEDGE BY:

NAME: NAME:

TITLE: TITLE: Coordinator CHSEMS

(598295696) 08.0 Article 3.0 Section D - HSE(27012015)

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