CSM Audit Checklist

	B	C	D	E	F	H
1	HSE Performace Audit Checklist
2	Contract :		Date of Audit :
3	Location :		Scope of Work :
4	Area / Site Manager :		Auditor Representative :
5	Sr. No.	Description of Item	Max. Marks.	Mark Obtained	Remarks / Action
6	(A)	Safety Organization :
7	1	Does the organization have an HSE policy? Is it displayed at the site office ? Check management commitment towards HSE policy.	10
8	2	Is project HSE Goal communicated/Displayed at prominent place. Check Awareness. Is the organization displayed, communicate their site performance statistics?	10
9	3	Is Organization have approved project specific HSE Plan? Check communication record?	10
10	4	Has the company Project In-charge and HSE attending Safety Committee meeting effectively?	50
11	5	Submission of MIS by company like Monthly report, Tool box talk attendance record, etc.	10
12	6	Do they conduct HSE inspection and Monthly audit? Check at least last two audit records? Check recommendations and compliance status of both external and internal audits. Is there any action plan on Audit Finding (Internal/External)and communication record to top management ?	40
13	7	Regular Tool box talk conducted? Check the documents and awareness among workers. Is management participation schedule prepared and participation of Management in TBT.	30
14	8	Daily inspection register PPE's etc.maintained (Check the documents).	10
15	9	Do they report/Investigate incident/Accident as per procedure? Do they implement recommendations? Check compliance status. Is consolidate recommendation tracking register available?	40	N/A
16	10	Is All Required procedure, Checklist, and Forms are available with Company (hard/Soft copy)	30
17	11	Is lesson learned from incident has been communicated? Check awareness and documents.	20	N/A
18	12	Have constituted safety committee? Is it periodically convened?	40
19	13	Emergency Preparedness Plan available and practiced	20
20	14	First aider & first aid kit available?	20
21	15	Risk Assessment done & records available?	30
22	16	Is training modules & training matrix available? Check training records and attendance?	20
23		Sub Total	260	0
24	(B)	House Keeping :
25	1	Whether Scrap Bins are provided / used?	10
26	2	Whether material and scrap stored and stacked properly at identified area for them?	10
27	3	Are Passageways / Walkways clear?	10
28	4	Is General neatness good?	20
29		Sub Total	50	0		72
30	(C)	Personal Protective Equipment's :
31	1	Do the company maintain PPE issue register?	5
32	2	Do they maintain keep 10 % additional stock of PPE that of their manpower?	5
33	3	Is the quality of PPE is good? Any site complains may be taken into account.	5
34	4	Do the workmen use mandatory PPEs?	80
35	5	Do they replace the PPEs when damaged and predetermined intervals?	5
36		Sub Total	100	0
37	(E)	Work at Height :
38	1	Are all engineers and supervisors trained and aware of safe use of ladder/scaffold while working at height? And fall protection plan as prescribed is prepared and followed.	10
39	2	In case of use of ladder, ladder safety norms are followed?	5
40	3	Is the scaffold erected and checked using scaffolding procedure.	40
41	4	Is Full body harnesses (Safety Belt) are inspected daily, Is TPI certificate available?	10
42	5	are leading edges,Floor oepings barricated or covered?	10
43	6	Whether ISI approved quality and good condition Full body safety harness are available and used while working at height?	5
44	7	Whether the erection and dismantling of scaffold is done by trained/skilled persons under supervision?	20
45		Sub Total	100	0
46	(I)	Confined Space :
47	1	Whether confined space entry permit is obtained?	40	N/A
48	2	Is the work performed under the competent supervision?	20	N/A
49		Sub Total	60	N/A
50	(M)	Traffic
51	1	Are all drivers/ operators having valid driving license? Are the details of Driving license & its validity maintained?	10
52	2	Are vehicles parked only at designated parking area?	10
53		Sub Total	20	0
54	(N)	Welfare
55	1	Are adequate urinals, toilet, drinking water facilities available at site? Is it maintened properly with hyginic condition and cleaning schedule.	40
56	3	Is First aid box available at site? Is it properly maintained? Is inspection record maintained ?	20
57	4	Are rest sheds provided at site? Are workers restricted to sit at unsafe locations?	20
58		Sub Total	80	0
59	(O)	Trade Validation test
60	1	Trade Validation test record. Check reords of semi skilled / skilled workers.	10
61		Sub Total	10	0
62	(P)	General :
63	2	Is permit to work for the activity is followed?	10
64	3	Is emergency prepardness/rescue plan prepared and communicated.	10
65	4	Are display and caution boards provided at strategic locations? E.g. Assembly Point	10
66	6	Are vehicles being checked like brakes, oil, lights etc. on regular basis by using daily checklist ?	10
67	8	Are only proper clothes and not loose clothes being used while working around machinery?	10
68	9	Are clamps or other scaffolding objects are removed?	10
69	11	Are the approaches to work sites being maintained & kept clear of obstacles?	10
70	12	Whether Risk Assessment is prepared , approved and avilable at site for all activities? Check implementation,communication and awarness record.	20
71	14	Is Material stored/organised at site store properly? check Storage of pipes and clamps. Are they seperated? Is loading,unloading and handling at site Safely?	20
72		Sub Total	110	0
73	(Q)	Serious Safety Concern :
74	1	Does area have any Lost Time Incident? (-25 for each LWC)	-25
75	2	Does area have any Medical Treatment, RWC Accident? (-10 for each MTC & RWC)	-10
76	3	Is there any specific serious safety violation or long pending safety concern? (-25 for each one) eg.. Height Work, Electrical Work etc. issues	-25
77	Statics
78		Total Observation :
79		Total Marks :	730
80		Marks Obtained :
81		Executional Person Not Participation in Audit
82		Total Marks :
83		Rating :
84		Overall Rating :
85		Previous Months Overall Rating :	NA
86	Representatives
87			Auditor Name		Sign
88		1
89		2
90		3
91			Auditee Name		Sign
92		1
93		2
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