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Chemical Industries Council of Malaysia (CICM)
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Responsible Care for SMEs
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EMPLOYEE HEALTH AND SAFETY CODE
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Assessment Checklist 2026
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Name of Company: __________________________________
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Stages of Implementation
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NoManagement Practices 12345N/ARef No
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1Management Leadership & Commitment: Commitment by all levels of management to protect and promote the Health & Safety (H&S) of people working at or visiting company facilities through published policies, accountability for implementation and provision of sufficient resources including qualified H&S personnel
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2Stakeholder Engagement: Opportunities for employees (including contractors) to participate in developing, implementating and reviewing of H&S programs
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3Documentation & Program: Each site should have written and current H&S documents, e.g. procedures, work instructions, manuals & guidelines and programs which are appropriate to the H&S matters on site and re-evaluated for any changes and current good practice and updated as necessary
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4Audit & Assessment: Means to verify that the H&S documents & programs are effective and that actual practices are consistent with them
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5Record & Performance Review: Establish system for maintaining H&S records and analyzing data to evaluate H&S performance, determine trends and identify areas for improvement
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6H&S Hazards Identification: Establish methods to identify and evaluate potential health and safety hazards in plants / facilities & processes including new and to be modified plants / facilities & processes
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7Health & Safety Equipment: Establish system for selection, issuance, use (including limitation) and maintenance of H&S equipment* including training of employee in proper use of the equipment. *Example: PPE, first aid equipment & facilities, fire-fighting equipment & system, emergency shower, eye wash, alarm system & devices, ladder, crane, lifting hoists, equipment fence, machine guardings pressure vessels, elevators & electrical tools
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8Incident Investigation & Effectiveness of Action: Establish documented illness, injury and incident investigation process, set corrective actions to prevent recurrence and evaluate the effectiveness of the corrective and preventive action taken
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9Communication: Communicate H&S information to all stakeholders relevant to specific job function / task and the work site in general
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Important Note:
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Please provide documents / brief descriptions on another sheet of paper to support the self-evaluation rating
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for every management practices listed. You are also requested to indicate the reference number of the
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attachments in the given column on the right, for the CICM RCP Technical Committee's easy reference
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Maturity Level
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Rating AssessmentDescription Stages of Maturity
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% ImplementationInitiatePlan & PolicyDo & ImplementCheck & AssessReview & Improve
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1Insignificant or Minimum Practice of Responsible Care®No or minimal action taken0-20Yes
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2Committed to Responsible Care® - Initiate & PlanSystem in process of being developed. However, more effort is required21- 40YesYes
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3Implement Responsible Care® - Plan & Do (PD)System & requirements are mostly met but some improvements are needed41-60YesYesYes
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4Continuously Improving - PDCA EstablishedPDCA requirements are largely in place with minor improvements61-80YesYesYesYes
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5Promote and Sustain Excellence - PDCA EnhancedSystem requirements in place and performance improved, supported by continuous improvement process.80-90YesYesYesYesYes
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NANot applicable
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Submitted by:
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For Self-Assessment:
For Documentation / Site Assessment:
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Name:
Name of Assessor(s):
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Email Address:
Email Address:
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Contact No:
Contact No:
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Date: Date:
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