EGA EHS Prequalification Questionnaire

GENERAL INFORMATION

1. Company name:

2. Address:

3. Telephone number:

4. How many years has your organization been in business under your present firm name?

5. Name subsidiaries or parent company if applicable:

6. Contact number for insurance purposes:

7. Contact for requesting bids:

8. Pre-qualification completed by:

ENVIRONMENTAL HEALTH AND SAFETY (EHS) STAFFING

9. Mention highest ranking EHS professional in the Company:

Name: Title: leave 3 options

10. If applicable, will the Company provide a full-time EHS Manager to the
Yes No N/A
project?

If, yes include resume as part of the Companys supporting documentation submittal

11. Will the Company provide a full time project EHS Advisor(s)? Yes No

12. Identify the person within the Company directly responsible for administration of the EHS management system

Name: Title:

ENVIRONMENT, HEALTH AND SAFETY MANUAL

13. Does the Company have a written EHS manual? If yes, please provide copy. Yes No

If yes, does the EHS manual contain:

Written EHS Policy Statement, signed and dated annually Yes No N/A

Accountabilities and responsibilities for managers & supervisors? Yes No N/A

Do managers / executives visit worksites? Yes No N/A

How often?

Accountabilities and responsibilities for employees? Yes No N/A

Management commitment and expectations? Yes No N/A

Periodic employee EHS performance appraisals? Yes No N/A

Hazard recognition and control? Yes No N/A

How are employees informed of job hazards?

Reference to legislation? Yes No N/A

Address the Company Suppliers and Sub-Suppliers EHS Management Yes No N/A

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Systems

14. What is the date of the last revision for the EHS manual?

RISK REGISTER

15. Does the Company use a Risk Register? Yes No N/A

16. Is this Risk Register reviewed periodically? Yes No N/A

INDUCTION AND TRAINING

17. Do you have a Health & Safety Orientation Program for new hires Yes No N/A

18. Do you have a addtiional Health & Safety Orientation Program for newly
Yes No N/A
hired or promoted Supervisors?

19. Are exams given? If not how do you test for comprehension:

20. How often are refresher topics covered?

21. Does the Company have a Training policy, Matrix & programs? Pls. Attach Yes No N/A

FORMAL AUDITING

22. Does the Company conduct corporate EHS audits? Yes No

If yes, provide the following specifics:

Frequency of audits: Audit protocol used:

Who does the audits?

23. Are areas for improvement identified and an action plan established? Yes No

24. If requested, can a copy of the last audit done on a similar project be provided? Yes No

SAFE WORK PRACTICES

25. Does the Company EHS management system include standards, procedures and practices such as Incident
Reporting, Communication, Barricades, Emergency Preparedness, Excavation etc.

SAFETY AND MISCELLANEOUS OTHER EQUIPMENT

26. Is applicable PPE provided, free of charge, for employees? Yes No N/A

27. Do you have a program in place to inspect and maintain PPE? If so please
Yes No N/A
provide evidence

28. Do you have a system for establishing applicable health, safety and
Yes No N/A
environmental specifications for the acquisitoin of materials & equipment?

29. Do you conduct inspections for equipment (e.g. cranes, forklifts, JLGs) in
Yes No N/A
compliance with regulatory requirements and keep records?

POLICIES, STANDARDS AND PROGRAMS

30. Does the Company provide insurance for their employees? Yes No N/A

31. Does the Company have personnel trained to perform First Aid and CPR? Yes No N/A

32. Does the Company have a formal process for job and task hazard Yes No N/A
identification, risk assessment and control for each job description or type

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of operation performed?

33. Does the Company maintain and update, scheduled inspection and
maintenance certification records for operating equipment (cranes, forklifts,
Yes No N/A
JLGs, etc.), in accordance with laws and regulations, industry and
Company standards and protocols?

34. Does the Company have a procedure for inspection/certification of tools,

Yes No N/A
equipment and vehicles prior to arrival/use on site?

35. Does the Company have a Behaviour Based safety program? Yes No N/A

If yes, describe and state the Companys position on Behaviour Based Safety Programs?

36. Are Positive Incentives used for EHS? Yes No N/A

37. Does the Company have an Environmental Management System and Policy? Yes No N/A

38. Does the Company have a Waste Management System? Yes No N/A

39. Does the Company carry out environmental monitoring? Yes No N/A

40. Does the Company detain a third party environmental certificate? Yes No N/A

If yes, which certificates?

41. Does the Company have a grievance mechanism? Yes No N/A

42. Does the company have a process to ensure fitness for work of the
Yes No N/A
employees?

ENVIRONMENT, HEALTH AND SAFETY MEETINGS

43. Does the Company hold EHS meetings to ensure proper communication of environment, health and safety
information to:

Yes No Daily Weekly Bi-weekly Monthly Quarterly

Employees

Contract Managers

Customers

Others? (Specify below)

44. Are EHS meetings documented? Yes No N/A

INCIDENT MANAGEMENT

45. Does the Company investigate first aid incidents? Yes No N/A

46. Does the Company have a procedure to investigate and follow-up on all
Yes No N/A
incidents?

47. Are the following incident formally investigated? Yes No N/A

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Lost Time injuries? (Injured not being able to return to work on the next
Yes No N/A
working shift)

Restricted Work Injuries? (Injured not being able to return to normal

Yes No N/A
duties but able to perform modified duties)

Medical Treatment injuries? (Injured treated by a Medical Doctor with a

Yes No N/A
medical procedure conducted but return to normal duties)

48. Does the Company have an injury management program in place? Yes No N/A

49. List the last 5 Recordable Incidents (lost workday/restricted workday/medical treatment) and the action take

Outcome
Incident Actions Taken
(including statutory penalty/fine/notice)

50. Are incident reports and report summaries sent to the following within the Company and if so, how often are they
reported?

Quarte
Yes No Monthly Annually
rly

Project Management

Vice President

President / CEO

SUBCONTRACTORS

51. Does the Company use environment, health and safety performance
Yes No N/A
criteria in the pre-screening and selection of subcontractors?

52. Does the Company evaluate the ability of subcontractors to comply with
applicable environment, health and safety requirements as part of the Yes No N/A
pre-screening and selection process?

53. Does the Company require its subcontractors to have a written

Yes No N/A
environment, health and safety program?

54. Does the Company require its subcontractors to have written

Yes No N/A
environment, health and safety procedures?

55. Do you involve your subcontractors in:

- Health & safety induction Yes No N/A

- Health & safety meetings Yes No N/A

- Inspections Yes No N/A

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 EGA EHS Prequalification Questionnaire

- Audits Yes No N/A

INSPECTIONS, WALKTHROUGHS AND SITE AUDITS

56. Does the Company conduct environment, health and safety

Yes No N/A
walkthroughs & inspections?

If yes, what is the frequency of the walkthroughs & inspections?

57. Does the Company conduct internal environment, health and safety
Yes No N/A
program audits?

If yes, what is the frequency of the audits?

58. Does the Company have a standard form or checklist to conduct the
Yes No N/A
walkthroughs, inspections and audits? If yes, please provide a copy.

59. Are the walkthroughs, inspections and audits documented, including

corrective actions (if any) of deficiencies noted & communicated to Yes No N/A
employees?

WORK HISTORY

60. Largest single project in the last 3 years: AED

61. Your Firms ideal project size: Between AED and AED

62. Major jobs in progress?

Customer / location Type of work Size AEDM Customer Contact Telephone

63. Major jobs completed in the last three years

Customer
Customer / location Type of work Size AEDM Telephone
Contact

SAFETY PERFORMANCE

64. Injury and illness data

A. Total employee (excluding sub-contractor) hours worked in the last three years

Year 20 20 20

Total hours

B. Provide the following data

For calculating rates please utilizing the following: 20 20 20

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200,000
= No Rate No Rate No Rate

Injury related fatality no. and rate

Lost work day no. and rate

Restricted work day no. and rate

Medical treatment no. and rate

Total recordable injury no. and rate

AWARDS

65. Has the Company received any awards for safety performance
Yes No N/A
achievement?

If yes, please list all awards received.

LABOR MANAGEMENT

66. Does the Company have a policy on labor camp management? Yes No N/A

67. Does the Company carry out labor camp inspection Yes No N/A

If yes, what is the inspection frequency?

68. Does the company use a checklist for the inspection? Yes No N/A

69. Does the Company check for Fire/security, Health & Safety, Environment and Waste,
Yes No
Working Conditions, Catering Food, Medical Services, Grievance Mechanism

70. Does the Company detain a third party environmental certificate Yes No N/A

71. What languages are spoken by your employees? For non English or Arabic speakers, what plans, initiatives and
process do you have in place to address comprehension, understanding and team management?

This document must be signed by a company officer.

_________________________________ _______________________________
Title Signature

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