Section 1Safety Policy Statement

Contractor’s Safety Management Questionnaire /

Instructions:

1. Please complete all items in the questionnaire and provide all necessary supporting documents.
2. Please circle where appropriate for parts marked with ‘*’.

Contractor’s Name
Contact Person
- Phone
- Fax

SECTION 1SAFETY POLICY STATEMENT

1.1Please attach a photocopy of your Company Safety Policy Statement. / Attached
1.2How is the Safety Policy Statement drawn to the attention of your employees?
1.3When was the Safety Policy Statement last updated?
1.4How often is it formally reviewed?
1.5What is the name and title of the individual in your company who has ultimate responsibility for the Safety of your employees?

SECTION 2SAFETY ORGANIZATION

2.1Please describe the safety organisation with your company, in relation to:
(a)Number of full-time safety officers employed.
(b)Please attach a copy of your organisation chart showing the structure / hierarchy of management responsible for safety management. / Attached
(c)Are the safety officer(s) registered with the Labour Department under the F&IU (Safety Officers & Safety Supervisors) Regulations? / Yes / No *
(d)Have the registered safety officer(s) received recognised safety auditing training? / Yes / No *
(e)Have the safety supervisor(s) received formal safety supervisor training? / Yes / No *

SECTION 3SAFETY TRAINING

3.1Please describe your safety training programme for your employees including construction managers, engineers, supervisors/foremen, operatives, workers and sub-contractors etc.

SECTION 4IN-HOUSE SAFETY RULES AND REGULATIONS

4.1Please describe your in-house safety rules and specific work instructions / method statements for hazardous jobs and how you communicate them to your employees.

SECTION 5PROGRAMME FOR INSPECTION OF HAZARDOUS CONDITION

5.1Please describe your safety inspection programme in identifying, reporting and rectifying workplace hazards.

SECTION 6JOB HAZARD ANALYSIS AND HAZARD CONTROL

6.1What systems do you have in conducting job hazard analysis and controlling hazards arising from work?

SECTION 7PERSONAL PROTECTION PROGRAMME

7.1Please describe your programme on the identification, selection, provision, maintenance and replacement of personal protective equipment and training on their use.

SECTION 8ACCIDENT/DANGEROUS OCCURRENCE INVESTIGATION AND REPORTING

8.1What are your standing procedures for reporting incidents, reportable accidents and dangerous occurrences to CLIENTS?

SECTION 9EMERGENCY PREPAREDNESS

9.1Please describe your emergency preparedness plan and procedures in handling anticipated emergencies, organising drills and training of employees.

SECTION 10SAFETY COMMITTEE

10.1Please describe the safety committee established in your Company or site safety committee.

SECTION 11SAFETY PROMOTION

11.1Please describe your promotion programme in promoting safety awareness amongst all personnel on site.

SECTION 12HEALTH ASSURANCE PROGRAMME

12.1Please describe your programme for the identification, evaluation and control of health hazards that employees may be exposed to and the associated arrangements on health surveillance.

SECTION 13EVALUATION, SELECTION AND CONTROL OF SUBCONTRACTORS

13.1How do you evaluate, select and monitor the safety performance of subcontractors?

SECTION 14SAFETY PLAN / SAFETY MANAGEMENT SYSTEM

14.1Please attach a copy of your company safety plan or a construction safety plan for any specific contract. / Attached
14.2When did you last update the safety plan?
14.3How often is the safety management system formally reviewed?

SECTION 15SAFETY AUDIT

15.1Please describe your arrangements in conducting regular safety audit to the safety management system.
15.2Is the safety audit conducted by a registered safety auditor?

SECTION 16ACCIDENT AND OFFENCE RECORDS

16.1Please provide the following information for the last two years as follows (N.B. Including subcontractors working on your sites). / Last Year / Year Before Last Year
(a)Number of fatal accidents occurred
(b)Number of accidents resulting in serious bodily injuries or permanent disabilities
(c)Annual number of reportable accidents per 1000 employees
(d)Number of prosecutions related to safety offences
(e)Number of Improvement Notice / Suspension Notice received
16.2Are there any prosecutions against your company for alleged safety offences in hand or outstanding? / Yes / No *

SECTION 17 OTHER INFORMATION

17.1Please provide followingor any other information that you consider relevant in relation to your safety record and safety management.
(a)Method Statement for un-load the Rail
(b)Other …please specify

Declaration:

We confirm that all the information provided in our response to this questionnaire is true and correct.

Signed: Date:

Name: Position / Title:

On behalf of (Contractor’s Name):