Health Safety and Environmental Documentation Template

The following EHS document templates (toolkits) are provided totally complimentary, free of charge to use as a starting point for ISO 14001:2015 and 45001:2018 compliance. These are the actual EMS documents currently in use for compliance with ISO 14001:2015 and 45001:2018 requirements. As each business is different, additional EHS documents or revisions would be required to meet your organization’s specific needs, requirements, context, risk profile, etc. If after reading through all of these documents, you feel like you still need a consulting partner to help you develop your new EHS documents – Contact Us. We’re always looking for interesting new clients and projects.

Aspects And Impacts Analysis Register

Sr. no

Areas/ Location

Activity

Activity Type (R / NR / E)

Aspects

Impacts

E (emergency)

IPC (Interested Party Concern)

LC (Legal concern)

RSP (Resource saving potential)

Present / Existing controls

Severity

Frequency of Occurrences

Time to notice

Present risk factor

Calculated significance (S/NS)

Link to Objective / Program, OCP

HAZARDS AND RISKS ANALYSIS REGISTER

Sr. no

Date of Entry

Areas/ Location

Activity

Activity Type ( R/NR)

Hazards

Risk

E (emergency)

IPC (Interested Party Concern)

LC (Legal Concern)

RSP (Resource saving potential)

Present / Existing controls

Severity

Frequency of Occurrences

Time to notice

Present risk factor

Controls added to reduce risks

Severity

Frequency of Occurrences

Time to notice

Present risk factor

Final (S/NS)

Link to Objective / Program, OCP

SIGNIFICANT ASPECTS AND IMPACTS ANALYSIS REGISTER

Sr.No.	Activity	Aspect	LC	IPC	Impact	Controls

SIGNIFICANT HAZARDS AND RISKS ANALYSIS REGISTER

Nature Of Activity	Hazard	Likely Hazardous Incidence/ Situation	Risk Involved	Current Risk Control System	Is Risk Tolerable	If No, Proposed Risk Control System

Targets and Objectives

Sr No	Description of Objectives	EHSMP Description	MP No, Rev No & Date	Present Status	Set Target	Time Frame	Derived From

Training Plan for the year xxx

Sr. No

Training Topic

Target Group

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Awareness Training on EOHS Management System.

All employees

Awareness Training on EOHS Policy

All employees & Workers

Awareness Training on Environmental Legal & Other requirements

Core Team Members

Awareness Training on OH&S Legal & Other requirements.

Core Team Members

Identification of Aspects & Impact & Evaluation of Environmental aspects.

Core Team Members

Awareness Training on Significant Aspects

Core Team Members

Identification of Hazard, Risk & Risk assessment

Core Team Members

Awareness of Significant Hazard

Core Team Members

Awareness of EOHS Objectives.

All employees & Workers

Roles, responsibility & authority for effective implementation of EOHS Management System.

Core Team Members

Communication with Interested parties

Security

Awareness Training on Operational Control procedure.

Respective personnel from all areas

Awareness training on Mock Drill

All employees including workers & Interested Parties

Awareness training on safety requirement in shop floor during handling of product & Specific requirements

Employees & Workers

Fire Fighting

ERT

First Aid

ERT

Emergency Preparedness & response

ERT

Awareness of Handling Chemicals & Oils including Haz waste

Respective personnel

Awareness of Material safety data sheet.

Respective personnel

Hazardous waste Handling, storage & disposal

Personnel involved in Haz waste handling

Waste Management

Workers

Storage of oil barrels & used oils.

Workers

Spillage management

ERT

Identification of environmental Non-conformities.

Supervisors / ERT

EOHS Internal Auditors Training

Core Team Members

Fork Lift Maintenance

Maintenance

Machine maintenance & Handling of different waste

Maintenance

Scrap Handling, storage & Maintenance of scrap.

Workers

Master List of waste

Non-Hazardous Waste ( General Waste)

Sr. No	Name of Waste	QTY	Department
1	Corrugated Boxes	171kg	QA, PDN, PUR
2	Toilet Paper	1 kg	Admin
3	Old Records	5kg	All Depts.
4	Waste paper & carbon	2kg	All Depts.
5	Packing boxes etc.	21kg	QA, PDN, PUR
6	Packing material of welding rods	3kg	Tool Room
7	Plastic Articles, Cans	11kg	All depts.
8	Empty water bottle	27kg	All depts.
9	Waste PP belt of packing	0.5kg	PDN,
10	Broken Plastic Bins	200kg	STR
11	Metal Flash	23kg	Production
12	Metal End Pieces	5kg	SNS
13	Forgings	123kg	QA
14	Turning Burr & Boring Burr	33kg	Tool Room, SNS
15	Welding rods	73kg	Tool Room
16	Used tooling	126kg	Tool Room, Maint
17	Maintenance scrap tools	1kg	Maintenance
18	Gun Metal Parts	4kg	Maintenance
19	EDM Wire	0.5kg	Tool Room
20	Stainless Steel Metal Flash	0.5kg	Production
21	Metal End Pieces	0.5kg	SNS
22	Forgings	12kg	QA
23	Turning Burr & Boring Burr	47kg	Tool Room, SNS
24	Maintenance scrap	0.5kg	Maintenance
25	HRC Trays	3kg	Heat Treatment
26	Waste boxes of waste packing material	18kg	PDN, PUR
27	Garden Waste	9kg	Admin
28	Waste packing material	132kg	PDN, QA

Hazardous Waste

Sr. No	Name of Waste	QTY	Department
	All type of Used Oil	100l	PDN, QA, MNT,
	Used coolant	4567l	PDN, Tool Room, SNS, PAD/MFD Machine Shop
	Grease	34kg	Maint, Production
	Oil soaked Gunny Bags	657kg	Maint, Production
	Oil filters	3kg	Maint.
	Oil soaked cotton waste & hand gloves, Cotton Rags	1234kg	All dept.
	Empty oil container	1245kg	MNT, STR, QA, SNS, Tool Room
	Paint Cans	253kg	Shipping, Maintenance, QA, Prod
	Used Brushes	12kg	Production, Maintenance, TRM, QA
	Oil Soaked Scrap	1274kg	Maintenance, Production, QA, HT
	Phosphating Chemicals	0.5 kg	Production, QA
	HCL Acid	0.5 kg	QA lab
	Ceramic Wool	5kg	HT
	Choke, Ultra violate lamp, Tube light, all types of bulb, Cells	0.5 kg	All dept.
	Carbon paper, Printing ribbon, Toner cartridge	0.5 kg	All dept.
	Magnaflux Powder	2kg	QA, Production
	Oil Based Die Lubricant	0.5 T	Production
	Water Based Die Lubricant	1.5 T	Production

HSE INDUCTION TRAINING

Inductee Name:

Position:

Induction Date:

Topics to be discussed

S/N	Description	Yes	No	Remarks
1	Project Description
2	Company HSE Policy
3	Induction of Key Personnel
4	Site Layout and Welfare Facility
5	Site Rules (e.g. Drugs, alcohol & smoking policy, different signage’s, wearing PPE’s, avoid wearing pieces of jewelry, etc.)
6	Site Specific Hazards/ Risks/ Near Miss
7	Risk Assessment
8	Responsibility for accident prevention and the maintenance of a safe & healthful work environment
9	Work Permits
10	Environment and Waste Disposal
11	Emergency Procedures (alarm system, first aid box, assembly point, evacuation plan, escape routes, fire warden, first aider)
12	Employee and Supervisor for Reporting Accident
13	Vehicle on Site (Traffic Management)
14	Relevant and Applicable Laws

INCIDENT REPORT AND INVESTIGATION

Contract No	Project Name	Location
Prepared by [HSE Rep]:	Report No:	Date of Report:

TYPE OF INCIDENT (check all that apply)

Injury/ Illness	Vehicle Damage	High Potential (Near Miss)	Quality	Fire
Spill/ Release	Property Loss/ Damage	Permit or equivalent. Exceed	Security	Other

GENERAL INFORMATION

Company or subcontractor Name (s):

Date of incident:
Day of Week:
Time:

Supervisor on duty:
Was Supervisor on Scene:Yes/No
Phone:

Location of incident:

Weather/ Lighting Conditions:

DESCRIBE WHAT HAPPENED (step by step, use additional pages if necessary)

1. What was the employee doing, or what was happening, just before the incident occurred? Describe the activity, as well as the equipment, tools, or materials in use. Be specific, e.g., “Climbing a ladder while carrying tools” or “Driving near the parking area.”

2. What happened? What was the contact or event and how did it occur? E.g., “When the ladder slipped on the wet floor, the employee fell 20 feet” or “was distracted by a bee, swerved off the right side of the road and struck the stop sign”

IMMEDIATE CORRECTIVE ACTIONS (use additional pages if necessary)

AFFECTED EMPLOYEE INFORMATION (include injured person or employees whose activities resulted in the incident)

Name:
Male/Female

Company:

Home Address:
Home Phone#:

Date of Birth:

Job Classification:
Years in job classification:
Date of Hire:

Time Employee began work:

Did the incident relate to routine task for job Classification?: Yes/No

INJURY/ ILLNESS INFORMATION

Nature of the injury or illness (Body part affected and how it was affected, e.g. strained back):

Description of Injury:

Object/ Equipment/ Substance causing harm:

First Aid Provided: Yes/No
If Yes, Where?: On-Site/Off Site

If Yes, who provide first aid?

Will the injury/ Illness result in:Restricted Duty/ Lost Time/Unknown

TREATMENT OR EVALUATION INFORMATION (Attach Provider’s Report/Statement)

Was the treatment or evaluation provided? Yes /No First Aid Evaluation Medical Treatment

If yes, where? On-Site Dr.’s Office Hospital Others:

Name of persons (S) Providing treatment or evaluation:

Address where treatment or evaluation was provided:

Type of treatment or evaluation:

Was the employee hospitalized overnight? Yes/No

PROPERTY LOSS OR DAMAGE INFORMATION

Property or Vehicle involved? Yes/No

Description of loss or damage:
Estimated KWD Lost:

SPILL OR RELEASE INFORMATION

Substance spilled or released:From Where: From Where:

Estimated quantity/Duration:

The reportable quantity (RQ):
RQ Exceeded? Yes/ No

Released to Water of State? Yes/No
CERCLA Hazardous Substance? Yes.No

Response action is taken:

PERSONS PREPARING REPORT (Employee and Supervisor to Complete Report)

Employee’s Name:	Signature:	Date:
Employee’s Name:	Signature:	Date:
Employee’s Name:	Signature:	Date:

PERSONNEL NOTIFIED (Notify Health and Safety Representative Immediately)

ORGANIZATION	NAME (S)	DATE/TIME
HS Department Head
Project Manager

Received by [HS Rep] :		Date/Time:

Serious Incidents require immediate notification to the Corporate Safety Department. Fatalities or hospitalization (admittance) of three or more individuals requires notification to OSHA within 8 hours. Contact the Safety Manager to make the notification. If unavailable, the senior operations person on site should make the notification.

INCIDENT SKETCH

Write in street names and, if possible, the points of the compass.
If a sketch appears on a police report or insurance form, this need not be completed. Attach the other report.

GENERAL INFORMATION

Company:		Date of Incident:	Date of Investigation Report:
Incident Cost:		Estimated: KWD	Actual: KWD
OSHA Recordable:	Yes/No	# Restricted days:	# Days away from work:
Was the activity addressed in an AHA? :	Yes (attach a copy)/No

CAUSE ANALYSIS

IMMEDIATE CAUSE- What actions and conditions contributed to this event? (See examples on next pages)

BASIC CAUSES- What specific personal or job factors contributed to this event? (See examples on next pages, use SCAT chart for guidance)

ACTION PLAN

ACTION	PERSON RESPONSIBLE	TARGET DATE	DATE COMPLETED	VERIFIED BY

REMEDIAL ACTIONS- What has been and/ should be done to control the causes listed? If applicable, include management program (see attached list) for control of incidents.

PERSONNEL PERFORMING INVESTIGATION

Name: (Print)	Signature:	Date:
Name: (Print)	Signature:	Date:
Name: (Print)	Signature:	Date:
Name: (Print)	Signature:	Date:

REVIEW AND APPROVAL

HS Dept. Head:	Signature:	Date:
Comments:
Project Manager:	Signature:	Date:
Comments:
Operations Manager:	Signature:	Date:
Comments:

NOTE: Attach additional information as necessary, i.e. pictures, statements, etc.

EXAMPLES OF IMMEDIATE CAUSES

Substandard Actions

Substandard Conditions

1.Operating equipment without authority

2. Failure to warn

3. Failure to secure

4. Operating at an improper speed

5. Making safety devices inoperable

6. Using defective equipment

7. Failure to use PPE properly

8. Improper loading

9. Improper placement

10. Improper lifting

11. Improper position for the task

12. Servicing equipment in operation

13. Horseplay

14. Under the influence of alcohol/drugs

15. Using equipment improperly

16. Failure to follow the procedure

17. Failure to identify hazard/risk

18. Failure to check/monitor

19. Failure to react/correct

1. Inadequate guards or barriers

2. Inadequate or improper protective equipment

3. Defective tools, equipment, or materials

4. Congestion or restricted action

5. Inadequate warning system

6. Fire and explosion hazards

7. Poor housekeeping/disorder

8. Noise exposure

9. Exposure to radiation

10. Exposure to temperature extremes

11. Inadequate or excess illumination

12. Inadequate ventilation

13. Presence of harmful substances

14. Inadequate instructions/procedures

15. Inadequate information/data

16. Inadequate preparation/planning

17. Inadequate support/assistance

18. Inadequate communications hardware/software/process

19. Road conditions

20. Weather conditions

EXAMPLES OF BASIC CAUSES

Personal Factors

Job Factors

1. Inadequate physical/physiological capability

2. Inadequate mental/physical capability

3. Physical or psychological stress

4. Mental or psychological stress

5. Inadequate training or lack of knowledge

6. Lack of skill or qualifications

7. Improper motivation

8. Abuse or misuse

1. Inadequate leadership/supervision

2. Inadequate engineering

3. Inadequate purchasing

4. Inadequate maintenance or calibration

5. Inadequate tools/equipment

6. Inadequate work standards or procedural controls

7. Excessive wear and tear

8. Inadequate communications

MANAGEMENT PROGRAMS FOR CONTROL OF INCIDENTS

1. Leadership and administration

2. Management training

3. Planned inspections and maintenance

4. Task analysis and procedures

5. Task observation

6. Emergency preparedness

7. Rules and work permits

8. Accident/incident analysis

9. Personal protective equipment

10. Health control

11. Program audits

12. Engineering and change management

13. Personal communications

14. Group communications

15. General promotions/awareness

16. Hiring and placement

17. Purchasing controls

18. Off-the-job safety

EHS Management Program

A.	Significant Environmental Aspect/Hazard:
1.	Objective(s):
2	Target(s):
3	Reason for Significance:
4	Legal or Other Requirements:
Sr. No.	Action	Responsibility	Timeline	Budget	Remark



Sr. No.	Action	Responsibility	Timeline	Budget	Remark



Sr. No.	Action	Responsibility	Timeline	Budget	Remark



6	Other Documents Related to this EMP (Operational Control or Procedure):
7	Records and Documents: Person Responsible and Location:
8	Person(s) Responsible for Program Management:

List of Safety Committee/CFT/Fire fighting team/First aid team

Sr. No.	Name of the person	Designation	Status	Department	Contact number

HOUSEKEEPING INSPECTION CHECKLIST

General Information

Area/Location:	Date:
Conducted by [HS Rep]:	Signature:

Description

S/N	ITEM	EVALUATION YES/NO/NA	REMARKS (Corrective action and recommendations)
1	Proper signage’s posted on the fence, lay-down area and around the offices?
2	Roads in good condition and dust control are maintained?
3	No water accumulation and floors are dry?
4	Clear and safe access to work areas?
5	All stairways, passageways, gangways, and access ways shall be kept free of materials, supplies, and obstructions at all times.
6	Tools, materials, extension cords, hoses, or debris shall not cause tripping or other hazards.
7	Form and scrap lumber and debris shall be cleared formwork areas and access ways
8	Site office and the site area in general cleanliness and orderliness?
9	Construction waste and debris collected in the designated area?
10	Adequate rubbish container and rubbish removed daily?
11	Old timber de-nailed and all protruding steel bars are capped?
12	Material stacking and any loose materials had been properly stored?
13	Site in general cleanliness and orderliness?

Note: Corrective and recommended actions must be implemented immediately. ( references in parenthesis)

Reviewed by [HS Dept]:

POSITION	NAME	SIGNATURE	DATE

Distribution and acknowledgment:

Project Manager	Construction Manager	QA/QC Engineer	Site Engineer

PPE INSPECTION CHECKLIST (PERSONAL PROTECTIVE EQUIPMENT)

General Information

Area/Location:		Date:
Conducted By [HSE Rep]:		Signature:

Description

S/N	ITEM	EVALUATION (YES/NO/ NA)	REMARKS (Corrective action and recommendations)
1	Are PPE used as required?
2	Minimum PPE (i.e. helmet, safety boots, hi-visibility vest, safety glasses) provided to all employees and records maintained?
3	A copy of the PPE manufacturer manual is available?
4	Users trained on using, maintenance and storage of PPE?
5	Additional PPE have been provided as appropriate for those who are executing critical activities (e.g. fully body harness for working at height, full face mask breathing apparatus, etc.)?
6	PPE correctly selected based on the task risk assessment?
7	Regularly inspected, cleaned and maintained and replace when deemed necessary?
8	Safety glass complies with ANSI standard?
9	Protective (cover) glass used for the person using eyeglasses?
10	Hearing protection being used for workers exposed to noise?
11	Head protection being used on hardhat area?
12	Are protective head gears in compliance with ANSI standard?
13	Is protective footwear being used?
14	Do protective footwear meets the ASTM F2412?
15	Are high visibility vest being used on site? )
16	Are high visibility vest complies with ANSI standards?

Note: Corrective and recommended actions must be implemented immediately.

Reviewed by [HS Dept]:

POSITION	NAME	SIGNATURE	DATE

Distribution and acknowledgment:

Project Manager	Construction Manager	QA/QC Engineer	Site Engineer

VISITORS SITE BRIEFING CHECKLIST

Visitors name:
Area/Location:		Date:
Conducted By [HSE Rep]:		Signature:

Topics to be discussed

S/N	Description	EVALUATION (YES/NO/ NA)	REMARKS
1	SITE SAFETY TOOLS
2	PPE
	Smoking
4	Consumption of Food and Drinks
5	Access and Safe Walk Area
6	Vehicle Speed Limit
7	Safety and Advisory Sign
8	SITE HAZARDS
9	Ongoing Activity
10	Vehicle Movement
11	SITE MAP
12	Site Offices
13	Welfare Facility
14	Emergency Muster Station

Note: Corrective and recommended actions must be implemented immediately.

Signature and Remarks

Visitor’s Signature	Name:	Company	Remark:
Visitor’s Signature	Name:	Company	Remark:
Visitor’s Signature	Name:	Company	Remark:
Visitor’s Signature	Name:	Company	Remark:
Conducted by:	Job Title:	SIGNATURE	DATE:
Reviewed by [HS Dept]:	Job Title:	SIGNATURE	DATE:

Sample Environment, Health, and Safety Policy

EHS Policy

We, at XXX, are committed for continual improvement to achieve Safe, Healthy and Environmental friendly working conditions
Through…..

Creating awareness amongst the employees for safe working practices

Inculcating in all employees, a sense of responsibility for Safety, Health & Environment not only at the workplace but also in society at large
Complying with relevant legislation, regulations and other requirements for Environmental Management System, Occupational Health & Safety
Conservation of natural resources and prevention of pollution, prevention of ill health & injuries
Effective recycling and minimizing waste generation

METAL PRODUCTS COMPANY’s IMS Policy

METAL PRODUCTS COMPANY is committed to:

The satisfaction of our customers in all respects by supplying high-quality products, complying to the relevant standards, always on time
Fulfill our commitment through total involvement of all at METAL PRODUCTS COMPANY and with continual improvement in our integrated management system.
Identify, prevent, control and minimize adverse environmental impacts associated with our operational activities.
Comply with all quality, environmental, Health & Safety requirements.
Develop and maintain a highly motivated and trained workforce for effective management of the quality, environment, and Health & Safety issues.
Communicate our environmental commitment to clients, employees and other interested parties.
Strive to continually improve our quality, environmental and Health & Safety performance keeping in view the regulatory requirements, Health & Safety requirements, environmental requirements, community concerns, and technological advancements. Establish & maintain a healthy work environment.
Comply with applicable legal requirements.
Adopt the best practice of operations to prevent ill health & injuries

WEEKLY SAFETY REPORT

Contract No

Project Name

Location

Date From: To:

Description

JOB SAFETY ACTIONS/SAFETY INSPECTIONS	CONDUCTED (YES/NO/ NA)	REMARKS
Was the Job Safety Meeting Held?
Were there lost time Accidents?
Miscellaneous Incidents?
Trench/Excavations: Competent Person daily inspection performed?
Scaffolding: Competent Person daily inspection performed?
Confined Space: Competent Person pre-entry inspection performed?
Reported to:	IR Submitted:

Safety/QC Meetings/Inspections Conducted (List):

Field Activities:

Safety Findings & Corrective Actions:

Safety Findings

Corrective Actions

Prepared by [HSE Rep]:		Reviewed by [HS Dept]:
Signature:		Signature:

For Head Office use only:

Operations Manager

Project Director

Others

Risk Register

Risk description	“Likelihood (L)”	“Severity (S)”	“Risk level *(L S)”**	Risk Mitigation	Responsibility	Deadline	Evaluation date	Evaluation result

Opportunity Register

Opportunity description	“Likelihood (L)”	“Benefit (B)”	“Opportunity Factor *(L B)”**	Opportunity Pursuit Plan	Responsibility	Deadline	Evaluation date	Evaluation result

Noncompliance Notice

Employee Information

Employee Name:	Job Title:	Date:
Dept/ Organization (Third party):	Supervisor Name:

Type of Notice

First Notice

Second Notice

Final Notice

Classification

	Failure to use PPE Properly		Inadequate Guards/Barriers		Inadequate Warning System		Other:
	Defective tools/Equipment/Materials		Poor Housekeeping/Disorder		Violation of Safety Rules

Details

Description of Noncompliance:

Non-Compliance Picture:

Violation Photo

Immediate Action Taken:

Close-Out Picture:

Correction Photo

Recommended Corrective Action:

Acknowledgment:

By signing this form, you confirm that you understand the information in this warning. You also confirm that you and your Supervisor have discussed the issue and a plan for improvement. Signing this form does not necessarily indicate that you agree with this warning.

Employee Name: Signature Date

Supervisor Name Signature Date

Witness Name & Signature (if the employee understands warning but refuses to sign)

Date

Prepared by [HS Dept]:

Job Title:

Name:

Signature:

TOOLS INSPECTION CHECKLIST

General Information

Area/Location:	Type of Tools:
Conducted By:	Signature:	Date:

Description

S/N	ITEM	EVALUATION (YES/NO/ NA)	REMARKS (Corrective action and recommendations)
1	Tools checked and inspected before use?
2	Guards are fitted, adjusted, and tools in good condition?
3	Non sparkling tools used near source ignition area?
4	No loose and frayed clothing while working with power tools?
5	Are floor and bench mounted power tools anchored or securely clamped to a firm foundation?
6	Grinder and abrasive machinery with the guard?
7	Damaged or cracked abrasive wheel?
8	Has circular saw equipped with guard and kickback device?
9	Are safety clips and retainers installed and maintained on pneumatic tools?
10	Is the explosive actuated tool operator trained and qualified?
11	Is proper safekeeping power actuated tool being followed?
12	Is manufacturer instruction is available and being followed?
13	All hoses, coupling, and fittings of the correct rating and inspected and maintained regularly?
14	Tools secured to the hose by positive means to prevent disconnection?
15	Air supply line protected from drainage, maintained and inspected regularly?
16	The safety device is provided for air hose with large diameter?
17	Home-made tools are not used and tools being used fit for the job?
18	Suitable PPE provided for any type of job using portable tools?

Reviewed by [HS Dept]:

POSITION	NAME	SIGNATURE	DATE

Distribution and acknowledgment:

Project Manager	Construction Manager	QA/QC Engineer	Site Engineer

JOB HAZARD / SAFETY ANALYSIS

Job Hazard/Safety Analysis (JHA/JSA) REVIEWS

Reviewed & Approved by:	Reviewed & Approved by:	Reviewed & Approved by:
Signature & date:	Signature & date:	Signature & date:

All signature blocks completed indicate authorization to perform identified Activity’s.

Drawings Attached: Yes No

Definable Work Activity:	Revision No:	Date:
Work Task	Potential Hazard(s)	Control Measure (s), Required Training, -required Permits or Plans, and Competent Person (s)

Equipment to be Used	Required Inspections	Required Training

JHA REVIEW/Pre-Job Brief attendance roster

Name	Signature	Date	Name	Signature	Date

By signing below, I agree to the following:
§   I agree to follow the work steps and implement the controls as written.
§   I agree to stop work when conditions or hazards change or when I encounter unexpected conditions during the execution of work, or when work cannot be performed as written, or instructions become unclear during execution.
§   I confirm that I am authorized, qualified and fit to perform the work.

Instruments Calibration history chart

Description:		Location:
Identification no:		Specification:
Acceptance criteria:		Cal. Frequency:

Sr no.	Calibration Date	Calibration.Agency	Certificate. No.	Calibration Status	Cal.Due On	Inspected By	Approved By	REMARKS

Calibration Schedule

Sr.No	Device ID NO.	Description	Calibration Frequency	Calibration Done on (Date)	Next Calibration Due on (Date)	REMARKS

Lessons Learnt log

ID	Date	Entered By	Subject	Situation	Recommendations & Comments

Communication Plan

Communications item	what	Who	Who Attends	When	When Format

TRAINING NEEDS IDENTIFICATION

	TRAINING NEEDS IDENTIFICATION	Year:	Jan-2023 TO Dec-2023
	DEPARTMENT:
Sr No	Name of Employee	Employee No	Signature






	NOTE – MARK ” √ ” if particular employee needs training of specified topic
	HOD Name & Signature:

ON JOB TRAINING RECORD

Sr. No	Name of employees	Emp – No	Date	Time	Department/ Section	Training Topic	Emp Sign	Training Give By	Training Effectiveness	Remarks








	VERIFIED BY:	Dept Head				CHECKED BY	: HR. IR & ADMIN

TRAINING ATTENDANCE SHEET

Name of Trainer:		Title of Trainer:
Title of Training Course:
Date of Training:		Duration:
List of Attendees
LAST NAME	FIRST NAME	TITLE	SIGNATURE

SERVICING OF FIRE EXTINGUISHER

Sr. No	F.E. No	Location	Type of Fire Extinguisher	Capacity	H.P. tested on	H.P test due date	Refilled on	Refilling Due date:	Defect / Required spare	Remarks/ Corrective action








VERIFIED BY: Dept Head							CHECKED BY: HR. IR & ADMIN

Document Matrix

Sr.No.	Document Name and Identification	Location	Responsibility	Revision	Document Type (Soft/ Hard/ Both)	Protection	Retrieval	Retention Time	Disposition

Example of Report of Mock drill

Scenario: Oily rags used in the shop floor are removed outside and thrown in the storage area where they catch fire due to welding activity. Dried grass present around gets ignited resulting in a wildfire.

11:00 am: Smoke coming out from the back of the Press shop is seen by the security guard Mr. P. P. Deshmukh who was on a patrol round.

11:02 am: Mr. P. P. Deshmukh immediately reached on the spot to find that there was a fire in an incipient stage due to the welding activity going around and the sparks flying out of it.

11:03 am: Mr. P. P. Deshmukh immediately stopped the welding activity and alerted the contractor person working around who did not keep any water or sand bucket or any water fire extinguisher with him while working.

11:04 am: Mr. P. P. Deshmukh immediately called up Gate office/Emergency Control Centre and Security supervisor Mr. M. N. Jorvekar who in turn called up Asst. Safety Manager Mr. Santosh Kasalkar, Site Controller Mr. Sunilkumar Shinde and Incident Controller Mr. J. G. Swami.

11:05 am: Mr. Kasalkar and Mr. Jorvekar rushed to the spot to find that the fire had grown wild due to the surrounding dry grass. Mr. Kasalkar immediately informed Mr. Sunilkumar Shinde about the situation who inturn declared it an emergency and ordered the Main Gate to be closed and the wailing emergency siren to be sounded.

11:07 am: Fire fighting team members rushed on to the spot with ABC fire extinguishers and the garden pipe was also started.
One of the operators Mr. Gangadhar Suryawanshi got injured while trying to rush to the spot with the extinguisher. Communication Officer Mr. Padghan immediately called the Ambulance which took him away to the medical dispensary for first aid. In the meanwhile, all the operators working inside rushed out and gathered at the safe assembly point. A head count was taken to check for any missing person.

11:10 am: Fire was completely extinguished with the help of ABC fire extinguishers and the garden hose. The all-clear siren was sounded.
A meeting was held on the spot to study the observations and take corrective and preventive action.

Following were the Observations made:
1) Welding activity should have been carried out under the supervision of concerned department supervisor.
2) Before starting, adequate safety measures like availability of fire extinguishers, water and sand buckets, etc should be made.
3) Welding activity should be carried out at such a place which is away from flammable liquids, gas or other fuels like dried grass, oily rags, etc which can easily catch fire due to the flying sparks.
4) The welder had a small piece of a broken glass which he held in front of his eyes during welding while his helper did not have anything and held his hand in front of his eyes.
5) The electrical connection was far off and the wire traveled all along the floor without any protection. Also, there was no proper 3 pin plug and the wires were just tucked inside the switchboard.
6) Took some time for the fire fighting team members to transfer the extinguisher to the site as ABC fire extinguisher was not visible anywhere.
7) Ambulance siren and light not working.

Following Corrective actions are taken.

1) All welding activity will be done under the supervision of the contractor and the concerned dept supervisor.
2) Both the responsible persons will ensure that welding is done at a safe designated area, with proper electrical connections and with the right PPE’s used.
3) Fire fighting extinguishers, buckets, etc will be first arranged for before starting the activity.
4) The security dept is to be made aware of by informing them before starting the welding work.
5) The ambulance needs to be checked by the security every day for level of fuel, and every week for battery charge status, condition of first aid box, siren light, etc.
6) Response time to be reduced further by swift transfer of extinguishers to the site. Training to be given for fast operation to the firefighters.

Prepared By: Approved By:

Nonconforming Service Report (NSR)

Date:
Reported by:
Recorded by:

Summarize the reported service nonconformity. Attach or reference applicable documentation (emails, etc.)

Initial Review:

◙ Nonconformity affirmed, proceed with the investigation
◙ Nonconformity could not be affirmed or replicated; stop and monitor for further occurrences.
◙ No nonconformity; stop.

Initial Review by:
Date:

Root cause analysis:

Disposition (check all that apply)

◙ Issue Refund
◙ Provide corrected service. Details:
◙ Provide new services. Details:
◙ File [CAR Form Abbreviation]; reference [CAR Form Abbreviation] #:
◙ Customer waiver. Details:
◙ Other action. Details:

Remark:

Disposition Approval by:
Date:

Customer Approval by:
Date:

List of Internal Auditor

Sr. No.	Name of Internal Auditor	Designation	Reporting to






	Criteria for selection of Internal Auditor w.r.t. experience & skill –

NCR Status Log.

S No.	NCR No	NCR issued to	Date	Action completion date	Proposed follow-up date	Date NCR closed	Remarks	MR (Sign)

Aspects And Impacts Analysis Register

HAZARDS AND RISKS ANALYSIS REGISTER

SIGNIFICANT ASPECTS AND IMPACTS ANALYSIS REGISTER

SIGNIFICANT HAZARDS AND RISKS ANALYSIS REGISTER

Targets and Objectives

Training Plan for the year xxx

Master List of waste

HSE INDUCTION TRAINING

INCIDENT REPORT AND INVESTIGATION

EHS Management Program

List of Safety Committee/CFT/Fire fighting team/First aid team

HOUSEKEEPING INSPECTION CHECKLIST

VISITORS SITE BRIEFING CHECKLIST

Sample Environment, Health, and Safety Policy

WEEKLY SAFETY REPORT

Risk Register

Opportunity Register

Noncompliance Notice

Acknowledgment:

Prepared by [HS Dept]:

TOOLS INSPECTION CHECKLIST

JOB HAZARD / SAFETY ANALYSIS

Instruments Calibration history chart

Calibration Schedule

Lessons Learnt log

Communication Plan

TRAINING NEEDS IDENTIFICATION

ON JOB TRAINING RECORD

TRAINING ATTENDANCE SHEET

SERVICING OF FIRE EXTINGUISHER

Document Matrix

Example of Report of Mock drill

Nonconforming Service Report (NSR)

List of Internal Auditor

NCR Status Log.

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