OLD – Jumbo Questionnaire

June 11, 2021 GSES System

Welcome to the GSES System

Please register at the GSES Platform for further instructions: Register

Full name of business:
Registration no:
If private, name of owner:
Established since (date):
Address:
Location of yard(s), fabrication or service facilities if different from main address:
Telephone no:
Fax no:
Our General Manager is:
Our Procurement Manager is:
Our QHSE Manager is:
Our On Site Supervisor is:
2.1 Is there a company structure Organogram of Responsibilities and Authority:
2.2 Is the Jumbo Shipping Mandatory Agreement correctly completed and signed?:
2.3 Is there proof of Public Liability Insurance cover:
2.4 Does the management periodically participate in Health, Safety and Environmental activities on site? Please describe:
2.5 Is senior management involved in communicating QHSE aspects to staff, contractors and clients?:
2.6 Are HSE meetings organised? If yes, please describe and indicate frequency:
2.7 Are supervisors held accountable for QHSE performance within their individual areas of influence?:
2.8 Are workers at all levels permitted to stop work if they identify unsafe conditions at the worksite?:
2.9 Is good HSE behaviour recognized and rewarded, for example via a safety incentive scheme?:
3.1 Does your company have a QHSE policy document? If yes, please include a copy:
3.2 Who has overall and final responsibility for QHSE in your organization?:
3.3 Does your Company have a documented QHSE Management System?:
3.4 If yes, is the Management System externally registered or accredited (e.g. ISO 9001, ISO14001, OHSAS 18001)? If yes, please include copy(ies) of certificate(s):
3.5 Are the requirements outlined in your QHSE Policy explained to all employees? If yes, please indicate how:
3.6 Are QHSE objectives and targets developed to improve the performance of your company? If yes, please describe:
3.7 Do you periodically identify new industry or regulatory standards that may be applicable to your activities?:
4.1 How is your company structured to effectively manage and communicate QHSE matters? Please provide the company’s QHSE organisation chart:
4.2 Does your company have a system for assessing resource requirements? If yes, please provide details:
4.3 Are personnel responsibilities defined? Are minimum qualifications for positions established and detailed in job descriptions?:
4.4 Are employee and sub-contractor qualifications verified? If yes, please provide details:
4.5 Employees and sub contractors joining a Jumbo Shipping vessel must be medically fit. Provide medical certificates:
4.6 Have supervisors received formal QHSE training in their responsibilities? If yes, please provide details e.g. an example of training matrix:
4.7 How do you ensure required specialised training, for instance training related to specific health hazards such as radiation, noise, asbestos and chemicals?:
4.8 Is documentation maintained to attest that training requirements (and any required testing) have been completed?:
5.1 Does your company identify hazards, assess risk and identify control measures?:
5.2 Does your company operate a Permit To Work (PTW) system? If yes, please provide details and index of procedures and forms:
5.3 Does your company have procedures for confined space entry? If yes, please provide details:
5.4 Does your company have procedures for working at heights? If yes, please provide details:
5.5 Does your company have a policy for personal protective equipment? If yes, please provide details:
6.1 Have emergency plans been developed to define responses to foreseeable scenarios? Are these plans accessible and communicated to the involved parties?:
6.2 Are emergency exercises (drills) performed? How frequently?:
6.3 Are lessons learned from emergency exercises implemented within the company? Provide details:
6.4 Does your company have a list with emergency contacts and numbers. Please provide:
7.1 Is there a system in place to evaluate the QHSE competence of subcontractors prior to awarding work?:
7.2 Are subcontractors supervised at the worksite?:
7.3 Are regular meetings with the subcontractors held, wherein QHSE issues are discussed?:
7.4 Is there a system to provide QHSE information to the subcontractors? If affirmative, provide details:
8.1 Does your company have a documented incident reporting procedure?:
8.2 Does your company have an incident investigation procedure?:
8.3 If affirmative, have the incident investigators been formally trained?:
8.4 Are incident investigation reports analyzed to establish trends and take remedial action?:
8.5 Does your company keep incident statistics? If affirmative, please provide the incident statistics for the past 3 years:
9.1 Is there a system to ensure that the tools and equipment used by your employees within your premises, on-site or at other work locations, are accurately registered, controlled and maintained in a safe working condition? Please provide details:
9.2 Is the reliability and availability of safety critical equipment tested and maintained? Please provide details:
10.1 Does your company conduct internal audits? What is the frequency?:
10.2 Is there a process for managing action items to ensure remedial follow actions are carried out?:
10.3 Does your company undertake periodic assessments / reviews to measure the effectiveness of its QHSE management system procedures?:
10.4 Is there a process in place to identify the necessary legal requirements and respectively update the company’s procedures / practices to comply with changing legal requirements?:
10.5 Does your company conduct on-site QHSE inspections? If affirmative, please state frequency:
11.1 Are personnel assessed for their fitness to work prior to placement and at periodic intervals thereafter?:
11.2 Is there a Drug and Alcohol Policy available? If affirmative, please provide a copy:
11.3 Is there a system in place to monitor and assess the exposure of the workforce to chemical or physical hazards?:
11.4 Does your company have any first aid or medical facilities?:
11.5 Are there sufficient qualified personnel available to administer first aid during all working hours?:
11.6 Employees and sub contractors joining a Jumbo vessel must be medically fit. Provide medical certificates:
12.1 Does your company have ISO 14001 Certification?If yes please provide details:
12.2 Have potential environmental impacts of the operations / activities been identified?:
12.3 Is there a pollution prevention plan in place to ensure any accidental releases do not result in a pollution incident?:
12.4 Are there programs to reduce the impact of worksite activities on the environment? Give details:
12.5 Are there procedures in place to ensure waste is correctly stored, transported and disposed (or reused / recycled)?:
12.6 Is waste disposal documentation kept on site to demonstrate waste is managed in a responsible and appropriate manner?:
12.7 Does your company assess the impacts of chemicals and materials prior to selection and use?:
12.8 Is there an inventory kept for all hazardous chemicals and substances used?:
12.9 Is the following relevant documentation available: information on hazardous substances e.g. MSDS (Material Safety Data Sheets), assessments regarding proper handling, exposure limits and first aid treatment?:
12.10 Does your company have an Environmental Legal Aspect Register?:
Company Name:
Date:
Completed By:
Initials:
Surname:
2.2 Upload Jumbo Shipping Mandatory Agreement correctly completed and signed:
3.1 Upload copy of QHSE policy document:
3.4 Upload copy(ies) of certificate(s):
4.1 Upload company’s QHSE organisation chart:
4.2 Upload details for assessing resource requirements:
4.4 Upload details about employee and sub-contractor verified qualifications:
4.5 Upload medical certificates:
4.6 Upload e.g. an example of training matrix:
5.2 Upload details and index of procedures and forms:
5.3 Upload details:
5.4 Upload details:
5.5 Upload details:
6.3 Upload details:
6.4 Upload list:
7.4 Upload details:
8.5 Upload the incident statistics for the past 3 years:
9.1 Upload details:
9.2 Upload details:
11.2 Upload drug and alcohol policy:
11.6 Upload medical certificates:
12.1 Upload details:
12.4 Upload details:
Signature:
Cellphone no. of the General Manager:
Cellphone no. of the Procurement Manager:
Cellphone no. of the QHSE Manager:
Cellphone no. of the On Site Supervisor:

Thank you



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