EHS 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

    Overriding Criteria CriteriaTotalActivity 
Sr.No.ActivityAspect(R – O   – A)LCIPCImpactSCSEDuDeP( S* SE*P*DU *DE)Significant or Non-SignificantProposed Controls
               
               
               
               
               

HAZARDS  AND RISKS ANALYSIS REGISTER

Activity No.Process / ActivityNature  Of Activity R/NR/EHazardLikely Hazardous Incidence/ SituationRisk InvolvedCurrent Risk Control SystemRisk AnalysisRisk  Factor (AXB)Is Risk TolerableIf No, Proposed Risk Control System
Likelihood  Of Occur  (A)Severity Of  Consequence   (B)
            
            
            
            
            
            
            

SIGNIFICANT ASPECTS AND IMPACTS ANALYSIS REGISTER

    Overriding Criteria  
Sr.No.ActivityAspect(A-O-P-R-C)LCIPCImpactControls
       .
       .
       .
       .
       .
       .
       .
       .
       .

SIGNIFICANT HAZARDS AND RISKS ANALYSIS REGISTER

Nature  Of Activity R/NR/EHazardLikely Hazardous Incidence/ SituationRisk InvolvedCurrent Risk Control SystemIs Risk TolerableIf No, Proposed Risk Control System
       
       
       
       
       
       
       
       
       

Targets and Objectives

Sr NoDescription of ObjectivesEHSMP DescriptionMP No, Rev No & DatePresent StatusSet TargetTime FrameDerived From
        
        
        
        
        
        
        
        
        

Training Plan for the year 2019

Sr. No Training Topic Target Group Jan19Feb19Mar19Apr19May19Jun19Jul19Aug19Sep19Oct19Nov19Dec19
1Awareness Training on EOHS Management System.All employees            
2Awareness Training on EOHS PolicyAll employees & Workers            
3Awareness Training on Environmental Legal & Other requirementsCore Team Members            
4Awareness Training on OH&S Legal & Other requirements.Core Team Members            
5Identification of Aspects & Impact & Evaluation of Environmental aspects.Core Team Members            
6Awareness Training on Significant AspectsCore Team Members            
7Identification of Hazard, Risk & Risk assessmentCore Team Members            
8Awareness of Significant HazardCore Team Members            
9Awareness of EOHS Objectives.All employees & Workers            
10Roles, responsibility & authority for effective implementation of EOHS Management System.Core Team Members            
11Communication with Interested partiesSecurity            
12Awareness Training on Operational Control procedure.Respective personnel from all areas            
13Awareness training on Mock DrillAll employees including workers & Interested Parties            
14Awareness training on safety requirement in shop floor during handling of product & Specific requirementsEmployees & Workers            
15Fire FightingERT            
16First AidERT            
17Emergency Preparedness & responseERT            
18Awareness of Handling Chemicals & Oils including Haz wasteRespective personnel            
19Awareness of Material safety data sheet.Respective personnel            
20Hazardous waste Handling, storage & disposalPersonnel involved in Haz waste handling            
21Waste ManagementWorkers            
22Storage of oil barrels & used oils.Workers            
23Spillage managementERT            
24Identification of environmental Non-conformities.Supervisors / ERT            
25EOHS Internal Auditors TrainingCore Team Members            
26Fork Lift MaintenanceMaintenance            
27Machine maintenance & Handling of different wasteMaintenance            
28Scrap Handling, storage & Maintenance of scrap.Workers            

Master List of waste

Non-Hazardous Waste ( General Waste)Hazardous Waste
Sr. NoCategoryName of WasteDepartmentSr. NoCategoryName of WasteDepartment
1PaperCorrugated BoxesQA, PDN, PUR OilAll type of Used OilPDN, QA, MNT,
2Toilet PaperAdmin  Used coolantPDN, Tool Room, SNS, PAD/MFD Machine Shop
3Old RecordsAll Depts.  GreaseMaint, Production
4Waste paper & carbonAll Depts.  Oil soaked Gunny BagsMaint, Production
5Packing boxes etc.QA, PDN, PUR  Oil soaked cotton waste & hand gloves, Cotton RagsAll Depts
6PlasticPacking material of welding rodsTool Room  Oil filtersMaint
7Plastic  Articles, CansAll depts.  Empty oil  containerMNT, STR, QA, SNS, Tool Room
8Empty water bottleALL  Paint CansShipping, Maintenance, QA, Prod
9Waste PP belt of packingPDN,  Used BrushesProduction, Maintenance, TRM, QA
10Broken  Plastic BinsSTR  Oil Soaked ScrapMaintenance, Production, QA, HT
11FerrousMetal FlashProduction  Phosphating ChemicalsProduction, QA
12Metal End PiecesSNS  Empty paint  marker, permanent marker etc.STR,PDN,QA
13ForgingsQA    
14Turning Burr & Boring BurrTool Room, SNS    
15Welding rodsTool Room    
16Used toolingTool Room, Maint    
17Maintenance scrap     
18Non FerrousGun Metal PartsMaintenance    
19EDM WireTool Room    
20Stainless SteelMetal FlashProduction  HCL AcidQA Lab
21Metal End PiecesSNS  Ceramic WoolHT
22ForgingsQA  Choke, Ultra violate lamp, Tube light, all types of bulb, CellsAll Depts
23Turning Burr & Boring BurrTool Room, SNS  Carbon paper, Printing ribbon, Toner cartridgeAll Depts
24Maintenance scrapMaintenance  Magnaflux PowderQA, Production
25HRC TraysHeat Treatment  Oil Based Die LubricantProduction
26WoodWaste boxes of waste packing materialPDN, PUR  Water Based Die LubricantProduction
27Garden WasteAdmin    
28Waste packing materialPDN, QA    

HSE INDUCTION TRAINING

General Information
Inductee Name:Position:Induction Date:

Topics to be discussed

S/NDescriptionYesNoRemarks
1Project Description   
2Company 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

   
7Risk Assessment   
8

Responsibility for accident prevention and the maintenance of a safe & healthful work environment

   
9Work Permits   
10Environment 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 NoProject NameLocation
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: Phone: Supv. On Scene? Yes/No
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/FemaleCompany: 
Home Address: 
Date of Birth: Home Phone#: 
Job Classification: Years in job classification: 
Time Employee began work:Date of Hire: 
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):
 
Object/ Equipment/ Substance causing harm: 
First Aid Provided: Yes/NoIf 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:To 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)
ORGANIZATIONNAME (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
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.
ACTIONPERSON RESPONSIBLETARGET DATEDATE COMPLETEDVERIFIED BY
     
     
     
     
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 ActionsSubstandard 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 FactorsJob 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:
5. Program Description, Budget, and Responsibility:

 

Sr. No. Action Responsibility Timeline Budget Remark
           
           
           
Sr. No.ActionResponsibilityTimelineBudgetRemark                  Sr. No.ActionResponsibilityTimelineBudgetRemark                  
Sr. No.ActionResponsibilityTimelineBudgetRemark
      
      
      
Sr. No.ActionResponsibilityTimelineBudgetRemark
      
      
      
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 personDesignationStatusDepartmentContact number
      
      
      
      
      
      
      

HOUSEKEEPING INSPECTION CHECKLIST

General Information
Area/Location: Date: 
Conducted by [HS Rep]: Signature: 
Description
S/NITEMEVALUATIONREMARKS

 

(Corrective action and recommendations)

YESNON/A
1Proper 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
       
Reviewed by [HS Dept]:POSITIONNAMESIGNATUREDATE    Reviewed by [HS Dept]:POSITIONNAMESIGNATUREDATE    
Reviewed by [HS Dept]:
POSITIONNAMESIGNATUREDATE
    
Reviewed by [HS Dept]:
POSITIONNAMESIGNATUREDATE
    
Distribution and acknowledgment:
Project Manager Construction Manager QA/QC Engineer Site Engineer
Distribution and acknowledgment:Project ManagerConstruction ManagerQA/QC EngineerSite EngineerDistribution and acknowledgment:Project ManagerConstruction ManagerQA/QC EngineerSite Engineer
Distribution and acknowledgment:
Project ManagerConstruction ManagerQA/QC EngineerSite Engineer
Distribution and acknowledgment:
Project ManagerConstruction ManagerQA/QC EngineerSite Engineer

PPE INSPECTION CHECKLIST (PERSONAL PROTECTIVE EQUIPMENT)

General Information
Area/Location: Date: 
Conducted By [HSE Rep]: Signature: 
Description
S/NITEMEVALUATION 
YESNON/A
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?

   REMARKS

 

(Corrective action and recommendations)

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?

    
9Protective (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?

    
13Is 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]:
POSITIONNAMESIGNATUREDATE
    
Distribution and acknowledgment:
Project ManagerConstruction ManagerQA/QC EngineerSite Engineer
    

VISITORS SITE BRIEFING CHECKLIST

Visitors name:
Area/Location: Date: 
Conducted By [HSE Rep]: Signature: 
Topics to be discussed
S/NDescriptionEVALUATIONREMARKS
YESNON/A
1SITE SAFETY TOOLS    
2PPE    
 Smoking    
4Consumption of Food and Drinks    
5Access and Safe Walk Area    
6

Vehicle Speed Limit

    
7

Safety and Advisory Sign

    
8SITE HAZARDS    
9Ongoing Activity    
10Vehicle Movement    
11SITE MAP    
12Site Offices    
13Welfare Facility    
14Emergency Muster Station    
Signature and Remarks

Visitor’s Signature

Visitor’s Signature

Visitor’s Signature

 Remark: 

Visitor’s Signature

Visitor’s Signature

Conducted by: Job Title: Signature: 
Reviewed by [HS Dept]:
POSITIONNAMESIGNATUREDATE
    
Note: Corrective and recommended actions must be implemented immediately. (EM385-1-1 references in parenthesis)

Sample Environment, Health, and Safety Policy

Kalyani Forge Limited’s EHS Policy

We, at Kalyani Forge Limited, 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 NoProject NameLocationDate
   From: To: 
Description
JOB SAFETY ACTIONS/SAFETY INSPECTIONSCONDUCTEDREMARKS
YESNON/A
Was the Job Safety Meeting Held?    
Were there lost time Accidents?   Reported to: 
Miscellaneous Incidents?   IR Submitted: 
Trench/Excavations: Competent Person daily inspection performed?    
Scaffolding: Competent Person daily inspection performed?    
Confined Space: Competent Person pre-entry inspection performed?    
Safety/QC Meetings/Inspections Conducted (List):
 
Field Activities:
 
Safety Findings & Corrective Actions:
Safety FindingsCorrective Actions
  
Prepared by [HSE Rep]: Reviewed by [HS Dept]: 
Signature: Signature: 
For Head Office use only:
Operations ManagerProject DirectorOthers

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: 
Organization: Supervisor Name: 

Type of Notice

 First Notice Second Notice Final Notice
 

Classification

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

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 NameSignature                   Date
   
Supervisor NameSignature                   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/NITEMEVALUATIONREMARKS

 

(Corrective action and recommendations)

YES N/A
1Tools checked and inspected before use?    
2

Guards are fitted, adjusted, and tools in good condition?

    
3

Nonsparkling 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]:
POSITIONNAMESIGNATURE DATE
    
Distribution and acknowledgment:
Project ManagerConstruction ManagerQA/QC EngineerSite 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 TaskPotential Hazard(s)Control Measure (s), Required Training, -required Permits or Plans, and Competent Person (s)
   
   
   
Equipment to be UsedRequired InspectionsRequired Training
   
JHA REVIEW/Pre-Job Brief attendance roster
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.
NameSignatureDateNameSignatureDate
      
      
      

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. DescriptionCalibration  FrequencyCalibration Done on  (Date)Next  Calibration Due on  (Date)REMARKS
       
       
       
       
       
       
       

Lessons Learnt log

IDDateEntered BySubjectSituationRecommendations & Comments
      
      
      
      
      
      
      

Communication Plan

Communications   item what WhoWho AttendsWhenWhen Format
      
      
      
      
      
      
      

TRAINING NEEDS IDENTIFICATION

TRAINING NEEDS IDENTIFICATION FOR THE YEAR Jan-2018 TO Dec-2018
DEPARTMENT:
Sr.No.Name of EmployeeEmp NoTraining Topics
     
        
        
        
        
        
NOTE – MARK ” √ ” if particular employee needs training of specified topic
                                                                                                                                                                                                                                         HOD Name & Signature:

SERVICING OF FIRE EXTINGUISHER

Sr. NoF.E.
No
LocationType of Fire ExtinguisherCapacityH.P.
tested on
H.P test due dateRefilled onRefilling Due date:Defect / Required spareRemarks/ Corrective action
           
           
           
           
           
           
           
           
           
                                                                                                                                                                 VERIFIED BY: Dept Head                                                     CHECKED BY: HR. IR & ADMIN

TRAINING ATTENDANCE SHEET

Theme :
Trainer / Faculty :Date :
Venue : Time :
Sr.NoName of EmployeeEmp .NoSign.
1   
2   
3   
4   
5   
6   

Document Matrix

Sr.No.Document Name and IdentificationLocationResponsibilityRevisionDocument TypeProtectionRetrievalRetention TimeDisposition
(Soft/ Hard/ Both)
          
          
          
          
          
          

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:

List of Internal Auditor

Sr. No.Name of Internal AuditorDesignationReporting to
    
    
    
    
    
    
    
Criteria for selection of Internal Auditor w.r.t. experience & skill –

NCR Status Log.

S No.     NCR NoNCR issued toDateAction completion date Proposed follow-up date Date NCR closedRemarksMR (Sign)
         
         
         
         
         
         
         

 

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One thought on “EHS Documentation Template

  1. Hi, I went through the docs for EHS from your post in LinkedIn group. Can you send it to me through mail ? Let me know

    Like

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