CONTRACTOR SAFETY COMPETENCY ASSESSMENT FORM Organization Name: Contractor Proprietor Name: Organization Registered Address: Business Registration Number: Vendor Code: Department: ‘Assessment Team: Team Leader: Team Member: 1 2. 3. 4,Annexure 13~Annual safety competency assessment'Star Rating System” [(6 Star- 850-1000), (4 Star-750-849), (3 Star-650-749), (2 Star- 550-649), (1 Star- 450-549), (No Star-Less than 450)] Alll the requirements will be evaluated in a scale of 1 to 5 which will be weighted for star rating score calculation. Evaluation Criterion for Star rating and safety performance evaluation Notinitiated the process /No System. 1 = Poor: weak safety system and process, Weak system of lead indicator identification, reporting and compliance monitoring. Little awareness. Minimal or No ownership and commitment. (Survival) | | 2 = Reasonable- Some system & process exists. Inconsistent system of lead indicator identification, reporting and compliance monitoring. Awareness may be present but implementation of the aspectof the Safety Management System is haphazard or notin evident at all. (Reactive stage) 3. = Good: Safety management system & process exists and documented, Improving trend of system of lead indicator identification, reporting and compliance monitoring. The system is implemented at minimum levels. Ownership and commitmentis visible at some extend. (Dependent stage ) 4 = Very Good- Health and Safety Management System is addressed systematically and documented and updated regularly, reaching the respective targets regularly. Good system of lead indicator identification, reporting and compliance monitoring, Integration with other activities athigh levels. Felt and visible ownership and commitment. (Independent stage) 5 = Excellent- Can be recognized as a leader in this particular aspect of the Health and Safety Management System. Everyone is involved and high levels of integration and ownership & commitment are demonstrated. Continuous improvements evident. (Interdependent stage) “The contractor rated 3 Star or below will have to submit a Safety management system improvement plan.“ype of Contract: Risk Parameter: (Risk of job where contractors to be engaged) stign Rik: = aiowrie - abo - O Manpower contract ‘Supervision contract: Set apart contract: Eee @ Transient contract: Other Services: Oo Tick the type of work the company is capable of undertaking, Lifting equipment Utlty Services Maintenance and Services we Building Maintenance Electrical Maintenance and Services Mechanical Maintenance Cleaning Services and services Transportation and Material Handling Instrumentation Callration and Testing Catering Services eet fT ge > he ‘Waste materials / slag / reclaiming &cisposal Mining related activity ‘Manpower supply Ling, Loading, Unioading feeding & packaging Rail maintenance Road maintenance elas 2) a), a ee) oO Any Others, please specify Lene ta olsa|* oe 1. Whatistotal manpowerstrength of our organisation workingin Tata Stee!? 4.4 Numberof Supervisors and their qualification (Attach lis) 1.2. Numberofskited employees (Please attach ist of employee with skillevel) 4.3. Numberofunskiled employees: 4.4 Numberof Site Safety Supervisors and heir qualification (Attach list: 2. Total Value in Rupees working with Tata Steel (Less than § Lacs, >S lacs<25 Lacs, > 25 Laos< 1 crore, and> 1 crore) If more than one crore mention value. 3. Name of departments where you are engagedin currently in Tata Stee! 4, Organisational Structure of your organisation: (e.g. MD, GM, Managers etc)Attributes SN Requirements Evaluation (1055 scale) Multiplying factor Max Weighted ‘Score ‘Actual Score Audit findings 14 Safety & Health ‘Management System (Policy & Principles, Safety Manuals, Safety Organization) (Safety manuals ~ (Look for HIRA ‘or JHA document, Legal ‘compliance system, Emergency Planning system, Safety dash board, Safety audit & review system, Operational control, Asset Management). 10 50 12 Procedure for selection ‘and deployment of skiled employees, Managers, ‘Supervisors and Site Safety Supervisors 10 50 4.0 Planning of safety system {and process: 13 ‘Safety planning process for safe execution of jobs. (JHA, Audit pian, ‘Tools & equipment, Job ‘execution plan, HSE pian, Permit required, Method statement) 10 14 ‘System and processes for training on Safety standard, Behavioural based, Job specific, sil development, emergency preparedness for employees and supervisors, 10 50 15 ‘System for two way ‘communication (Top ~ Bottom — Top) between ‘contractor leadership and their workforce (Proprietor engagement in line walk, Safety meeting etc). 10 50 16 ‘Annual assessment of safety management system & processes (Self (or Third Party Audit) 10 2.0 Implementation] Of safety system and process 24 Capability of Workforce, {(Skiled manpower, ‘Competent Supervisor, Site Safely Supervisors etc. )Verify through site visit and Interview. 10 50 22 Conducting Tool box and mass meeting regularly. (Verify through Records and Interview) 10Attributes sn | Requirements Evaluation (1t0 5 scale) Multiplying factor Max Weighted Score Actual Score ‘Audit findings 23 Providing & ensuring sage of standard (IS/EN) and right PPEs while performing the job, Ensure timely replacements. (Verify through site visit and Interview), 10 50 24 Providing & ensuring safe usage of standard, certified and right tools & tackles, equipment’s and calibrated safety gadgets (e.g, Gas detectors) while performing the job. (Verify ‘through Reoords and Site visit) 10 50 25 Ensuring a good housekeeping free from any slip / trip / fall hazards at working sites. (Very through site visit) 10 26 Self-Safety Initiative / Project by contractor for Safety Improvement 10 3.0 Chocking of safely system and procedures aa Contractor safety aucit by the contractors! supervisor and site safety supervisors in the field. (Verity records) 30 32 ‘Corrective and preventive action on self-audit report specifically on 4 & 5 severity potential. (Verity records & site visit) 30 33 ‘Compliance to Generic {and Specific Safety clauses as per contract (Verify through site visit | and Interview based on some Work order), —s 4.0 Performance rmeasure- Lead Indicator a4 Reporting, investigation and learning of all incident accident, Health issue. 30 42 Near miss and Unsafe act condition reporting, investigation and corrective action. 30 43 ‘Skil retention, amenities, employees liability etc. (Verify through records ‘and Interview)Attributes SN| Requirements Evaluation | Multiplying | Max | Actual | Audit (1105 scale) | factor | Weighted | Score | findings ‘Score 44 | Campaign e.. (Safety 6 30 qui, Safety ki etc) o develop Safety Culture. (Weil through records and Interview) “45 | Reward, Recognition and 6 6 30 Consequence Management System of Contractor. (Very through records) 5.4 | Zero Losttime feerious [0-60 score 60 60 injury or permanent ‘or more score disability z Tasco 52 | Zoro Fist aid case Dal sry ae aaa Be AS 5.0Periormance | 2 |Nor-injury incidents (eg. |0-20ser0 | af 890 are [oo Property Damage) ‘or more0 score Fe : imeret* 4 sasy von a om TG reeleore potential of seventy 485 Peay {reference contractor salty audit system) 85 | Safety noncompliance —_|0-20 score 2 a, cost recovery /Penalty | 1-0 score 9° imposed / Job stopped, 56 | Fatality yectecor 90 er = -ve 200) score