Contractor Occupational Health Safety Evaluation

Hydro
Aluminium Metal
Primary Production Kurri Kurri
Contractor OH&S Evaluation (Company Questionnaire) V1.1
Hydro Aluminium Kurri Kurri Pty Ltd is committed to providing a safe and healthy environment
for all persons entering the site. A component of that commitment requires companies who
work on site to demonstrate they have the same commitment to OHS and have systems in
place to meet Hydro’s expectations.
The OHS Evaluation must be completed and returned to the Contracts and Supply Coordinator
for evaluation prior to any company performing work on site or being added to Hydro’s list of
approved suppliers. Hydro Aluminium is committed to its Occupational Health & Safety Policy.
As part of this policy Hydro Aluminium expects all Contractors to work to the same level of
commitment, in all aspects of their work, to ensure a safe place of work for all on site. The
answers to the questions set out in this evaluation will be confidential and shall only be used by
Hydro Aluminium for the purpose of assessing the ability of Contractor company to perform the
tendered work in a safe and healthy manner.
If you have any questions regarding the completion of the questionnaire please contact the
Hydro Aluminium Contracts and Supply Coordinator. Electronic copies of the evaluation form
are available upon request.
Company Details
Trading Name
Describe the type of work undertaken by your company

Number of employees
Addresses of the main office and/or facilities relevant to work to be performed on Hydro site.
Main Office Street & Number
City/Town
State Postcode
Main Facility/Workshop Street & Number
(if different to main office)
City/Town
State Postcode
Statement of accuracy:
The information contained in this questionnaire is a true and accurate representation of
the systems the company I represent has in place (at the time of completing) to ensure
the health and safety of its employees and the employees of sub-contractors working
under the direction of the company.
Name of person completing questionnaire:
Signature: Date:

Position held in Company represented:
Postal Address Company Address Telephone

Hydro Aluminium Kurri Kurri Pty Ltd Hydro Aluminium Kurri Kurri Pty Ltd (61 2) 4937 1555
PO Box 1 ABN 55 093 266 221 Fax
Kurri Kurri NSW 2327 Hart Road (61 2) 4937 3452
Australia Loxford via Kurri Kurri NSW 2327
Australia
Contractor OH&S Evaluation V1.1
Company Questionnaire Page 2 of 7
Safety Program
Does the company have a written Health and Safety Policy?
If yes, please attach a copy of the policy to this questionnaire
Does the company have a written safety program, OHS Manual or Safety
Management System?
Does the company have a written Health and Safety Policy?
If yes, please attach a copy of the index or contents page to this questionnaire
Is the manual readily available to your employees?

Will a copy of the manual be kept at the work site?

Are Health & Safety responsibility part of Job/Position Descriptions?
If yes, please attach copies of Job/Position Descriptions to this questionnaire.
Injury/Incident Reporting & Safety Performance

Does the company have a formal system for the reporting, recording and
investigation of incidents, injuries and illnesses?
If yes, please attach copies of a recent incident report/investigation and details of actions.
Please enter the Company’s Injury Frequency Rates for the past 3 years
Note: frequency rates are to be calculated per million hours worked
20 20 20
LTIFR Number of injuries where the person was not able to return to
work on the next rostered shift following the injury
RDFR Number of injuries where the person was not able to return to full
pre-injury duties on the next rostered shift following the injury
MTIFR Number of injuries where the person was required treatment
(beyond first aid) form a doctor or medical personnel
For the last year, please provide the following:

a) Number of lost time injury cases
b) Number of restricted work cases
c) Number of medical treatment injuries
d) Number of fatalities
e) Employee hours worked
Are lost time injury reports and report summaries sent to the following? How often?
Yes/No Frequency of reporting (monthly, quarterly etc.)
Site Manager/Superintendent

State/Regional Manager
CEO/Managing Director
PO Box 1 ABN 55 093 266 221 Fax
Australia
Safety Communication

Does the Company have a Safety Committee/Safety Representative(s)?
If yes, please provide details (positions) of the Committee Members/Safety Representatives.

Committee Chairperson Name & Job Title

Committee Member/Safety Representatives Name & Job Title

Does the company hold regular site safety meetings?

What frequency are meetings held?
Please attach a copy of a recent field supervisor’s safety meeting minutes to this questionnaire.
Does the company hold regular "toolbox" safety meetings?

What frequency are meetings held?
Please attach examples of a recent toolbox safety meeting record/minutes to this questionnaire.
Inspection/Audit
Does the company conduct project or work site safety inspections?
Who conducts inspections/audits? (Name/Title)
How often are inspections/audits conducted?
Do inspections/audits include sub contractors?
Please attach a copy of a recent project or work site inspection/audit to this questionnaire.
Does the company have a system of inspecting plant, tools and equipment prior to
entry to site and while they are on site?
Please attach examples of registers, inspection checklists and inspection frequencies for plant,
tools and equipment relevant to the work to be done on site to this questionnaire.

PO Box 1 ABN 55 093 266 221 Fax
Australia
Training
Does the company have an induction program for employees?
If yes, please attach a copy of the training agenda/topics covered in inductions.

Does the induction program cover the following:
Yes/No/NA Comments
Personal Protective Equipment
Foot protection
Eye protection
Hand protection
Hearing protection
Respiratory protection
Scaffolding
Housekeeping
Fire protection
First aid facilities
Emergency procedures
Hazardous substances
Excavation and Trenching
Confined spaces
Working at Heights
Signs, barricades, flagging
Electrical safety
Rigging and crane safety
Incident/Injury Reporting
Consultation Process
Does the company have a system for recording training, qualifications,
competencies and licences of its employees?
If yes, please attach a copy of an employee’s training records to this questionnaire

PO Box 1 ABN 55 093 266 221 Fax
Australia
Does the company have a program for newly hired or promoted Supervisors?
If yes, does training include instruction on the following?
Yes/No Comments
OHS Legislation & Duty of Care
Safe work practices
Safety supervision
Toolbox meetings
Emergency procedures
First aid procedures
Equipment inspection procedures
Injury/incident investigation
Fire protection and prevention
Lock out/tag out procedures
Personal Protective Equipment.

What PPE do you provide for your employees and sub-contractors?
Employees Sub-contractors
Type of PPE Yes/No/NA Yes/No/NA
Foot protection
Eye protection
Hand protection
Hearing protection
Respiratory protection
Safety Harnesses/Fall Protection
Other (specify)
Other (specify)
Other (specify)
Other (specify)
How is the issue and use of PPE controlled?


PO Box 1 ABN 55 093 266 221 Fax
Australia
Hazard Identification and Risk Assessment

Does the company have a system for conducting risk assessments?
If yes, please attach a copy of 2 recent risk assessments to this questionnaire
Does the company have a system to manage hazardous substances?

Does the company keep a register of hazardous substances
If yes, please attach a copy of the register to this questionnaire
Are Material Safety Data Sheets (MSDS) available where hazardous substances are
stored/used?
Disciplinary Policy
Does the company have a Disciplinary Policy in place?
Alcohol and Other Drugs Policy

Does the company have an Alcohol and Other Drugs Policy in place?
Rehabilitation
Does the company have an Injury Management/Rehabilitation Policy/Program for
employees who suffer work related injury/illnesses?
If yes, please attach a copy of the policy/program to this questionnaire
Does the company have a company doctor?

Do you have a WorkCover accredited Rehabilitation Coordinator?

PO Box 1 ABN 55 093 266 221 Fax
Australia
List of Attachments
(Please indicate which of the following documents are attached to your completed questionnaire)
Document Yes/No
Copy of Health and Safety Policy
Index/Contents page of safety program or Safety Management System
Copies of Job/Position Descriptions outlining OHS responsibilities
Copies of two (2) recent injury/incident investigation reports
Copy of a recent site supervisor’s safety meeting minutes
Copies of recent ‘toolbox’ meeting minutes.
Copies of equipment registers, inspection checklists and inspection frequencies
Recent project/work site inspection/audit report.
Induction training agenda/list of topics covered
Sample of an employee’s training records
Copies of 2 recent risk assessments
Copy of hazardous substance register
Copy of Disciplinary Policy
Copy of Alcohol and Other Drugs Policy
Copy of Injury Management/Rehabilitation Policy/Program

PO Box 1 ABN 55 093 266 221 Fax
Australia

Contractor Occupational Health Safety Evaluation

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Hydro

Contractor OH&S Evaluation (Company Questionnaire) V1.1

Describe the type of work undertaken by your company

Signature: Date:

Postal Address Company Address Telephone

If yes, please attach a copy of the policy to this questionnaire

Is the manual readily available to your employees?

If yes, please attach copies of Job/Position Descriptions to this questionnaire.

Injury/Incident Reporting & Safety Performance

For the last year, please provide the following:

e) Employee hours worked

Yes/No Frequency of reporting (monthly, quarterly etc.)

Site Manager/Superintendent

If yes, please provide details (positions) of the Committee Members/Safety Representatives.

Does the company hold regular site safety meetings?

Does the company hold regular "toolbox" safety meetings?

Postal Address Company Address Telephone

If yes, please attach a copy of the training agenda/topics covered in inductions.

If yes, please attach a copy of an employee’s training records to this questionnaire

Postal Address Company Address Telephone

Personal Protective Equipment.

How is the issue and use of PPE controlled?

Postal Address Company Address Telephone

Hazard Identification and Risk Assessment

If yes, please attach a copy of 2 recent risk assessments to this questionnaire

Does the company have a system to manage hazardous substances?

If yes, please attach a copy of the register to this questionnaire

If yes, please attach a copy of the policy to this questionnaire

Alcohol and Other Drugs Policy

If yes, please attach a copy of the policy to this questionnaire

If yes, please attach a copy of the policy/program to this questionnaire

Does the company have a company doctor?

Postal Address Company Address Telephone

Postal Address Company Address Telephone

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