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Supplier/Contractor Name: BIN OMRAN TRADING & TELECOMMUNICATION

Supplier/Contractor 6TH FLOOR, SALAM TOWERS, WEST BAY, DOHA, QATAR. P.O BOX 288
Address:

Bank Account Details:

General Telephone: General Fax:
General Email: Website:

Quality Representative
Name: AHSAN ZAMIR Title: QHSE MANAGER
Telephone/Extension: Email Address: ahsan.zamir@binomran.com
Products/Services Offered:
Employee Count
Officers Managers/Supervisors Engineers Office Staff QA/QC Staff HSE Staff Total Staff
3 11 8 23 2 5 52

Pre-Audit Question Yes No

1) Are you third party certified (ISO 9000/TS16949/RC14001)? √
2) Do you apply statistical process controls? √
3) Does the supplier agree to upgrade their system to meet audit requirements? √

Name & Title of Company Officer responsible for ensuring the accuracy of this document:

Ahsan Zamir QHSE MANAGER 10.11.2016

Name: _________________________________Title:_______________________________ Date: _____________

Signature:
_____________________________________________________________________________________________
For Q-Chem Use Only:

Q-Chem
Evaluated by
Printed name Signature / Date

Q-Chem
Reviewed By
Printed name Signature / Date

Q-Chem
Materials Mgr.
Printed name Signature / Date

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SUPPLIER/CONTRACTOR INFORMATION:

SUPPLIER/CONTRACTOR COMPANY NAME: : BIN OMRAN TRADING & TELECOMMUNICATION

DIVISION/DISTRICT: DOHA QATAR

MANAGER: AHSAN ZAMIR

SAFETY CONTACT Phone (50391341) Fax (.……………....)

TYPE OF WORK PERFORMED:

TRANSPORTATION, MAINTENANCE, CONSTRUCTION, ETC.

KIND OF OPERATION I.E. OFFSHORE OR ONSHORE:

SECTION-1 INJURY /INCIDENT DATA

EMPLOYEE WORKHOURS

PLEASE SHOW THE AVERAGE NUMBER OF EMPLOYEES AND TOTALWORKHOURS FOR THE LAST
FOUR (4) YEARS FOR THE COMPANY /DIVISION /DISTRICT SHOWN ABOVE.

YEAR 2016 2015 2014 2013

NUMBER OF EMPLOYEES 210 196 199 205

TOTAL WORKHOURS 504000 470400 477600 492000

OCCUPATIONAL INJURY/ILLNESS EXPERIENCE

PLEASE PROVIDE SHOW THE OCCUPATIONAL INJURY/ILLNESS EXPERIENCE FOR THE LAST FOUR
(4) YEARS FOR THE COMPANY/DIVISION DISTRICT SHOWN ABOVE.

YEAR 2016 2015 2014 2013

NUMBER OF FATALITIES NIL NIL NIL NIL

NUMBER OF LOST WORKDAY CASES NIL NIL NIL NIL

(An injury/illness case where an incident in the work
environment causes an individual to be unable to work for
one full shift or more beginning on the day following the
incident.)
TOTAL NUMBER OF LOST WORKDAYS NIL NIL NIL NIL
(Sum of number of lost days from each lost workday case.)

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YEAR 2016 2015 2014 2013

NUMBER OF MEDICAL TREATMENT CASES NIL NIL NIL NIL
(An injury/illness case where an incident in the work
environment required or resulted in:
 Medication or treatment requiring prescription
by licensed healthcare professional
 Loss of consciousness for any length of time
 Immunization or hypodermic injection other
than tetanus immunization
 Stitches, sutures, or staples for wound closure
 Rigid means of immobilization such as
cervical collar, hard splints, or plaster cast
(except when used as a precaution for
transporting an accident victim)
 Fracture or break of any bone or tooth
 Punctured or ruptured eardrum
 Hospitalization)
NUMBER OF RESTRICTED WORK CASES NIL NIL NIL NIL
(An injury/illness where an incidentin the work environment
(beginning the day after the incident occurs) results in:
 The contractor employer keeping an employee
from performing one or more of the regular duties of the
employee’s work;
 The contractor employer keeping the employee
from working a full schedule the employee was
originally scheduled to work
 A licensed healthcare professional recommends
the employee not perform one or more of the regular
duties of the employee’s work;
 A licensed healthcare professional recommends
the employee not work a full schedule the employee
was originally scheduled to work
NOTE: Regular duties are defined as those work activities
an individual regularly performs at least once per week.)
TOTAL NUMBER OF RESTRICTED WORKDAYS NIL NIL NIL NIL
(Sum total of number of days in which work was restricted
from each restricted workday case.)
NUMBER OF FIRST-AID CASES 3 2 2 3
(Any injury/illness where an incident in the work environment
does not meet the definition of a Restricted Work Case,
Medical Treatment Case or Lost Workday Case.)

CONTRACTORS ARE REQUIRED TO SUBMIT A PHOTOCOPY OF THEIR WORKERS COMPENSATION

INSURANCE POLICY AND PROPERTY LIABILITY INSURANCE

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SECTION 2: AWARENESS OF Q-CHEM HSE PROGRAMS

WE HAVE REVIEWED THE CONTRACTUAL EXHIBIT(S) AND TERMS AND YES NO

CONDITIONS OUTLINING THE CONTRACTOR COMPANY’S RESPONSIBILITY TO  
FOLLOW ALL APPLICABLE Q-CHEM HSE RULES, REGULATIONS, PROCEDURES,
AND REQUIREMENTS.
WE HAVE REVIEWED THE TERMS AND CONDITIONS OUTLINING THE
YES NO
CONTRACTOR COMPANY’S RESPONSIBILITY TO FOLLOW ALL APPLICABLE LAWS,  
REGULATIONS, AND CODES.
WE HAVE REVIEWED THE TERMS AND CONDITIONS OUTLINING CONTRACTOR
YES NO
COMPANY’S SELECTION AND USE OF SUB-CONTRACTOR COMPANIES.  
NOTE: INCLUDE DATA ON ALL SUB CONTRACTORS TO BE USED ON THE JOB ON SEPARATE,
IDENTICAL SHEETS.
CONTRACTOR: BIN OMRAN TRADING & TELECOMMUNICATION
DIV/DIST: DOHA
PREPARED BY: AHSAN ZAMIR
DATE: 1 0 . 1 1 . 2 0 1 6

SECTION 3: CONTRACTOR HSE PROGRAM

HEALTH, SAFETY & ENVIRONMENTAL MANAGEMENT:

Name of highest ranking HSE professional in the company:

Name: Title: Telephone:
Certifications: Fax:
This person reports to: Title:
Do you have or provide:
Yes No Full-time Company HSE Manager / Yes No Specific HSE training program for
Director? supervisors?
Yes No Full-time Client Site HSE Supervisor? Yes No Company-paid HSE training?
HEALTH, SAFETY, & ENVIRONMENTAL PROGRAMS / PROCEDURES:

Yes No Do you have a written Health, Safety, & Environmental Program?

If yes, does the program address the following key elements:

Yes No HSE Policy? Yes No Periodic HSE performance audits /
reviews that are documented?
Yes No Management commitment and Yes No HSE Incentive Program?
expectations for HSE?
Yes No HSE accountabilities and Yes No HSE hazard recognition and control?
responsibilities for managers,
supervisors, and employees?
Yes No Requirements for your employees to follow the HSE rules of the client?
Yes No Requirements for your employees to advise the client of any unique hazards presented by your
work?
Yes No Requirements for your employees to advise the client of any hazards found by your employees?

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Yes No Do you have personnel trained to perform first aid and CPR?
Do you have written Safe Work Practices and procedures for:
Yes No EquipmentLockoutandTagout(LOTO)? Yes No Confined Space Entry?
Yes No Heat Stress Prevention? Yes No Hot Work / Fire Watch?
Yes No Fall Protection? Yes No Personal Protective Equipment?
Yes No Hearing Conservation? Yes No Line Breaking / Vessel Opening?
Yes No Respiratory Protection? Yes No Hazard Communication?
Yes No Accident/Incident Reporting? Yes No Excavations?
Yes No Housekeeping? Yes No Scaffold Building /Scaffold Use?
Yes No Vehicle Safety / Maintenance / Yes No Portable Electrical/Power Tools?
Inspection?
Yes No Ergonomics? Yes No Portable Equipment Grounding
Assurance?
Yes No Flammable / Combustible Liquids? Yes No Compressed Gas Cylinders?
Yes No Hazardous Materials Training? Yes No Powered Industrial Vehicles (Cranes,
Forklifts, manlifts, etc.)?
Yes No Waste Disposal/Waste Yes No Specialized Equipment (e.g.
Minimization/Spill Prevention? hydroblasters, extractors, etc.)?
Health, Safety, and Environmental Communications:
Yes No Do your Supervisors and Lead Workers speak and comprehend English such that they can
understand and perform their assigned tasks safely without an interpreter?
If not, provide a description of your plan to assure that they can safely perform their jobs.

Do you hold client site HSE meetings for:

Yes No Field Supervisors? Frequency: Weekly
Yes No Employees? Frequency: Weekly
Yes No New Hires/Transfers? Frequency: Weekly
Yes No Subcontractors? Frequency:
Yes No Are the safety, health and environmental meetings documented?
Yes No Do you conduct client site HSE inspections?
Yes No Do you conduct Health, Safety, & Environmental program audits?
Yes No Are audits and corrections of deficiencies documented?
Personal Protective Equipment (PPE):
Yes No Is applicable PPE provided for Yes No Do you have a program to ensure that
employees? PPE is inspected and maintained?
Mobile Equipment:
Yes No Do you have a system for establishing applicable health, safety, and environmental specifications
for mobile equipment?
Yes No Do you conduct inspections on mobile equipment e.g., cranes, forklifts, manlifts) in compliance with
regulatory requirements?
Yes No Do you maintain mobile equipment in compliance with regulatory requirements?
Yes No Do you maintain the applicable inspection and maintenance certification records for mobile
equipment?
Subcontractors:
Yes No Do you use subcontractors? (If no, skip to next section)
Yes No Do you use HSE performance criteria in selection of subcontractors?

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Yes No Do you evaluate the ability of subcontractors to comply with applicable safety health and
environmental requirements as part of the selection process?
Yes No Do you require your subcontractors to have a written HSE program?
Do you include your subcontractors in:
Yes No HSE Orientations?
Yes No HSE Meetings?
Yes No HSE Inspections?
Yes No HSE Audits?

HEALTH, SAFETY, & ENVIRONMENTAL TRAINING

Yes No Do you have a HSE training program for your employees?

Yes No Do your employees receive HSE training prior to beginning active work?
Yes No Do your employees receive refresher Frequency: Monthly
HSE training?
Yes No Is employee HSE training documented?
Yes No Are all employees trained in the work practices needed to safely perform his job prior to beginning
active work?
Yes No Are all employees trained on the tools and equipment needed to perform his job prior to beginning
active work?

INFORMATION SUBMITTAL
PLEASE PROVIDE A COPY OF THE FOLLOWING DOCUMENTS TO ASSIST US IN OUR OVERALL
EVALUATION.

INSURANCE CERTIFICATE(S) YES  NO 

HSE POLICY(S) YES  NO 
HSE / SAFETY MANUAL YES  NO 
ORGANIZATION CHART / EXPERIENCE OF HSE STAFF YES  NO 
HSE ORIENTATION / TRAINING PROGRAM OUTLINE YES  NO 
HSE INSPECTION / AUDIT PROGRAM FORM / CHECKLIST(S) YES  NO 
INCIDENT REPORTING PROCEDURE / FORMS YES  NO 
HSE PROCEDURE / PROGRAM AS INDICATED BELOW: YES  NO 
 Hazardous Energy Control / Lockout and Tagout (LOTO) YES  NO 
 Confined Space Entry YES  NO 
 Fall Protection / Working at Heights YES  NO 
 Personal Protective Equipment (PPE) YES  NO 
 Portable Electric / Power Equipment YES  NO 
 Vehicle Safety YES  NO 
 Heat Stress Prevention YES  NO 
List of major equipment (e.g., cranes, generators, industrial trucks, power supplies, YES  NO 
etc) your company will be using for work at this facility.

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SECTION 4: REGULATORY COMPLIANCE AND ENVIRONMENTAL/PROPERTY/DAMAGE

INCIDENT EXPERIENCE

PLEASE SHOW THE INDUSTRIAL ENVIRONMENTAL AND PROPERTY/DAMAGE EXPERIENCE FOR

THE LAST FOUR (4) YEARS FOR THE COMPANY /DIVISION /DISTRICT SHOWN ABOVE.
YEAR 2016 2015 2014 2013
NUMBER OF REPORTED PERMIT EXCEEDANCES NIL NIL NIL NI L
(AIR/WATER).
NUMBER OF NOTICES OF VIOLATION NIL NIL NIL NI L
AMOUNT OF FINES/PENALTIES PAID NIL NIL NIL NI L
NUMBER OF FIRES /EXPLOSIONS (>US$25,000). NIL NIL NIL NI L
NUMBER OF PROPERTY DAMAGE INCIDENTS NIL NIL NIL NI L
(>US$25,000).
NUMBER OF TOTAL OF INCIDENTS/NEAR MISSES NIL NIL NIL NI L
NUMBER OF NIL NIL NIL NI L
CRISIS/EMERGENCY/PREPAREDNESS
EXERCISES
NOTE: INCLUDE DATA ON ALL SUB CONTRACTORS TO BE USED ON THE JOB ON SEPARATE,
IDENTICAL SHEETS.

CONTRACTOR: BIN OMRAN TRADING & TELECOMMUNICATION

DIV/DIST: DOHA

PREPARED BY: AHSAN ZAMIR

DATE: 1 0 . 1 1 . 2 0 1 6

SECTION 5: QUALITY SYSTEM

Questions Answers
To what standard is your Quality System ISO 9001:2008 CERTIFIED BY TUV SUD
certified, (ie. QS, TS or audit schedule to MANAGEMENT SERVICE GmbH
achieve TS certification)? Attach copy of
relevant certificate(s)
Do you have in-house machine and N/A
product design capabilities?
Do you have an in-house machine shop? N/A

Do you have in-house facilities YES

management?
Do you have a safety program? YES

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Questions
Do you have in-house testing or do you
utilize an outside lab? Are these
resources accredited?
Do you maintain lot control for inventory
from raw materials through to finished
goods?
How long do you retain quality records?
Can the records be transmitted
electronically?
Do you utilize end of line lot control? If
yes, are those lot numbers printed on the
finished product boxes/packs?
How are process efficiencies tracked and
monitored? How are they communicated
to management?
How do you utilize Statistical Process
Control?
How are your production and design
specifications controlled?
What is your typical employee turnover
broken down by salary and hourly?
How are your employees trained and
monitored?
What is your employee to supervisor ratio?
Answers
ACCREDITED CALIBRATION CENTERS ARE
USED FOR ANNUAL TESTING.
YES
ALL RECORDS CAN BE TRANSMITTED
ELECTRONICALLY AND RETAINED ON
ELECTRONIC SERVERS.
NOT APPLICABLE
PROCESS EFICIENCIES ARE TRACKED
THROUGH REGULAR INTERNAL AUDITS AND
THIRD PARTY AUDITS.
NOT APPLICABLE
THROUGH STANDARD OPERATING
PROCEDURES.
THROUGH INTERNALLY PLANNED TRAINING
PROGRAMS AND EVALUATION.
1 SUPERVISOR FOR 4 EMPLOYEES.

How often do your employees receive a YEARLY

documented performance review?
How do you manage first in first out ENSURING THAT ALL NEW GOODS ARE KEPT
inventory control for raw materials and BEHIND THE EXISTING GOODS IN THE
WAREHOUSE WITH LEGIBLE LABELS.
finished goods?
Are you prepared to immediately notify us YES
of non-conforming product and recall /
replace said product should the need
arise?
Are you current regarding Substances of YES
Concern regulations?

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SECTION 5: QA/QC
Item Manufacturing Process / Aspect YES NO N/A
1. Do you maintain a documented quality manual describing your Quality System? √
Describe:

2. Are controls exercised over the approval and revision of internal documents, (e.g. √
procedures, forms, drawings, specifications), external documents? (e.g. flow-down of
customer requirements, customer drawings, industry standards)?
Describe:

3. Are controls exercised over the filing, maintenance, and disposal of hard-copy √
records?
Describe:

4. Is regular backup, restore verification, anti-virus, and other relevant maintenance of √

your computers/servers/networks conducted?
Describe:

5. Does a quality policy exist, which is articulated by senior management? √

Describe:

6. Is the quality policy communicated and understood within the organization? √

Explain:

7. Does the quality policy emphasize customer focus, attainment of objectives, and √
continual improvement?
Explain:

8. Is the quality policy reviewed periodically for appropriateness and continuing √

suitability?
Explain:

9. Is planning conducted to achieve the objectives articulated by the quality policy? √

Describe:

10. Is planning conducted in conjunction with Quality System development and revision, √
to ensure the achievement of objectives articulated by the quality policy?
Explain:

11. Are responsibilities, authorities, qualifications and skills, and organizational √

relationships defined? (e.g. job specs, org chart)
Explain:

12. Are quality and other operational performance measurements communicated to √

management and staff?
How, when:

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Item Manufacturing Process / Aspect YES NO N/A

13. Are regular management review meetings conducted; which cover (e.g.) quality and √
other operational performance issues, customer feedback, audit results, setting of
goals and objectives, and assignment of resources to achieve goals and objectives?
Describe:

14. Is employee competence regularly evaluated? √

How:

15. Is training provided as required to ensure continuing employee competence? √

Describe:

16. Is quality awareness training conducted? √

Explain:

17. Is company infrastructure regularly evaluated and maintained? (e.g. plant, equipment, √
workspace, support services)
Describe:

18. Is company work environment regularly evaluated and maintained? (e.g. light, heat, √
noise, cleanliness, morale)
Describe:

19. Is planning conducted prior to product realization? (e.g. quality plans defining quality √
requirements, processes, documentation, inspections/tests, records)
Describe:

20. Are customer requirements reviewed and determined prior to submission of a √

quotation or acceptance of an order?
Explain:

21. Are customer communication interfaces and methods defined? (e.g. inquiries, √
orders/amendments, feedback/complaints, contact names)

22. Are project management plans implemented for R D/design efforts? (e.g. schedule, √
budget, tasks, responsibilities, deliverables)
How:

23. Are project management plans controlled and revised in accordance with project √
evolution?
Explain:

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Item Manufacturing Process / Aspect YES NO N/A

24. Are design inputs defined and controlled? (e.g. customer or marketing requirements, √
functional specifications)
Describe:

25. Are design outputs defined and controlled? (e.g. fabrication drawings, BOMs, √
specifications, test reports)
Describe:

26. Are design outputs verified for accuracy and adequacy prior to approval and release? √
(e.g. procurability, manufacturability, tolerances/acceptance criteria, safety/operational
considerations)
How:

27. Are design reviews conducted at appropriate stages to verify evolving design outputs √
and to resolve identified design problems?
Explain:

28. Do design reviews include all appropriate process stakeholders? √

Describe:

29. Do purchase orders to suppliers clearly specify all relevant product and/or service √
requirements?

30. Are prospective suppliers audited or otherwise evaluated prior to product and/or √
service procurement?
How, what frequency, to what standard:

31. Is the quality and delivery performance of existing suppliers regularly evaluated? √
How, what frequency, to what standard:

32. Are purchased products verified prior to use? (e.g. Receiving inspection, certificates √
of compliance, etc.)
How:

33. Are relevant product requirements/information available to production, service and √

QA/QC staff? (e.g. drawings, specifications, acceptance criteria)

Describe:

34. Are relevant Work Instructions available? √

Describe:

35. Are product, process, and Quality System improvement initiatives undertaken based √
upon monitoring, measurement, and analysis of data?
If not, how:

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Item Manufacturing Process / Aspect YES NO N/A

36. Are customer satisfaction, product/service conformity, process measurement, √
supplier, and trend data analyzed and used as a basis for continual improvement?
If not, how:

37. Is customer satisfaction regularly monitored and measured? √

How:

38. Is internal quality auditing conducted to ensure ongoing compliance and effectiveness √
of the Quality System?

39. Are audits planned and scheduled at defined intervals? √

Describe:

40. Does audit planning take process/area importance and previous audit results into √
account?

41. Does internal quality auditing cover the entire Quality System scope? √

42. Are auditors trained and independent of the areas they are auditing? √

43. Are audit results, action s taken, and verification of actions taken presented to senior √
management?
How:

44. Are critical processes monitored and measured to ensure the achievement of planned √
results?

45. Is effective corrective action taken when planned results are not achieved? √

46. Are nonconforming products or services controlled to prevent their unintended delivery √
or use?

47. Are authorities for the disposition of nonconforming products defined? √

48. Is customer approval obtained for use concession of nonconforming products or √

services?

How:

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Item Manufacturing Process / Aspect YES NO N/A

49. Is a review conducted and appropriate action taken when nonconforming products are √
detected after their delivery or use? (e.g. product containment, customer advisory,
product recall)

How:

50. Are corrective actions initiated to eliminate the causes of product or process √
nonconformities?

51. Does the corrective action process entail problem investigation, analysis, and √
identification of root cause?

52. Is corrective action effectiveness verified to ensure that problem recurrence has been √
eliminated?

53. Are preventive actions initiated to preclude product or process nonconformities? √

54. Does the preventive action process entail problem investigation, analysis, and √
identification of cause?

55. Is preventive action effectiveness verified to ensure that problem occurrence has been √
prevented?

56. Are nonconforming products or services that undergo rework subjected to re- √
verification prior to delivery?

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