KAP - HSE - FORM - 11 - Audit Checklistt

Doc.
No: KAP/HSE/FORM/04
QUALITY, HEALTH, SAFETY &
ENVIRONMENTAL MANAGEMENT Revision: B
SYSTEM – FORMS
Date: 11th Sept. 2015
DESCRIPTION Y N REMARKS
1. GENERAL REQUIREMENTS/PERSYARATAN
UMUM
 Does the organization established and maintained an
HSE management system?/ Apakah organisasi
menetapkan dan memelihara sistem manajemen K3L?
2. HSE POLICY/KEBIJAKAN K3L

 Does the organization’s top management authorize and
clearly states the overall HSE objectives?/Apakah
manajemen puncak organisasi memberi wewenang dan
menyatakan tujuan K3 secara keseluruhan secara
keseluruhan?
 Is the organization’s HSE policy appropriate to the
nature and scale of the organization’s HSE risks?
 Is there a commitment to continual improvement?
 Does the organization comply with current applicable
HSE legislations and other requirements?
 Is the HSE policy documented, implemented and
maintained?
 Is the HSE policy communicated to all employees?
 Are all employees aware of their individual HSE
obligations?
 Is the HSE policy available to interested parties?
 Is the HSE policy reviewed periodically and remains
relevant and appropriate to the organization?
3. PLANNING
3.1. Planning for hazard identification, risk
assessment and risk control
 Does the organization establish and maintain
procedures for the ongoing identification of hazards,
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Doc.No: KAP/HSE/FORM/04
SYSTEM – FORMS
the assessment of risks, and the implementation of

necessary control measures?
 Was the identification of hazards, the assessment of
risk, and the implementation of control measures
applied to:
-Routine and non-routine activities?
-Activities of all personnel having access to the workplace
(including subcontractors and visitors)?
-Facilities at the workplace provided by the organization
and others?
 Are the results of those assessments and the effects of
those controls kept and updated?
 Is the organization’s methodology for hazard
identification and risk assessment
-Defined with respect to its scope, nature and timing?
-Classify the risks and identify those that are to be
eliminated or controlled?
-Consistent with operating experience and capabilities of
risk control measures?
-Provide input into the determination of facility
requirements, identification of training needs and / or
development of operational controls?
-Provide for the monitoring of required actions to ensure
the effectiveness and timeliness of their implementation?
3.2. Legal and other requirements

 Does the organization establish and maintain a
procedure to identify and ensure access to the legal and
other requirements that are applicable to it?
 Is the legal and relevant requirements kept up-to-date?
 Are the relevant information on the legal and other
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SYSTEM – FORMS
requirements communicated to the employees and

other interested parties?
3.3. Objectives
documented HSE objectives at each relevant function
and level within the organization?
 Are the objectives consistent with the HSE policy,
including the commitment to continual improvement?
3.4. HSE management program (s)

 Are HSE management programs for achieving its
objectives established and maintained?
 Are the designated responsibility and authority for
achieving the objectives at relevant functions and
levels of the organization documented?
 Are the means and time-scale by which objectives are
to be achieved documented?
 Are the HSE management program (s) reviewed at
regular and planned intervals?
 Are the HSE management program (s) amended when
required due to changes in the activities, products,
services, or operating conditions of the organization?
4.4 IMPLEMENTATION AND OPERATION
4.4.1 Structure and responsibilities
 Are the roles, responsibilities of authorities of
personnel who manage perform and verify activities
having an effect on the HSE risk of the organization
defined, documented and communicated?
 Did the organization appoint a member of top
management to be responsible for ensuring the HSE
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SYSTEM – FORMS
management system is properly implemented and

performing to requirements in all locations and spheres
of operation within the organization?
 Are resources essential to the implementation, control
and improvement of the HSE management system?
 Does the organization’s management appointee:
-Ensure that the HSE management system requirements
are established, implemented and maintained as stated in
OHSAS 18001?
-Regularly report to top management on the performance
of the HSE management system?
4.4.2 Training, awareness and competence

 Are all employees competent in performing their task?
 Have all employees received appropriate education,
training and / or experience in order to be competent?
 Are procedures in place to ensure that employees are
fully aware of:
-The need to conform to the HSE policy, procedures and
the requirements of the HSE management system?
-The HSE consequences of their work activities and
benefits of improved individual performance?
-Their roles and responsibilities in achieving conformance
to the HSE policy requirements?
-The potential consequences of departure from specified
operating procedures?
-The emergency preparedness and response requirements?
 Does the training procedures take into account:
-The differing levels of responsibilities, ability and literacy
of the employees?
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SYSTEM – FORMS
-The differing levels of risks?
4.4.3 Consultation and communication

 Are there procedures for ensuring pertinent HSE
information is communicated to and from employees
and other interested parties?
 Are employee involvements and consultation
arrangements documented and interested parties
informed?
 Are employees:
-Involved in developing and reviewing of policies and
procedures to manage risk?
-Consulted when there are changes that affect workplace
health and safety?
-Represented on health and safety matters?
-Informed of their HSE representative(s)?
4.4.4 Documentation
 Are information that describes the core elements of the
management system and their interaction established
and maintained in a suitable medium?
 Does the information provide direction to related
document?
4.4.5 Document and data control

 Are procedures established and maintained for
controlling all documents and data required by OHSAS
specifications?
 Can the procedures be located?
 Are the procedures periodically reviewed, revised
when necessary and approved by authorized
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SYSTEM – FORMS
personnel?
 Is there document control procedure to ensure that the

current version of documents is available at all
locations where their accessibility is essential to the
effective functioning of HSE system?
 Are obsolete data removed to assure against
unintended use?
 Are Documents and data for legal and knowledge
preservation purpose retained or suitably identified?
4.4.6 Operational control
 Are those operations and activities that are associated
with identified risks where control measures need to be
applied, identified?
 Are those activities planned to ensure that they are
carried out in specific conditions?
 Are there any established and maintained procedures to
cover situations where their absence could lead to
deviation from HSE policy and objectives?
 Are the procedures stipulating operating criteria?
 Are there procedures to identify the HSE risks of
goods and services purchased from outside suppliers
and contractors?
 Are there procedures for the design of workplace,
process, installation, machinery, operating procedures
and work organization, in order to eliminate or reduce
HSE risks?
4.4.7 Emergency preparedness and response

 Are there procedures to identify and response to
incidents and emergency situations and to prevent and
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SYSTEM – FORMS
mitigate the likely illness and injury associated with

them?
 Does the organization review its emergency
preparedness and response plans and procedures
especially after the occurrence of incidents or
emergency situations?
 Does the organization periodically test out such
procedures?
4.5 CHECKING AND CORRECTIVE ACTION Y N REMARKS

4.5.1 Performance measurement and monitoring
 Are the procedures to monitor and measure HSE
performance on a regular basis established and
maintained?
 Does the procedures provide for:
-Both qualitative and quantitative measures that are
appropriate to the needs of the organization?
-Monitoring the extent to which the HSE objectives are
met?
-Proactive measures of performances that monitor
compliance with the HSE management program,
operational criteria and applicable legislation and
regulatory requirements?
-Reactive measures of performance to monitor accidents,
ill health, incidents and other historical evidence of
deficient HSE performance?
-Recording of data and result of monitoring and
measurement sufficient to facilitate subsequent corrective
and preventive action analysis?
 Are procedures for the calibration and maintenance of
monitoring equipment that are used for performance
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SYSTEM – FORMS
measurement and monitoring established and

maintained?
 Are the records of calibration and maintenance
activities and results retained?
4.5.2 Accidents, incident, non-conformances and

corrective and preventive action
procedures for defining responsibility and authority
for:
-The handling and investigation of accidents, incidents and
non-conformances?
-Taking action to mitigate any consequences arising from
accidents, incidents or non-conformances?
-The initiation and completion of corrective and preventive
actions?
-Confirming the effectiveness of corrective and preventive
actions taken?
 Does the procedure require all proposed corrective
actions to be reviewed through the risk assessment
process before implementation?
 Are the corrective action taken appropriate to the
magnitude of problems and commensurate with the
HSE risk encountered?
 Were the changes in procedures due to the corrective
and preventive action taken implemented and
recorded?
4.5.3 Records and records management
 Are the procedures for the identification, maintenance
and disposition of HSE records, established and
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SYSTEM – FORMS
maintained?
 Are the records legible, identifiable and traceable?
 Are the records readily retrievable and protected
against damage, deterioration or loss?
 Are the retention times of the records established and
recorded?
 Are the records maintained to demonstrate
conformance to the requirements of the OHSAS
standard?
4.5.4 Audit
 Are there procedures for the periodic HSE
management system audit to be carried out, established
and maintained?
 Does the internal audit determine if the HSE
management system:
-Conforms to the planned arrangements for HSE
management and the requirements of the OHSAS
specification?
-Has been properly implemented and maintained?
 Does the audit provide information on the results of
audits to management for review?
 Does the organization’s audit program, including
schedule, consider the results of risk assessments of the
organization’s activities, and the results of previous
audits?
 Does the audit procedures cover the scope, frequency,
methodologies and competencies, as well as
responsibilities and requirements for conducting audits
and reporting results?
4.6 MANAGEMENT REVIEW Y N REMARKS

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SYSTEM – FORMS
 Does the organization’s top management periodically

review the HSE management system to ensure its
suitability, adequacy, and effectiveness?
 Are there sufficient and necessary information
collected to allow management to carry out the
management review?
 Is the management review documented?
 Does the management review address:
-Possible changes to policy?
-Possible changes to objectives and other elements of the
HSE management system?
-Possible changes in the light of HSE management system
audit results?
-Possible changing circumstances?
-The commitment to continual improvement?
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2. HSE POLICY/KEBIJAKAN K3L

the assessment of risks, and the implementation of

3.2. Legal and other requirements

requirements communicated to the employees and

3.4. HSE management program (s)

management system is properly implemented and

4.4.2 Training, awareness and competence

-The differing levels of risks?

4.4.3 Consultation and communication

4.4.5 Document and data control

 Is there document control procedure to ensure that the

4.4.7 Emergency preparedness and response

mitigate the likely illness and injury associated with

4.5 CHECKING AND CORRECTIVE ACTION Y N REMARKS

measurement and monitoring established and

4.5.2 Accidents, incident, non-conformances and

4.6 MANAGEMENT REVIEW Y N REMARKS

 Does the organization’s top management periodically

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