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HSE Management System Template

This is a comprehensive HSE management system template which can be used by confirmed staff to evaluate how companies and businesses handle health and safety in their workspace or environment. It is split into 2 sections: HSE management and HSE performance monitoring. Each entails an assessment of HSE management protocols. Finish the audit by giving an overall rating of the HSE management and record all people involved in the assessment. You can use the Lumiform app on your mobile device anytime, even when you’re offline.
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HSE Management System Template


Section 1 - HSE Management

1.1 HSE Overview

Does your company have a written HSE Policy?

Does your company have an HSE Management System? Is it approved by an acknowledged independent expert (e.g. N.S.C.A., Du-Pont Stop, WorkCover-Self Insurer, ISO 18001, AS/NZS 4801, Civil Contractors Federation Integrated Management System)? If so, what was the latest outcome?

1.2 Responsibilities

Are health and safety duties clearly identified for all levels of personnel?

1.3. HSE Consultation

How does your business identify and report HSE issues?

Are workers involved in decision making over HSE concerns?

Is there a workplace HSE committee or routine meetings conducted with workers (e.g. safety meetings, toolbox talk etc.)?

Does your company have an HSE representative? Have they admitted HSE training?

1.4 HSE Management System

Does your company have permission to work system?

Does your company have a process for the selection, evaluation, monitoring and investigation of sub-contractors that incorporates HSE demands?

Does your business have methods to prevent and reduce environmental emissions and damage?

Do you have schemes for selection, use, storage, handling, spill control & disposal of dangerous substances and dangerous goods (e.g. corrosives, toxics, flammable fluids and gases,...)?

Is a reported Job Safety & Environmental Analysis (JSEA) conducted previous to the commencement of a job (i.e. risk identification, evaluation, control and investigation procedures)?

Does your company conduct routine HSE audits of your HSE Management System by external companies?

Do you have procedures for identifying, evaluating and controlling risks connected to manual handling?

Do your environmental procedures approach containment and recovery processes?

Do you have methods for the maintenance & examination of plant equipment owned and/or managed by your company (e.g. excavator, compressor, electrical equipment, fire-fighting equipment, etc.)?

Does your company have emergency response methods and/or management process?

1.5 Hazard Management

How does your company communicate risks to your workers and your sub-contractors?

Give an example of the Hazard Management process to be used by your company.

Does this method involve a proper hazard register?

Is there a method by which workers can report risks at workplaces and potential health, safety & environmental risks?

1.6 HSE Training & Induction

Explain briefly how HSE Training & Induction is conducted in your business.

Are records maintained of all training (certificates & licenses) and induction programs are undertaken for workers (current and new employees) in your company?

How does your organisation plan to manage inductions for staff involved in projects with ISS?

Is there other particular HSE training for staff?

1.7 HSE Workplace Inspection

Does your organisation have a method for regular HSE inspections at the workplace?

How is information given to stakeholders?

Are standard workplace examination checklists used to conduct health, safety and environmental examinations?

1.8 Incident Management

Is there a system for evaluating incidents to determine root causes? Does the system identify and implement proper improving actions?

Is there a reported incident management and investigation method?

Is there a method for the announcement of incidents to regulatory agencies?

1.9 HSE Offences

Has the company had any enforcement activity or been convicted for an HSE offence in the last 3 years?

1.10 Quality

What systems are the to show that all HSE demands of a contract are being met and sustained (e.g. compliance with Standards, Codes of Practice and Specifications, etc.)?

Section 2 - HSE Performance Monitoring & Statistics

2.1 Performance Monitoring

Are workers regularly provided with information on your HSE performance?

Is there a system for documenting and analysing HSE review statistics?

2.2 Statistics

2.2.1 Days Away/Restricted or Transfer Rate for current and previous 3 years

Current year:

Year 1:

Year 2:

Year 3:

2.2.2 YTD Number of First Aid Injuries and for current previous 3 Years

Current Year:

Year 1:

Year 2:

Year 3:

2.2.3 Total Recordable Incident Rate for current and previous 3 Years

Current year

Year 1:

Year 2:

Year 3:

2.2.4 Number of Environmental Incidents & Non-Compliances for current and previous 3 Years

Current Year:

Year 1:

Year 2:

Year 3:

Summary/Grading----Check Yes to ONE

Overall rating

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