Pre-Execution HSE Checklist

AFPC Contract no: Subcontract Agreement No:

Contractor Name : Subcontractor Name:

Item Assessment Details and Agreed Score

any Agreed Remedial Action [1-3]
Actions Dates
1 Subcontractor has provided documentary evidence that all
personnel have received the following training, where appropriate
for their jobs:
1. Site Induction including Top 10 Hazards
2. Defensive Driving
3. Permit to Work
4. Safety Intervention
5. Journey Management
6. In Vehicle Monitoring
2 Subcontractor confirms that the current workforce does not
include anyone who has been previously dismissed from the work
for infringements relating to Life Saving Rules (e.g. alcohol
abuse, seatbelts, speeding or other serious infringement).
Subcontractor also confirms agreement for prompt removal of
staff from the project in line with the Company’s Zero Tolerance
policy.
3 Subcontractor commits to provide full time supervision for each
work location by supervisors who have been trained in Permit to
Work, Safety Intervention, and Journey Management where
required
4 Subcontractor confirms that all professional drivers are over the
age of 25 and have more than 5 years driving experience in
relevant vehicle class. All drivers (professional and non-
professional) have passed the Defensive Driving course
5 Subcontractor confirms that all plant, equipment and vehicles on
the contract have been offered for inspection and have been
issued with a valid Site Access Pass and that there are no
defects to safety critical items (such as seatbelts, tyres, brakes,
steering)
6 All passenger-carrying vehicles and pick-ups have been fitted
with IVMS. Applicable restrictions to speed and use of vehicles
are monitored and enforced by the Contractor/Company
7 Subcontractor commits to implement the Company’s Journey
Management Procedure or own equivalent procedure to assess,
approve, control and monitor road journeys as per the Procedure.
Subcontractor commits to employ adequate journey
managers/dispatchers/key controllers
8 Subcontractor commits to provide a fully functional means of
communication to teams working in remote areas and where
required by Journey Management Plans.
9 Subcontractor has notified Contractor of all Sub-subcontractors
employed on the work and will not employ any Sub-
subcontractors without express approval of the Contractor
10 Subcontractor does not pay incentives or apply penalties which
could cause unsafe behaviour such as speeding, making
excessive working hours, overloading of vehicles or continuation
of work with defective vehicles or lack of PPE
Scores: [1]: Not compliant and no remedial plan in place
[2]: Remedial plan in progress and partially compliant
[3]: Substantially compliant
Confirmed by Subcontractor Representative: Endorsed by Contractor Representative:
Name: Name:
Signature: Signature
Date: Date:

Subcontractor Checklist