MALAYSIAN SOCIETY FOR OCCUPATIONAL SAFETY …msosh.org.my/v2/wp-content/uploads/2017/11/Application-Form-Osh... · PART B Page 16 of 25 MALAYSIAN SOCIETY FOR OCCUPATIONAL SAFETY AND

PART B Page 14 of 25

MALAYSIAN SOCIETY FOR OCCUPATIONAL SAFETY AND HEALTH

Doc: OSH Award 2017 Application Form PART B - Page 14 of 25

Please send this completed form together with payment and required documents to:

CHAIRMAN

MSOSH OSH Awards 2017

4th

Floor,Wisma PERKESO, Jalan Selangor 46050 Petaling Jaya, Selangor.

Tel: 03-79561763 / 79588396

A. PARTICULARS OF COMPANY/ORGANIZATION

1. Name of Company :

SOCSO code no. :

Postal Address :

:

Tel No. : Fax No :

2. Name of site to be

audited

:

Postal Address of site :

(Please attach route map)

Site Contact person :

Designation :

E-mail :

Tel No. : Fax No:

H/p No. :

3. Business Sectors

Petroleum, Gas, Petrochemical and Allied

Sectors Agricultural Sectors (Fishery/Forestry/Plantation)

Electronics and Electrical Sectors

Services Sectors (Hospitality/Banks/Theme Parks,

etc)

Manufacturing & Chemical Sectors Logistics and Transportation

Utilities Sectors Educational Sectors

Construction & Engineering Construction

Sectors (Project Progress = ______%)

*refer to term and condition no.15 page 3

of Part A (Application Form)

Public Sectors & Statutory Bodies




I. OSH MANAGEMENT SYSTEMS EVALUATION CRITERIA

This questionnaire must be duly completed and submitted together with the application form and requested

attachments.

Please mark in appropriate box. *Please attach supporting documents.

Every attachment must be labeled according to the topic number.

1. S&H POLICY

Yes No

(1) S&H policy is written.

(2) S&H policy is written in language understood by the employees/ contractors and

made known to them

(3) S&H policy signed and dated by the top management and reviewed regularly.

*Please attach

a) Latest Company Organization Chart

b) Latest copy of S&H policy.

2. ORGANISATION.

2.1 OSH Organization & Responsibilities

Yes No

(1) There is a competent safety & health officer in the company.

(2) There is authorized manager for OSH in the organization

(3) The SHO / authorized manager reports direct to the top management

(4) There is an OSH department/unit established and reports direct to the top

management.

(5) Department managers and line supervisors are accountable for OSH in their

respective work area and NOT the OSH personnel.

(6) OSH responsibilities are stated in each employee, supervisor and manager's job

description

(7) OSH responsibilities are also stated on the Purchase Order awarded to contractors

who provide services

(8) OSH elements are being considered before and whenever new employees are

recruited

*Please attach

a) Copy of the company's OSH organization structure

b) A copy of one of the Department Manager's job description

c) Sample copy of Purchase Order or attach contractor additional requirement that states

contractor/supplier's OSH responsibilities

d) Special interview checklist for high risk job eg: Confined Space worker, Working At

Height worker, Welder, Chargeman, etc

e) HR new employee interview checklist




2.2

Safety and Health Committee

Yes No

(1) The S&H Committee is established and chaired by the top management.

(2) Composition of members complied with Sub Reg. 5 of S&H Committee Regulations,

1996

(3) Last four SHC meeting dates in year 2017: 1______, 2_______, 3_______, 4______

(4) Sub Committees were also established to handle various types of programs or tasks.

(5) The attendance of members for every meeting is above 85%

(6) OSH issues brought up in meeting are assigned to PIC (Person in charge) &

completion dates identified.

(7) Majority OSH actions raised in meeting are closed.

* Please attach

a) Copy of at least four (4) 2017 S&H Committee meeting minutes complete with attendance

record.

b) The structure & composition of the Main Committee and the Subcommittee members.

2.3 Documentation & Data Control

Yes No

(1) Level of OSH documents have been identified eg: manual, procedures, work

instructions/SOP/SWP, records, etc

(2) There is a master list for all OSH documents and records (i.e: OSH document &

record registers)

(3) All these documents are well controlled, current, numbered, issued, periodically

reviewed and approved by PIC.

(4) All these documents are accessible and communicated to the relevant employees

(5) There is a procedure to manage items (1), (2), (3) & (4)

* Please attach

a) Copy of the company complete procedure on controlling OSH documents/ data/records

b) Master List of OSH Documents and Master List of OSH Records.

2.4 Communication, Participation &Consultation

Yes No

(1) There are means to communicate the OSH related news to employee eg: Notice

Board, E-mail, staff meetings, Intranet, Banners, etc.

(2) There are means for employees to give feedback/ suggestions/ hazard reporting to

Management eg: reporting scheme, suggestion scheme, STOP, AWAS, SUSA, I See I

Act, ACT, UAUC, etc

(3) Actions are taken on feedback and suggestions submitted by the employees

(4) There is an arrangement to communicate to employees any new laws, changes in the

OSH Management System, etc

(5) There is an arrangement to receive, document and respond to an external OSH

communication.

(6) There is a procedure to manage items (1), (2), (3), (4) & (5)




* Please attach

a) Copy of the company complete procedure on OSH Communication &Consultation

b) An evident of past hazard reporting/feedback/suggestion submission.

3. PLANNING

3.1 Hazard Identification, Risk Assessment & Determining Controls (HIRADC).

Yes No

(1) All sites, office activities, canteen activities and other supporting activities (including

low & medium risk activities) have been analyzed, OSH hazards are identified, risks

are assessed and control measures identified and implemented.

(2) ONLY High risk activities are analyzed, OSH hazards are identified, Risks are assessed

and determined control measures identified and implemented.

(3) HIRADC is also performed on new activities or jobs.

(4) HIRADC result is considered in establishing OSH Objectives, action plan, training plan,

work instructions, SOP, etc

(5) HIRADC result is reviewed after each time an accident, near miss, dangerous

occurrence or occupational illness happened

(6) HIRADC result is periodically monitored in an OSH Committee meeting or other

meetings.

*Please attach

a) Complete copy of the company HIRADC Procedure

b) 1 sample copy of completed HIRADC document (1 or 2 pages minimum)

c) Sample of 2017 HIRADC, JSA/JHA or equivalent.

3.2 Legal and Other Requirements (LOR)

Yes No

(1) OSH related legal and other requirements (eg: customer/corporate requirements)

that the company has to comply have been identified.

(2) Legal & Other Requirements Register, to identify any non-compliance with the

applicable requirements has been developed.

(3) The non-compliances are considered in establishing OSH objectives, action plan,

training plan, procedures, work instructions, SOP, etc

(4) The Non-compliance status is periodically monitored in an OSH Committee meeting

or other meetings.

(5) Local authority permit/license register is established and maintained to monitor the

validity and the compliance status of the permit/license

(eg: PMA, PMT, PMD, workplace registration with DOSH, Bomba Cert, LPTA cert,

etc).

(6) There is a procedure and PIC for managing and keeping LOR up to date.

(7) Conducted CHRA for all chemicals?

*Please attach

a) Complete copy of the company LOR Procedure

b) List of Legal and Other Requirements the company has to subscribe to




c) Copy of the local authority permit/license register (list only).

d) 1 copy of Borang A and CHRA Action Plan

3.3 Objectives & Action Plan

Yes No

(1) Result of HIRADC, legal & other requirements non-compliance status, accident/

incident report, audit/inspection reports, etc. are used as a basis to establish the

OSH objectives of the company

(2) The company's OSH objectives are supported by and linked to each departmental

objectives

(3) The status of the objectives is being monitored in S&H committee meeting or

management team meeting

(4) The achievement of the objectives is linked to each employee's year end

performance appraisal scheme

(5) Employees are made known of the company's OSH objectives

*Please attach

a) Copy of the company's 2017 OSH objectives, and also 2016 OSH objectives list (for

Platinum and Grand Only)

b) One of the departmental OSH objectives

c) Sample format of employee performance appraisal form.

d) Evidence on how employees were made known on the Objectives

3.4 Action Plan (OSH Management Program)

Yes No

(1) Each Objective in item (3.3) above is supported in detail by an Action Plan (What,

Who, When)

(2) The progress of the action plan is being monitored in S&H committee meeting or

management team meeting

*Please attach

A sample of the action plan to support the achievement of the objectives in item 3.3

4 IMPLEMENTATION

4.1 S&H Training & Competency

Yes No

(1) Basis for identifying OSH training needs are clearly defined

(2) There is a yearly OSH training plan for managers, supervisors, employees &

contractors

(3) There is an employee competency plan for jobs that fall under the legal

requirements.

(4) Majority of OSH training planned were implemented




*Please attach

a) Copy of Training Procedure

b) Sample 2017 Training Need Analysis (TNA) form

c) 2017 Training Plan (and also 2016 training plan for Platinum and Grand applicant)

d) Minimum of 3 OSH training attendance for training conducted in 2017 (and also 2016 for

Platinum and Grand applicant )

4.2

Controlling Safe Operation

Yes No

(1) There is a General S&H rules/procedures established, implemented and

communicated to employees & other affected parties.

(2) There are S&H Work Instructions (WI)/SOP/Rules established. Example are: selection

& control of contractors, forklift safety, office safety, chemical safety, electrical safety,

hot work, confined space safety, permit to work, management of PPE, hearing

conservation, lock out tag out, indoor air quality, etc

(3) The WI/SOP/S&H Rules are implemented and communicated to relevant employees

and contractors.

(4) Permit to work (PTW) system and its procedure to control high risk activities such as

contractor work, hot work, confined space, working at height, radiography work,

excavation work, etc has been established and implemented.

* Please attach

a) Copy of the General S&H rules/procedures

b) A Copy of PTW Procedure & the forms used.

c) Minimum 3 samples of other S&H WI/SOP/Rules.

4.3 Procurement

Yes No

(1) S&H elements are being considered whenever labour services from contractors are

contracted.

(2) S&H elements are being considered whenever materials and chemicals, gases and

other substances are purchased.

(3) S&H elements are being considered whenever PPE from the supplier are purchased

(4) S&H elements are being considered whenever machines (including pressure vessels),

equipment and tools from suppliers are purchased.

(5) S&H elements are being considered whenever workstation equipment eg: chairs,

tables, workbench, etc are purchased.

*Please attach

A copy of the complete Procurement procedure. Procedure shall reflect that elements of S&H are

being considered whenever purchases are made.

4.4 Contracting

Yes No

(1) There is a S&H pre-evaluation questionnaire before contractors are registered with

the organization

(2) S&H criteria are used when deciding which contractor to be awarded




(3) All new contractors are subject to S&H induction before starting any work, induction

pass is issued and subsequent periodic refresher thereafter.

(4)

Contractors have to sit for internal / external exams before they are issued the

induction pass

(5) Contractors have to pass the alcohol & drug test before they are issued the

induction pass

(6) There is a contractor S&H sub-committee established and the meeting is held

periodically

(7) A S&H tool box talk or pre job briefing is held before the start of every job

(8) Regular S&H inspection and supervision is carried out while the job is being

performed by the contractors

(9) Permanent contractors are requested to have an ongoing S&H training

(10) There is a post evaluation questionnaire or checklist to be filled up once the job is

completed to assess the contractor's compliance to the company's S&H

*Please attach

a) Complete copy of managing contractor S&H procedure or managing contracts procedure

b) Evidence of Drug & Alcohol test was carried out.

c) Sample of Contractor Induction booklet

d) A copy of the Contractor 2017 S&H Induction attendance list

e) Copy of Contractor 2017 S&H Sub Committee meeting minutes

f) A copy of 2017 S&H Tool Box Talk or Pre Job briefing attendance

g) A copy of Contractor S&H post-evaluation questionnaire

h) A copy of Contractor S&H pre-evaluation questionnaire

4.5 Hazard Communication & Health Surveillance

Yes No

(1) There is a written procedure on occupational health surveillance, safe handling of

chemicals and other hazardous materials (e.g: gases, asbestos, mineral dusts, lead,

dusts, etc).

(2) Personnel exposed to health hazards have been adequately trained.

(3) PPE needed for the job are provided, correct type, correctly used, properly

maintained and regularly inspected.

(4) All chemicals, other hazardous material and hazardous waste containers are properly

labeled.

(5) SDS for all chemicals stored, used and disposed are available, and in Bahasa Malaysia

and English languages and comply to CLASS Regulations 2013 Requirements.

(6)

All chemicals, other hazardous material and hazardous waste containers are

appropriately labeled, segregated and stored/ disposed.

(7) Ergonomics, stress, indoor air quality and confined space program are implemented.

(8) Perform initial employee noise exposure monitoring, positive noise exposure

monitoring and audiometric testing program (if applicable).

(9) Perform employee chemical exposure monitoring and/or local exhaust ventilation

inspection and testing (if applicable).




*Please attach

a) Minimum 3 samples of SDS which comply to CLASS Regulations 2013 Requirements

b) A Simple copy of occupational health surveillance report

c) A complete copy of chemical control or management procedure

d) A complete copy of management of PPE Procedure

e) A copy of 2017 chemical safety training attendance

f) A copy of 2017 PPE training attendance

g) A summary of initial employee noise exposure monitoring, positive noise exposure monitoring

and audiometric testing program (if applicable).

h) A summary of employee chemical exposure monitoring and/or local exhaust ventilation

inspection and testing (if applicable).

4.6

S&H Awareness & Promotional Activities

Yes No

(1) Regular S&H promotional activities such as S&H newsletter, campaign, exhibition,

talks, quiz, are organized

(2) There is involvement of local community in the S&H projects/ programs/activities

conducted (Note: Environmental project is not considered)

(3) Managers, employees and contractors are involved in the S&H awareness &

promotional activities

*Please attach

a) The 2017 S&H awareness & promotional activity plan (details on types of S&H awareness &

promotional activities organized)

b) Copy (s) of newsletter, newspaper cuttings, in-house S&H magazines

c) Samples of S&H quiz, contest, survey, competition materials, etc

d) Attendance of talks, photos, competition activities, blood donation etc, and copy of evidence of

S&H activities with local community conducted in 2017.

4.7 Disciplinary Action Program

Yes No

(1) There is a disciplinary procedure implemented to enforce the implementation of S&H

WI/SOP/rules

(2) All employees including managers, executives, supervisors, floor people and

contractors are subject to this.

(3) The top management is serious about S&H and will take appropriate disciplinary

action if required.

*Please attach

a) Complete copy of the Disciplinary Action Procedure

b) Any past evidence that disciplinary action has been taken on errant employees for S&H

noncompliance.




4.8 Management of Change (MOC)

Yes No

(1) Any major internal changes (on process, working procedure, equipment,

organizational structure) and external changes (new law introduced, new corporate

or customer requirement) that have impacts on the S&H of the organization is being

controlled through a management of change procedure.

(2) Workplace hazard identification & risk assessment are carried out before any

modification or introduction of new work methods, materials, chemicals processes or

machinery.

(3) Employees, their representatives & S&H committee are involved in such assessment.

(4) All affected members in the company are properly informed and trained on the

changes.

*Please attach

a) Complete copy of the Management of Change Procedure

b) Past year evidence of any MOC carried out eg: forms used, etc.

4.9 Emergency Response Plan (ERP)

Yes No

(1) Emergency response plan manual written, and contents are communicated to

employees

(2) Specific and related emergency scenarios (eg: Fire, Chemical Spill, Gas Leak, Bomb

Threat, Earthquake, etc) Action Plan are written and simulated.

(3) ERT (Team) is established & members are regularly &adequately trained.

(4) ER Equipment is available, adequate, regularly inspected and tested.

(5) Drills, exercises, simulations, evacuations are carried out (minimum yearly)

*Please attach

a) Copy of the company's ERP Procedure table of contents

b) 1 sample of specific emergency scenario action plan (eg: Fire, Chemical Spill, Gas Leak, Bomb

Threat, etc)

c) 2017 ER training attendance

d) ER equipment inspection checklist

e) Drill Post Mortem Report

5. EVALUATION

5.1 Performance Measurement

Yes No

(1) OSH Key Performance Indicators (KPI) eg: LTI FR, LTI SR, recordable cases, medical

treatment cases, first aid cases, near misses, no. of medical leaves, etc are used in

measuring the organizational OSH performance.

(2) OSH Key Performance Indicators (KPI) eg: LTI FR, LTI SR, recordable cases, medical

treatment cases, first aid cases, near misses, no. of medical leaves, etc are used in

measuring the departmental OSH performance.

(3) This KPI is continuously monitored in the S&H committee meeting or management




team meeting and action taken if necessary

(4) This KPI is regularly communicated to all employees through Notice Board, Intranet,

Newsletter, meeting, etc

(5) The achievement of this KPI is linked to the Organizational & Departmental OSH

objectives and year end performance appraisal criteria or bonus scheme

*Please attach

a) Copy of the 2017 OSH KPI (and also 2016 OSH KPI for Platinum and Grand Only)

b) Photos of the OSH Incident Statistics board

c) A sample of year end employee performance appraisal form to show OSH elements are being

considered.

5.2 Performance Monitoring

Yes No

(1) Quarterly site OSH inspection is being carried out by Management Team, Supervisors,

Employees and Contractors

(2) Action is taken on the result of the inspection, continuously monitored and eventually

closed

(3) Regular personal meeting between department managers & the subordinates to

discuss OSH issues is on-going

(4) Yearly OSH management system audit covering reviewing documents, interviewing

personnel and inspecting site is done.

(5) Health/Medical surveillance program is carried out during pre-employment and

regularly during employment

(6) Health /Medical surveillance program includes Occupational Poisoning, Occupational

Disease, Bological monitoring & Noise Induced Hearing Loss (NIHL)

(7) Health/medical surveillance program is carried out at post-employment.

(8)

Health/Medical Program covers Mental Health, Medical Removal, MSD Management,

Fitigue Management, Quit Smoking, Weight Management, Workers Vaccination, Drug

& Alcohol Control, Dengue/Malaria/Zika Prevention Non Communicable Disease

Program etc

(9)

OSH Performance covers tracking and analyzing of Medical leave, Medical cost,

Hospitalization cost and Insurance cost, SOSCO reporting and commuting accident

cases

*Please attach

a) Copy of the 2017 OSH site inspection report & the status

b) 2017 OSH management system audit report & the status

c) A copy health/medical surveillance summary report (including Occupational Poising,

Occupational Disease, Biological monitoring & Noise Induced Hearing Loss (NIHL) Noise

Monitoring

d) A copy of the employee's health/medical surveillance summary report, medical removal report

(with the name erased)

e) Copy of report/photos on Health/Medical Programs conducted in 2017.

f) Summary of overall OSH Performance Report (including Medical Leave, Medical cost,

Hospitalization cost and Insurance cost, SOCSO reporting and Commuting accident cases for

2017




5.3

Injuries, Occ. Illnesses, Incidents, Dangerous Occurrence, Non-Conformances (IOIIDONC) Reporting &

Investigation

Yes No

(1) There is a procedure managing IOIIDONC Reporting and Investigation established &

implemented in the company

(2) Incident Investigation is carried out whenever any IOIIDONC is reported

(3) Incident investigation team is established and adequately trained.

(4) The result of the investigation is documented, corrective and preventive actions

taken, communicated to OSH Committee and other relevant employees, and

reported to DOSH (if required by law)

(5) Related HIRADC of the investigated IOIIDONC and the Training Plan of personnel

involved in the IOIIDONC are reviewed after the incident.

(6) The Corrective and Preventive Actions (CPA) and the effectiveness of CPA are

continuously monitored and eventually closed.

(7) Annual report to DOSH (JKKP Form 8) is submitted in January of each year

*Please attach

a) Complete copy of the company's IOIIDONC reporting and investigation procedure

b) A sample of the 2017 completed IOIIDONC investigation form and the findings

c) A copy of the incident investigation team training attendance list.

d) A copy of the 2017 JKKP 8 Form.

5.4 Other Incidents:

List the last three (3) dates and brief description of the above that happened in 2017, if any.

1)___________________________________________________________________________

2) ___________________________________________________________________________

3) ___________________________________________________________________________

5.5 Internal Audit.

List dates of any OSH internal audits in 2017 and attach the executive summary of the audit

___________________________________________________________________________

*Please attach

Executive Summary of audit

5.6

Management Review

Yes No

(1) There is a management review meeting (as per procedure) carried out to discuss the

progress of overall performance of OSH

(2) The meeting is attended by the top and senior management team members in the

company

(3) The meeting discusses the KPI, OSH objectives and action plan achievements, system

audit result, legal compliance status, past management review actions, IOIIDONC

status, etc

(4) The results of the management review are recorded, implemented and




communicated to S&H committee & relevant employees.

*Please attach

a) Copy of the 2017 management review meeting attendance

b) Minutes of the meeting and status of the action items.

6.0 ACTION FOR IMPROVEMENT

6.1 Corrective and Preventive Action (CAPA) & Continuous Improvement

Yes No

(1) CAPA resulting from performance monitoring activities, performance measurement

results, OSH management system audits, other external OSH audits and IOIIDONC

that happened are taken action and eventually closed.

(2) Continuous improvement actions are taken on objectives, action plans, management

review and S&H committee meeting, results of hazard identifications & risks

assessment, legal compliance status, employee's OSH training & competency status,

employee's suggestion and feedback, employee's health surveillance reports, etc.

*Attach the relevant documents or evidences.

7.0 THE ORGANIZATION’S OSH ACHIEVEMENTS IN 2017

Yes No

(1) International Level (eg: ROSPA/IOSH/HSE Awards, etc)

(2) At National Level (eg: NCOSH Award, MSOSH Award, CIDB OSH Award, etc)

(3) At Corporate Level/ Customer Level

*Attach a list of the achievement and copies of the Award Certificates.

Thank you very much for your enthusiastic participation and concern on your

Occupational Safety and Health Management System.

Please complete this form, attach the required documents which are accurately labeled and mail them together with the

entrance fee and shall reach MSOSH office latest by Friday, 26th

JANUARY 2018

Thank you very much.