Saudi Authority For Industrial Organization

MODON Program

Quarterly HSE Audit Report

Eammar Infrastructure Co. (DAM1-03-004 )
Storm Water Connection to Municipality Network Dammam 1st
industrial city.

REPORT DAM1-03-004-EMR-TS9-1-HSF-AUD-00007-00

Signature Signature Signature

Date: 28- Dec. -2021 Date: 28- Dec. -2021 Date: 28- Dec. -2021
Prepared By: Reviewed By: Authorized By:

Khalid Atta Almnan Tareq Balghunaim Zeyad Yaseen

HSE Audit Checklist

Instruction:
This spreadsheet contains four (4) tabs including this introduction, the audit checklist, executive summary and the corrective
action plan. Read each question carefully and place an X in the appropriate column according to the following guidelines:

— 100% for evidence of full compliance and full implementation

— 75% for evidence of full compliance with only minor exceptions in implementation

— 50% for evidence of partial compliance and/or partial implementation

— 0% for evidence of no compliance and/or no implementation

— N/A if the question is not applicable

The boxes requiring input are:

- Compliance boxes with an X

Audit sheet Comments and action required (please end all comments and actions with a FULL
-
STOP)
- Audit details (once only at top of sheet 1)

Executive Summary sheet Nothing to enter

Corrective Action Plan sheet Date closed out

(Instruction - sheet 1 of 4)
Page 2 of 31
 Inspection Sheet
Project number DAM1-03-004 Project Name Storm Water Connection to Municipality Network 1st Industrial City Dammam

Auditor Khalid Atta Almnan Auditee Eammar Infrastructure Co.

Audit date 31-Jan-22 Audit reference DAM1-03-004-EMR-TS9-1-HSF-AUD-00008-00 Sheet 1 of 9

Compliance % Possi
Reference Actual Evidence Observation & action required
Khalid Atta Almnan ble (CA = Corrective Action
number Score reviewed IR = Improvement recommendation)
100 75 50 0 NA Score

OHS MOD PR 16 Policy Statement

Has the company Safety Health & Environment Policy been signed by top
1.0 50 0 Eammar HSE Policy
management and posted?
Are the latest ISO 14001 and OHSAS 18001 certificates available on ü ISO 14001 & ISO
2.0 50 50 45001 certificates
site/posted on notice boards?

3.0 Are the 'Policy - aims set and responsible infomred' show the evidence? ü 50 50 Eammar HSE Policy

Does the Safety Health & Environment Policy satisfy the requirements of ü
4.0 50 50 Eammqr HSE policy.
OHSAS 18001 and ISO 14001?
Online share point.
Does the site / office have access to intranet and can access the HSE https://drive.google.c
5.0 ü 50 50 om/drive/folders/16K
documents and forms be accessed? Check at least 3 personnel. Pi333w6Yhbs6ohYdI
I3nNfRDHjKiLy

Has the policy been reviewed, revised and communicated in the last 12 ü Eammar HSE
6.0 50 50
months? Policy
Is the Safety Health & Environment Policy made available to the public and ü Eammar HSE
7.0 50 50
other interested parties? Policy
Has evidence been provided that demonstrates that policy changes have ü TBT attendanse
8.0 50 50 dated 18/09/2021
been communicated e.g. Tool Box talk on Policy changes?
Score 400 350

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 3 of 31
 OHS MOD PR 05 Environmental Aspects Health & Safety Risk Planning

Have Environmental Risk Assessments for the site been completed? Are ü
1.0 50 50
they up to date with current activities?

Do these identify the applicable environmental aspects and impacts to the ü

2.0 50 50
activities being carried out?
3.0 Have all Health & Safety Risk Assessments been completed? ü 50 50
Have all construction phase Health & Safety Risk Assessments been Confined space
completed? This includes all operational tasks, hot works, work at height, RA Ref.: DAM1-
4.0 excavations, work adjacent to traffic, work on / over water, confined spaces, ü 50 50 03-004-EMR-
hazardous substances, Noise, Manual handling, Fire, Lifting (mechanical), TS9-1-HSEF-
behaviors etc. SNT-0015-00
5.0 Do the present risk assessments identify all the risks of current activities? ü 50 50
Has the Construction Phase Health and Safety Plan been completed and are ü
6.0 50 50
its requirements being implemented?

Has the Project Environmental Management Plan been completed and are ü
7.0 50 37.5
its requirements being implemented?

Does this identify the environmental issues based on the impact and risk ü
8.0 50 50
assessment, the control measures and responsible persons?

Is there a permit to work system in place on site to manage operational ü

9.0 50 50
risks? If so are these being completed and used for relevant operations?

Are the requirements identified within Safety Health & Environment Risk
10.0 Assessments being implemented on site and incorporated into method ü 50 50
statements?

ORT DAM1-03-004-EMR-TS9-1-HSF-AUD-00007-00 Score 500 487.5

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 4 of 31
 Project Number DAM1-03-004 Project Name Storm Water Connection to Municipality Network 1st Industrial City Dammam

Signature Khalid Atta Almnan Auditee Eammar Infrastructure Co.

DAM1-03-004-EMR-TS9-1-HSF-AUD-
Audit date 31-Jan-22 Audit reference Sheet 2 of 9
00008-00

OHS MOD PR 08 Legal and Other Requirements

Have the specific legal requirements applicable to the site been identified ü
1.0 50 50
and incorporated into the Project Environmental Management Plan?

Have the specific legal requirements applicable to the site been identified ü
2.0 50 50
and incorporated into the Health and Safety Plan?

Have the legal requirements applicable to the site been incorporated into ü
3.0 50 50
method statements?

Are health, welfare and hygiene facilities sufficient and appropriate for the
Khalid Atta Almnan site? Are they kept clean and in good order? This includes vaccination and ü 50 50
health screening programmes.

Are there any consents to discharge / permits / licences applicable to the

ü Local authorities
#VALUE! site? Are they being adhered to? This includes numerical and none 50 50
permits.
numerical conditions.

Do we have a system in place to assist in the management of compliance

ü Local authorities
#VALUE! with permits / consents / licences etc? e.g. programme of sampling, 50 50
permits.
responsibility, reporting, exceedance procedure etc?

Are details of Duty of Care Waste Transfer Notes available for inspection on ü
#VALUE! 0 0
site?

#VALUE! Are details of Waste Carriers Licences available for inspection on site? ü 0 0

#VALUE! Do we have confirmation of the suitability of the landfill sites to accept waste? ü 0 0

Score 300 300

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 5 of 31
 OHS MOD PR 14/
OHS MOD PR 11
Objectives & Targets and Management Programmes

The contractor is to prepare acheivment plan

1.0 Are the MODON Objectives & Targets being implemented into site activities? ü 50 37.5 for MODON objectives.

Eammar
Has the site set its own Objectives & Targets based on risk, aspects and ü
2.0 50 50 Objectives and
impacts? Are these being implemented into site activities?
targets.
Have the responsibilities for safety, health and environmental actions been ü TBT dated
3.0 50 50
designated? Are they being discharged? 25/09/2021
4.0 Are objectives and targets being achieved? Check results ü 50 50
Are records and reports of audits, inspections, site tours etc being compiled ü
5.0 50 50
on a monthly basis as required?
6.0 Do records demonstrate the achievement of objectives? ü 50 50
Score 300 287.5

OHS MOD PR 17 Structure & Responsibility

Are there adequate qualified resources available on site to enable ü

1.0 50 50
implementation of the requirements of the HSE Management System?

EMP ref.
(DAM1-03-004-
Does the Project Environmental Management Plan identify the key staff on ü
2.0 50 50 EMR-TS9-1-
site and their responsibilities?
HSF-PLN-0005-
01
Does the Construction Phase Health & Safety Plan identify the key staff on ü TBT dated
3.0 50 50
site and their responsibilities? 25/09/2021
Have nominated individuals had their responsibilities explained to them, and
ü TBT dated
4.0 have they discharged their responsibilities correctly? Is authority delegated 50 50
25/09/2021
due to absence etc?
Check an individuals performance review to ensure HSE metrics have been ü TBT dated
5.0 50 50
included in the review. 25/09/2021

Score 250 250

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 6 of 31
 Project number DAM1-03-004 Project Name Storm Water Connection to Municipality Network 1st Industrial City Dammam

Auditor Khalid Atta Almnan Auditee Eammar Infrastructure Co.

DAM1-03-004-EMR-TS9-1-HSF-AUD-
Audit date 31-Jan-22 Audit reference Sheet 3 of 9
00008-00

Compliance %
Reference Evidence Observation & action required
Procedure / Subject Poss Act (CA = Corrective Action
number reviewed IR = Improvement recommendation)
100 75 50 0 NA

OHS MOD PR 94 Performance Reporting

Training
Has all HSE data, including incidents, accidents, near misses etc been ü
1.0 50 50 attendance dated
reported to the HSE Department to assist in the Management Review? 6/12/2021

Does the HSE Manager report directly to the senior management to discuss ü
2.0 50 50
safety issues and solutions?

3.0 Has the site completed monthly self assessments? ü 50 50

Walk-through The contractor is set a plan for the
4.0 Are regular site tours carried out by management? ü 50 50 management tours.
attendance

Score 200 200

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 7 of 31
 QA Training, Awareness & Competence

Have all staff attended Induction / Safety, Health & Environmental ü

1.0 50 50
Awareness Training?

Have a training needs been identified from performance reviews? Has the ü Eammar project There is a traing matrix available whoever,
the contractor has to conduct training
2.0 50 50
training needs analysis been completed for all personnel? training matrix analysis.

Is there a training matrix or some similar method that tracks all employees to ü Eammar project
3.0 50 50
be sure that all employees are taught the information necessary? training matrix

Have all Safety Health and Environmental issues raised during the
preparation of the Project Safety Health & Environmental Plans been ü
4.0 50 50
incorporated into the Site Induction, Operational Method Statements and
Risk Assessments?

Have all plant operatives on site received the appropriate training to operate
that plant and equipment? Are there records and certificates of training ü
5.0 50 50
available on site? Are all plant operators in possession of a current driving
licence?

6.0 Have all operatives / visitors attended the following:

6.1 - Site specific inductions / Company induction / Visitors induction ü 50 50

ü TBT attendance
6.2 - Method statement briefings 50 50
dated 26/9/2021

6.3 - Risk assessment briefings ü 50 50

6.4 - Tool box talks ü 50 50

7.0 Are all records available? Sample 5 operatives on site. ü 50 50

Score 500 500

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 8 of 31
 Project number DAM1-03-004 Project Name Storm Water Connection to Municipality Network 1st Industrial City Dammam

Auditor Khalid Atta Almnan Auditee Eammar Infrastructure Co.

DAM1-03-004-EMR-TS9-1-HSF-AUD-
Audit date 31-Jan-22 Audit reference Sheet 4 of 9
00008-00

Compliance %
Reference Evidence Observation & action required
Procedure / Subject Poss Act (CA = Corrective Action
number reviewed IR = Improvement recommendation)
100 75 50 0 NA

OHS MOD PR 02 Communication Participation and Consultation

Are relevant laws and regulations communicated to the site and office
ü TBT attendance
1.0 personnel? Are relevant contractual requirements communicated to site and 50 50
dated 29/9/2021
office personnel?

Have all environmental aspects and impacts been communicated to site and ü TBT attendance
2.0 50 50
office personnel? dated 19/9/2021

ü available in the
3.0 Is the latest HSE Inspection Report available on site? 50 50
permit box
4.0 Does the site notice board display the following:
4.1 - The current Safety Health & Environment Policy ü 50 50
The contractor to prepare lesson leared and
4.2 - Lesson learned from previous audits/history ü 50 37.5 post on the notice board.

ü available in the
4.3 - Environmental Risk Assessments 50 50
permit box

ü available in the
4.4 - Health & Safety Risk Assessments 50 50
permit box

ü available in the
4.5 - Latest HSE Inspection Report 0 0
permit box

4.6 - Internal Safety, Health and Environmental Alerts ü 50 50

Have any issues arising from external communications been recorded? i.e. ü
5.0 Complaints from neighbours, interested parties, regulatory authorities/agencies? 0 0

6.0 Check minutes of last HSE meeting for actions, feedback and closure. ü 50 50

ü TBT attendance
7.0 Is there a reward and recognition plan in place and is it communicated? 50 50
dated 1/10/2021

8.0 Do site safety co ordination meetings take place and are minuted? ü 50 50
Score 550 537.5

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 9 of 31
 QA Document and Data Control

google drive
username:
Does the office / site have intranet access? Check at least 3 people have ü eammar622@g
1.0 50 50
access and can find the HSE documents and forms. mail.com /
Password:
eammar2020

Are the correct and up to date versions of supporting documentation and ü

2.0 50 50
records available and in use on the project / office?

Are the Construction Phase Safety Plan and Project Environmental ü

3.0 50 50
Management Plan up to date?

Are all method statement revisions controlled and reviewed by the ü

4.0 50 50
appropriate people? (Project/Site Manager and Subs).

5.0 Do all method statements have a Method Statement Review Sheet. ü 50 50 all MSTs
Score 250 250

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 10 of 31
 Project number DAM1-03-004 Project Name Storm Water Connection to Municipality Network 1st Industrial City Dammam

Auditor Khalid Atta Almnan Auditee Eammar Infrastructure Co.

DAM1-03-004-EMR-TS9-1-HSF-AUD-
Audit date 31-Jan-22 Audit reference Sheet 5 of 9
00008-00
Compliance % Observation & action required
Reference Evidence
Procedure / Subject Poss Act (CA = Corrective Action
number 100 75 50 0 NA reviewed IR = Improvement recommendation)

OHS MOD PR 15 Operational Control

Have all method statements incorporated the requirements of both ü

1.0 50 50
Environmental Risk Assessment and Health & Safety Risk Assessment?

Have the requirements of Environmental Guidance been incorporated into ü

2.0 50 50 All MSTs
method statements?

Have Emergency Procedures been taken into consideration in method ü

3.0 50 50
statements or work operations?

Do all hazardous substances / chemicals on site have MSDS and

4.0 Assessments? Are chemicals being stored used and disposed of in ü 50 50
accordance with these?

Is plant and equipment being maintained and operated in accordance with

ü previntive
5.0 policy and manufacturers instructions? Are operators trained to use all plant? 50 50
maintenace log.
Are vehicles and traffic segregated? Is there a site speed limit in place?

Are all scaffolds, ladders and platforms on site erected, used, inspected and ü The contractor to maintain safe scaffold and
6.0 50 50 inspection system.
maintained in good order? Are Scafftag in place?
Have all operatives been given the relevant method statement and risk
ü TBT dated
7.0 assessment briefing applicable to their work? Check at least 5 operatives / 50 50
19/9/2021
personnel.
8.0 all the above based on operations being carried out at the time of the audit. ü 50 50

Score 400 400

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 11 of 31
 QA Subs management

1.0 Have all subs been reviewed and accepted for use? ü 0 0

Have all relevant HSE requirements for their work been communicated to the ü
2.0 0 0
subs?
NB all the above based on operations being carried out at the time of the ü
3.0 0 0
audit.

Score 0 0

Project number DAM1-03-004 Project Name Storm Water Connection to Municipality Network 1st Industrial City Dammam

Auditor Khalid Atta Almnan Auditee Eammar Infrastructure Co.

DAM1-03-004-EMR-TS9-1-HSF-AUD-
Audit date 31-Jan-22 Audit reference Sheet 6 of 9
00008-00

Compliance % Observation & action required

Reference Evidence
Procedure / Subject Poss Act (CA = Corrective Action
number 100 75 50 0 NA reviewed IR = Improvement recommendation)

OHS MOD PR 03 Emergency Preparedness and Response

Has an Emergency Plan been developed for the site / office? Has this been Ref to ERP
ü (DAM1-03-004-
1.0 reviewed to reflect any changes? Is there a plan indicating emergency exits, 50 50 EMR-TS9-1-HSF-
assembly points, fire call points etc? PLN-0004-02)

Ref to ERP
ü (DAM1-03-004-
2.0 Does the Emergency Plan include a communication pathway? 50 50 EMR-TS9-1-HSF-
PLN-0004-02)

Have emergencies been incorporated into method statements with actions ü

3.0 50 50 All MSTs
identified in the event of an emergency?

4.0 Have potential emergency situations been raised in the following:

4.1 - HSE Inspection Report ü 50 50

Provide Emergency alarm and emergency

5.0 Is there any emergency equipment available on site e.g. alarms, spill kits etc? ü 50 25 spill kit.

The contractor to generate emergency

6.0 Is this equipment regularly inspected / checked / tested for use? ü 50 37.5 equipment check list and maintain the
record regularly.

Training training for fire extinguisher is available

7.0 Are people trained in the use of the emergency equipment? ü 50 37.5 attecndance however, no emergency alarm and spill kit is
dated 28/9/2021 found at site.

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 12 of 31
 fire RA ref.
(DAM1-03-004-
EMR-TS9-1-
HSF-SNT-0014-
Have practice drills been carried out to test emergency plans? Are these ü 00) Fire The contractor to conduct fire dril in the
8.0 50 50
recorded? prevention plan fourth quarterly drill.
ref. (DAM1-03-
004-EMR-TS9-
1-HSF-PLN-
0012-00)

9.0 Has a fire safety risk assessment been carried out and documented? ü 50 50
10.0 Have any recommendations from the Civil Defense / RA closed out? ü 0 0
Is there at least one first aider on site? Are there sufficient first aiders on site ü
11.0 50 50
for the risks associated?
12.1 Is there a first aid kit on site? Is the kit fully supplied? ü 50 50

Score 550 500

Project number DAM1-03-004 Project Name Storm Water Connection to Municipality Network 1st Industrial City Dammam

Auditor Khalid Atta Almnan Auditee Eammar Infrastructure Co.

DAM1-03-004-EMR-TS9-1-HSF-AUD-
Audit date 31-Jan-22 Audit reference Sheet 7 of 9
00008-00

OHS MOD PR 13 Monitoring & Measurement

Have HSE Inspection Reports been completed? Have any unsatisfactory

The weekly inspection reports are available
1.0 areas been identified? Have corrective actions been identified and completed ü 50 50 however, no record for daily inspection.
within the nominated timescale?

Did the project achieve > 85% compliance? If not, have appropriate actions ü
2.0 50 50
been recorded?

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 13 of 31
 3.0 Are all areas of concern identified being addressed in the report? ü 50 50

4.0 Have all actions arising out of the Report been closed out? ü 50 50

The contractor to monitor the waering of

5.0 Are all people on site wearing the appropriate PPE? ü 50 37.5 safety glass.

Is any additional monitoring been carried out on the project? What type of
6.0 monitoring is being completed and are the results acceptable? E.g. ill health, ü 0 0
incidents, near misses.

Housekeeping - is there an effective housekeeping regime in place? Is the ü The contractor to improve the housekeeping
7.0 50 37.5 in the pump station area.
site and office areas tidy, no trip hazards, no floor holes / gaps etc?

Score 300 275

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 14 of 31
 OHS MOD PR 96 Monitoring & Measurement Equipment

Does the site use monitoring and measuring equipment? If so, do we have ü
1.0 50 50
current service and calibration certificates?

2.0 Does all equipment carry the label notifying of the next calibration date? ü 50 50

Score 100 100

OHS MOD PR 09 Legal compliance

Has any external regulatory authority visited site? If so was OHS MOD PR 6 ü
1.0 0 0
followed? Was the HSE Department notified of the visit?

Have all actions required from previous Site Inspection Reviews been ü
2.0 0 0
completed within the agreed timescale?
Have any additional audits been carried out under the MODON Internal Audit ü
3.0 0 0
Programme?
Have all non-conformances raised been reported with the actions required ü
4.0 0 0
identified?
Where the site has a consent / permit / licence etc, are all numerical and ü
5.0 0 0
none numerical conditions being met?

Score 0 0

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 15 of 31
 Project number DAM1-03-004 Project Name Storm Water Connection to Municipality Network 1st Industrial City Dammam

Auditor Khalid Atta Almnan Auditee Eammar Infrastructure Co.

DAM1-03-004-EMR-TS9-1-HSF-AUD-
Audit date 31-Jan-22 Audit reference Sheet 8 of 9
00008-00

Compliance %
Reference Evidence Observation & action required
Procedure / Subject Poss Act (CA = Corrective Action
number reviewed IR = Improvement recommendation)
100 75 50 0 NA

OHS MOD PR 01 Accidents, Incidents, Non-conformance and Corrective and Preventive Action

Have all safety, health & environmental incidents been reported to the HSE ü
1.0 50 50
Department using OHS MOD PR 01?

Has an investigation been completed and any remedial actions implemented

to prevent it happening again? Has the root cause worksheet been used to ü
2.0 0 0
evaluate cause, and assist in the investigation, identify improvements,
corrective and preventive actions?

Have all Accidents, Incidents, & Near misses been reported to the HSE To the time of the
ü audit there are 15
3.0 Department? Have these been reported to corporate on a monthly basis to 50 50 near-miss reports
comply with Corporate reporting protocols? and 0 accident.

Are all accidents reported using OHS MOD RR 05? Have all Accidents, ü
4.0 50 50
Incidents, & Near misses been reported in Industrysafe?

Have all Reportable Accidents, Diseases, Dangerous Occurrences been ü

5.0 0 0
reported to the regulatory authority as and when required?
Have any non-conformances arisen from previous audits? Check all previous ü
6.0 0 0
audits and inspections for action closure.

7.0 Has the nominated individual closed out the actions identified? ü 0 0

8.0 Are records of the previous non-conformances available for inspection? ü 50 50

Score 200 200

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 16 of 31
 QA Records and Records Management

Have all the records required in the Project Environmental Management Plan ü
1.0 50 50
and Construction Phase Health and Safety Plan been completed?

Have the documents and records referred to in the HSE Implementation

2.0
System been completed and retained including:

2.1 - Project Environmental Management Plan ü 50 50

2.2 - Construction Phase Health and Safety Plan ü 50 50 HSE Plan

2.3 - Induction Briefing Records ü 50 50

ü TBT attendance
2.4 - Method Statement briefings 50 50
21/9/2021

ü TBT attendance
2.5 - Risk assessment briefings 50 50
20/9/2021

2.6 - Monthly Inspections and HSE Inspections ü 50 50

2.7 - Incident Reports ü 50 50

3.0 Have additional records been completed and retained on site:

3.1 - Discharge Consents ü 0 0

3.2 - Waste Transfer Notes ü 0 0

3.3 - Waste Carrier Licenses ü 0 0

Score 400 400

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 17 of 31
 Project number DAM1-03-004 Project Name Storm Water Connection to Municipality Network 1st Industrial City Dammam

Auditor Khalid Atta Almnan Auditee Eammar Infrastructure Co.

DAM1-03-004-EMR-TS9-1-HSF-AUD-
Audit date 31-Jan-22 Audit reference Sheet 9 of 9
00008-00

Compliance %
Reference Evidence Observation & action required
Procedure / Subject Poss Act (CA = Corrective Action
number reviewed IR = Improvement recommendation)
100 75 50 0 NA

QA Internal Audit

The contarctor shall establish a close-out

Have all actions required from previous Site Inspection Reviews been ü report after the audit and adress the
1.0 50 50
completed within the agreed timescale? findings to the project management

Is the audit programme complete and up to date? Are internal auditors ü contractor Audit
2.0 50 50
identified and trained in the system audit process? schedule

Have any additional audits been carried out under the MODON, Internal ü
3.0 0 0
Audit Programme? e.g. HSE system audit, Office audit etc.

The contarctor shall establish a close-out

Have all non-conformances / corrective / preventive actions raised been ü report after the audit and adress the
4.0 50 37.5
reported with the actions required identified? findings to the project management

Have all non-conformances / corrective / preventive actions raised been ü

5.0 0 0
closed out? Check last 3 reports.

6.0 Has the relevant documentation been completed including:

6.1 - Audit Checklist ü 50 50

6.2 - Audit Record ü 50 50

6.3 - Audit Report ü 50 50

The contarctor shall establish a close-out

6.4 - Corrective/ Preventive action closure ü 50 37.5 report after the audit and adress the
findings to the project management

Score 350 325

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 18 of 31
 QA Management Review

ü MRM dated
1.0 Has a Management Review been carried out within the last 12 months? 50 50
15/9/2021

Have the minutes from the Management Review Meeting been issued to all ü MRM dated
2.0 50 50
personnel? 15/9/2021

ü MRM dated
3.0 Do the minutes clearly identify responsibilities and timescales for action? 50 50
15/9/2021
Have any changes identified been implemented into the HSE Management ü MRM dated
4.0 50 50
System? 15/9/2021

Score 200 200

General Comments

This assessment has been conducted in presence of contractor Project Manager and Site Engineer . This was the First OHSMS audit on the 2022 to see the overall compliance with MODON H&S procedure / standards and contractors approved HSE
Plan.
The positive points of the audit were:
1. Supportive and dedicated Management.
2. System in place for the minimum documentation and control.

The negative aspects of the audit were:

1. poor housekeeping. 2- Scaffold safety requirements are not in place
In conclusion, the audit identified the main areas where the contractor needs an improvement, all areas required actions are highlighted on corrective action page for contractor action to improve compliance with legal and contractual
requirements.

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-2894-00

Revision Number: 00 Page 19 of 31
 Executive Summary

Project Name Storm Water Connection to Municipality Network 1st Industrial City Dammam

Project number DAM1-03-004

Inspection date 31-Jan-22

Auditor Khalid Atta Almnan

Auditees Eammar Infrastructure Co.

Actual
Reference no. Procedure / Subject Possible score
score
OHS MOD PR 16 Policy Statement 400 350
OHS MOD PR 05 Environmental Aspects Health & Safety Risk Planning 500 487.5
OHS MOD PR 08 Legal and Other Requirements 300 300
OHS MOD PR 14/
OHS MOD PR 11
Objectives & Targets and Management Programmes 300 287.5

OHS MOD PR 17 Structure & Responsibility 250 250

OHS MOD PR 94 Performance Reporting 200 200
QA Training, Awareness & Competence 500 500
OHS MOD PR 02 Communication Participation and Consultation 550 537.5
QA Document and Data Control 250 250
OHS MOD PR 15 Operational Control 400 400
QA Subs management 0 0
OHS MOD PR 03 Emergency Preparedness and Response 550 500
OHS MOD PR 13 Monitoring & Measurement 300 275
OHS MOD PR 96 Monitoring & Measurement Equipment 100 100
OHS MOD PR 09 Legal compliance 0 0
Accidents, Incidents, Non-conformance and Corrective and
OHS MOD PR 01 200 200
Preventive Action
QA Records and Records Management 400 400
QA Internal Audit 350 325
QA Management Review 200 200
Total Score 5,750 5163
REPORT DAM1-03-004-EMR-TS9-1-HSF-AUD-00007-00 90

100
98
96
94
PORT # S19022/DAM3/INF/WOR/SAL/LTR/TS9/0101
Signature
92
90
88
86
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Khalid Atta Almnan

HSE Audit Checklist

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HSE Audit Checklist
Page 21 of 31
 Corrective Action Plan Log

Project Name Storm Water Connection to Municipality Network 1st Industrial City Dammam

Project no. DAM1-03-004

Audit date 31-Jan-22

Auditors Khalid Atta Almnan

Auditees Eammar Infrastructure Co.

Reference no. Observation and corrective action required Agreed target Date
close out date closed out
OHS MOD PR 16 Policy Statement

1.0 0

2.0 0

3.0 0
4.0 0
5.0 0

6.0 0

7.0 0

8.0 0

OHS MOD PR 05 Environmental Aspects Health & Safety Risk Planning

1.0 0

2.0 0

3.0 0

4.0 0

5.0 0

6.0 0

7.0 0

8.0 0

9.0 0

10.0 0

HSE Audit Checklist

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 Reference no. Observation and corrective action required Agreed target Date
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REPORT DAM1-03-004-EMR-TS9-1-HSF-AUD-00007-00
Legal and Other Requirements

1.0 0

2.0
0
3.0 0

Signature 0

#VALUE! 0

#VALUE! 0

#VALUE! 0

#VALUE! 0

#VALUE! 0

OHS MOD PR 14/

Objectives & Targets and Management Programmes
OHS MOD PR 11

Khalid Atta Almnan The contractor is to prepare acheivment plan for MODON objectives. 20-Feb-22

2.0 0

3.0 0

4.0 0

5.0 0

6.0 0

OHS MOD PR 17 Structure & Responsibility

1.0 0

2.0 0

3.0 0

4.0 0

5.0 0

OHS MOD PR 94 Performance Reporting

1.0 0

2.0 0

3.0 0

4.0 The contractor is set a plan for the management tours. 20-Feb-22

HSE Audit Checklist

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 Reference no. Observation and corrective action required Agreed target Date
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QA Training, Awareness & Competence

1.0 0

2.0 There is a traing matrix available whoever, the contractor has to conduct training analysis. 20-Feb-22

3.0 0

Have nominated individuals had their responsibilities explained to them, and have they discharged their responsibilities correctly? Is
4.0 20-Feb-22
authority delegated due to absence etc?

5.0 0

6.1 0

6.2 0

6.3 0

6.4 0

7.0 0

HSE Audit Checklist

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 Reference no. Observation and corrective action required Agreed target Date
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OHS MOD PR 02 Communication Participation and Consultation

0.0 0

2.0 0

3.0 0

4.1 0

4.2 The contractor to prepare lesson leared and post on the notice board. 20-Feb-22

4.3 0

4.4 0

4.5 0

4.6 0

5.0 0

6.0 0

7.0 0

8.0 0

QA Document and Data Control

1.0 0

2.0 0

3.0 0

4.0 0

5.0 0

HSE Audit Checklist

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 Reference no. Observation and corrective action required Agreed target Date
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OHS MOD PR 15 Operational Control

1.0 0

2.0 0

3.0 0

4.0 0

5.0 0

6.0 The contractor to maintain safe scaffold and inspection system.

7.0 0

8.0 0

QA Subs management

1.0 0

2.0 0

3.0 0

OHS MOD PR 03 Emergency Preparedness and Response

1.0 0

2.0 0

3.0 0

4.1 0

5.0 Provide Emergency alarm and emergency spill kit. 20-Feb-22

6.0 The contractor to generate emergency equipment check list and maintain the record regularly. 20-Feb-22

7.0 training for fire extinguisher is available however, no emergency alarm and spill kit is found at site. 20-Feb-22

8.0 The contractor to conduct fire dril in the fourth quarterly drill. 20-Feb-22

9.0 0

10.0 0

11.0 0

12.1 0

HSE Audit Checklist

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 Reference no. Observation and corrective action required Agreed target Date
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OHS MOD PR 13 Monitoring & Measurement

1.0 The weekly inspection reports are available however, no record for daily inspection. 20-Feb-22

2.0 0

3.0 0

4.0 0

5.0 The contractor to monitor the waering of safety glass. 20-Feb-22

6.0 0

7.0 The contractor to improve the housekeeping in the pump station area. 20-Feb-22

OHS MOD PR 96 Monitoring & Measurement Equipment

1.0 0

2.0 0

OHS MOD PR 09 Legal compliance

1.0 0

2.0 0

3.0 0

4.0 0

5.0 0

HSE Audit Checklist

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 Reference no. Observation and corrective action required Agreed target Date
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OHS MOD PR 01 Accidents, Incidents, Non-conformance and Corrective and Preventive Action

1.0 0

2.0 0

3.0 0

4.0 0

5.0 0

6.0 0

7.0 0

8.0 0

QA Records and Records Management

1.0 0

2.1 0

2.2 0

2.3 0

2.4 0

2.5 0

2.6 0

2.7 0

3.1 0

3.2 0

3.3 0

HSE Audit Checklist

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 Reference no. Observation and corrective action required Agreed target Date
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QA Internal Audit

1.0 The contarctor shall establish a close-out report after the audit and adress the findings to the project management 20-Feb-22

2.0 0

3.0 0

4.0 The contarctor shall establish a close-out report after the audit and adress the findings to the project management 20-Feb-22

Has an Emergency Plan been developed for the site / office? Has this been reviewed to reflect any changes? Is there a plan indicating
5.0 20-Feb-22
emergency exits, assembly points, fire call points etc?

6.1 0

6.2 0

6.3 0

6.4 The contarctor shall establish a close-out report after the audit and adress the findings to the project management 20-Feb-22

QA Management Review

1.0 0

2.0 0

3.0 0

4.0 0

General Comments

HSE Audit Checklist

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 Reference no. Observation and corrective action required Agreed target Date
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This assessment has been conducted in presence of contractor Project Manager and Site Engineer . This was the First OHSMS audit on the 2022 to see the overall compliance with MODON H&S procedure / standards and contractors
approved HSE Plan.
The positive points of the audit were:

1. Supportive and dedicated Management.

2. System in place for the minimum documentation and control.

The negative aspects of the audit were:

1. poor housekeeping. 2- Scaffold safety requirements are not in place

In conclusion, the audit identified the main areas where the contractor needs an improvement, all areas required actions are highlighted on corrective action page for contractor action to improve compliance with legal and contractual
requirements.

HSE Audit Checklist

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 No drinking cups found at site. No sign board for the temporary materials
staging area.

Some of the workers are not aware of the

site emergency assembly point.

Positive findings:
1- Workers are aware of the STARRT/ Take 5 for safety.
2- Workers are wareing complete PPE.
3- Cold drinking water and toilet are provided for the site workers.
4- Workers are aware of the emergency contact numbers.