INTRODUCTION

The annual occupational safety and health performance awards are intended to give due recognition to all
organizations/companies which have achieved commendable safety and health records and/or have shown
improvement in occupational safety and health processes through sound safety and health management
systems.

The MSOSH Occupational Safety and Health Awards provide the opportunity to give employees, management
and public the chance to hear about your companys success story on safety and health performance which can
be an example to inspire other organizations.

All organizations are strongly encouraged to participate in the 2016 Occupational Safety & Health Award. This
exercise will provide the Society the opportunity to identify areas where the Society can provide assistance to
the respective companies/organizations in the development of a long term safety and health management
systems to benefit the employees in particular and the organization at large.

Each successful applicant will receive the award at the presentation ceremony, which will be held at a leading
hotel, and presented by the Guest of Honors on the auspicious night.

BUSINESS GROUPING

For the 2016 Occupational Safety and Health Awards, MSOSH has categorized organizations into ten (10)
business groupings. This will enable participants to compete fairly within their own grouping and they are as
follows:
1. 1. The Petroleum, Gas, Petrochemical & Allied Sectors
2. 2. The Electronics and Electrical Sectors
3. 3. The Manufacturing & Chemical Sectors
4. 4. The Utilities Sectors
5. 5. The Construction & Engineering Construction Sectors
6. 6. The Agricultural Sectors(Fishery/Forestry/Plantation)
7. 7. The Services Sectors(Hospitality/Banks/Theme Parks, etc)
8. 8. The Logistics and Transportation Sectors
9. 9. The Educational Sectors
10. 10. Public Sectors &Statutory Bodies

USE OF AWARD LOGO.

The award winning company eligibility to use the Awards logo for publicity purposes within the winning year
until the announcement of the next award winners or until the printed letterhead is used up.

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 TERMS AND CONDITIONS :

1) The application for the award is open to All MSOSH Corporate Members and Non-Members. Deadline for
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the submission of application form and requested documents is Monday, 27 February 2017.
2) No submission will be entertained after the deadline.
Those who need additional time for submission can submit a written appeal enclosing a NON
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REFUNDABLE appeal fee of RM550-00 for each site on Monday, 20 February 2017.
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Extended deadline for successful appeal cases is on Monday, 13 March 2016 (upon receiving of appeal
fees).
3) The administration and auditing fees:

Category Award Member Non-Member

a) Platinum RM2,200-00 RM3,300-00
b) Grand and Gold Merit RM1,650-00 RM2,200-00
c) Gold, Silver and Bronze RM1,100-00 RM1,650-00
d) Additional Fee for Offshore Facilities RM2,000-00 RM3,000-00

MSOSH seeks your understanding and cooperation for an additional fee audit offshore facilities,
the expenses of which were paid for our auditors to undergo the mandatory Basic Offshore Safety &
Emergency Training (BOSET), Special Training for H2S, medical checkup fees and additional
travelling days required to audit offshore facilities.

e) RM1,100-00 fee for member per site and RM2,000 fee for non- member per site for an
organization requesting for a written REPORT.
No written reports will be issued by the Auditors after the audit. Findings will be presented orally at
the closing meeting at the end of the site audit. However, an organization can still request for a
written report within two (2) weeks from the date of site audit. A written report will be submitted to
the auditee within one (1) month following the request date. The content of the report will cover the
issues discussed during the closing meeting.

f) All fees should be made payable to:

Malaysian Society for Occupational Safety and Health

Account No : 8002324462
CIMB Bank Berhad, Section 52, Petaling Jaya, Selangor.

4) All requested documents SHALL be attached.

GRAND AWARD and PLATINUM AWARD APPLICANTS are given the option of submitting soft
copy of scanned documents via CD to MSOSH.
Panel of Auditors has the right to assume unavailability of required documents should the requested
documents are not attached. Points will not be given if any required document is not attached.

5) Documents shall be relevant and applicable to the site being audited. Eg: Do Not send HQ documents to
represent the site unless it is being implemented at site. As much as possible, the documents should be
from the site to be audited. Every site must submit a complete and independent set of documents.
6) The document contents shall be orderly arranged and clearly identified in accordance with the OSH
Management System Evaluation Criteria.
7) Applicant needs to ensure adequate preparation in terms of manpower, site documentation, personal
protective equipment, etc are ready during the site audit. Applicant need to ensure site personnel are
aware of the audit dates and relevant preparation are made prior to the audit
8) The Panel of Auditors has the right to disqualify entries which contain false information / declaration.
9) Companies, including their contractors that have fatalities in the competition period shall not apply for
Grand & Gold Merit Award.
10) Companies those are unable to attach any document along with this application because it is against their
companys policy SHALL NOT participates.

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 11) The assessment period:
a) 1 January 2015 to 31 December 2016 (TWO year period) for Platinum and Grand Only
b) 1 January 2016 to 31 December 2016 (ONE year period) for Gold Merit, Gold, Silver and Bronze
Award.

12) All documents will be treated with the strictest confidence and can only be viewed by the Panel of
Auditors.

13) Participating companies may collect their documents from MSOSH office within 3 months after the award
dinner failing which MSOSH reserves the right to dispose the documents in an appropriate manner.

14) An Award Technical Committee, which is independent from the auditors, will make the decision and the
decision is final. Any appeal will NOT be entertained.

15) MSOSH HAS THE RIGHT TO HOLD OR NOT TO AWARD ANY PARTICIPATING ORGANIZATION
WITH THE AWARD APPLIED/ELIGIBLE IF ANY MAJOR OR SERIOUS ACCIDENT/INCIDENT
OCCURS OUTSIDE THE AUDIT PERIOD IN THE CURRENT YEAR (BEFORE OR DURING THE
AWARD PRESENTATION DAY)

CRITERIA AND CATEGORIES OF AWARDS

The 2016 Occupational Safety and Health Awards are based on the participating companie's safety and health
management performance. There will be six categories of awards, namely, Platinum, Grand, Gold Merit, Gold,
Silver and Bronze. The performance levels for the categories are as described below:

a) Platinum = Ultimate OSH Performance

b) Grand = Superior OSH Performance

c) Gold Merit = Excellent OSH Performance

d) Gold (Class I & II) = Very Good OSH Performance

e) Silver = Good OSH Performance

f) Bronze = Satisfactory OSH Performance

The qualification required to participate in the states categories is listed below:

1. MSOSH PLATINUM AWARD

1.1 No limit to the number of employees.

1.2 Companies which have won three (3) Grand Awards since 2003 qualify to apply for Platinum
Award.
1.3 No worksite fatalities for 5 consecutive years including the year of participation.
1.4 The company shall participate in the current OSH Award Competition.
1.5 Candidates are subject to document audit, site audits and Platinum audit checklist.

Note: The Organization which applies for the Platinum Award but does not qualify for the applied
category will be granted any other category, as decided by the Award Technical Committee.

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 2. MSOSH GRAND AWARD

2.1 MSOSH GRAND AWARD (minimum 50 employees)

2.1.1 Minimum 50 employees.

2.1.2 Achieved No Lost Time Injury (LTI) for assessment period of 2 years i.e. from 1 January 2015 to
31 December 2016. No Worksite Fatality for 2 consecutive years.
2.1.3 Documentation Audit score shall be at least 90%.
2.1.4 Site audit to verify the OSH implementation & the physical condition of the worksite will be
conducted by min. 2 Panel of Auditors. Auditors will again validate related documents & also
interview Staff/Contractors at site to determine their level of OSH competency & awareness.
2.1.5 Site audit score shall be at least 90%
2.1.6 Workplace Assessment score shall be at least 90%
2.1.7 Panel of auditors may conduct second site audit to verify the nomination and the result of the
first audit, if deemed necessary.
2.1.8 Company should have won at least one (1) Gold Award since 2003. (Please submit documented
evidence).

2.2 MSOSH GRAND AWARD (Less than 50 employees)

2.2.1 Less than 50 employees.

2.2.2 Achieved No Lost Time Injury (LTI) for assessment period of 2 years i.e. from 1 January 2015 to
31 December 2016 and No Worksite Fatality for 5 consecutive years.
2.2.3 Documentation Audit score shall be at least 90%.

2.2.4 Site audit to verify the OSH implementation & the physical condition of the worksite will be
conducted by min. 2 Panel of Auditors. Auditors will again validate related documents & also
interview staff/contractors at site to determine their level of OSH competency & awareness.
2.2.5 Site audit score shall be at least 90%.

2.2.6 Workplace Assessment score shall be at least 90%

2.2.7 Panel of auditors may conduct second site audit to verify the nomination and the result of the
first audit, if deemed necessary.
2.2.8 Company should have won at least one (1) Gold Award since 2003 (Submit documented
evidence)
Note: The Organization which applies for the Grand Award but does not win the applied category will
be granted any other category, as decided by the Award Technical Committee.

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 3. MSOSH GOLD MERIT AWARD

3.1 MSOSH GOLD MERIT AWARD (minimum 50 employees)

3.1.1 Minimum 50 employees.
3.1.2 Achieved No Lost Time Injury (LTI) for assessment period of 1 year i.e. from 1 January 2016 to
31 December 2016 and No Worksite Fatality for 1 year.
3.1.3 Documentation audit score shall be at least 85%.
3.1.4 Site audit to verify the OSH implementation and the physical condition of the worksite will be
conducted by min. 2 Panel of Auditors. Auditors will again validate related documents & also
interview staff/contractors at site to determine their level of OSH competency and awareness.
3.1.5 Site audit score shall be at least 85%.
3.1.6 Workplace Assessment score shall be at least 85%
3.1.7 Panel of Auditors may conduct second site audit to verify the nomination and the result of the
first audit, if deemed necessary.
3.1.8 Company should have won at least one (1) Gold Award since 2003 (Submit documented
evidence)

3.2 MSOSH GOLD MERIT AWARD (Less than 50 employees)

3.2.1 Less than 50 employees.
3.2.2 Achieved No Lost Time Injury (LTI) for assessment period of 1 year i.e. from 1 January 2016 to
31 December 2016 and No Worksite Fatality for 5 years.
3.2.3 Documentation audit score shall be at least 85%.
3.2.4 Site audit to verify the OSH implementation and the physical condition of the worksite will be
conducted by min. 2 Panel of Auditors. Auditors will again validate related documents & also
interview staff/contractors at site to determine their level of OSH competency and awareness.
3.2.5 Site audit score shall be at least 85%.
3.2.6 Workplace Assessment score shall be at least 85%
3.2.7 Panel of Auditors may conduct second site audit to verify the nomination and the result of the
first audit, if deemed necessary.
3.2.8 Company should have won at least one (1) Gold Award since 2003(Submit documented
evidence)

4. MSOSH GOLD AWARD (Class I)

4.1 No limit to the number of employees

4.2 Documentation audit score shall be at least 78%.
4.3 Site audit to verify the OSH implementation and the physical condition of the worksite will be
conducted by min. 1 Panel of Auditor. Auditor will again validate OSH related documents and
also interview staff/contractors at site to determine their level of OSH competency.
4.4 Site audit score shall be at least 78%.
4.5 Workplace Assessment score shall be at least 78%

5. MSOSH GOLD AWARD (Class II)

5.1 No limit to the number of employees

5.2 Documentation audit score shall be at least 70%.
5.3 Site audit to verify the OSH implementation & the physical condition of the worksite will be
conducted by min. 1 Panel of Auditor. Auditor will again validate OSH related documents and also
interview staff/contractors at site to determine their level of OSH competency.
5.4 Site audit score shall be at least 70%.
5.5 Workplace Assessment score shall be at least 70%

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 6. MSOSH SILVER AWARD

6.1 No limit to the number of employees

6.2 Documentation Audit score shall be at least 50%.
6.3 Site Audit to verify the OSH implementation and the physical condition of the worksite will be
conducted by min. 1 Panel of Auditor. Auditor will again validate OSH related documents and
also interview staff/Contractors at site to determine their level of OSH competency
6.4 Site audit score shall be at least 50%.
6.5 Workplace Assessment score shall be at least 50%

7. MSOSH BRONZE AWARD

7.1 No limit to the number of employees.

7.2 Documentation audit score shall be at least 35%.
7.3 Site audit to verify the OSH implementation and the physical condition of the worksite will be
conducted by min. 1 Panel of Auditor. Auditor will again validate OSH related documents and
also interview staff/contractors at site to determine their level of OSH competency
7.4 Site audit score shall be at least 35%.
7.5 Workplace Assessment score shall be at least 35%

8. MSOSH CERTIFICATE OF PARTICIPATION

8.1 Organizations that do not qualify under any one of the categories above will be awarded with
MSOSH OSH Award Certificate of Participation

9. DEFINITIONS

9.1 Lost Time Injury/Illness (LTI) cases. These include:

9.1.1 Fatality

Death resulting from a work injury or occupational illnesses

9.1.2 Permanent Total Disability

Work injury which incapacitates an employee permanently and results in termination of

employment on medical grounds.

9.1.3 Permanent Partial Disability

Work injury which results in complete loss, or permanent impairment of functions of parts of the
body.

9.1.4 Lost Time Injury

Work injury other than permanent partial disability which renders the injured person temporarily
unable to perform a regular job after the next cycle shift on which the injury was received.
Eg: 1 full day MC is already considered an LTI.

9.1.5 Lost Time Illness

Illnesses due to the work that renders the person temporarily or permanently unable to perform
a regular job after the next cycle shift on which the illness was established. Subsequent
MC due to the same illness shall also be counted. Occupational Health Doctor's (OHD) advice
is needed before any case can be considered to be work related.

9.1.6 In all the above cases, LTI of permanent and temporary contractor's or vendor's at worksite
shall also be included.

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 9.2 LTI Case

Numbers of LTI incident in one year. LTI means Lost Time Injury or Lost Time Illness

9.3 LTI Frequency Rate (FR)

LTI frequency rate is the number of lost time injuries/illnesses per 1,000,000 exposure hours worked
(based on Notification of Accident, Dangerous Occurrence, Occupational Poisoning and Occupational
Disease (NADOPOD) Regulations 2004 Form JKKP 8) during the year, and is calculated as follows:

No. of LTI CASES

LTI FR = --------------------------------------- X 1,000,000MAN HOURS

TOTAL MAN HOURS WORKED

9.4 Total Man Hours Worked (TMHW)

Number of Employees & Contractors employed in one year multiplied by Number of Hours worked in a
day multiplied by Number of Days worked in a Year

TMHW = Number Employee & Contractors X Number Hours/day X Number Days/Year

Note: TMHW shall include the total Man Hours Worked by the Permanent & Contractual Staff and
Permanent & Temporary Contractors.

9.5 LTI Severity Rate (SR)

LTI Severity rate is the number of working days lost (i.e: no. of MC days) per 1,000,000 exposure hours
worked (based on Notification of Accident, Dangerous Occurrence, Occupational Poisoning and
Occupational Disease (NADOPOD) Regulations 2004 Form JKKP 8) during the year, and is
calculated as follows:

No. of LTI Days

LTI SR = ------------------------------------------- X 1,000,000 MANHOURS

TOTAL MAN HOURS WORKED

10. EMPLOYEE

Includes permanent/contract staff and permanent & temporary contractors

(Temporary = minimum duration of six months).

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 11. APPLICATION FORM

Organizations applying for the awards should complete the enclosed application form and questionnaire
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and return them together with requested documents and the application fee not later than Mon, 27
February 2017.

12. PANEL OF AUDITORS

1. Department of Occupational Safety and Health (DOSH),

2. Social Security Organization (SOCSO),
3. Malaysian Society for Occupational Safety and Health (MSOSH),
4. Federation of Malaysian Manufacturers (FMM),
5. National Institute of Occupational Safety and Health (NIOSH),
6. SIRIM Berhad.
7. Malaysian Employer Federation (MEF),
8. Other selected resources.

13. AWARD TECHNICAL COMMITTEE

Minimum Three (3) or Maximum Five(5) Independent MSOSH Members appointed by the Management
Committee

14. MSOSH OSH AWARDS DINNER

Participants are encouraged to buy the table to support the Society.

SUSTAINABLE OSH CULTURE

ZARIMAN BIN ZAINUDDIN

ORGANISING CHAIRMAN
MSOSH OSH AWARDS 2016

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

CHAIRMAN
MSOSH OSH Awards 2016
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4 Floor,Wisma PERKESO, Jalan Selangor 46050 Petaling Jaya, Selangor.
Tel: 03-79561763 / 79588396

A. PARTICULARS OF COMPANY/ORGANIZATION

1. Name of Company :

SOSCO code no. :

Address :

Tel No. : Fax No :

2. Name of site to be :
audited

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 Agricultural Sectors

Allied Sectors (Fishery/Forestry/Plantation)
Services Sectors (Hospitality/Banks/Theme
Electronics and Electrical Sectors
Parks, etc)

Manufacturing & Chemical Sectors Logistics and Transportations

Utilities Sectors Educational Sectors

Construction & Engineering Construction
Public Sectors & Statutory Bodies
Sectors

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 4. Number of Employees Incl. : More than 1000
(Contract Employees &
Permanent Contractors) 501 - 1000

301 - 500

101 - 300

50 - 100

Less than 50

Please
Where applicable.
Mark

B. PARTICULARS OF CHIEF EXECUTIVE OFFICER & PERSON SUBMITTING THE ENTRY FORM

1. Application submitted by

Name:

Position:

E-mail:
Signature & stamp
Tel No:

Fax No:

2. Contact Person:

Position:

E-mail

Tel No. Fax:

H/p No.

3. Name of Chief Executive Officer/ Managing Director / General Manager

Name:

Designation:
Signature & stamp

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 C. CATEGORY OF AWARDS

Based on the company's 2015 (for Platinum, Grand and Gold Merit Awards only) and/or 2016 (for Gold
and other awards) OSH performance and based on the Award criteria stated on the front page, tick the
category applied for: (Note that new participations CAN ONLY apply for Gold Category and below)

PLATINUM GRAND GOLD MERIT

GOLD SILVER BRONZE

Note:
Applicants for Platinum Award have to provide documented evidence of winning the MSOSH Grand
Award three times since 2003. Grand & Gold Merit award applicants should include evidence of having
won gold awards before.

D. APPLICATION FEE

Category Award Member Non-Member

a) Platinum RM2,200 RM3,300
b) Grand and Gold Merit RM1,650 RM2,200
c) Gold, Silver and Bronze RM1,100 RM1,650
d) Additional Fee for Offshore Facilities RM2,000 RM3,000
e) Written REPORT per site RM1,100 RM2,000

TOTAL RM

Cheque No:

Payment should be made payable to : Malaysian Society for Occupational Safety and Health
Account No.: 8002324462 CIMB Bank Berhad, Section 52, Petaling Jaya, Selangor.

E. FIRST TIME PARTICIPANT:

YES

NO
(Please indicate year & award received)

Year :

Award Received :

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 F. OSH PERFORMANCE MEASUREMENT

Please provide the following information

1. 2016 OSH Performance:

a) Total man-hours worked accumulated in 2016:

______________________________________________
(Refer to item 9.4 page 8 on the front)

b) Average number of Staff & Permanent Contractors employed in 2016:

___________________________

c) Number of dangerous occurrence/s:

_______________________________________________________

d) Total no of fatalities :
_______________________________________________________________

e) Total no. of LTI cases in 2016:

__________________________________________________________

f) Total no. of days away from work in 2016:

_________________________________________________

g) Latest LTI was on __________________________________________________(date)

h) LTI frequency rate:

____________________________________________________________________
(Refer to item 9.3 page 8 on the front for calculation)

i) LTI severity rate:

_____________________________________________________________________
(Refer to item 9.5 page 8 on the front for calculation)

2. 2015 OSH Performance (Applicable for Platinum and Grand Award applicants only):

a) Total man-hours worked accumulated in

2015:______________________________________________
(Refer to item 9.4 page 8 on the front)

b) Average number of staff & contractors employed in 2015:

____________________________________

c) Total Fatality :
_______________________________________________________________________

d) Last fatality date :

_____________________________________________________________________

e) Last LTI was on __________________________________________________ (date)

f) Last dangerous occurrence was on __________________________________ (date)

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G. 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

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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
Last 4 SHC meeting dates in year 2016: 1______, 2_______, 3_______,
(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) 2016 S&H Committee meeting minutes complete with
attendance

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)

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 * 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)

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.

*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).

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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 2016 OSH objectives and 2015 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 to 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 2016 Training Need Analysis (TNA) form
c) 2016 Training Plan (and 2015 training plan for Platinum and Grand only)
d) Minimum of 3 OSH training attendance for training conducted in 2016 (and 2015 for
Platinum and Grand only)

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 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 periodical refresher thereafter.
Contractors have to sit for internal / external exams before they are issued the
(4)
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

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 (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) A copy of Contractor S&H pre-evaluation questionnaire
c) Sample of Contractor Induction booklet
d) A copy of the Contractor 2016 S&H Induction attendance list
e) Copy of Contractor 2016 S&H Sub Committee meeting minutes
f) A copy of 2016 S&H Tool Box Talk or Pre Job briefing attendance
g) A copy of Contractor S&H post-evaluation questionnaire
h) Evidence of Drug & Alcohol test was carried out.

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) MSDS/SDS for all chemicals stored, used and disposed are available, and in
Bahasa Malaysia and English languages.
(6) All chemicals, other hazardous material and hazardous waste containers are
appropriately stored/ disposed.
(7) Noise monitoring, dust exposure, ergonomics, stress, indoor air quality and
confined space program are implemented.

*Please attach
a) Minimum 3 samples of MSDS/SDS
b) A sample 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 2016 chemical safety training attendance
f) A copy of 2016 PPE training attendance.

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 2016 S&H awareness & promotional activity plan (details on types of S&H

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 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 2016.

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

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 b) 1 sample of specific emergency scenario action plan (eg: Fire, Chemical Spill, Gas Leak,
Bomb Threat, etc)
c) 2016 ER training attendance
d) 1 copy of 2016 ER equipment inspection checklist records (that have been filled up).
e) 1 copy of 2016 drill/ exercise/ simulation/ evacuation 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 2016 OSH KPI (and 2015 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

Health/Medical surveillance program includes Occupational Poisoning,

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

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

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

Management, Fatigue Management, Quit Smoking, Weight Management,
(8)
Workers Vaccination, Drug & Alcohol Control, Dengue/Malaria/Zika Prevention,
Non Communicable Disease Programs etc

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 OSH Performance covers tracking and analyzing of Medical Leave, Medical
(9) cost, Hospitalization cost and Insurance cost, SOCSO reporting and commuting
accident cases

*Please attach
a) Copy of the 2016 OSH site inspection report & the status
b) 2016 OSH management system audit report & the status
c) A copy health/medical surveillance summary report (including Occupational
Poisoning, Occupational Disease, Biological monitoring & Noise Induced Hearing
Loss (NIHL) Noise Monitoring)
d) A copy of the employees health/medical surveillance summary report/, medical
removal report (with the name erased)
e) Copy of reports/photos on Health/Medical Programs conducted in 2016
f) Summary of overall OSH Performance Report (including Medical Leave, Medical cost,
Hospitalization cost and Insurance cost, SOCSO reporting and Commuting accident
cases for 2016
g) Sample of Health-related program or photos (MSD Management, Fatigue
Management, Quit Smoking Program etc.)

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 2016 completed IOIIDONC investigation form and the findings
c) A copy of the incident investigation team training attendance list.
d) A copy of the 2016 JKKP 8 Form.

5.4 Other Incidents:

List the last three (3) dates and brief description of the above that happened in 2016, if any.

1)___________________________________________________________________________

2) ___________________________________________________________________________

3) ___________________________________________________________________________

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 5.5 Internal Audit.
List dates of any OSH internal audits in 2016 and attach the executive summaries of the audit

1) ___________________________________________________________________________

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 2016 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 OSH Management System

Yes No
(1) The Company has established and implemented a recognized OSH
Management System (eg:OHSAS18001, MS 1722, ISRS, BS 8800,
Responsible Care Program, OIMS, HSE MS, etc)
(2) The complete cycle (policy, organizing, planning, implementation and evaluation
& action for improvement) of OSH Management System has been fully
implemented.
(3) Only partial cycle of the OSH Management System is implemented

(4) Has not embarked on any recognized OSH Management System yet

*Please attach
a) Copy of the company's OSH management system manual table of content
b) The name of the OSH management system the company is subscribing
c) Certification body's cert if the OSH management system is certified by any certification
body.

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 8.0 The Organizations OSH Achievements in 2016

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

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

Thank you very much for your sincere 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
th
the entrance fee and shall reach latest by Monday, 27 February 2017.

Thank you very much.

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