HSE Department

CONTRACTOR MANAGEMENT SYSTEM

QUESTIONNAIRE

The purpose of this questionnaire is to:

 Determine and apply criteria for the evaluation, selection, monitoring of performance, and re-
evaluation of external providers, based on their ability to provide processes or products and
services in accordance with Occupational health, Safety and Environment requirements.

All information and requested document provided in this questionnaire will be treated strictly
confidential.

From # EHS/O/037/F01- Ver.02

HSE Department

General Information about the Company

1.
1.1 Contractor/Company name ‫اسم الشركة‬
1.2 Address of Contractor/Company ‫عنوان الشركة‬

1.3 Telephone (Switchboard) and Fax number ‫رقم الفاكس‬/‫رقم التلفون‬

1.4 E-mail address ‫االيميل‬
1.5 Name of contact person ‫أسم المتواصل معه‬
1.6 Approximate number of employees ‫عدد العمال‬
2 Commitment & Leadership / Company Accreditation Scoring
2.1 Evidence - Please provide a copy of your current HSE Policy. Yes No --/5
‫يرجى تقديم نسخة سياسة من السالمة والصحة المهنية والبيئة الخاصة بك‬.
2.2 Does your senior management team participate in safety observation Yes No --/5
tours, safety conversations, safety walks or similar out on site?
‫هل يشارك الفريق في إبداء المالحظات المحادثات والجواالت الخاصة بالسالمة وماشابه ذلك؟‬
2.3 Do you have a senior manager who is responsible for Yes No --/5
environment ,health and safety in your company?
‫هل لديك مسئول عن السالمة والصحة المهنية والبيئة في شركتك؟‬
2.4 Is the company/plant certified according to Management System standard Yes No --/5
(e.g. ISO 9001/2015- ISO 14001/2015- ISO 45001/2018)?
ISO 9001 / 2015- ISO 14001 / 2015- ‫هل الشركة معتمدة• وفقًا لمعايير اإلدارة (مثل‬
‫( ؟‬ISO 45001/2018
2.5 List the environment , health and safety qualifications and/or experience below. --/5
.‫أكتب قائمة بالخبرة الخاصة بالسالمة والصحة المهنية والبيئة أدناه‬

3 Non-compliance Scoring
3.1 Has the company been prosecuted for environment , health and safety Yes No --/5
related breaches in the last three years?
‫هل تمت مقاضاة الشركة بسبب أي مخالفات متعلقة بالسالمة والصحة المهنية والبيئة خالل‬
‫السنوات الثالث الماضية؟‬
4 Planning and Continuous Improvement Scoring
4.1 Does your company have any recent Environment, Health and Safety Yes No --/5
Improvement Plans (or similar) you are working towards?
‫هل لدى شركتك أي خطط لتحسين السالمة والصحة المهنية والبيئة (أو ما شابه) ؟‬
5 Training and Supervision Scoring
5.1 Do your workers receive any environment, health and safety training prior Yes No --/5
to starting work?
‫هل تلقي عمالك أي تدريب خاص بالسالمة والصحة المهنية والبيئة قبل بدء العمل؟‬
5.2 Does your company aware about Safety principles and legislation? Yes No --/5
‫هل لدى شركتك معرفة بمعايير السالمة والتشريعات• ؟‬
5.3 Does your company aware about Hazard identification and the hierarchy Yes No --/5
of controls?
‫هل لدى شركتك معرفة بتحديد المخاطر وهرم التحكم للمخاطر؟‬
5.4 Does your workers aware about The relevance of site inductions and site Yes No --/5
specific safety plans?
‫هل لدى عمالك معرفة بالتدريب التقديمى وخطط السالمة؟‬
5.5 Does your workers receive training prior to High risk work activity and Yes No --/5
what safe looks like for relevant tasks?
‫هل تلقي عمالك أي تدريب خاص على العمل علي المخاطر وماهية العمل االّمن؟‬

SOP No.:-
SOP:- Contractor Management System Version # 02 From # EHS/O/037/F01 Page 2 of 3
EHS/O/037
6 Health & Safety Induction Scoring
HSE Department
6.1 Does your company has provision of information on site Yes No --/5
hazards, controls and/or what to do to eliminate or minimize any
risk, and site rules
‫ وضوابطه و ما يجب فعله إلزالة أو‬، ‫هل توفر الشركة معلومات عن مخاطر الموقع‬
‫تقليل أي مخاطر؟‬
6.2 Does your company has procedures for task analysis (or similar) Yes No --/5
and reporting of all accidents and near misses?
‫هل لدى شركتك إجراءات خاصة باالبالغ• عن جميع الحوادث؟‬
6.3 Does your company has procedures prior to report medical Yes No --/5
conditions that may impact workers or any other persons on site?
‫هل لدى شركتك إجراءات خاصة باإلبالغ• عن الحاالت الطبية التي قد تؤثر على‬
‫العمال؟‬
7 Risk / Hazard Management / Site Safety Risks / PPE Scoring
7.1 Describe how hazards/risks are identified, assessed and managed in your company. --/5
‫أوصف كيف يتم تحديد المخاطر والتحكم فيها‬.

7.2 Describe how you involve your workers in identifying hazards and assessing risks. --/5
‫أوصف كيف يتم إشراك العمال في تحديد وتقييم المخاطر‬.

7.3 Describe how you provide workers with the highest level of protection. --/5
‫أوصف اجراءات الحماية ال ُمقدمة للعمال مع أعلى مستويات الحماية‬.

7.4 Is there a system for identifying new hazards / risks? Yes No --/5
‫هل هناك نظام لتحديد المخاطر؟‬
7.5 Describe how you determine the minimum PPE requirements for your work sites. --/5
‫أوصف متطلبات معدات الحماية الشخصية لعملك‬.

8 I hereby declare that I provided clear and correct information mentioned in the questionnaire to PHARCO Total
Pharmaceuticals company. Score
‫أتعهد بأن كل المعلومات الموثقة باإلستبيان المقدم لشركة فاركوأنها صحيحة‬.

Completed by: -----------------

100
Title: ------------------- Sign. /date: --------------

SOP No.:-
SOP:- Contractor Management System Version # 02 From # EHS /O/037/F01 Page 3 of 3
EHS/O/037
N.B: The total Score is calculated by PHARCO Pharmaceuticals.
 HSE Department
CONTRACTOR EVALUATION REPORT / YEAR (--------)
Company Date / / Audit Questionnaire
Activity /Service/Product Lead Auditor Sign/Date:
Address Auditor Sign/Date:
Country Auditor Sign/Date:

S.N Contractor Name Total Scoring Class Recommendation

Total Scoring < 50 50- < 75 75-< 90 90-100

Class Disapproved Agreeable Approved Qualified
Symbol D C B A

Title Sign/date
Prepared by
Reviewed by
Approved by
SOP:- Contractor Management System SOP No.:- EHS/O/037 Version # 02 From # EHS/O/037/F02
HSE Department
CONTRACTOR EVALUATION PLAN / YEAR(……..)

S.N Contractor Name Jan. Feb. Mar. Apr. May June July Aug. Sep. Oct. Nov. Dec.

 Planned  Done  Unplanned

Name Title Sign/date

Prepared by

Approved
SOP:- Contractor by System
Management SOP No.:- EHS/O/037 Version # 02 From # EHS/O/037/F03
 HSE Department

S.N Contractor Address Classification Symbol Remarks

SOP:- Contractor Management System SOP No.:- EHS/O/037 Version # 02 From # EHS/O/037/F04
CONTRACTOR LIST / year (-------)

Title Sign/date

Prepared by

Reviewed by

Approved by HSE Manager

HSE Department
SOP:- Contractor Management System SOP No.:- EHS/O/037 Version # 02 From # EHS/O/037/F05

Contractor Follow up Record

1. General Information about the Company
1.1 Contractor/Company name
‫اسم الشركة‬
1.2 Address of Contractor/Company
‫عنوان الشركة‬
1.3 Telephone (Switchboard)
‫رقم الفاكس‬/‫رقم التلفون‬
and Fax number
1.4 E-mail address ‫االيميل‬
1.5 Name of contact person ‫أسم المتواصل معه‬
1.6 Approximate number of employees
‫عدد العمال‬
1.7 Workplace site/Location ‫مكان العمل‬
1.8 The activity type ‫نوع النشاط‬
1.9 Does the contractor workers receive Pre-Work OHS and Environmental standards Induction Training prior to starting work? Yes No
‫هل تلقي عمالك أي تدريب خاص بمعاييرالبيئة والسالمة والصحة المهنية قبل بدء العمل؟‬
1.10 Are the hazards/risks identified, assessed and managed in workplace site? Yes No
‫هل تم تعريف المخاطر والخطر وتقييمه والتحكم به فى بيئة العمل؟‬
1.11 Is the contractor workers wear any PPE as detailed in their own safe work practices or risk assessments? Yes No
‫أى من معدات الحماية الشخصية كما تم وصفه من ممارسات بيئة العمل أو مخاطره؟‬Contractor ‫هل يرتدى عمال الـ‬
1.12 Start date of contractor activity ‫بداية النشاط‬
1.13 Observations ‫ مالحظات‬Significant Environmental aspects Significant OHS Risk
1.14 End date of contractor activity ‫نهاية النشاط‬
1.15 Remarks ‫مالحظات‬

Title Sign/date
Prepared by
Contractor in charge
Reviewed by (HSE in charge)