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ZIMBABWE OCCUPATIONAL SAFETY AND HEALTH ASSESSMENT FORM

A. INFORMATION ABOUT THE ESTABLISHMENT/ORGANIZATION

COMPANY NAME………………………………………………………………………………….……

PHYSICAL ADDRESS: ………………………..……………………………………………………….

POSTAL ADDRESS …………………………….…………………………………………………………

SITE MANAGER……………………………………………………………………………………………

CONTACT PERSON:…………………………………………………….……………………………….

DESIGNATION…………………………………………………………………………………….........

TELEPHONE:……………………………………MOBILE……………………………………………..

E-MAIL ADDRESS……………………………….…………………………………………..............

OSH PERFORMANCE REVIEW PERIOD JANUARY TO DECEMBER 20………………..

SOCIAL SECURITY REGISTRATION (SSR) NUMBER: …………………………………….

Industrial Code Number ………………

INDUSTRIAL SECTOR: Mining/Quarrying Agriculture/Forestry

Building & Construction Manufacturing Commerce & Distribution

NO.OF EMPLOYEES………................................. NO.OF CONTRACTOR EMPLOYEES………………

B. ACCIDENTS/INCIDENT STATISTICAL RECORDS

1. Total Number of accidents recorded in accident register

a) Company………........................ b) Contractor/s.........................................

2. Number of fatalities a) Company……………………….. b) Contractor/s…………………………....

3. Number of claims submitted to WCIF (i) Fatal……………….

(ii) Non-fatal……………..

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4. Number of lost time injuries (including disabling and fatal injuries)

a) Company………… b) Contractor/s…………….
5. Lost Time in hours a) Company……… b) Contractor/s……………..
Lost time in days (divide hours by 8) a) Company….…… b) Contractor/s…………….

6. Number of property damage accident(s)a) Company…….... b) Contractor/s…………….

7. Total cost of property damage accident(s)……………………………………………

8. Lost Time Injury Frequency Rate = NO OF LOST TIME INJURIES X 1 000 000
NO OF WORKERS X 250 DAYS X 8 HOURS
(Exposure time)

9. INJURY SEVERITY RATE = TOTAL TIME LOST (DAYS) X 1 000 000

NO OF WORKERS X 250 DAYS X 8 HOURS
C. POINTS SCORED

Total possible points=

Total points awarded=
Percentage awarded=

NB* Any fatal accident disqualifies entry into the competition. Property or equipment damage
to the tune of US$50 000 automatically disqualifies entry into the competition for the year of
consideration.*

1. OCCUPATIONAL SAFETY AND HEALTH POLICY

Yes Pts No
1.1. Does the organization have a comprehensive written
occupational safety and health policy? 25

1.2. Does the policy mention the business the organization is

involved in? 15

1.3 Is the policy appropriate to the nature, scale of operation

and OSH risks of the organization? 15

1.4 Is the policy dated, signed and operationalized by the most 15

senior accountable person in the organization?

1.5 Does the policy include commitment to comply with 15

applicable laws, industrial codes of practice and other
requirements to which the organization subscribes.

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1.6 Does the policy include a commitment to Continual 15

Improvement and prevention of accidents, injuries and
Industrial diseases?

1.7 Is the policy communicated and readily accessible to 15

workers and all other persons at the workplace?

1.8 Does the policy provide the framework for setting up 15

And reviewing OSH objectives and targets for the
management, control or elimination of OSH risks?

1.9 Does the policy ensure the consultation and participation of 15

workers and their representatives in all elements of the OSH
management system?

1.10 Is OSH management integrated into normal business 15

management of the organization? If so provide evidence.

1.11 Does the policy ensure the safety and health of all persons 15
in the work place including contractors, temporary workers
and visitors

1.12 Is the policy implemented, maintained and made available

to the public 30

1.13 Is the policy reviewed regularly? If so provide evidence. 15

Section Total : 220

1.2 OCCUPATIONAL SAFETY AND HEALTH MANAGEMENT SYSTEMS (OSHMS)

1.2.1 Is there an OSHMS being implemented? 50

1.2.2 Is the OSHMS audited by any standards authority 50

regularly? If so provide evidence

1.2.3 Is the OSHMS certified? If so provide evidence. 100

Section Total: 200

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2. IMPLEMENTATION OF OSH SYSTEMS AND PROGRAMMES

Yes Pts No
2.1 Is there an OSH structure with an OSH professional? 30

2.2 Are there any OSH objectives and targets at every level of 30
the organization?

b. If yes to 2.2 above, has management communicated the OSH objectives and targets
to all employees? 20
2.3 Is there an accident register with evidence of use? 25

2.4 Is there an OSH annual report for the year under review? 25
2.5 Is there an annual company report, which covers OSH performance? 25
2.6 Are there specific programmes for industrial hygiene 25
and occupational health in general ?

2.7 Is there an appointed management representative on OSH 20

2.8 Is there an OSH budget? If so provide evidence. 25

2.9 Is there a person appointed as responsible for machinery 25

safety?

2.10 Is there a hazardous work (hot work, working on heights,

confined space) permit system? If so provide evidence. 15

2.11 Is there a system of recording and resolving 25

non-conformities? If so provide evidence.

2.12 Is there a house-keeping programme at all levels? 15

Section Total: 305

3. LEADERSHIP AND OSH MANAGEMENT

Yes Pts No
3.1 Does the management demonstrate visible felt leadership 20
in OSH management?

3.2 Does management discuss OSH matters at their executive 15

meetings? If so, provide evidence.

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3.3 Has management put in place a rewards system for pointing out
of hazardous conditions at the workplace? 15

3.4 Is there an OSH performance appraisal system for management? 20

3.5 Does management know the top three causes of accidents

in their organisation? 15

3.6 Does the CEO attend NSSA OSH programmes for executives? 20

3.7 Does the management have a feedback system from employees

to check on their leadership on OSH? 20

3.8 Does management regularly review OSH performance and take

appropriate action? 20

Section Total: 145

4. SAFETY AND HEALTH LEGISLATION AND OTHER REQUIREMENTS

Does the organization have a legal register which includes but not
limited to the following:
Yes Pts No
4.1 NSSA Statutory Instrument 68 of 1990 and/or S.I 109 of 5
1990 Regulations

4.2 Factories and Works Act Chapter 14:08 of 1996 or Mines and
Minerals Act Chapter 21:05. 5

4.3 Environmental Management Act Chapter 20:27 5

4.4 Labour Act Chapter 28:01 5

4.5 Public Health Act, Chapter 15:09 of 1996 5

4.6 Pneumoconiosis Act Chapter 15:08 5

4.7 Road traffic Act Chapter 13: 11 as amended by RTA No.3 5

4.8 Radiation Protection Act chapter 15:15 5

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4.9 National OSH Policy 5

4.10 Applicable OSH Conventions 5

4.11 Is there a method of keeping the legislation up to date with

new ones, amendments and repeals? If so provide evidence. 30

4.12 Is there evidence that the applicable provisions of these laws are
complied with? 30

Section Total: 110

5. HAZARD IDENTIFICATION AND RISK ASSESSMENT

Yes Pts No
5.1 Does the organisation have a documented HIRA protocol/ procedure
for identification of hazards, assessment of risks and the implementation
of necessary control measures? 50

5.2 Does the organisation’s HIRA programme cover all its processes
including routine and non-routine activities, activities of all personnel
having access to the workplace including subcontractors and visitors? 50

5.3 Are the organisation’s risks evaluated taking into account the likelihood of
occurrence and the potential severity of consequences of injury or damage? 20

5.4 Is there a hazard/risk register with evidence of use ? 20

5.5 Does the organisation have key personnel involved in the implementation
of HIRA? 20

5.6 Is the HIRA programme monitored and reviewed periodically for

its effectiveness and relevancy? 40

Sectional Total: 200

6. TRAINING
Yes Pts No
6.1 Is there a documented safety and health training
programme for both management and workers? 25

6.2 Is there a documented procedure for OSH training needs

identification? If so provide evidence. 30

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6. 3 Is there a training record for every trained employee?

Provide evidence. 15

6.4 Is there an induction programme for all new employees, visitors

and contractors? If so provide evidence. 20

6.5 Has there been any training on occupational safety and

health for all management and supervisors in the 25
year under review?

6.6 Is there a training programme on OSH legislation at all 15

levels of employees? If so provide evidence.

6.9 Is there a training programme on accident prevention,

reporting and recording for all levels of employees? 25

6.10 Is there a training programme on accident and incident

investigation procedure for management and employees?
If so provide evidence. 15

6.11 Is there a training programme on emergency

preparedness and response procedure? If so provide 20
evidence.

6.12 Is there a training programme on the 7 golden rules of Vision Zero? 25

6.13 Is there a method in use for the evaluation of the impact

of training on the trained individual and the organization? 25
If so provide evidence

Section Total: 240

7. ORGANISATION OF OCCUPATIONAL SAFETY AND HEALTH

Yes Pts No
7.1 Does the establishment have a safety, health and
environmental (SHE) committee? 10

7.2 Is the SHE committee composed of senior management

and safety representatives. If so provide evidence. 15

7.3 Is the responsible/competent person a member of the

committee? 15

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7.4 Is the secretary of the SHE committee a SHE

professional? If so provide evidence. 15

7.5 Are the SHE committee meetings chaired by the top

manager of the establishment? If so provide evidence. 20

7.6 Does the SHE committee meet monthly to discuss and

pass resolutions on SHE issues? 15

7.7 Is there a record (minutes) of the proceedings of the SHE

Committee meetings? If so provide evidence. 15

7.8 Are minutes of the SHE committee meetings circulated to

senior management and all departments? 15

7.9 Is there a corrective/preventive action plan arising from

the SHE committee meetings? 15

7.10 Does Top Management discuss and make resolutions on

SHE issues? If so provide evidence. 50

7.11 Is the SHE professional at management level in the

organization? 50

Sectional Total: 235

8. INCIDENT/ACCIDENT REPORTING AND RECORDING

Yes Pts No
8.1 Does the establishment have an incident/ accident reporting
procedure? 20

8.2 Does the organisation record near misses? 20

8.3 Is there a safety performance communication board at the

entrance to the establishment? 20
8.4 If yes to 8.3, is the board updated daily? Provide evidence. 20

8.5 Does the supervisor have the responsibility to report internally

all the accidents that occur in the area under his/her authority?
If yes, provide evidence. 15

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8.6 Does the establishment determine its Lost time injury

frequency rate. If so obtain evidence. 15

8.7 Is there a procedure to calculate and record lost time due to

occupational accidents? 10

Sectional Total: 120

9. INCIDENT / ACCIDENT INVESTIGATION

9.1 Is there a written procedure on incident/accident

investigation? If so provide evidence. 25

9.2 Are accidents investigated within 3 days of occurrence? If

so provide evidence. 15

9.3 Does the organisation investigate near misses? 15

9.4 Are investigations for fatal or very serious accidents chaired

by top management? If so provide evidence. 25

9.5 Are accident investigations carried out by a committee

including safety representative(s)? If so provide evidence 25

9.6 Are the results of accident/incident investigations communicated to

both workers and management in the organization? 15

9.7 Are accidents statistics analysed and discussed by the SHE

committee? If so provide evidence. 15

9.8 Is there a corrective/preventive action plan to prevent accidents? 15

9.9 Is there a SHE professional involved in closing corrective/preventive

programmes? 15
9.10 Are the impacts of accidents evaluated operationally and
financially? If so provide evidence. 15

Sectional Total: 180

10. PLANNED AUDITS

Yes Pts No
10.1 Does the establishment have an internal audit programme? 30
If so provide evidence.

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10.2 Is there a detailed audit checklist? If so provide evidence. 10

10.3 Is there a system of recording and resolving nonconformities?

If so, provide evidence. 25

10.4 Are there any audit reports written after the audit? If so
provide evidence. 15

10.5 Are previous audit reports reviewed as part of preparations

for the next audit? 10

10.6 Are audit results discussed by the SHE committee? If so

provide evidence. 20

10.7 Does the establishment have a team of trained internal SHE

auditors? If so provide evidence. 30

10.8 Are there any visibility tours of the establishment by top

management? If so provide evidence. 25

10.9 Is every part of the establishment audited at least three

times in a year? If so provide evidence. 10

Sectional Total: 175

11. PLANNED PREVENTIVE MAINTENANCE PROGRAMME

Yes Pts No
11.1 Is there a written planned preventive maintenance
Programme for plant and equipment? 25

11.2 Is the person responsible for the maintenance programme a member of

management? 20

11.3 Are equipment and machinery adequately and effectively

guarded? 40

Sectional Total: 85

12. SAFETY AND HEALTH AWARENESS CAMPAIGNS

Yes Pts No
12.1 Is there an occupational safety and health promotional
programme? If so provide evidence. 30

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12.2 Is there a needs assessment procedure in place? If so
provide evidence. 15

12.3 Do the planning and implementation of the awareness

campaigns involve the safety committee? If so provide 30
evidence.

12.4 Do the occupational safety and health campaigns include

teach-ins, posters, magazines , newsletters and awards
system? If so provide evidence. 15

12.5 Have any external resource institutions such as NSSA, been

involved in the conducting of SHE training courses? 30

Sectional Total: 120

13. OCCUPATIONAL HEALTH SERVICES (OHS)

Yes Pts No
13.1 Does the establishment offer occupational health services or
have any arrangement for the provision of such services to its
employees? 15

13.2 If yes to 13.1, are the services administered by personnel with

occupational health qualifications? If so provide evidence. 25

13.3 Does the establishment have an occupational health hazard 15

register? If so provide evidence.

13.4 Does the establishment have a comprehensive medical register for

all occupational injuries and illnesses treated locally or referred
or both? 15

13.5 Is there a pre-employment medical examination programme 15

in place? If so provide evidence.

13.6 Is there a medical surveillance programme for all occupational

diseases that may arise from workplaces of the 15
establishment? If so provide evidence.

13.7 Is there an exit medical examination programme? If so 15

provide evidence.

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13.8 Is there a post-employment medical surveillance for pneumoconiosis? 15

If so provide evidence.

13.9 Does the establishment have adequate first aid services

including trained first aiders? If so provide evidence. 15

13.10 If first aider(s) exist, do they have current certificate(s)?

(First aid certificates must be renewed every 3 years) 30

13.11 Is the establishment linked to any hospital or trauma center?

If so provide evidence. 30

13.12 Is there a procedure for reporting occupational diseases to

NSSA in terms of S. I. 68 of 1990? 15

13.13 Is there a records management system for the health

institution? If so provide evidence. 15

13.14 Are health reports discussed in top management meetings?

If so provide evidence. 35

13.15 Does the establishment have a health counselling

programme? If so provide evidence 15

13.16 Is there a medical waste disposal plan? If so provide evidence 15

Sectional Total: 300

14. WELLNESS PROGRAMMES

Yes Pts No
14.1 Does the establishment have a comprehensive and
documented company wellness policy? 25

14.2 Does the policy contain a commitment from management to promote

wellbeing of workers? 25

14.3 Were the employees consulted in the formulation of the

Wellness policy? If so provide evidence. 25

14.4 Is there a Wellness programme in place? If so provide 25

evidence.
14.5 Is there a budget for Wellness programmes? If so provide evidence? 25

14.6 Does the establishment have trained Wellness Champions?

If so provide evidence 25
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14.7 Is the wellness program supporting employees living with

HIV and AIDS especially counselling and ARV treatment? 15

14.8 Are employee family members involved in the programmes? 15

14.9 Is there confidentiality on health status of an employee? 15

14.10 Does the policy prohibit the testing of HIV/AIDS as a
condition of employment, promotion, training and/or
development? 15

14.11 Does the establishment have a grievance handling

procedure to address aspects of discrimination and/or
stigmatization in the workplace as a result of the worker’s
health status? 15

14.12 Is the wellness policy reviewed periodically for its

effectiveness? If so provide evidence. 15

Sectional Total: 240

15. EMERGENCY PREPAREDNESS AND RESPONSE PLANNING

Yes Pts No
15.1 Is there an emergency preparedness and response plan and
procedure? 25
Is there,
15.2 Identification of all types of potential emergencies in the
establishment? 20

15.3 A person responsible for declaring an emergency 10

15.4 Orderly and systematic shutdown of machinery and 20
equipment
15.5 An orderly evacuation of personnel 20
15.6 Actual calling of an emergency using a siren or any other 25
contrivance.
15.7 If the siren is available, is it regularly tested? 15
15.8 Protection of assets 15
15.9 Reverse parking of vehicles 15
15.10 Firefighting system? 15
15.11 If a sprinkler system is in place, the regular testing of it. 20

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15.12 Training of key personnel and awareness for all employees 15

15.13 Symbolic marking of all the key escape routes 10
15.14 Designation of assembly points and roll call system 20

15.15 Are assembly points marked with dedicated departments or sections? 15

15.16 The periodic testing (mock emergencies) of the emergency 35

preparedness and response procedure (at least twice a
year)

15.17 Availability of written reports of emergency tests. 10

15.18 An Emergency preparedness organizational

structure? 15

15.19 A return to normal procedure? 15

15.20 Does the establishment have appropriately coded

emergency escape routes? If so provide evidence. 15

15.21 Are emergency response procedure drills carried out

at least once every month at the establishment? 20

15.22 Are fire extinguishers properly and adequately provided in

terms of fire risk assessments? 15

15.23 Are fire points appropriately marked and conspicuously

designated? 15

15.24 Are proper records kept for inspections and maintenance of

Fire-fighting equipment including the sprinkler system? 15

Sectional Total: 415

16. PERSONAL PROTECTIVE CLOTHING AND EQUIPMENT

Yes Pts No
16.1 Does the establishment have a comprehensive programme
on the provision of appropriate and adequate personal 25
protective clothing and equipment?

16.2 Is a SHE professional involved in deciding the appropriate 50

PPC/E to be acquired? If so provide evidence.

16.3 Are employees trained on the proper use of PPC/E? If so

provide evidence. 15
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16.4 Is there a system for evaluating effectiveness of personal

protective clothing and equipment? 15

16.5 Does the establishment provide adequate lockers and locks

for employees? 40

16.6 Does the establishment have a procedure for monitoring

wear and tear of PPC/E and replacement thereof? If so 30
provide evidence.

16.7 Is PPC/E control programme integrated with other hazard

control provisions including engineering controls? 15

Sectional Total: 190

17. SAFE USE OF CHEMICALS AND HAZARDOUS SUBSTANCES

Yes Pts No
17.1 Does the establishment have a written procedure on the
procurement, handling, storage, transportation and disposal of 20
chemicals? If so provide evidence.

17.2 Does the establishment have a programme on the safe use 20

of chemicals? If so provide evidence.

17.3 Are quantities of chemicals kept on site at any one time known?
If so, provide evidence. 20

17.4 Are material safety data sheets (MSDS) for each chemical
available at the point of use? If so provide evidence. 20

17.5 Is there a register of all chemicals kept and/or used on site?

If so provide evidence. 15

17.6 Does the establishment have an industrial hygiene 15

programme for chemicals?

17.7 For liquid chemicals kept and/or used on site, is the storage
area bunded? 15

17.8 Is the chemical storage area well ventilated? 15

17.9 Is there a training programme for all levels of employees

and management on the proper management of chemicals? 20

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17.10 Does the establishment have a procedure for updating

developments on legal and regional and international
standards on exposure to chemicals (WHO, ACGIH, ILO 15
Conventions, SADC Code of Practice and National legislation)?

17.11 Does the establishment provide antidotes against chemicals

in the event of an accident? 15

17.12 Does the establishment have an operational procedure for 15

the labelling of chemicals that also includes sub containerization
into smaller containers?

Sectional Total: 205

18. WELFARE FACILITIES

Yes Pts No
18.1 Do sanitary facilities (toilets, urinals, wash hand basins etc.)
satisfy the requirements of the Model Buildings By-Laws or 50
RGN 262 (Registration and Control of Factories)?
18.2 Do the female toilets have adequate sanitary disposal 25
facilities (foot bin, incinerator etc.)

18.3 Are the toilets well supplied with toilet paper? 25

18.4 a) Are the toilets well supplied with water? 15

b) Are the toilets well supplied with soap? 10

18.5 Is there a canteen for workers? 40

18.6 Are the toilet facilities and canteen properly maintained? 15

18.7 Do food handlers hold current medical certificates? If so

provide evidence. 50

18.8 Does the establishment have resting beds for female 50

employees?

Sectional Total: 280

19. WASTE MANAGEMENT

Yes Pts No

19.1 Does the establishment have a written waste management 50

plan?

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19.2 Are waste streams identified and recorded? If so provide 20

evidence.
19.3 Is there a waste minimization programme? If so provide 40
evidence.
19.4 Is there an inventory with characterization of waste? If so 25
provide evidence.
19.5 Is there a waste treatment programme 40
19.6 Does the establishment hold a waste disposal license or 30
authority?
19.7 Are all discharges to the environment monitored? If so
provide evidence. 50

Sectional Total: 255

20. CONTRACTOR SAFETY AND HEALTH

Yes Pts No
20.1 Is there a procedure for the induction of contract workers? If 20
so provide evidence.

20.2 Is there a structural arrangement for enforcing safety, health

and environmental requirements on contractor workforce? If 30
so provide evidence.

20.3 Do contractors have adequate PPC/E all the time? 40

20.4 Do the contractors use the same canteen as permanent 40

employees?

20.5 Do the contractors use the establishment’s medical facilities

if injured? 30

20.6 Is there a procedure for reporting to NSSA or Ministry of

Mines accidents involving contractors? If so provide 25
evidence.

20.7 Is there a programme to inspect and pass contractor

equipment before use on site? 25

Sectional Total: 210

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21. ON AND OFF SITE TRANSPORTATION

Yes Pts No
21.1 Does the establishment provide transport for workers to and 30
from work?

21.2 If yes to 21.1 above, is there a medical surveillance

programme for public transport drivers? 50

21.3 Does the establishment have a procedure and checklist for

daily inspection of vehicles and equipment at the beginning 30
of every shift?

21.4 Do all drivers hold defensive driving certificates? 15

21.5 Does the establishment have a handover take over system

for different operators of vehicles and equipment? 15

21.6 If the establishment operate forklift(s), do the operators

have kidney belts? If so provide evidence. 30

21.7 Are the forklift operators trained? If so provide evidence. 30

Sectional Total: 200

Name of Assessor:………………………………………….. Signature…………………….................

Company Representative:………………………………….Signature………………………..............

Date of Assessment:…………………………………………………….

Place of assessment:………………………………………………......

The organization’s representative should be the Chief Executive or his or her

senior appointee

Checked by:

Principal Officer…………………………………….................................

Signature …………………………………………………… Date……………….

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Document Custodian: Chief OSH and APWCS Officer