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CBRE - Health & Safety Questionnaire
Company:
AMCE Corp.
Tax ID:
00-11223344
Company Information
Provide the name and phone number for the person responsible for health and safety for your company. A contact that can answer questions regarding the Environmental, Health and Safety (EHS) data provided.
In the event of an emergency, please provide the name and phone number for the person that CBRE can contact.
What CBRE location(s) do you perform the majority of your work?
What is your company primary NAICS code?
What is your company secondary NAICS code?
Does your company have an HSE training program in place?
- Select -
Yes
No
Does your company perform services in line with required HSE legislation in the country of operation?
- Select -
Yes
No
DISCIPLINARY POLICY
The disciplinary policy is aimed at ensuring that issues of misconduct are managed and dealt with in a fair and consistent manner. Provide a policy that promotes high standards of behavior and conduct for all employees and appropriate corrective action will be taken where those standards are not met.
Please upload your Disciplinary Policy
EMERGENCY PREPAREDNESS AND RESPONSE
Provide procedures regarding how to respond and actions to be taken in the event of an emergency. This includes who to call, where to report in the event of evacuation, and accounting for employees. Contractor should have detailed plans for things such as, but not limited to incidental and hazardous spills, fire, earthquake, threatening storms, etc.
Please upload your Emergency Preparedness and Response Procedures
FIRST AID / CPR
Contractors must show employees are certified bi-annually in first aid, CPR and AED
Please upload your First Aid / CPR Certificates
HAZARD IDENTIFICATION
Contractors must define how they identify hazards in the workplace. This could be through risk assessments, inspections, and accident or incident investigations. Also include, how corrective actions will be addressed and followed through to completion.
Please upload your Hazard Identification Policy
INCIDENT INVESTIGATION / REPORTING
Provide procedures for reporting injuries, illness and near misses. Once these have been reported, what is the process for investigating and identifying the root cause and identify if there was an unsafe act or condition. Show how action items are tracked to completion.
Please upload your Incident Investigation/Reporting Procedures
INJURY AND ILLNESS PREVENTION PROGRAM (IPPP) (FOR CALIFORNIA ONLY)
In California, every employer is required by law to provide a safe and healthful workplace for his/her employees. If you have ten or more employees, you are required to have a written IIPP in place. The Injury and Illness Prevention Program (IIPP) is a way to document how the company will reduce workplace injuries and illnesses. If you are not in California, provide a policy statement to show how you provide a safe and healthful work environment under the general duty clause.
Does your company perform services in the state of California?
- Select -
Yes
No
Please upload your company Injury and Illness Prevention Program (IIPP)
PERSONAL PROTECTIVE EQUIPMENT (PPE)
One way to prevent injury at work is to wear proper personal protective gear. Provide a program or procedures on how hazards are identified and then how the proper equipment to protect against those hazards is selected. This should include contractor’s procedures for conducting PPE Assessments to determine the proper equipment for protecting the head, eyes, hands, feet and body.
Please upload your Personal Protective Equipment (PPE) Program
STOP WORK
Provide a policy on employee’s right to stop work if an unsafe work condition or act is observed.
Please upload your Stop Work Policy
ASBESTOS
The safe removal and handling of asbestos is vital to preventing dangerous exposures.
Does your company remove asbestos containing materials?
- Select -
Yes
No
Please provide the Asbestos Building Inspector or Supervisor Certification
Please upload your Asbestos program
CONFINED SPACE
To keep workers safe, an employer must develop a detailed plan for each confined space, train employees on the plan, and implement immediate emergency response procedures including a rescue plan. Provide a written plan and proof of training for your employees to that plan. Make sure to detail the following: • Who enters confined spaces? • How do employees enter and exit? • Have proper Confined Space Permit. • What equipment workers need for each space? • The work scheduled for each confined space. • Have the proper equipment to test and monitor the atmosphere. • Require attendant(s) outside each confined space to monitor the work, recognize an emergency, and activate a rescue if needed.
Will your employees be entering permit or non-permit required confined space?
- Select -
Yes
No
Please upload your Confined Space Program
Please upload your Confined Space Training records employees performing the work
CRANE / HOISTS SAFETY
If you plan to use cranes, hoists or other lifting or aerial devices, provide a program or policy that details equipment to be used, policies on regular inspections and operator training. Even if the contractor is renting equipment, proof of employee training must be provided.
Will employees be performing work using a hoist or crane?
- Select -
Yes
No
Please upload your Crane Training
Please upload your Certificates to operate equipment to be used on site
ELECTRICAL SAFETY
Electrical safety programs must be in accordance with OSHA regulations and NFPA 70E standards. Electrical contractors or those conducting work that involves the electrical systems, must be provided a program that identifies how their employees recognize hazards and prevent injury and exposure, safe work practices, Qualified Electrical Persons (QEPs), the training they require, PPE, and job specific policies related to the work tasks they will be conducting.
Will your company be performing ENERGIZED electrical tasks for voltages more than 50 volts?
- Select -
Yes
No
Please upload your Electrical Safety Program.
Please provide your Qualified Electrical Person Training for employees performing work
FALL PROTECTION
Contractors must show how they protect their employees when working from heights. This includes use of fall protection equipment and personal fall protection equipment.
Will employees be working from heights above 4ft (i.e. roof work, ladder work, elevated work platform, etc.)
- Select -
Yes
No
Please upload your Training Records for applicable employees
Please upload your Working at Heights (Fall Protection) Program
GENERAL WASTE MANAGEMENT
Provide programs and policy on how waste generated onsite is managed and disposed of. This includes but not limited to regular trash, non-hazardous waste, hazardous waste, recycling materials.
Does your company ship or remove hazardous materials (including wastes)?
- Select -
Yes
No
Please upload your General Waste Management Programs and Policy
HAZARD COMMUNICATION
HazCom is employee right to know as it relates to chemicals in the workplace. Provide a written program including how chemicals are managed for use and storage. Details on how and where chemicals will be stored, how they will be labeled, availability of safety data sheets, and employee training must be included. Programs must be updated to include Global Harmonized System (GHS).
Does your company use or store hazardous materials?
- Select -
Yes
No
Please upload your Hazard Communication Program
HAZARDOUS ENERGY CONTROL / LOTO
Contractors must show proof they have a policy for controlling hazardous energy that includes the use of energy control procedures, application and removal of locks, tags and necessary devices, and training for authorized employees.
Will employees be performing tasks that require de-energizing equipment and the use of Lockout/Tagout equipment?
- Select -
Yes
No
Please upload your Hazardous Energy Control / LOTO Program
Please upload your LOTO Training Records for employees performing the work
HEAVY EQUIPMENT OPERATOR
Heavy equipment safety is particularly important because when accidents happen, they often lead to a lot of people being injured. Therefore, there is mandatory safe operator training specific to the equipment used.
Will your company be using heavy equipment while on-site?
- Select -
Yes
No
Please provide your Heavy Equipment Operator Training Certification
HOT WORK
Welding and Hot Work, such as brazing or grinding present a significant opportunity for fire and injury. All precautions of this program must be applied prior to commencing any welding or hot work by company employees or contractors.
Will your company be performing hot work (i.e. welding, cutting, grinding, brazing)?
- Select -
Yes
No
Please upload your Hot Work Program (with fire watch policy)
JANITORIAL SERVICES
Cleaning Industry hazards are addressed in specific OSHA standards for general industry. Janitorial crews should have training on identifying hazards, reporting injuries and illnesses, and emergency procedures. Janitorial crews shall maintain safety data sheets for the chemicals they use. Janitorial employees shall be informed by the hiring client on the hazards that they may be exposed to during their work.
Does your company perform janitorial service(s)?
- Select -
Yes
No
Please upload your Janitorial Training Program
LEAD
Take precautions to reduce the risk of lead poisoning. Whatever method is used for removing lead-based paint, safety procedures and precautions must be taken. Lead paint must be removed by certified individuals and a plan must be put into place prior to removal.
Will your company be inspecting for and/or removing lead paint?
- Select -
Yes
No
Please upload your Lead Inspector Certification
Please upload your Site Safety Plan for remediation activities
PEST CONTROL
Pest control companies must obtain proper licenses and certifications per federal, state and local requirements. A company should consider the safeguards to prevent worker injury and injuries related to pest control activities.
Does your company provide pest control services?
- Select -
Yes
No
Please provide licenses / certifications for the specific pest control category
Document Expires
POWERED INDUSTRIAL TRUCKS (PIT)
Powered industrial truck (PIT) as any mobile, power-propelled truck used to carry, push, pull, lift, stack, or tier materials, whether ridden by the operator or controlled by a walking operator.
Will your company be operating a forklift or other powered industrial truck or vehicle (PIT)?
- Select -
Yes
No
Please provide your Operator Training Certificate
Please provide your PIT Safety Program
SUBCONTRACTED WORK
With respect to subcontracted work, the prime contractor and any subcontractor or subcontractors shall be deemed to have joint responsibility. Subcontractors must prepare a site safety plan for the scope of the work subcontracted. All subcontractors must be licensed and bonded as appropriate for the work being perofrmed. Subcontractors must be able to provide evidence that their workers have been trained in the areas work will be performed. Subcontracotrs are required to follow all applicable local, state, and federal rules and regulations.
Will your company be using sub-contractors to perform work for CBRE or its Clients?
- Select -
Yes
No
Please provide the percentage of work to be performed by sub-contractors for CBRE and its Clients
- Select -
< 10%
10-30%
>30%
Does your company have a written Subcontractor Safety Management Process?
- Select -
Yes
No
Please upload a copy of your Subcontractor Safety Management Program
TRENCHING AND SHORING
Trenching for buried utilities, pipelines, water transport, and other activities may be hazardous. Trenches are usually deeper than wide, and the walls may become unstable and collapse on top of workers. Activities of trenching and shoring much follow the applicable regulations and safety protocols.
Will your company be creating or completing work in trenches?
- Select -
Yes
No
Please upload your Trenching and Shoring Program
Please upload your Training Records for employees conducting the work
SAFETY & REGULATORY PERFORMANCE
Recent Data
2022
2023
2024
YTD
Total Man-Hours
Total Number of Reportable Injuries
Total number Lost Time Injuries
Total Reportable Incident Rate
Lost Time Incident Rate
Average TRIR
Standard Industry TRIR
Has your company had a fatal occupational accident in the past 3 years?
- Select -
Yes
No
Has your company been responsible for any regulatory agency reportable spill in the past 3 years?
- Select -
Yes
No
Has your company received any notice of violations in the past 3 years?
- Select -
Yes
No
Does your company have ISO 45001 certification?
- Select -
Yes
No
Please upload your ISO 45001 Certification
Document Expires
Does your company have ISO 9001 certification?
- Select -
Yes
No
Please upload your ISO 9001 Certification
Document Expires
Please upload your OSHA 300 and 300A logs for the past 3 years.
Does your company qualify to obtain an EMR from your WC Carrier?
- Select -
Yes
No
Please upload your EMR
Document Expires
What is your company's EMR range?
- Select -
< 1.00
> 1.00
Please specify your company's EMR value in decimal format
Please specify your company's EMR value in decimal format
SUMMARY
Fatality Score
Reportable Spill Score
Violation Score
EMR Score
TRIR Score
Safety Program Score
Inherent Service Risk Score
Residual Risk Score
Overall HSE Risk Score