STATE OF QATAR TENDER TECHNICAL DELIVERABLES ASHGHAL QUALITY, HEALTH, SAFETY, ENVIRONMENTAL & SECURITY ASSURANCE FORM G-1 OCCUPATIONAL HEALTH, SAFETY, ENVIRONMENT AND SECURITY QUESTIONNAIRE FOR CONTRACTORS Tenderer's Legal Name: Project Date: Current less. Current less. 4 Years 2014 tem Description HEALTH AND SAFETY ‘Average Number of Employees ya2ist | | VAS 182 GS4OF | 154622) Average Number of HSES Empiovees B os 2a Total Man-hours A210 | |asis20 5463210) } Number of Restricted Workday Cases (RWC) Number of Medical Treatment Cases (MTC) Number of First Aid Case (FAC) Number of Heat Stress Related Cases Property Damage — Ultities (cables, pipelines, etc) Property Damage — Contractor's As Property Damage ~ Third Party Asset (fence, private cars, etc) Number of Significant incidents PIG|S|P |O!oLololobylo Number of Work Related linesses Number of Non-Work Related Deaths bb bP blolofololob he S 0 oO 2 0 2 © o O © 6 Number of Near Misses Date: ...2.9-109J20 Volume 3: (Quality, Heath, Safety, Environmental & Securky Assurance) Page 28 ‘Tenderer's Stamp & initials: Project IO: 1A 2019 ¢ 0036 Construction Diversion of Sewage Flows rom Doha Industal Area to Doha West STW —C819‘STATE OF QATAR TENDER TECHNICAL DELIVERABLES ASHGHAL QUALITY, HEALTH, SAFETY, ENVIRONMENTAL & SECURITY ASSURANCE tem Description less 3 Years number of man-hours) INJURY FREQUENCY (formula = Number of cases X 200,000/ Current | | Current iese Current iose Lost Time Injury Frequency Rate (LTIFR) Medical Treatment Cases Frequency Rate (MTCFR) ‘and RWC) Total Recordable Injury Frequency Rate (TRI ity, MT, LTI JOURNEY MANAGEMENT ‘Number of Light VehicleMMotor Incidents (MVI) Number of Heavy Vehicles, Buses & Mobile Plant/Equipment Incidents Total Kilometres Driven 1210421 ENVIRONMENT MANAGEMENT [Number of incidents to Flora and Fauna Number of Fire Incidents Number of Spills and Leak Incidents Number of Incidents Associated with Hazardous Waste "Number of Surface Water Contamination Incidents Number of Groundwater Contamination Incidents ‘our of Watr Used fo Dust Suppression Mesure hoo Number of Permit to Work (PTW) issued (p02) ‘Number of Too! Box Talks (TBTs) Tenderer's Stamp & initials: Project ID: 1A 2019.¢ 003 Construction version of Sewage Flows fom (Doha Industial Area to Doha West STW ~C819 ol S3 vate. .22-|02,120)4 ‘Volume 3: (Quaity, Health, Saety, Environmental & Securty Assurance) Page 29 Rev.0STATE OF QATAR TENDER TECHNICAL DELIVERABLES ASHGHAL QUALITY, HEALTH, SAFETY, ENVIRONMENTAL & SECURITY ASSURANCE ‘Current Item Description Zz less 3 Years | 2015 Number of Employees Trained Third Party 93 Potable Water Consumption ebz1q1 Non Potable Water Consumption (othr than dust suppression) \ 1Zh60 Total Fuel Consumption aséih Electric Power Generation n kWh 213109 ‘SECURITY MANAGEMENT. Number of Security Violations” u Number of Routine Seoury Checks Completed S160 Number of Security Audits Completed 240 “Security violations include all physical and cyber violations. This will include and will not be limited to theft of property or Information, sabotage, impersonation, unauthorised access and any procedural non-conformity. Tenderer's Stamp & initials: seuss Date’ 22) peg Project D: 1A 2019.6 0036 Volume 3: (Quality, Health, Safety, Environmental & Securty Assurance) Page 30 Construction Diversion of Sewage Flows from Dona Industal Area to Doha West STW —C819