ROSEBEL GOLD MINES
CONTRACTOR SAFE WORK PLAN

Table of contents

Background:
Purpose:
Scope:
1.	General information
2.	Health & Safety Policy
3.	Responsibilities
4.	Work activity
5.	Hazard analysis
6.	First Aid and Injury Management
7.	Emergency Procedures
8.	Site Rules
9.	Incident reporting and investigation
10.    Specialised Work or Licensing
11.    Induction & Training Requirements
12.    Contractor Leading Indicator (KPI)
13.    Contractor Management (Equipment fleet specification)
14     Sign Off

Background:
Rosebel Gold Mines-RGM is committed to safety as a key company value which is ZERO HARM. Contractors directly affect RGM safety performance in promoting and maintaining a safe and healthful workplace. Contractors are an integral part of RGM business and therefore we expect contractors to provide the same commitment to health and safety.

Purpose:
The purpose of Contractor Safety Management is to set policies/procedures and expectations for contractors performing work at Rosebel Gold Mines; and establish roles and responsibilities for contractor personnel throughout the RGM/Contractor relationship.

Scope:
The Safe Work Plan form applies to all contract works > 1year which will be done on behalf of Rosebel Gold Mines. For work/job <1 year there is the contractor work/job scope form that should be filled in prior to starting with the work/job. This will be provided to the contractor after the job is awarded.

 
1.	General information

Project Name:		

Contract company details:

Contractor name:	

Contractor address:		
Phone: 	
Contractor Safety representative:	

Type of work:	

Location of work:	

	

Total manpower                

RGM Contractor Safety representative:	              Phone:

2.	Health & Safety Policy
Please state Contractor Company Health & Safety policy or Health & Safety commitment below:

•	Contractor Company Health & Safety policy:

RGM HSS policy

3.	Responsibilities
List persons with the different responsibilities that are assigned on job/project:

•	

4.	Work activity
List the potential hazards with the mitigations:

Work Activity:  	
Potential Hazards	Mitigations	
Gravity
 Overhead work
 Falling object
 Excavation 
 Collapsing roof/equipment
 Elevated/Uneven work surface
 Open holes
 Other:  
Motion
 Vehicle/Equipment movement
 Limited mobility (confined space)
 Material movement
 Water/Wind movement
 Body positioning/Ergonomics
 Manual Lifting
 Other:  
Mechanical
 Rotating equipment
 Drive belts and conveyors
 Motors
 Power/Hand tools
 Other:  
Electrical
 Power lines (above/below)
 Energized equipment
 Static charges
 Wiring
 Batteries
 Other:  
Pressure
 Piping
 Cylinders
 Vessels/Tanks
 Hoses
 Other:  
	Temperature
 Ignition source
 Hot/Cold surfaces
 Hot/Cold liquids
 Hot/Cold gases
 Hot weather conditions
 Other:  

Chemical
 Explosive
 Toxic Compounds
 Corrosive Compound
 Reactive Compounds
 Other:  

Biological
 Animals/Insects
 Bacteria/Viruses
 Contaminated food/water
 Other:  
Radiation
 Lighting
 Welding arc/flash
 Sunlight
 X-rays
 Other:  
Sound
 Equipment noise
 Impact noise
 Venting noise
 Communication
 Other:  	Hazard Controls (Engineering and Administrative)	
		 Work Permits
 PPE Program
 Warning signs
 Pipeline markers
 Spotters/Attendants
 Barricades
 Housekeeping	 Ignition source controls
 Gas monitoring
 Material Safety Data Sheets
 Scaffolding
 Parking Plans
 Equipment Staging Plans
 Essential personnel only	 Break Rotation
 Temporary Lighting
 Isolation of Hazardous Energy
 Equipment Inspections
 Specific safety training  
 Other:  	
		Safety Controls (Personal Protective Equipment)	
		 Hard hat
 Safety shoes
 Safety glasses
 Face shield
 Goggles
 Cotton gloves	 Leather gloves
 Chemical gloves
 Electrical rated gloves
 Chemical suit
 Work vest/Life vest
 Full body harness	 Hearing protection
 Fire Resistant Clothing
 HV vest  
 Other:  	
		Safety Equipment	
		 Fire Extinguishers
 Fire retardant tarps
 Locks and tags
 Gas detectors	 Personal Monitors
 Tag line
 Safety cable 
 Safety Barricade	 Caution tape
 Area Monitors
 Fall arrest equipment  
 Other:  	
		Emergency/Contingency Plans	Environmental Equipment	
		 Spill Control
 Spill Contingency Plans
 Emergency Evacuation Plans	 Incident Reporting Procedure
 Near miss reporting
 Other:  	 Absorbent pads
 Containment pans
 Other:  	
		Certification Requirements	
		 Certified Welder
 Qualified Crane Operator
 Qualified Rigger
 Qualified Signal Man
 Competent Person Fall
 Scaffolding Inspector	 Qualified fall person
 Confined Space rescue
 Fire Watch
 Equipment Operator
 Confined Space rescue
 Qualified Gas tester
 	 Confined space authorized person
 Lock out Tag out authorized person
 HAZWOPER
 Rope rescue
 Other:  

		Safe Work Practices		
		 JHA
 SLAM
 Confined Space entrée permit
 Safety procedures	 Electrical Safe Work
 Excavation
 Lifting and Rigging
 Hot Work permit	 Isolation of Hazardous Energy
 Fall plan 
 Other:  	

Other: 

5.	Hazard analysis
List the hazards of the work with the potential outcome and control/mitigation measure used.  
Note: this should be done using the Hierarchy of Control methodology. 

Job	Description	Hazards	Outcome	Control/mitigation measure	
•						
•						
•						
•						
Example of hazard analysis

 
Hierarchy of controls

6.	First Aid and Injury Management
Describe any specific Injury Management processes for this job/project, including reporting to RGM Health & Safety Department for all incidents types.

7.	Emergency Procedures
State job/project emergency and evacuation procedures:
•	

8.	Site Rules
List below specific rules which all persons working at RGM must abide to:
•	

9.	Incident reporting and investigation
Describe how incidents will be reported, recorded and investigated and how you will report it to the affected Departments.

10.	Specialised Work or Licensing
List any special licences required for the job/project.

11.	Induction & Training Requirements
Inductions for contractors are to be completed in accordance with RGM Induction process.  

List training requirements that are applicable for work/project:

Description		Description		
Drilling & Blasting		Hazard Identification and Awareness		
Back Injury Prevention		Hazmat Training		
Basic New Employee Orientation		HAZWOPER Training		
Basic Principles of Safety		Hearing Conservation 		
Behaviour Based Safety		Heat Stress Prevention		
Chemical Awareness		Pressure taps		
Crane safety		Hot Taps		
Body Positioning Training		Hot Work		
Defensive Diving		Incident Investigation and Reporting		
Confined Space Entry		Industrial Hygiene Exposure Monitoring		
Hoisting and rigging		Job Hazard Analysis		
Fatigue management		Line Breaking/Opening Process		
Lock-Out/Tag-Out Verification		Near Miss Reporting		
Electrical Safety		Personal Protective Equipment		
Emergency Evacuation 		Power Actuated Tools		
Emergency Response Plan		Radiation Control		
Excavation and Trenching		Respiratory Protection Program		
Mobile equipment		Safety Observation/Audit		
Safety Equipment Usage		Scaffolding Safety		
Fall Protection		Signs and Barricades		
Ladder safety		Start-up Safety Workshop		
Fire Safety		Water Survival		
Fire Watch		Welding/Cutting		
First Aid 		Other		
Flammable and Toxic Material Handling		Other		
Hazard Communication (MSDS), Labelling, etc.		Other		

12.	Contractor Leading Indicator (KPI)
The contractor is requested to report to the RGM contractor safety representative on monthly basis:
•	Task observations inspections
•	Work Floor presence inspections by contractor management
•	Tool box meetings
•	Safety inspections
•	Safety meetings

13.	Contractor Management (Equipment fleet specification)
Number of Light Vehicles and Mobile Equipment onsite. If contractor will be using any subcontractors, they must be supervised at all time by the main contractor and understand RGM policies and safety procedures.

Note: the vehicles and mobile equipment used for work/project needs to be inspected with the RGM safety representative according the RGM-mobile equipment standard.

Equipment fleet:
•	

14.	Sign Off

Signature Contractor Manager: 

(Name and Signature)  ……………………………………

Signature RGM Contractor Safety representative: 

(Name and Signature)  …..………………………………….