E2HSMS Internal Audit Checklist

Page 1 of 8 SP-ADB-4.06 F4 (29 June 2012)

1. 2. 3. 4.

Audit Purpose:

To verify the effective implementation of ADB's Environment, Health and Safety Management System (EHSMS). To determine adequacy effectiveness of EHS risk control measure. To determine the implementation/ Effectiveness of documented Best Practices in meeting ADB's policy, objectives, targets, and programs. To follow up pending action items and verify effectiveness of corrective and preventive actions arising from previous audits conducted and issued Corrective Action Request (CAR).

Audit Scope

Operation and Maintenance of xxxxx ISO 14001:2004 Standard OHSAS 18001:2007 Standard ADB's Best Practices Date: 15 March 2013 Auditor (s) CPMI O & M Representative
ASSESSMENT LEVEL (1, 2, 3)

Audit Criteria Function/ Area Air-conditioning System Auditee (s)

CPMI O & M Representative

CLAUSE/ ITEM

REQUIREMENTS

Evidence

Remarks

EFFECTIVENESS (Plan vs. Actual Results)

4.3.1 HIRAC Confirm availability of the updated HIRAC and the understanding of the personnel involved Consistency and adequacy of all entries in the HIRAC Form against actual Where any change in the product/ activity/ materials in the area has occurred, EHS hazards have been timely identified, assessed on SCS, LOS, ECM and indicated in the HIRAC Form o SP-ADB-2.02 F1 Risk Assessment of New Materials, Processes and Services form was utilized to permit assessment HIRAC Form updated at least once every 2 years

Legend: 1=Compliance; 2=Observation; 3=Non-conformity Auditor's Signature:

ADB Form No. 506/06

Revised June 2012

E2HSMS Internal Audit Checklist

Page 2 of 8 SP-ADB-4.06 F4 (29 June 2012)

Function/ Area Air-conditioning System Auditee (s) CPMI O & M Representative

CLAUSE/ ITEM

Date: 15 March 2013 Auditor (s) CPMI O & M Representative

ASSESSMENT LEVEL (1, 2, 3)

REQUIREMENTS

Evidence

Remarks

4.3.2

Legal and Other Requirements The entries in the SP-ADB-2.03 F1 List of Applicable Legal and Other Requirements are up-to-date and are consistent with the entries in the HIRAC Form. Where any change in the legal and other requirement has occurred, the relevant documents (e.g. HIRAC, Control Plan, EHSMPs) has beeen timely updated.

4.3.3

Objectives, Targets and Programmes Confirm availability of the following EHSMSP and understanding of the personnel involved: o EHSMP 1 Paper Conservation o EHSMP 2 Waste Generation Reduction o EHSMP 3 Water Conservation o EHSMP 4 Energy Conservation o EHSMP 5 Reduction of EHS Accidents and Emergencies o EHSMP 6 Chemical Supplies Mngt o EHSMP 7 Legal & Other Requirements Relevant EHSMP (i.e. objectives, targets, programs) is available and remains consistent and suitable to address the identified high risks based on the o HIRAC Form o List of Applicable Legal and Other Requirements o Incidents, accidents and non-conformity

Legend: 1=Compliance; 2=Observation; 3=Non-conformity Auditor's Signature:

ADB Form No. 506/06

Revised June 2012

E2HSMS Internal Audit Checklist

Page 3 of 8 SP-ADB-4.06 F4 (29 June 2012)

Function/ Area Air-conditioning System Auditee (s) CPMI O & M Representative

CLAUSE/ ITEM

Date: 15 March 2013 Auditor (s) CPMI O & M Representative

ASSESSMENT LEVEL (1, 2, 3)

REQUIREMENTS

Evidence

Remarks

Confirm availability of suitable program(s) to address the identified EHS hazards (i.e. Threat barriers, Recovery measures) o Hierarchy considerations (i.e. elimination, substitution, administrative control, engineering control and PPE) Confirm evidence of timely review of the EHSMP and whether its up-to-date Verify consistency of EHSMP with the other related documentation o Control Plan o Systems Procedures/ Best Practices Current EHSMP remains aequate and consistent with the ADB's Policy on EHSMP

CONFORMANCE
4.4.1 Resources, roles, responsibility and authority Resources are available and sufficient to ensure the effective implementation of ADB EHSMS requirements (e.g. EHSMP, Control Plan, Systems Procedures/ Best Practices). Roles, responsibilities and authorities to carry out the requirements of ADB EHSMS (e.g. EHSMS, Control Plan, Systems Procedures/Best Practices) are clearly defined. o Confirm availability of records

Legend: 1=Compliance; 2=Observation; 3=Non-conformity Auditor's Signature:

ADB Form No. 506/06

Revised June 2012

E2HSMS Internal Audit Checklist

Page 4 of 8 SP-ADB-4.06 F4 (29 June 2012)

Function/ Area Air-conditioning System Auditee (s) CPMI O & M Representative

CLAUSE/ ITEM

Date: 15 March 2013 Auditor (s) CPMI O & M Representative

ASSESSMENT LEVEL (1, 2, 3)

REQUIREMENTS

Evidence

Remarks

4.4.2

Competence, training and awareness Personnel (i.e. ADB staff, contractors) performing tasks affecting ADB EHSMS are competent on the basis of education, training, skills or experience. o Confirm availability of records Personnel (i.e. ADB staff, contractors) are aware of o Importance of conformity to ADB Policy and EHSMS requirements o HIRAC, EHSMP and Systems Procedures o Potential consequences of departure from specified procedures

4.4.3

Communication Current channels of communication (i.e. internal and external) are able to support the requirements of ADB EHSMS and the attainment of its policies and EHSMSPs. o Concerned personnel are timely provided with accurate information to enable them to satisfy the requirements of ADB's EHSMS

4.4.4

Documentation Current documentation system is sufficient to ensure effective planning, operation and control of processes that relate to ADB's EHS hazards o Verify any issue relating poor documentation

Legend: 1=Compliance; 2=Observation; 3=Non-conformity Auditor's Signature:

ADB Form No. 506/06

Revised June 2012

E2HSMS Internal Audit Checklist

Page 5 of 8 SP-ADB-4.06 F4 (29 June 2012)

Function/ Area Air-conditioning System Auditee (s) CPMI O & M Representative

CLAUSE/ ITEM

Date: 15 March 2013 Auditor (s) CPMI O & M Representative

ASSESSMENT LEVEL (1, 2, 3)

REQUIREMENTS

Evidence

Remarks

4.4.5

Control of Documents Confirm availability of up-to-date ADB EHSMS documents (e.g. Systems Procedures, Best Practices, HIRAC, EHSMP, etc.) Confirm availability of up-to date documents of external origin (e.g. Legal and other requirements) necessary to meet the requirements of ADB EHSMS Confirm whether any obsolete documents (internal/ external) are removed from the points of use or otherwise identified to prevent its unintended use

4.4.6

Operational Control Confirm whether operational controls are in place and are effectively implemented to address the hazards identified in the HIRAC, EHSMPs, Control Plan, Systems Procedures and Best Practices. o Confirm availability of records

4.4.7

Emergency Preparedness and Response Confirm availability of up-to-date procedure/s on emergency preparedness and response for the identified emergency/ies in the area.

Legend: 1=Compliance; 2=Observation; 3=Non-conformity Auditor's Signature:

ADB Form No. 506/06

Revised June 2012

E2HSMS Internal Audit Checklist

Page 6 of 8 SP-ADB-4.06 F4 (29 June 2012)

Function/ Area Air-conditioning System Auditee (s) CPMI O & M Representative

CLAUSE/ ITEM

Date: 15 March 2013 Auditor (s) CPMI O & M Representative

ASSESSMENT LEVEL (1, 2, 3)

REQUIREMENTS

Evidence

Remarks

Where an emergency has occurred, confirm availability of evidence to demonstrate compliance to the established procedures on emengency preparedness and response. o Confirm whether the procedure/s have been updated as a result of the anysis after the occurrence of accidents or emergency situations Confirm evidence of timely review of the EHSMP and whether its up-to-date. Verify consistency of EHSMP with the other related documentation o Control Plan o Systems Procedures/ Best Practices Current EHSMP remians adequate and consistent with the ADB's Policy on EHSMS

IMPROVEMENT
4.5.1 Checking Recording are available to demonstrate the timely and periodic: o Monitoring and Measurement of actual EHSMS performance against set EHSMP o Evaluation of compliance to legal and requirements Where monitoring and measuring device was used, evidence of timely verification/ calibration of the measuring device is made available to provide confidence in the accuracy of the measurement results

4.5.2

Legend: 1=Compliance; 2=Observation; 3=Non-conformity Auditor's Signature:

ADB Form No. 506/06

Revised June 2012

E2HSMS Internal Audit Checklist

Page 7 of 8 SP-ADB-4.06 F4 (29 June 2012)

Function/ Area Air-conditioning System Auditee (s) CPMI O & M Representative

CLAUSE/ ITEM

Date: 15 March 2013 Auditor (s) CPMI O & M Representative

ASSESSMENT LEVEL (1, 2, 3)

REQUIREMENTS

Evidence

Remarks

4.5.1

Effectiveness of the EHSMS is periodical reviewed and analyzed to identify and address any o actual non-conformity/incident/accident o potential non-conformity/incident/accident o continual improvement Relevant processes/ documentation within the EHSMS have been reviewed and. updated as a result of the anaysis o HIRAC o EHSMP o Control Plan o Systems Procedures/ Best Practices Nonconformity/ Incident/ Accident Records are available to demonstrate that actions were taken without undue delay to correct/ mitigate the impacts of the identified non-conformity/ incident/ accident (e.g. CPAR, Incident Report, etc.) Actions taken were appropriate to the magnitude of the Nonconformity/ incident/accident that occurred Relevant documentation/s has been updated as a result of the action taken (e.g. EPR, Systems Procedures, Best Practices, Control Plan, HIRAC, etc.)

4.5.1

4.5.3

Legend: 1=Compliance; 2=Observation; 3=Non-conformity Auditor's Signature:

ADB Form No. 506/06

Revised June 2012

E2HSMS Internal Audit Checklist

Page 8 of 8 SP-ADB-4.06 F4 (29 June 2012)

Function/ Area Air-conditioning System Auditee (s) CPMI O & M Representative

CLAUSE/ ITEM

Date: 15 March 2013 Auditor (s) CPMI O & M Representative

ASSESSMENT LEVEL (1, 2, 3)

REQUIREMENTS

Evidence

Remarks

4.5.3

Corrective/ Preventive Action Evidence/s are available to demonstrate systematic approach in investigating and determining the cause of the potential or actual nonconformity, incident/ accident Actions were taken without undue delay and were suitable to eliminate the identified cause Evidence were available to demonstrate that as a result of the action taken (e.g. EPR, Systems Procedures, Best Practices, Control Plan, HIRAC, etc.)

4.5.4

Control of Records Records necessary to demonstrate conformity to the requirements of ADB EHSMS are available (easily accessible), legible, identifiable and traceable Verify compliance to established requirements on records management Confirm adequacy and suitability of the current practices in records management

4.6

Evidence/s to demonstrate that results of checking are reported to management review are available

Legend: 1=Compliance; 2=Observation; 3=Non-conformity Auditor's Signature:

ADB Form No. 506/06

Revised June 2012