Audit CAPA Implementation

 

TRACKING /MONITORING THE IMPLEMENTATION OF CORRECTIVE AND PREVENTIVE ACTIONS

To track the effectiveness of implementation of the WSH audit corrective and preventive actions , the auditors use an excel spreadsheet as the tracking mechanisms to track the closure of the corrective actions and preventive actions

Required information to be track may include:

·         Responsible person

·         Target completion date of corrective measure implementation

·         Status

·         Proposed corrective/preventive actions

·         Audit findings

The SHMS audit criteria is based on the Singapore Standard SS 506 Part 3 : 2006 Occupational safety and health (OSH) management system – Requirements for the chemical industry, and in accordance with the relevant WSH legislation and guidelines set out for each industry

S/N	SHMS Element	Audit Findings	Proposed Corrective /Preventive Actions	Person Responsible	Target Completion date
1	Safety policy	Company XXXX Safety Policy is an adoption of its parents company Safety Policy in US and hence the policy may not be appropriate to the nature and scale of its Singapore operation and its workforce culture	To establish a safety policy which  is appropriate to the nature and scale of its Singapore operation, its workforce culture and comply with Singapore Standard SS 506 Part 3 : 2006 Occupational safety and health (OSH) management system – Requirements for the chemical industry	Chief Executive Officer, Mr XXXX	End Dec 2013
2	Safe work practices	Established risk assessment is done by individual department with no cross functional collaboration to ensure no hazards/risks is left unidentified	Company XXXX  should establish a risk assessment team which is made up of cross functional employees with different background, knowledge and experience with the objective to ensure that no hazards from any aspect are left undetected and adopt a 5x5 risk assessment matrix to better classified its risk levels. Equipped the risk assessment team with the relevant practical knowledge on risk management and to formulate the safety rules and regulations taking into consideration the current WSH behaviour of its employee, the WSH performance and changes in the WSH regulations and other related legal requirements	XXXX, CEO YYYY, Senior management level staff KKKK HR Training Manager WSHO Willy Lee	End Dec 2013
3	Safety training	No training budget to improve current WSH performance WSH Training needs of west managers level staffs were neglected	Company XXXX  CEO to set some money aside as the HSE training budget ,establish the training needs analysis of its managers by conducting an internal training survey , analyse the results and collaborate with its WSHO to identify the training needs of it’s manager level employees by referencing to the Factories ( Safety Training Order) Regulations  and the WSH training for managers may  include a)Safety and Health Management system audit b)Quantitative Risk Assessment c)Project Management d)Behaviour safety management  etc	XXXX, CEO   YYYY, Senior management level staff   KKKK, HR Training Manager   WSHO Willy Lee	end Dec 2013
4	Group Meeting	No training budget to improve current WSH performance WSH Safety Committee team members are not trained and not competent to assume their roles as WSH Safety committee team member Company XXXX  to define the serving period of its nominated WSH safety committee team members	Company XXXX  CEO to set some money aside as the HSE training budget , establish procedure in analyzing the training needs of their WSH Safety Committee team and  to provide them with the relevant training to build their attitude ,skills and knowledge to make them competent to assume their role as WSH safety committee team members helping west to proactively manage its workplace WSH. And to define the WSH safety committee team member serving period to maximum one year with the objective to expose more  Company XXXX employees  CEO to discuss with senior management level staff on the allocation of safety budget to improve the workplace WSH competency and performance	XXXX, CEO   YYYY, Senior management level staff   KKKK, HR Training Manager   WSHO Willy Lee	End Dec 2031
5	Incident investigation and analysis	No training budget to improve current WSH performance Incident investigation team not trained on basic investigation skills and the use of investigation tools	Company XXXX  CEO to set some money aside as the HSE training budget , establish procedure in analyzing the training needs of their Incident investigation team and  to provide them with the relevant training to build their attitude ,skills and knowledge to make them competent to assume  their roles	XXXX, CEO YYYY, Senior management level staff KKKK, HR Training Manager WSHO Willy Lee
6	Safety Inspection	No training budget to improve current WSH performance of the WSH Safety Committee team	Company XXXX  CEO to discuss with senior management level staff on the allocation of safety budget to improve the workplace WSH competency and performance and   Company XXXX  CEO to set some budget aside as the HSE training budget	XXXX, CEO YYYY, Senior management level staff KKKK HR Training Manager WSHO Willy Lee
7	Hazard Analysis	No cross functional risk assessment team formed to assess west departmental risk assessment	Company XXXX  CEO should look into establishing and formation of a risk assessment team which comprises of employees across cross functional department to ensure no hazards/risks are being oversight or left unidentified Adopt a 5x5 risk assessment matrix to better represent the identified hazards /risks associated with their manufacturing  and equip the risk assessment team members with the relevant practical knowledge in risk management            West CEO to discuss with senior management level staff on the allocation of safety budget to improve the workplace WSH competency and performance	XXXX, CEO YYYY, Senior management level staff KKKK, HR Training Manager WSHO Willy Lee

 

TARGET SCHEDULE FOR COMPLETION OF ACTION ITEMS

The target schedule for completion of action items have been established after consultation with  the  Auditee management representative and it’s responsible persons following up on the action items and also after taking into consideration audit findings that have a high or critical associated risk rating, or lower

 Schedule for completion of action items are tabulated below

PERSONS RESPONSIBLE FOR ACTION ITEMS

For an organization Safety and Health Management System to be effective, it must have the commitment from the top management and the commitments from different level of employees within the organization hierarchy

Based on this principle, the persons responsible for following up on the action items have been established and tabulated as follows:

Name of Auditee : Company XXXX
Date of Assessment: 20 Jul 2013
Audit Team Members: Lead Auditor XXXX, Team Auditor YYYY
SHMS Elements	Corrective Action	Preventive Action	Responsible Person
Safety Policy	To establish a safety policy which  is appropriate to the nature and scale of its Singapore operation, comply with Singapore Standard SS 506 Part 3 : 2006 Occupational safety and health (OSH) management system – Requirements for the chemical industry     Development of the safety policy shall taking into consideration the current WSH behaviour of its employee, the WSH performance and changes in the WSH regulations and other related legal requirements and establish realistic and measurable WSH goals, objectives and target	Identify one senior management level staff to oversee the development and establishment of the safety policy and reporting periodically the progress and achievement	XXXX, CEO Company XXXX
Safe Work Procedure	Company XXXX t should establish a risk assessment team which is made up of cross functional employees with different background, knowledge and experience with the objective to ensure that no hazards from any aspect are left undetected and adopt a 5x5 risk assessment matrix to better classified its risk levels.   Equipped the risk assessment team with the relevant practical knowledge on risk management and to formulate the safety rules and regulations taking into consideration the current WSH behaviour of its employee, the WSH performance and changes in the WSH regulations and other related legal requirements	Company XXXX CEO to discuss with senior management level staff on the allocation of safety budget to improve the workplace WSH competency and performance   Identify one senior management level staff to oversee the formation of cross functional risk assessment team   Setting of KPI on employee WSH competency and prescribe WSH goals, objectives and target to stimulate WSH performance	XXXX, CEO Company XXXX YYYY, Senior management level staff   WSHO Willy Lee
Safety Training	Company XXXX to set some money aside as the HSE training budget ,establish the training needs analysis of its managers by conducting an internal training survey , analyse the results and collaborate with its WSHO to identify the training needs of it’s manager level employees which may  include   a)Safety and Health Management system audit b)Quantitative Risk Assessment c)Project Management d)Behaviour safety management  etc	Company XXXX CEO to discuss with senior management level staff on the allocation of safety budget to improve the workplace WSH competency and performance   Identify one senior management level staff to oversee the conduct of the survey, analyse of survey results and collaborate with WSHO to identify the training needs of it’s manager level employees   Set KPI on managerial WSH training to stimulate WSH performance	XXXX, CEO Company XXXX   YYYY, Senior management level staff   KKKK HR Training Manager   WSHO Willy Lee
Group Meeting	Company XXXX CEO to set some money aside as the HSE training budget , establish procedure in analyzing the training needs of their WSH Safety Committee team and  to provide them with the relevant training to build their attitude ,skills and knowledge to make them competent to assume their role as WSH safety committee team members helping west to proactively manage its workplace WSH.   And to define the WSH safety committee team member serving period to maximum one year with the objective to expose more west employees	West Company XXXX CEO to discuss with senior management level staff on the allocation of safety budget to improve the workplace WSH competency and performance   Identify one senior management level staff to oversee the conduct of the survey, analyse of survey results and collaborate with WSHO to identify the training needs of the WSH Safety Committee team members and equip the team member with the relevant training to make them competent to assume their roles	XXXX, CEO Company XXXX   YYYY, Senior management level staff   KKKK HR Training Manager   WSHO Willy Lee
Incident Investigation and Analysis	Company XXXX CEO to set some money aside as the HSE training budget , establish procedure in analyzing the training needs of their Incident investigation team and  to provide them with the relevant training to build their attitude ,skills and knowledge to make them competent to assume  their roles	Company XXXX  CEO to discuss with senior management level staff on the allocation of safety budget to improve the workplace WSH competency and performance   Identify one senior management level staff to oversee the conduct of the survey, analyse of survey results and collaborate with WSHO to identify the training needs of the incident investigation team members and equip the team member with the relevant training to make them competent to assume their roles	XXXX, CEO Company XXXX   YYYY, Senior management level staff   KKKK HR Training Manager   WSHO Willy Lee
Safety Inspection	Company XXXX CEO to set some money aside as the HSE training budget , establish procedure in analyzing the training needs of their WSH Safety Committee  team members and  to provide them with the relevant training to build their attitude ,skills and knowledge to make them competent to assume  their roles	Company XXXX CEO to discuss with senior management level staff on the allocation of safety budget to improve the workplace WSH competency and performance   Identify one senior management level staff to oversee the conduct of the survey, analyse of survey results and collaborate with WSHO to identify the training needs of the incident investigation team members and equip the team member with the relevant training to make them competent to assume their roles	XXXX, CEO Company XXXX   YYYY, Senior management level staff   KKKK HR Training Manager   WSHO Willy Lee
Hazard Analysis	Company XXXX should look into establishing and formation of a risk assessment team which comprises of employees across cross functional department to ensure no hazards/risks are being oversight or left unidentified   Adopt a 5x5 risk assessment matrix to better represent the identified hazards /risks associated with their manufacturing  and equip the risk assessment team members with the relevant practical knowledge in risk management	Company XXXX CEO to discuss with senior management level staff on the allocation of safety budget to improve the workplace WSH competency and performance   Identify one senior management level staff to oversee the conduct of the survey, analyse of survey results and collaborate with WSHO to identify the training needs of the incident investigation team members and equip the team member with the relevant training to make them competent to assume their roles	XXXX, CEO Company XXXX   YYYY, Senior management level staff   KKKK HR Training Manager   WSHO Willy Lee

 

VERIFICATION OF EFFECTIVENESS AND CLOSURE OF ACTION ITEMS

At this stage, The HSE Consultancy and Training Pte Ltd  Auditors are not able to verify the
effectiveness of the implemented control measures and closure of the action items

Follow up post audit meeting will be scheduled with West to verify effectiveness of the
implemented control measures and closure of the action items.

A)Reduced WSH risks, if not eliminated

Comparison between the residual risk level before and after the implementation of the action items will be used as a criteria in verifying the effectiveness of the action items. The comparison results should show that the after control measure implementation should yield a lower number of accident or injury or near-miss cases if the control measures implemented are effective in reducing the WSH risks, if not eliminated