HSE P0801 HSE Document Control and Records Management Procedure

Transcription

1 HSE P0801 HSE Document Control and Records 1. DOCUMENT CONTROL PURPOSE SCOPE DEFINITIONS ROLES AND RESPONSIBILITIES PROCESS DETAILS Document Control Records Management Creating a New HSE Document Revising an Existing HSE Document HSE Document Templates, Formatting and Numbering Document Approval Process Document Processing and Publication Reviewing an HSE Document HSE Records Identification and Management Record Content and Quality Record Storage, Maintenance, Access, Reproduction, Security and Protection Record Retention and Disposal External Documents and Websites Documents for Contractors REFERENCE MATERIALS ATTACHMENTS Appendix A: Creating a New HSE Document Process Appendix B Revising an Existing HSE Document Process Appendix C Reviewing an HSE Document Process Page 1 of 17

2 1. DOCUMENT CONTROL Document Information Document ID Document Administrator Document Name Information HSEP0801 WHS & HSE Systems Manager Issue Date 1 October 2015 Document History HSE Document Control and Records Rev No Date Description Approved by 0 11/07/ /01/2013 Document developed as part of HSE Integration project Updated section 3.6 to include description about checking out and managing the revision of documents. 2 20/01/2015 Updated as per scheduled review 3 June 2015 HSE Review Document Change Summary Date Section Change Description Mgr Sustainability & Safety Mgr Sustainability & Safety Mgr Business Operations WHS & HSE Systems Manager 11/07/2012 Original Issue 23/01/2013 Updated section 3.6 of original doc to include description about checking out and managing the revision of documents. 20/01/2015 Whole of document Updated to reflect current business structure and process Document Approvals Role Name Signature Date WHS & HSE Systems Manager Darren Pegram 16/9/15 Page 2 of 17

3 Related Documents Document Name HSEP Management of Change Procedure HT-DA2341 HT Retention & Disposal Schedule GG-AM Information Management Records & Data Management Guideline HSEF HSE System Change Variance Request and Approval Form HSEP0803 HSE Document Numbering Procedure HSER HSE Document Register HSE Management System Manual Author Joy Marsh Julie Wright Unknown Joy Marsh Joy Marsh Joy Marsh Kathryn Koay Page 3 of 17

4 2. PURPOSE To describe how Hydro Tasmania s (HT) Health, Safety & Environment (HSE) documents are developed approved, registered, published, and controlled and to ensure the currency and security of records requirements for the effective operation of the HSE Management System (HSEMS) in accordance with OHSAS18001 Health and Safety Standard and ISO14001:2014 Environmental Management System. 3. SCOPE The HSE Management System Manual and Elements apply to all Business Units across the HT Group. Some HSE Management System documents (with HSE numbers) may be superseded by Business Unit documentation where appropriate e.g. Momentum maintains separate Environmental Management System (EMS) documentation appropriate to their Environmental Management System scope. In such instances, the Business Unit document must state which HSE documentation they are replacing. 4. DEFINITIONS Term or Acronym Meaning See HSEREF Work Safe Roles and HSE Glossary Document Information documented in paper or in electronic or in photographic format and maintained for reference by Workers. Note: Documents (excluding records) may be reviewed regularly and are considered as active documents HSE Health Safety & Environment HSEMS Health Safety & Environment Management System HSE Review Team Consists of HSE representative, stakeholders (LG etc. and Subject Matter Experts) ISO14001 Australian / NZ standard Environmental management systems Requirements with guidance for use MOC Management of Change is the process used to review all proposed Management of changes to materials, technology, equipment, procedures, personnel, Change and facility operations before they are implemented to determine their effects on HSE vulnerabilities. OHSAS18001 Record Subject Matter Expert (SME) British Standards Health & Safety Management System Standard Document stating results achieved or providing evidence of activities performed. A record is a type of document that captures the story of something that has happened. Because it is a historical account, it does not change. Is a Worker who is an expert in a particular area or topic (i.e. technical expert) Page 4 of 17

5 5. ROLES AND RESPONSIBILITIES Work Requestor HSE Change Requestor Legislation Work Planner Work Authoriser HSE Review Team Work Supervisor Specialist Worker Roles Subject Matter Experts Document Author Workers Advice / Support Workers HSE Team Document Approver Work Requestor shall: request work to be done. HSE Review Team shall: consider new document creation or revision of existing HSE document requests; authorise the work to be done; assign appropriate Document Author responsibilities for the development and creation of HSE document(s); and determine if draft document is final and ready for approval. Document Author shall: prepare and revise of the HSE document as requested by the HSE Review Team ; and in the correct format as per HSE document preparation guidelines; obtain technical content of the document(s) if not a Subject Matter Expert in the relevant field; obtain approval of the final document; invite all concerned for comments and incorporating valid comments, as necessary; and forward the approved controlled document to the HSE Document Administrator for publication and communicating to the relevant audience. Subject Matter Expert shall: validate and approve technical contents of the HSE document(s) and revisions to existing HSE documents as relevant to their field. Page 5 of 17

6 Document Approver shall: approves the changed document; authorise the administrative formalities of all HSE documentation for publication; and ensure all information is compliant with HSE Management System requirements. HSE Document Administrator shall: process and publish and organise the review(s) of all HSE Management System documents. Workers shall: comply with HSE requirements as detailed in all HSE documentation HSE Team shall: coordinate the HSE Risk Assessments; maintain and review HSE documentation; and communicate and provide training in the application of HSE processes Page 6 of 17

7 6. PROCESS DETAILS 6.1 Document Control HSE document identification and creation underpins the HSE Management System, determines Control Measures to reduce Risk and demonstrates compliance with legislation (see Section 6.3 Creating a New HSE Document and Appendix A: Creating a New HSE Document Process); document maintenance includes review, revision and version control, removal of obsolete documents, retention and or authorised disposal (see Section 6.4 Revising an HSE Document and Appendix B: Revising an Existing HSE Document Process, and Section 6.8 Reviewing an HSE Document and Appendix C: Reviewing an HSE Document Process; document approval follows the approval process outlined in HT s Policy Framework; and document publication and communication is outlined in the HSE Management System Manual and legislative requirements in accordance with OHSAS18001 Health and Safety Standard and ISO14001:2014 Environmental Management System. 6.2 Records Management HSE Business Records are identified, stored, and maintained based on regulatory and business requirements; HSE Records shall be and remain legible, identifiable and traceable throughout their lifecycle; HT has statutory obligations (as a GBE) under the Archives Act and therefore has established, implemented and regularly maintains a process for the identification, storage, protection, retrieval, and disaster recovery for the HT s business records; and HSE Records retention and disposal is managed in accordance with business and statutory requirements (under the Archives Act) or as document authorised by HT-DA2341 HT Retention & Disposal Schedule 6.3 Creating a New HSE Document (See Appendix A: Creating a New HSE Document Process) When the need for a new document or an identified document gap (i.e. legislative change requirements) is recognised, HSEF HSE System Change Variance Request and Approval Form must be completed and submitted to the HT HSE Group; the HSE Review Team meets to determine the need for creating a new document or the revision of existing HSE document(s); Page 7 of 17

8 if a new HSE document is required, an appropriate Document Author or Subject Matter Expert is selected to prepare a draft document; upon completion of the draft document, the Document Author submits the document to all relevant parties including additional Subject Matter Experts (if required) for review and comment; if changes are required to the draft document, the Document Author revises the document incorporating the relevant comments until all parties deem the draft final ; the Document Author then forwards the final draft to the HSE Review Team for comments, review and Document Authorisation to proceed to the Document Approver; the Document Author forwards the document to the Document Approver who determines if the document is final, once approved the document is signed off, dated and returned to the Document Author; the Document Author forwards the approved document to the HSE Document Administrator for publication; the published document is communicated to the relevant parties and communication channels as identified by the HSE Review Team; and the HSE Review Team will be responsible for developing a training plan as required. 6.4 Revising an Existing HSE Document (see Appendix B: Revising an Existing HSE Document Process) When the need for revision of a document is identified, HSEF HSE System Change Variance Request and Approval Form may be completed and submitted to the HSE Group; the HSE Review Team considers the request and determines if changes should be made; if the HSE Review Team determines there is no requirement for change, the HSE Change Requestor will be notified of the outcome. If a document revision is considered necessary, the HSE Review Team also considers where there are major changes in a document/s and shall initiate HSEP Management of Change Procedure; an appropriate Document Author or Subject Matter Expert is selected by the HSE Review Team to revise the document; the Document Author invites comments from all relevant parties and revises the document incorporating comments received until the document revision is deemed final ; Page 8 of 17

9 the Document Author forwards the revised document to the HSE Review Team for comments, review and Document Authorisation to proceed to the Document Approver; the Document Author presents the reviewed, revised document to the Document Approver for comments and approval; once the document has been approved, the Document Author forwards the revised document to the HSE Document Administrator for processing and publication in the HSE Management System (HSEMS); and the published revised HSE document is communicated and or trained through the relevant channels as determined by the HSE Review Team and HSEP Management of Change Procedure. 6.5 HSE Document Templates, Formatting and Numbering For standardisation of format and use of a unique document identifier for HSE Management System documents, refer to the HSE templates (available through My Collaboration, Sustainability & Safety, HSE System, Templates and HSER HSE Document Register for next number sequence). 6.6 Document Approval Process Documents must be approved when a new HSE document is developed (including procedures, work instructions, forms, plans etc. as they apply to the HSE Management System) or when a document is reviewed. A record / signature of the document approval is created and retained. This can be either in the form of a signature on a hard copy or an approval of an electronic document. Electronic approvals must be retained for the life of the document. A copy of the approval titled Document Approval - Document ID (number and name) should be ed to the HSE Group. The record should also include the revision / version number and date of approval. The Document Approver must ensure that the clearly shows that the document is approved. 6.7 Document Processing and Publication The HSE Document Administrator is responsible for the processing and publication of all HSEMS documents: processing includes ensuring the documents are in the correct format, approved, and registered; HSE documents are reviewed and updated as necessary and re-approved, only current controlled version of the document is available to view online (printed documents are uncontrolled and therefore cannot be deemed as managed or controlled) and previous revisions superseded and archived. If retained, they Page 9 of 17

10 must be adequately identified with a watermark throughout the document to prevent unintended use; documents being reviewed are checked out by the HSE Document Administrator and a working copy saved in Documents in draft or under review folder in the HSE records library HSE08 Document & Record Management folder. The working copy is circulated to relevant reviewers (HSE Review Team ) and reviewed until finalised and ready for publication; documents are published to the relevant SharePoint library. These documents are available to all Workers via MyHydro HSE web portal or External HT website Contractor HSE. Working copies in the HSE records library are removed when the revision is published; and published document(s) are communicated to the relevant parties and communication channels as identified by the HSE Review Team. 6.8 Reviewing an HSE Document (see Appendix C: Reviewing an HSE Document Process) Reviews of controlled documents are performed as per the review period set for respective documents and no longer than a 3 yearly cycle. Alternately reviews may be triggered by events such as a change to operations, Incident, audit recommendations or legislative change; the HSE Document Administrator is responsible for organising the periodic review of HSE documents. This consists of organising a meeting for the Review Team, with the review document packs prepared and presented at the meeting; the HSE Review Team is responsible for managing the review process and activities from HSEP Management of Change Procedure if required as a result of review; if there is no change required to a document, the Document Revision Table is updated and the document sent to the Document Approver for re-approval; Note: A revision upgrade should be made where the content has changed at a level where a Worker will be impacted. A revision upgrade is not required where the document was amended only to correct a typing or format error if change is required to a document then the HSE Review Team also considers whether: there are major changes in a document(s); operational change; Incident investigation; audit recommendations; business structure change; and / or legislative change; Page 10 of 17

11 if any of these conditions apply, the Review Team shall invoke HSEP Management of Change Procedure; an appropriate Document Author or Subject Matter Expert is selected by the HSE Review Team to revise the document(s); the Document Author invites comments from all relevant parties and revises the document incorporating comments received until the document revision is deemed final ; the Document Author forwards the revised document to the HSE Review Team for comments, review and Document Authorisation to proceed to the Document Approver; the Document Author presents the reviewed, revised document to the Document Approver for comments and approval; once the document has been approved, the Document Author forwards the revised document to the HSE Document Administrator for processing and publication in the HSE Management System (HSEMS). (see Section 6.7 Document Processing and Publication); and the published revised HSE document is communicated and trained (if required) through the relevant channels as determined by the HSE Review Team and HSEP Management of Change Procedure. 6.9 HSE Records Identification and Management HT shall identify, establish and manage records as necessary to demonstrate conformity to the requirements of the HSE Management System, legislative requirements, and compliance with OHSAS18001 Health and Safety Standard and ISO14001:2014 Environmental Management System. Business records that represent a policy, standard, work instruction, or register etc. shall be produced using standard templates, including consistent formats and style and saved into the HSE Systems Library 6.10 Record Content and Quality Quality business records are sources of detailed information and evidence that can be relied on and used to support current activities. They are records that have been created and managed in ways to ensure that they can be reused and understood in the future. This can be for current business purposes, as evidence in legal proceedings, for accountability to internal or external stakeholders, or for future historical research Record Storage, Maintenance, Access, Reproduction, Security and Protection Recordkeeping systems and storage facilities are designed and implemented to protect records from unauthorised access, alteration, deletion or loss. Page 11 of 17

12 HT has statutory obligations (as a GBE) under the Archives Act and therefore incorporates the guidelines and advice contained within the following document into the day to day management of its information: GG-AM-109 Information Management Records and Data Management Guideline - HT DA2341 Disposal Schedule Where this schedule does not identify a record type, these records need to be permanently retained Record Retention and Disposal Records need to be retained to ensure legal compliance, due diligence and demonstrate conformity to the requirements of the HSE Management System. The HT Business Classification Scheme (BCS) provides a structure under which all business records shall be identified, secured and indexed in accordance with HT- DA2341 HT Retention & Disposal Schedule. In accordance with company and statutory requirements (under the Archives Act) records are archived and or disposed of under the management of HT s Information Management Team External Documents and Websites Externally created documents relevant to HT s HSE Management System, will be controlled and managed in a custodian role, ensuring their continued currency and applicability to the HT requirements, in line with this procedure. External documents may include, but are not limited to, regulations, Permits, reports, and instructions from external third parties. Tasmanian legislation and regulations are to be accessed through the Tasmanian Legislation Website. Australian Standards are to be accessed from the Standards Australia website (link takes you to the HT subscription page in MyHydro). EnviroLaw and SafetyLaw are online information services that summarise, in plain English, Environmental and Safety Legal Obligations, the subscription page is accessible from the HSE internal web portal 6.14 Documents for Contractors In addition to the document control requirements specified in this procedure, the versions of documents that are critical to the HSE Compliance of Contractors must be Page 12 of 17

13 monitored in the HT external web portal, to ensure that Contractors have accessibility to the most up to date version of the HSE document(s). Page 13 of 17

14 7. REFERENCE MATERIALS The following manuals and references are used to provide a safe system of work. These requirements are a minimum standard and shall not be compromised under any circumstances. Archives Act ISO14001:2014 Environmental Management System OHSAS18001 Health and Safety Standard EnviroLaw SafetyLaw Standards Australia website Tasmanian Legislation Website The following is a list of commonly referenced material used on HT sites. HSEREF Work Safe Roles and HSE Glossary Documents in draft or under review folder in the HSE records library HSE08 Document & Record Management folder External HT website Contractor HSE GG-AM Information Management Records & Data Management Guideline HSE internal web portal HSE Management System Manual HSEF HSE System Change Variance Request and Approval Form HSEP0301 Hazard Identification and Operational Risk HSEP Management of Change Procedure HSEP0803 HSE Document Numbering Procedure HSER HSE Document Register HT external web portal HT s Policy Framework HT-DA2341 HT Retention & Disposal Schedule Page 14 of 17

15 8. ATTACHMENTS Appendix A: Creating a New HSE Document Process Creating a New HSE Document Identify gap / need for new document HSE group of need for new document utilising Form HSEF HSE Review Team considers request HSE Review Team nominate document Author for creation of new document No Could an existing document be modified to fill the gap Yes Modify existing document. Refer to flow chart revising an existing HSE document Author prepares draft document and consults Technical Specialists (if required) for first review of content. Author sends draft document to all concerned for review and comments Author presents the revised final draft to the HSE Review Team Author revises the document incorporating the relevant comments HSE Review Team determines if document is final No Author revises document based on comments Yes Author forwards the authorised document to the HSE Document Controller for processing HSE DC reviews document to ensure all required document control information is captured then returns document to Author Document is approved, signed off, dated and returned to Author. Y Approved Y/N Author sends document to Approver for comments / approval N Author forwards document to HSE Document Controller for publication Published HSE document is communicated through relevant communications channels as determined by HSE Review Team END Page 15 of 17

16 Appendix B Revising an Existing HSE Document Process Revising an Existing HSE Document Need for revision of HSE document is recognised HSE group with proposed revision request utilising Form HSEF No Will the proposed changes result in other document revisions or process change? Yes HSE Review Team considers request and determines if changes should be made Yes No Initiate management of change process HSE Review Team discuss with the requestor why the proposed changes will not be made HSE Review Team nominate document Author for revision to existing document Author invites comments from all relevant parties including Subject Matter Expert Relevant parties provide comments to Author Author presents the revised final document Author to presents the HSE the Review revised Team final document to the HSE Review Team Author revises the document incorporating the relevant parties comments until document is deemed final HSE Review Team determines if document is final No Author revises document based on comments Yes N Author sends document to Approver for comments / approval Document approved, Y/N Published HSE document is communicated through relevant communications channels as determined by HSE Review Team and MOC process Y Author forwards document to HSE Document Controller for processing and publication END Page 16 of 17

17 Appendix C Reviewing an HSE Document Process Reviewing a HSE Document HSE Document Review Period Identified HSE DC notifies HSE Review Team prior to review date No Will the proposed changes result in other document revisions or process change? Yes HSE Review Team considers review and determines if changes required Yes No Initiate management of change process (MOC) HSE Review Team send document to Approver for re-approval. Review date is changed noting reviewed with no changes. HSE Review Team nominate document Author to revise document Author invites comments from all relevant parties including Subject Matter Expert Relevant parties provide comments to Author Author presents the revised final document Author to presents the HSE the Review revised Team final document to the HSE Review Team Author revises the document incorporating the relevant parties comments until document is deemed final HSE Review Team determines if document is final No Author revises document based on comments Yes N Author sends document to Approver for comments / approval Y Document is approved, signed off, dated and returned to Author or HSE Review Team. Published HSE document is communicated through relevant communications channels as determined by HSE Review Team and MOC process Document sent to HSE Document Controller for processing and publication END Page 17 of 17