SAMPLE SITE EHS MATRIX SCORE CARD

SITE EVALUATION REPORT
Facility:		Audit Date(s):
Location:		Audit Team:
Business Unit:		Safety Contact:
Plant Manager :		Env. Contact:
Sr.No.	Criteria	Score	Remark / Observations
1	Safety Performance  - LWT incident rate	10
2	LWT hrs / Total hrs. worked	10
3	% Compliance of CAP  within the requirements (External)  / (Internal)	5
4	Regulatory compliance	5
5	Training man days / hours per employees	10
6	LOTO and its effectiveness	10
7	Machine guarding and its effectiveness	10
8	Job safety analysis	10
9	Near Misses Reported /Timely Reporting of incidents	10
10	Site 5 S Audit Score / Housekeeping	10
11	Health & Environment hygiene monitoring & project tracker for the abnormal points	10
	Total Score	100
Score	Rating		Final Score
1	Poor		1 to 25
2	Fair		26 to 50
3	Good		51 to 75
4	Very Good		75 to 100