Re: Social Responsibility and Health and Safety self-assessment of contractors

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1 Prcurement Department Hlcim (Belgique) S.A. Prtes de l Eurpe Avenue Rbert Schuman 71 B-1401 Nivelles Tél Fax www;hlcim.be Re: Scial Respnsibility and Health and Safety self-assessment f cntractrs Dear Sir r Madam, The willingness and bjective f LafargeHlcim and its subsidiaries is t make a lng-term cmmitment with business partners wh adhere t the values f ur Supplier Cde f Cnduct. Fr the purpses f ur nging effrts t strengthen relatins with ur subcntractrs and service prviders, and in rder t guarantee the health and safety f their members f staff, when assessing ur cntractrs we aim t take n bard criteria ther than thse f perfrmance, price and quality. Therefre, please cmplete and send back the enclsed questinnaire entitled Pre-qualificatin Scial Respnsibility and Health and Safety questinnaire fr cntractrs. In this way, yu will undertake t respect and ensure that yur staff cmply with the safety rules in frce at Hlcim. We wuld als like t ask yu t send us the fllwing dcuments and certificates: Civil Liability insurance plicy ( bject & amunts) A certificate f entry upn the Cmmercial and Cmpanies register (Kbis)(FR)/ Databank f registered cmpanies (BE) r equivalent The dcument attesting yur agreement t the General Data Prtectin Regulatins (GDR). Please get in tuch with us if yu have any questins abut ur cntractr pre-qualificatin prcess and thank yu in advance fr yur help with meeting ur cmmitments. Best regards, Prcurement Supprt Frce. Perfrmance. Passin. Hlcim (Belgique) S.A R.P.M Nivelles Siège Scial : Prtes de l Eurpe Avenue Rbert Schuman 71 B-1401 Nivelles Banque : ING T.V.A. : BE

2 AGREEMENT IN RELATION TO THE SHARING OF PERSONAL DATA (GDPR) 1. DATA PROTECTION 1.1 The Parties agree t share with each ther certain Persnal Data (such data received by the ther Party: "Shared Data") n the basis f Article 6 par. 1 (b) f the EU General Data Prtectin Regulatin (GDPR) fr purpses f the perfrmance f this Agreement nly ("Permitted Purpse"). N special categries f persnal data (sensitive data) will be transferred and prcessed. The Party receiving Shared Data frm the ther shall be referred t herein as the "Data Receiver" and the Party transferring Shared Data t the Data Receiver shall be referred t herein as the "Data Disclser". Details f the Shared Data: (a) (b) Categries f data subjects cncerned: Individuals invlved in the executin f the Agreement at bth Parties r at third parties invlved in the executin f the Agreement Categries f Shared Data Cntact details, such as name, psitin, lcatin, telephne number r ther cmmunicatin channel data N special categries f data will be transferred and prcessed. 1.2 The Data Receiver shall at all times prcess Shared Data in a prfessinal manner in cmpliance with applicable law and this Agreement exercising due skill, care and diligence and shall implement and apply apprpriate, state f the art level f technical and rganizatinal data security standards. 1.3 Any disclsure r transfer f Shared Data by the Data Receiver t a third party is nly admissible if required fr the Permitted Purpse and must cmply with applicable laws, in particular Articles 25, 26 GDPR. 1.4 Where required under applicable law, either Party shall infrm data subjects cncerned abut the sharing f Shared Data under this Agreement. The Data Receiver shall prmptly ntify the Data Disclser f any requests, bjectins r any ther enquiries f Data Subjects under applicable laws regarding the prcessing f Shared Data ("Data Subject Requests") which may give rise t any legal bligatin r liability r therwise cncern the legitimate interests f the Data Disclser. 1.5 In the event f a Persnal Data Breach (Article 33 GDPR) r disputes with r claims f data subjects, supervisry authrities r ther third parties the Parties will prmptly ntify and infrm each ther prvided that such event cncerns the Prcessing f Shared Data and may give rise t any legal bligatin r liability r therwise cncern the legitimate interests f the ther Party. The Parties shall reasnably crdinate und supprt each ther in relatin t any such event. 1.6 The Data Receiver shall prmptly delete Shared Data nce they are n lnger required fr the Permitted Purpses unless the Data Receiver is required r legally permitted under applicable law t cntinue prcessing the Shared Data. Date : Signature :

3 Bx fr use by Hlcim nly Assessing fficer s name Cntractr s SAP n. Categry Pre-qualificatin validity perid Pre-qualificatin Scial Respnsibility and Health and Safety questinnaire fr cntractrs Cmpany number Identificatin f the cntractr Address Name: Cntact persn (fr cntractual & cmmercial aspects) Cntact persn (fr Health & Safety aspects) Number f emplyees Psitin: Tel. / mbile: NACE cde - Descriptin f business activity VAT n. Administrative wrk Cnsultant / Training Design and engineering ffice Office cleaning services Repairs t ffice equipment Crprate catering Gardening services Supervisry bdies Surveyr Within what gegraphical scpe d yu perate? France Belgium Netherlands Please state the regin: Cnstructin / Building and Public Wrks Quarrying (drilling, mining, extractin, etc.) Repairs / maintenance / emergency mechanical and electrical repairs, bilermaking, etc. n vehicles, buildings r facilities Treatment / handling f hazardus prducts and substances Crane peratin / twing Transprtatin / Distributin f prducts transprted by Hlcim (by rad, rail and waterways)

4 Cntractr s Health & Safety plicy and results Certificatins Des the cntractr have any certificatin in: Which? Expiry date Quality Health & Safety VCA* / VCA** BesaCC, OHSAS 18001, ther Envirnment Training prgramme safety f yur emplyees (please detail level f training and qualificatin wrker s) D yu have a general health & safety training prgramme as part f the inductin f yur peratinal supervisrs (e.g.vca) Training prgramme fr wrkers (e.g. basic VCA training) D yu have a specific training prgramme fr thse f yur emplyees wh engage in activities invlving special risks ( licence t drive vehicles, wrk at heights, etc.)? Statistics n industrial accidents Fr the whle f the cmpany At Hlcim Year N-3 Year N-2 Year N-1 Year N-3 Year N-2 Year N-1 Ttal number f industrial accidents with time ff wrk Number f fatal accidents Frequency rate Declaratin f intent The undersigned declares : That the answers given in this questinnaire are accurate That s/he undertakes t adhere and t ensure that all wrkers perating bth n behalf f his r her cmpany and n behalf f any subcntractrs adhere t the lcal legislatin and the Hlcim grup s Health & Safety and Crprate Scial Respnsibility requirements. Als available n site That s/he will take any csts relating t the Hlcim grup s Health & Safety and Crprate Scial Respnsability 1 requirements int accunt in his r her bids Intent t respect them and t have them respect by all wrkers in all circumstances. Date :.. Name + Signature : See annex : General safety requirement

5 HOLCI GENERAL SAFETY REQUIREMENTS (T be used by service prviders wrking at r n behalf f Hlcim France, Belgium and Netherlands) Legislatin: Generally speaking, the service prvider undertakes t adhere t the Health and Safety in the wrkplace legislatin currently in effect n the sites where the wrk is t be carried ut. Language: The dcuments supplied must be in the lingua franca f the site(s) in questin. Breaches / penalties: Hlcim reserves the right t call all wrk t a halt in the event f any at-risk situatins invlving the fllwing: A serius, imminent hazard A failure t adhere t a safety-related preventin prvisin defined by: A legislative / regulatry bligatin which is applicable n the site in questin The site rules which are applicable n the site in questin A wrk permit r authrisatin / preventin r start f wrk plan / safety prtcl, etc. A safety sign r ntice displayed n the site Any failure t adhere t a health and safety requirement cntractually defined between Hlcim and the service prvider shall autmatically lead t the payment by the service prvider f the fllwing penalties: 250 fr each Health and Safety discrepancy recrded 250 fr each failure t attend a Health and Safety meeting which has been scheduled and cnfirmed Safety inductin / start f wrk: Upn arriving n the site, the service prvider must g t receptin and sign the attendance register, if there is ne (every time that s/he arrives and leaves). In all cases, the service prvider must always g t see the persn placing the rder at Hlcim befre making a start n the peratins, fr the fllwing main reasns: Presentatin f the wrk and inspectin f the site Discussin f any risks f interference / chice f preventive measures Details f any instructins t be fllwed / drawing up f any safety dcuments Whenever this is specified t him r her, the service prvider must agree t any safety inductin infrmatin / training curses rganised by the sites where the wrk is t take place. Equipment / vehicles: Hlcim infrms these service prviders that, unless expressly stated therwise, the lending f equipment, machines and vehicles is prhibited. Generally speaking, all equipment used by service prviders must cmply with the current legislatin in applicatin n the sites where the wrk is t be carried ut, be in gd wrking rder and peridically checked. Fr certain peratinal equipment, Hlcim reserves the right t ask the service prvider fr the latest regulatry technical inspectin reprt. In any case the service prvider hereby gives an undertaking that, if necessary, s/he will be able t prve the cmpetence f any members f his r her staff emplyed in using his r her equipment (accreditatin, permit, authrisatin, certificate f cmpetence, etc.) Hazardus prducts: Fr any hazardus prducts, substances r items which may be brught nt a Hlcim site, the service prvider must be able t: General Safety Requirements - Hlcim Belgique Page 5/7 Versin 1 du 23rd may 2012 Prduce the prduct s technical data sheet Prduce the safety data sheet Ensure that the transprtatin, packaging and labelling all cmply with current legislatin These prducts must be temprarily stred with care taken t cntrl any risks relating t leaks (hlding tanks, absrptin kit, and the quantities stred must be limited t what is strictly necessary). Health and Safety crdinatin: Prir t carrying ut the peratins, the service prvider undertakes t send the persn placing the rder at Hlcim cntact details fr the peple frm his r her cmpany wh: Are authrised t sign cntractual health and safety dcuments Are in charge f mnitring the wrks n the Hlcim site Are in charge f the health and safety aspects All peratins carried ut by a service prvider n behalf f Hlcim may nly be undertaken after the drawing up and signing f a dcument analysing the risks and setting ut any preventive measures relating t the wrk (wrk permit r authrisatin, preventin / start f wrk plan, safety prtcl, etc.) Only service prviders wh are in pssessin f cpies f the dcuments stated abve may begin the wrk entrusted t them. Service prviders undertake t send these dcuments t any persns frm the cmpany wh they may have assigned t wrk n the Hlcim site. Service prviders undertake t infrm their Hlcim cntacts in advance if they wish t use subcntracting fr the purpses f carrying ut all r part f the wrk entrusted t them. Hlcim reserves the right t accept r reject the subcntractrs suggested by service prviders. Service prviders undertake t take part in site / safety meetings rganised by r n behalf f Hlcim. Cleanliness and tidiness: The service prvider undertakes t keep the wrking area clean and tidy bth whilst the wrk is being carried ut and prir t leaving the site. All service prviders are respnsible fr cleaning, repairing and verhauling any facilities they may have siled r damaged thrughut wrk n the site. Wrking alne: Service prviders must nt carry ut any wrk utside f pening hurs and days r when there are n Hlcim members f staff in attendance n the site. When permanent surveillance by a third party capable f prviding help is nt pssible, wrking alne is authrised nly subject t the prviding by the service prvider f suitable equipment allwing his r her peratives t alert the emergency services if necessary.

6 HOLCI GENERAL SAFETY REQUIREMENTS (T be used by service prviders wrking at r n behalf f Hlcim France, Belgium and Netherlands) Using explsives: Generally speaking, the service prvider undertakes t adhere t the current regulatins n the site where the wrk is t be carried ut fr the transprtatin, handling and use f explsives Explsives may nly be used by a persn wh has an apprpriate and currently valid certificate f cmpetence and a blasting licence issued by Hlcim If they are t be used as sn as they have been received, the quantities f explsives rdered must be used n the same day (therwise steps which are in line with the applicable regulatins must be taken t guarantee bth safety and prtectin against theft). The service prvider must remve any surplus explsives frm the site nce lading is cmplete (the service prvider must take back any explsives left ver after each peratin). Befre any blasting peratin: Ensure that the danger zne is evacuated, seal up any access pints and make sure that the danger zne is cmpletely clear Annunce the blast by giving three lng blasts n a hrn After any blasting peratin: Three minutes after the blast, check the tp and bttm f the blasting area In the event f any misfires, d nt sund the signal fr the end f blasting and fllw the regulatry prcedure Annunce the end f blasting by a lng blast n a hrn Cllect any undetnated explsives n the same day fr destructin Access t a cavity created by the blasting must nly be allwed after the discharging f any gases and the securing f the zne Wrk near / n bdies f water: In rder t avid any risk f drwning, wrk may nly be carried ut n r near a bdy f water prvided that: Wrk at heights: A lifejacket is wrn (including n bard a vehicle). Prf f swimming prficiency can be prduced (50 metres) The wrk must be carried ut under the cnstant surveillance f a third persn Wrk at heights may nly be carried ut upn a wrk surface which has been designed, installed r fitted ut in such a way as t guarantee the health and safety f the wrkers invlved. Generally speaking, the equipment (guardrails, cradles, platfrm lifts, scafflding, harnesses, ladders, etc.) used t carry ut wrk at heights must be: Cmpliant with the regulatry requirements and in perfect wrking rder Used by cmpetent staff wh are duly accredited / authrised by the head f the service prvider s establishment Fr certain kinds f equipment, Hlcim reserves the right t ask fr the fllwing: The latest regulatry technical inspectin reprts, Certificates f training / accreditatin / authrisatin Scafflding may nly be installed and used in line with the regulatry prvisins. The service prvider must be able t prve the cmpetence f the persn in charge f carrying ut the assembly and checking f any scafflding fr which s/he is respnsible. Medical fitness: The service prvider undertakes t adhere t the regulatry prvisins n the medical surveillance f his r her staff and t take the nature f any health hazards t which his r her emplyees may be expsed as a result f the activities f Hlcim int accunt. Persnal prtective equipment: Members f the service prvider's staff must wear any persnal prtective equipment which is stated t be cmpulsry n the sites where the wrk is t be carried ut (helmets, high-visibility clthing, safety shes, safety gggles, hearing prtectin, breathing prtectin, etc.) at all times. The chice and use f any persnal prtective equipment relating specifically t the actual risks f the service prvider s activities (wrk at heights, welding, handling f hazardus prducts, etc.), remains the latter's respnsibility. Lcking ut: All peratins (electrical, mechanical, hydraulic, etc.) n facilities, vehicles, buildings, etc., may nly be undertaken after fllwing the lck-ut prcedure currently effective at Hlcim. Electrical wrk: Wrk f an electrical nature may nly be carried ut by members f staff wh have been duly accredited by the head f the service prvider s establishment. The accreditatin must be up-t-date and match bth the types f wrk r peratin and the vltage range n which the accredited persn will be wrking. Hlcim reserves the right t check the accreditatin dcuments. Lifting / mechanical handling wrk: Wrk invlving the handling-mechanical lifting f equipment r materials requiring the use f vehicles r devices (frklift trucks, cranes, laders, telescpic handlers, etc.) may nly be carried ut by members f staff wh are duly authrised by the head f the service prvider s establishment. The authrisatin must be up-t-date and match the types f vehicles r devices used by the service prvider. Generally speaking, the equipment used t carry ut these mechanical handling-lifting peratins must be cmpliant and in perfect wrking rder. Fr certain kinds f equipment, Hlcim reserves the right t ask fr the latest regulatry technical inspectin reprts. General Safety Requirements - Hlcim Belgique Versin 1 du 23rd may 2012

7 HOLCI GENERAL SAFETY REQUIREMENTS (T be used by service prviders wrking at r n behalf f Hlcim France, Belgium and Netherlands) Ht wrk: Prir t carrying ut any ht wrk (xyacetylene cutting, grinding, brazing, welding, bitumen sldering, etc.), a fire permit must be drawn up in cnsultatin with Hlcim accrding t the prcedure currently effective at Hlcim. Wrk in cnfined spaces / material accumulatrs: Prir t carrying ut any wrk in a cnfined space material accumulatr (sils, aggregate hpper, etc.), a permit fr peratins in cnfined spaces material accumulatrs must be drawn up in cnsultatin with Hlcim accrding t the prcedure currently effective at Hlcim. A supervisr must be appinted t mnitr the wrk frm the utside and must be present thrughut whilst the wrk is being carried ut, and must nt leave the premises under any circumstances whatsever. S/he must cnstantly have a means f cmmunicatin allwing him r her t alert the emergency services if necessary. The prviding f adequate peratinal and emergency equipment must als be decided upn prir t carrying ut wrk f this type. Excavatin / earthwrks: Prir t carrying ut any excavatin earthwrks (excavatin, stripping f tp sil, cring / sunding, earthwrks / clearing / filling, wrk n undergrund pipes, etc.), an excavatin earthwrks permit must be drawn up in cnsultatin with Hlcim accrding t the prcedure currently effective at Hlcim. The wrk may nly cmmence nce the fllwing peratins have been carried ut: A search fr and the identificatin f any buried r verhead netwrks Adherence t the regulatry prvisins applicable n the site where the wrk is t be carried ut (crdinatin / cnsultatin / infrmatin wrking with the netwrk cncessin hlders) Acceptance f the wrks / end f peratins: At the end f the wrks, the service prvider must ntify the persn placing the rder at Hlcim befre leaving the site in rder t prceed t the acceptance f the wrks carried ut: Checks t ensure that the site has been tidied up and any materials, waste, etc. have been remved. Checks n tagging ut, Checks t ensure that there are n risks t future peratives (verhauling f safety devices, prtective equipment, emergency shutdwn, alarms, etc.) Checks t ensure that everything is wrking prperly Handver f dcuments, drawings, instructins, etc. The wrks may nt be deemed t be cmpleted and thus paid fr until this cnditin is fulfilled. Alchl / drugs / smking: When members f staff are present n a site belnging t Hlcim r carrying ut wrk n behalf f Hlcim, bth the cnsumptin and bringing f alchl r drugs nt the site, r wrking under their influence are strictly prhibited. As a general rule smking is banned n Hlcim premises (please adhere t the signs in place). Asbests: If the peratin entrusted t the service prvider expses him r her t wrking n r near asbests, Hlcim will send him r her an extract frm the asbests technical dcumentatin. These peratins may nly be perfrmed after a risk assessment has been carried ut and any preventive measures tailred t the risks f asbests have been implemented. Generally speaking, the service prvider is respnsible fr the remval f his r her wn waste, in adherence t the regulatry prvisins fr the site n which the wrk is t be carried ut. The discharging f prducts int the natural envirnment and int the water inflw r cllectin netwrks is strictly prhibited. All waste must be srted and then dispsed f thrugh authrised recycling channels suitable fr the type f waste. Pending dispsal, waste must be stred n the site in the skips prvided fr this purpse. The burning f waste is strictly prhibited. Any nisy wrk must be avided between 10 p.m. and 6 a.m. Dust must be captured and sucked up as clse t the surce as pssible. Dust / Silica: In rder t prevent the risk f emplyees being expsed t any dust and silica dust, the members f staff carrying ut the wrk must adhere t the safety signs specifically put int place and wear suitable breathing prtectin when required. Nise: In rder t prevent the risk f emplyees being expsed t nise, the members f staff carrying ut the wrk must adhere t the safety signs specifically put int place and wear suitable hearing prtectin when required. General Safety Requirements - Hlcim Belgique Versin 1 du 23rd may 2012

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Re: Social Responsibility and Health and Safety self-assessment of contractors Prcurement Department Hlcim (Belgique) S.A. Prtes de l Eurpe Avenue Rbert Schuman 71 B-1401 Nivelles Tél. +32 67 87 62 18 Fax +32 67 87 62 23 www;hlcim.be Re: Scial Respnsibility and Health and Safety

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