HSEQ & Org. Risk Department Internal Audit Report for: HSE ☐ QMS ☐ Other ☐ (Specify): Month, Year Project/Division/Department Name Auditors Details: Name Contact Details (email & number) Auditees Details: Name Title Contact Details (email & number) Signature Table of Contents 1. EXECUTIVE SUMMARY 3 1.1 PREVIOUS AUDIT FINDINGS 3 1.2 SUMMARY OF CURRENT AUDIT FINDINGS 3 1.3 OVERALL AUDIT RESULT 3 2. AUDIT FINDINGS 4 3. EXHIBITS 5 1. EXECUTIVE SUMMARY 1.1 PREVIOUS AUDIT FINDINGS FINDINGS RISK LEVEL NO. OF FINDINGS HIGH MEDIUM LOW 1.2 SUMMARY OF CURRENT AUDIT FINDINGS FINDINGS RISK LEVEL NO. OF FINDINGS HIGH MEDIUM LOW 1.3 OVERALL AUDIT RESULT Based on the levels of our individual findings and their collected impact on operations, we rate the audit of the Project as: Overall Audit Result Very Good Controls are functioning as intended and no additional actions are necessary at this time. Good Controls are functioning as intended with some areas for improvement. Average Controls are partially functioning as intended with some minor deficiencies. Below Average Many of the controls are not functioning with some potential major deficiencies. Unsatisfactory Controls are not functioning with several major deficiencies. 2. AUDIT FINDINGS Audit Area (1) Findings (2) Status (3) Risk Level (4) Root Cause (5) Proposed Corrective Action (6) Due Date (7) Notes: i. Columns 1-4 will be filled by Auditor, column 5 will be filled by Auditor in coordination with Auditee. Columns 6-7 will be filled by Auditee. ii. Column 3 (Status) will be: New/Open/Closed. iii. Column 5 (Root Causes) will be: 1. Inadequate Awareness/Communication, 2. Inadequate Supervision/Leadership, 3. Inadequate System/Procedure/Process, 4. Inadequate Corrective Action/Implementation, 5. Inadequate Investigation, 6. Others (Please Specify) 3. EXHIBITS

1. HSEQ & Org. Risk Department
Internal Audit Report for:
HSE ☐ QMS ☐ Other ☐
(Specify):
Month, Year
Project/Division/Department Name
Auditors Details:
Name Contact Details (email & number)
Auditees Details:
Name Title
Contact Details (email
& number)
Signature

2. Project Name/Month-Year Page 2 of 5 Form # HSEQ - HSEQAR (Rev 2 – Mar 23)
Table of Contents
1. EXECUTIVE SUMMARY .............................................................................. 3
1.1 PREVIOUS AUDIT FINDINGS ....................................................................3
1.2 SUMMARY OF CURRENT AUDIT FINDINGS ....................................................3
1.3 OVERALL AUDIT RESULT ........................................................................3
2. AUDIT FINDINGS ..................................................................................... 4
3. EXHIBITS.............................................................................................. 5

3. Project Name/Month-Year Page 3 of 5 Form # HSEQ - HSEQAR (Rev 2 – Mar 23)
1. EXECUTIVE SUMMARY
1.1 PREVIOUS AUDIT FINDINGS
FINDINGS RISK LEVEL NO. OF FINDINGS
HIGH
MEDIUM
LOW
1.2 SUMMARY OF CURRENT AUDIT FINDINGS
FINDINGS RISK LEVEL NO. OF FINDINGS
HIGH
MEDIUM
LOW
1.3 OVERALL AUDIT RESULT
Based on the levels of our individual findings and their collected impact on operations, we rate the audit
of the Project as:
Very Good
Controls are functioning as intended and no additional actions
are necessary at this time.
Good
Controls are functioning as intended with some areas for
improvement.
Average
Controls are partially functioning as intended with some minor
deficiencies.
Below Average
Many of the controls are not functioning with some potential
major deficiencies.
Unsatisfactory Controls are not functioning with several major deficiencies.
Overall Audit Result
0
2
4
High Medium Low
Issues
Risk

4. Project Name/Month-Year Page 4 of 5 Form # HSEQ - HSEQAR (Rev 1 - Mar 23)
2. AUDIT FINDINGS
Audit Area
(1)
Findings
(2)
Status
(3)
Risk
Level
(4)
Root
Cause
(5)
Proposed Corrective Action
(6)
Due Date
(7)
Notes:
i. Columns 1-4 will be filled by Auditor, column 5 will be filled by Auditor in coordination with Auditee. Columns 6-7 will be filled by Auditee.
ii. Column 3 (Status) will be: New/Open/Closed.
iii. Column 5 (Root Causes) will be: 1. Inadequate Awareness/Communication, 2. Inadequate Supervision/Leadership, 3. Inadequate System/Procedure/Process, 4. Inadequate
Corrective Action/Implementation, 5. Inadequate Investigation, 6. Others (Please Specify)

5. Project Name/Month-Year Page 5 of 5 Form # HSEQ - HSEQAR (Rev 1 - Mar 23)
3. EXHIBITS