SUB CONTRACTOR HEALTH AND SAFETY QUESTIONNAIRE
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1 SUB CONTRACTOR HEALTH AND SAFETY QUESTIONNAIRE Introduction and instructions. Those contractors employing less than five people and sole traders should complete section A and B only. Those companies employing more than five people should complete sections A and C This document is issued for your completion to enable your health and safety arrangements to be ascertained prior to your inclusion on the list of approved sub-contractors. The Health and Safety at Work Act 1974 places responsibilities on organisations to ensure that contractors and subcontractors perform their duties with due regard to health, safety and welfare. The Construction (Design and Management) Regulations 2007 require those who appoint contractors to them to ensure that these contractors are competent and adequately resourced. This questionnaire is to enable these requirements to be verified and enable the company to discharge its responsibilities under these regulations.
2 All Companies should complete this section DETAILS OF COMPANY SECTION A Name: Address Telephone Number Fax Number Please indicate below the trade or disciplines for which you wish to be considered How long have you Been in business? Provide details of three projects of a similar size and type Please Supply 2 Trade references Number of Employees Directly employed Number of Agency or Labour only contractors
3 SECTION B 1. Name of person responsible for Health and Safety within your organisation 2. Please advise what safety related training your employees have received in the last three years by marking the list of examples of training below. Please PROVIDE COPIES of the certificates with this form NEBOSH General Certificate IOSH Directing Safely IOSH Managing Safely IOSH Working Safely SMSTS CNCGS Passport to Safety CSCS Manger CSCS Operative MEWP ( IPAF) Mobile Scaffold (PASMA) Abrasive Wheels Manual Handling Gas Safety (CORGI) Forklift Truck Fixed Scaffold (CITB) Electricity at Work Electrical work (BS7671) Electrical Testing (fixed Installation) PAT Testing Use of Woodworking Equipment Plant (Detail Below Other training (detail Below) 3. Are you prepared to undertake health and safety training provided by the Company (this shall be at your own expense)? 4. Over the last three years has your company been prosecuted regarding health and safety or received any improvement or prohibition notices from the Health and Safety
4 Executive?. If yes, PROVIDE DETAILS below. (continue of an additional piece of paper if necessary. 5. Please provide details of all accidents resulting in over three days absence from work in the last three years. 6. Please provide details of your accident reporting procedure 7 Please list below the Personal Protective Equipment issued to employees. 8. Do you charge for any PPE provided? 9 Do you sub-contract any work to others, if so, PROVIDE DETAILS of how you assess their health and safety performance and competency 10 Please INCLUDE COPIES of you Public and Employers Liability Insurances. 11 Please INCLUDE COPIES of your CIS status 12 Provide details of your systems for ensuring safe plant and work equipment
5 SECTION C 1 Please POVIDE A COPY of your Health and Safety Policy inclusive of arrangements and revision date. If you are CHAS registered please enclose your CHAS Certificate and go to question Please provide details of how this policy is implemented or indicate the page in the policy where this is detailed 3 Over the last three years has your company been prosecuted regarding health and safety or received any improvement or prohibition notices from the Health and Safety Executive?. If yes, PROVIDE DETAILS below. (continue of an additional piece of paper if necessary. 4 Please PROVIDE COPIES of Health ands Safety training certificates for your employees. 5 Please detail the Health and Safety training given to Managers and Supervisors and INCLUDE COPIES of certificates 6 What procedures does your company have to ensure compliance with The Management of Health and Safety Regulations Please INCLUDE COPIES or Risk Assessments, Vibration risk Assessments, COSHH Risk Assessments and Manual Handling Risk Assessments. 7. How do you communicate the findings of such risk assessments to your employees? 8 Does your company have any written safety procedures, i.e. a safety manual or handbook, guide etc. Please INCLUDE COPIES as necessary. 9 What is your company procedure for reporting and investigating accidents, incidents and dangerous occurrences? 10. What are your company procedures to ensure that all plant and equipment for use site is maintained in a safe condition in accordance with the Provision and Use of Work Equipment Regulations (PUWER) 1998 and the Electricity at Work Regulations 1998?
6 11 Please provide the name of the senior executive responsible for health and safety 12 Do you employ or retain the services of a qualified safety advisor? Please detail below their name and qualifications. Please PROVIDE COPIES of their CV/Qualifications 13 Describe your company s arrangements for health and safety monitoring on site and inspections of your operations 14 Please list below the Personal Protective Equipment issued to your employees
7 15 Do you charge for any PPE provided? 16 Please provide details of how you assess the competence and health and safety performance of any sub-contract companies or individuals you may employ 17 Please detail how you ensure that sub-contractors adhere to the provisions of your company health and safety policy 18 Please attach any additional information that you believe is relevant and that will assist us in assessing your company s effectiveness in controlling risks and managing health and safety. 19 Please INCLUDE COPIES of you Public and Employers Liability Insurances. 20 Please INCLUDE COPIES of your Tax status
8 DECLARATION Name of person completing this form. PRINT SIGN POSITION DATE INCLUSIONS CHAS Certificate Included Project details supplied Trade References supplied Yes / No Yes / No Yes / No CIS Card copy Yes / No Employers Liability Insurance Certificate Yes / No Public Liability Insurance Certificate Yes / No Health and Safety Policy Yes / No Risk Assessments Yes / No Safety Advisor Credentials Yes / No Safety Manual Yes / No Training Certificates Yes / No
ebrit Services Ltd Sub Contractors Pre Qualification Questionnaire
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