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Chapter Content CHAPTER CONTENT... 16.1 16.1 SUB-CONTRACTOR MANAGEMENT PLAN... 16.2 16.2 SUB-CONTRACTOR INFORMATION... 16.4 Chapter 1 Page 16.1 Chapter Content
16.1 Wapiti Gravel Suppliers is committed to providing a healthy, safe and management, leadership, and systems have demonstrated superior results in health, safety, and environmental performance. Subcontractors must complete this Questionnaire prior to bidding for significant risk work with Wapiti Gravel Suppliers. As a guideline, all fieldwork will be considered significant risk (Safety Sensitive) work. Please return this Questionnaire to your Contracts Administrator with required documentation as outlined on page 9. If you have additional documentation that would support the Questionnaire, please identify it in the table on page 9 and include it with your submission. We expect you to specify relevant sections from your HSE Manual with the answers in each section. In the event that you as a subcontractor are approved for work with WGS and do not have a Health and Safety Manual, you will be orientated to the WGS Health Safety and Environmental program. You will be made aware of all applicable Health and Safety Policies, Procedures, Regulations, and you will operate utilizing the WGS HSE Manual and all applicable forms. You will operate under our COR. WGS will also ensure you are made aware of Owne Policies as you are required to adhere to them as well as to the Wapiti Gravel WGS requires confirmation and documentation supporting proof of Workers Compensation coverage from our subcontractors. Failure to complete and return the Questionnaire and supporting documentation will result in your company being excluded from performing work with Wapiti Gravel Suppliers. On-site Contractors will be included in the Hazard Identification Process, all Tailgate Safety Meetings and Work-Site Inspections. As per WGS requirements, all incidents are required to be reported to WGS by subcontractors. If a subcontractor is involved in an incident, WGS is required and responsible to report the incident to the Owner/Client. Should an incident occur, the subcontractor is expected to conduct and oblige to a team investigation coincided with WGS. The Questionnaire and documentation will be reviewed and evaluated by Wapiti Gravel Suppliers technical specialists based on WCB Details, Safety Statistics, and Performance. Once evaluated, a decision will be made determining the suitability of your company and included in the overall bidding. Chapter 1 Page 16.2
16.2 Sub-Contractor Information Mailing Address: City: GENERAL INFORMATION Remittance Address: City: Province: Postal Code : Province : Postal Code : Phone : Fax : Phone : Fax: 2. Previous Company Name (if applicable) 3. Contact Info. Name & Title Primary Information ( ) HS&E Purposes ( ) Telephone Number Email Address 5. List types of work normally performed by your Company and those sub-contracted to others. HEALTH, SAFETY & ENVIRONMENT MANAGEMENT 6. Do you have a full-time HS&E representative? Yes No Name: Telephone No. ( ) Qualification Email Address ACSA CET CHSC CRSP P.Eng. ROH Trade Cert Other 7. Do you have the ability to provide a full-time HS&E representative on site? Yes No Name: Telephone No. ( ) Email Address Qualification ACSA CET CHSC CRSP P.Eng. ROH Trade Cert Other Chapter 1 Page 16.4 Sub-Contractor Information
GENERAL REQUIREMENTS 8. Does your Company have Worker's Compensation Insurance? provide current letter of clearance Yes No 9. Does your Company have General Liability Insurance of: $2,000,000 Yes No $5,000,000 Yes No provide insurance certificate from Insurance provider 10. Does your Company have an Alberta WH&S Certificate of Recognition or equivalent? - provide copy of certificate or letter of interim. Yes No N/A 11. Does your Company have a Substance Abuse Policy? Yes No If yes, does it include the following? Provide a copy of your program. Work rules that prohibit & procedures to deal with impairment by alcohol, drugs and medication in the workplace Yes No Yes No Alcohol & Drug testing of employees/subcontractors for reasonable cause, post incident. Yes No Chapter 1 Page 16.5 Sub-Contractor Information
HEALTH, SAFETY & ENVIRONMENT PERFORMANCE This section must include all Sub-contractor Injury Statistics together with your Company's Performance 12. WCB Details Last Year 1 st Previous Year Your Industry WCB Premium Rate 2 nd Previous Year Employers' WCB Premium Rate Your Industry WCB Rate Adjustment, % Surcharge or (Discount) on WCB Rate 13. Safety Statistics & Occupational Illness Cases Number of fatalities Number of lost time injuries (LTI) Number of lost days Number of medical treatment cases (MTC) Number of Restricted Work Cases (RWC) Number of first aid injuries (FA) Exposure hours including sub-contractors Number of Vehicle Accidents (VA) Total Number of Kilometers driven NOTE: Each incident / case should only be recorded in one category, that category being the worst cast (e.g. a Medical Treatment Case becomes a Lost Time Injury - the incident would be re-classed from an MTC to an LTI and removed from the MTC category. RIF =(# MA + # LTI) x 200,000 LTIF = # LTI x 200,000 Severity = # Lost Days x 200,000 (Field) Exposure Hours (Field) Exposure Hours (Field) Exposure Hours NOTIFIABLE INCIDENTS/DANGEROUS OCCURANCES 14. Has your Company ever been cited, charged or prosecuted in Canada for any occupational health and safety non-compliance or environmental offense? If Yes, provide details: Yes No 15. Has your Company ever been issued with a stop order by/from a Government regulatory agency? If Yes, provide details: Yes No 16. Has the OHS/WHS regulator in the past three (3) years ever had cause to investigate your worksite? (not including regular inspections) If yes, provide details: Yes No Chapter 1 Page 16.6 Sub-Contractor Information
ENVIRONMENTAL PERFORMANCE 17. Spills release of liquid pollutant to land or water that is reportable to government authorities. 18. Compliance Incidents non-compliance to legislation that is reportable to government authorities. Last Year 1 st Previous Year 2 nd Previous Year HEALTH, SAFETY & ENVIRONMENT PROGRAM 19. Does the program cover the following? Accountabilities and responsibilities for managers/supervisors/employees: Yes No Employee participation: Yes No Management commitment and expectations : Yes No Periodic HS&E performance appraisals for all employees: Yes No Yes No Resources for meeting HS&E requirements: Yes No Hazard recognition and control. Yes No Community Impact consideration of potential impacts of work activities. Yes No Chapter 1 Page 16.7 Sub-Contractor Information
20. Does the program include work practices/procedures for the following? Housekeeping/Planned Inspections: Yes No Fitness to Work including Modified Work Program: Yes No N/A Near Miss, Unsafe Act, and Unsafe Condition Reporting: Yes No Accident/Incident Reporting and Investigation, including occupational illness: Yes No Emergency Preparedness: Yes No Fall Protection: Yes No N/A Ground Disturbance/Excavation/Trenching: Yes No N/A Confined Space Entry: Yes No N/A Load Securement : Yes No N/A Powerline Clearances: Yes No N/A Portable Electrical/Power Tools: Yes No N/A Vehicle Safety (e.g., Defensive Driving): Yes No Manual Lifting : Yes No N/A Mechanical Lifting & Hoisting: Yes No N/A First Aid Log Completion: Yes No N/A Working at Heights: Yes No N/A Near miss, Unsafe Act, and Unsafe Condition Reporting Yes No N/A Bulk Handling & Loading: Yes No N/A Equipment Lockout and Tagout: Yes No N/A Hazard Recognition and Control including chemical, physical, biological, ergonomic & psychological health hazards: Yes No N/A WHMIS Controlled Products Yes No General Practices and Procedures Yes No N/A Chapter 1 Page 16.8 Sub-Contractor Information
If you answered No to Question 20, please answer Question 21. 21. HS&E Orientation Program New Hires Supervisors Do you have an HS&E Management Orientation Program for new hires and newly hired or promoted supervisors? Yes No Yes No Does this program cover the following? Accident/Incident Investigation Yes No Yes No Emergency Procedures Yes No Yes No Fire Protection and Prevention Yes No Yes No First Aid and CPR Procedures Yes No Yes No Hazard Assessments, JSA and/or FLRA (Field Level Risk Assessment) Yes No Yes No Personal Protective Equipment Yes No Yes No Pro-Active Defensive Driving Yes No Yes No Refusal to Work Yes No Yes No Respiratory Protective Equipment Yes No Yes No Safe Work Permits and Practices Yes No Yes No Yes No Yes No Toolbox Meetings Yes No Yes No WHMIS Yes No Yes No How long is the orientation program? Hours Hours 22. Are your Company employees required to go for medical examinations / testing for? Hearing: Yes No Preplacement: Yes No Pulmonary function: Yes No N/A Vision: Yes No Other surveillance; if yes, please specify (e.g. Asbestos, benzene, lead) Yes No Chapter 1 Page 16.9 Sub-Contractor Information
23. Does your Company have written work practices for the following? Hearing Conservation Program : Yes No N/A Respiratory Protection: Yes No N/A Where applicable, have employees been: Mask Fit Tested: Yes No N/A Trained in use of RPE: Yes No N/A 24. HS&E Training Program Do you have a specific HS&E Training Program for supervisors? ie. LSE and/or Prime Contractor? Yes No Have employees received required HS&E training and retraining? Yes No Have employees received the legislated HS&E training? Yes No 25. Employee Training Have employees been trained in the appropriate job skills? Yes No Have employees been trained in WHIMIS? Yes No Have employees been trained in CSTS? Yes No 26. Does your Company provide supervisor leadership training? Yes No 27. Training Records Do you maintain HS&E and crafts training records for employees? Yes No Do the training records include the following? Yes No Chapter 1 Page 16.10 Sub-Contractor Information
28. Training Programs Workers Trained Yes No N/A CPR/First Aid Yes No N/A Defensive Driving Yes No N/A Emergency Response Yes No N/A Fall Protection Yes No N/A H2S Training (H2S Alive) Yes No N/A Hazard Recognition (i.e. JSA, FLRA) Yes No N/A Incident Investigation Yes No N/A Mechanical Lifting (forklifts, platform lifts, cherry pickers) Yes No N/A Personal Protective Equipment Use and Maintenance Yes No N/A Respiratory Protection (selection, use & care) Yes No N/A TDG Yes No N/A WHMIS Yes No N/A Other Yes No N/A 29. Vehicle Operation Does your company emphasize safe driving in training programs? Yes No Are driving records kept of employees operating company vehicles? Yes No Do you require a driver's abstract for all new hires? Yes No 30. Personal Protective Equipment (PPE) Is applicable PPE provided to employees? Yes No Do you have a program to ensure PPE is inspected and maintained?: Yes No Is the importance of wearing PPE explained to employees? Yes No Chapter 1 Page 16.11 Sub-Contractor Information
31. Equipment and Materials How does your Company ensure that tools and equipment used within your premises or at the worksite are controlled and maintained in a safe working condition? N/A What approval process does your Company have to modify tools? N/A Do you inspect hoses to comply with regulatory requirements? Yes No N/A Do you have a system to establish HS&E specifications for acquisition of materials and equipment? Yes No N/A Do you have a list of equipment (e.g., cranes, forklifts, JLGs, etc.) and the training provided to operate such equipment? Yes No NA Do you inspect equipment (e.g., cranes, forklifts, JLGs, etc.) to comply with regulatory requirements? Yes No N/A Do you maintain relevant inspection and maintenance certification records for operating equipment? Yes No N/A Do you maintain operating equipment in compliance with Provincial General Safety Regulations? Yes No N/A Chapter 1 Page 16.12 Sub-Contractor Information
32. HS&E Inspections and Audits Are HS&E inspections conducted in your Company and at work sites? : Revision Yes Date: No Chapter 16 Are HS&E Management Program audits conducted in your Company?: December Yes 1, 2010 No Are corrections of HS&E deficiencies documented? May Yes 1, 2010 No Does your Company investigate: Yes No First Aid Incidents: Yes No Medical Treatment Incidents: Yes No Occupational Illnesses : Yes No Environmental Incidents: Yes No Asset Loss Incidents: Yes No Near Miss Incidents: Yes No Automotive Incidents: Yes No Who normally conducts the Incident Investigation? (Provide a copy of an Incident Investigation Report. Confidential information should be marked out.) How are Incidents reviewed to prevent future occurrences? Conducted by (Title) General Worker Meeting Daily Weekly Monthly None Tailgate/Shift/Pre-job Meetings Shop/Office Meetings Daily Weekly Monthly None Daily Weekly Monthly None Chapter 1 Page 16.13 Sub-Contractor Information
RECOGNITION 33. Has your Company received any recognition for HS&E performance? Yes No If yes, explain: ENVIRONMENT 34. Does your company have an Environmental Policy? (provide a copy): Yes No N/A 35. Does your company have an Environmental Management System?: Yes No N/A 36. Is your Company aware of Government and legal requirements for disposal of hazardous wastes that may be generated or encountered during this work?: Yes No N/A 37. Is your Company capable of identifying hazardous wastes that may be generated or encountered during this work?: Yes No N/A 38. Does your Company have a Waste Management Program?: Yes No N/A Chapter 1 Page 16.14 Sub-Contractor Information
CHAPTER 17: INFORMATION SUBMITTAL Please provide copies of the following items (where applicable): Copy of Company Safety Manual Letter of clearance from WCB Insurance Certificate Individual to contact for clarification or additional information: Name: Telephone: I hereby certify that answers provided on this Questionnaire and any attachments to be correct and open to review by Wapiti Gravel Suppliers, or its Authorized Agent. Name and Position of person who completed the Questionnaire Signature Date Chapter 1 Page 17.15 Sub-Contractor Information
WAPITI GRAVEL SUPPLIERS HSE DEPARTMENT RECOMMENDATION SAFETY DEPARTMENT USE ONLY Contractor is: 1) Acceptable for Approved Contractor List CONTACT: 2) Conditionally acceptable for Approved Contractor List 3) DECLINED: Not Acceptable for Approved Contractor List Comments: Safety Contact: Date: Chapter 1 Page 17.16 Sub-Contractor Information