schoolpremisesmanual-contractorselectionhsquestionnaire

Title: School Premises Manual Templates Commissioning Procedure Contractor Selection H & S Questionnaire

Contract, Project or Service under consideration:

1. Please provide the following details about your company:

Company Name:

.........................................................................................................................................................

Annual Turnover: ....................................

Number of Employees:

a) Prof/Technical ............................................ b) Administration ............................................ c) Operatives/Tradesmen ............................................

Names of Directors or Principal Partners: (please continue on a separate sheet if necessary) .....................................................................................................................

.....................................................................................................................

.....................................................................................................................

2a

2b

Please attach general details of your company and market sector in which operating.

Commissioning Procedure - Contractor Selection (H & S) Questionnaire


Please outline 2 recently completed contracts/projects as outlined below together with details of referees:

i) Project: ........................................................................................................................................... Client/Employee: ........................................................................................................................................... Location: ........................................................................................................................................... Value: ........................................................................................................................................... Date Completed: ...........................................................................................................................................

Person who may be contacted to provide a reference:-

Name of referee: .................................................................................................................

Position in Company: .................................................................................................................

Address: .................................................................................................................

ii) Project: ........................................................................................................................................... Client/Employee: ........................................................................................................................................... Location: ........................................................................................................................................... Value: ........................................................................................................................................... Date Completed: ...........................................................................................................................................


Person who may be contacted to provide a reference:-

Name of referee: ..................................................................................................................

Position in Company: ..................................................................................................................

Address: ..................................................................................................................

FOR DCC USE 3 Please respond to either 3(a) or 3(b) regarding your company's health and

safety policy:

3(a) Please attach a copy of your company's current health and safety policy (including a signed and dated general policy statement and sections detailing organisation and working arrangements).

3(b) Where your company employees 4 persons or less and your policy on health and safety is not recorded, please prepare and submit an outline of your policy on health and safety and any relevant management systems which, may demonstrate a knowledge of and compliance with relevant health and safety legislation.

Policy attached YES/NO

Details attached YES/NO

4 Please attach copies of current certificates of public / third party / employers / product liability insurance certificates.

Copies attached YES/NO

5 Please provide the names, c.v. and job titles of those people in your organisation with the following responsibilities:

The director or partner with ultimate responsibility for health and safety:

CV attached YES/NO

CV attached YES/NO


Name:.......................................................................

Job Title:......................................................

The person who will have day to day responsibility for managing contracts with this organisation should your tender/application be successful:

Name:.......................................................................

Job Title:......................................................

(please continue on separate sheet if more than one person) The person appointed to provide health and safety advice and assistance as required under Regulation 7 of the Management of Health and Safety at Work Regulations 1999:

Name:.......................................................................

Job Title:......................................................

If health and safety assistance, as detailed above, is provided by consultants, please forward sufficient details and information regarding the consultancy and key personnel to demonstrate their suitably and competence in the provision of such health and safety advice and assistance:

Name of Consultancy:.................................................. Telephone No:

CV attached YES/NO

Consultants details attached YES/NO


................................

7 Please forward current copies of a selection of both generic and non-generic (task specific) risk assessments relevant to the contract under consideration. These may include assessments required under Regulation 3 of the Management of Health and Safety at Work Regulations 1999 and/or those made under specific legislation such as the Control of Substance Hazardous to Health Regulations 1999 or the Manual Handling Operations Regulations 1992. Please submit at least three examples of generic risk assessments and at least three non-generic or task specific risk assessment.

Where applicants employ 4 or less employees and risk assessments are not recorded, the applicant should submit evidence detailing how they identify hazards, assess risks arising and subsequently develop and implement control measures.

Assessments attached YES/NO

Evidence attached YES/NO

8 Please provide examples of two safe systems of work relevant to the contract or service under consideration. These may take the form of Method Statements or Risk Management Plans for individual service users. Examples should have been prepared for recent or current contracts or service provision.

Examples attached YES/NO

9 Please provide details of general health and safety training provided for managers, supervisors and general employees. Their details may be the following:

General details/records of training given (including details of providers)

Current training programme



Details of awards

10 Please provide details of your company's arrangements for the provision of first aid including details of the availability of trained First Aider's and Appointed Persons for the contract or service under consideration.


11 Please provide details of management systems employed by your company in the selection, management, co-operation and communication with, contractors employed by yourselves.


12 Please detail your in-house accident reporting procedures and submit the last full page of your current Accident Report Book.


13 Please provide details of your company's emergency procedures applicable to contracts or services similar to those under consideration.

Details provided YES/NO

14 Please provide details of any accidents, illnesses or incidents involving employees or non-employees as reported by you or on your behalf to the Health and Safety Executive (as required under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995) during the last three years.


15 Has the Health and Safety Executive taken enforcement action against your company - e.g. Improvement or Prohibition Notices or Legal proceedings - since April 1999?

YES/NO

If yes, please attach details of such enforcement action together with the corrective measures set in place as a result.


16 Does your company, or any key member of staff, hold membership of any relevant trade or professional body?


YES/NO

If yes, please indicate the name of such bodies and detail below membership/class of membership or attach details.


Please provide the following details about the person completing this form and accompanying documentation

Name: .............................................................................. (please print) Signature: .............................................................................. Position in company: ............................................................................................................................................

Date: ................................................

Documents

schoolpremisesmanual-contractorselectionhsquestionnaire