In Confidence
Supplier Evaluation Questionnaire
1. General Company Details
1.1.Company Name
1.2.Address
1.3. Town/City
1.4.P.O. Box
1.5.Country
1.6.Telephone Number
1.7.Facsimile Number
1.8.E-mail Address
1.9.Web Site Address
1.10.Contact Name Position
1.11.Geographical Coverage : Please indicate below where work can be undertaken
……………………………………………………………………………………………
1.12.Products/ Service Provision: Please provide details of the type of services/ products your company offers.
1.13.Company Type, e.g. LLC/ Partnership/Sole Trader/ Consortium/ Overseas Corporate Body/Government Agency/ Other:
1.14.Trade License Number
(Provide Copies)
1.15.Trade Registration
(If not LLC Company please enter the year that the company was established)
1.16. Country of Registration
- Brief Employee and Management Information
2.1. Total numbers employed for each of the last 3 years Current Year
Last Year
Previous Year
2.2. Percentage Staff Turnover in the Last Year
2.3. Management Structure
Please enter name of the five senior directors, their position and number of years served as director:
No: / Name / Position / Period Served1.
2.
3.
4.
5.
- Insurance Information
3.1 Insurance: Please provide copies of your current an applicable insurance cover, i.e. Employers Liability, Public/ Products Liability, Professional Indemnity, and Contracts Work Insurance.
Insurance Document / Expiry Date / Cover Value / Copy attaché (Y/N)- Financial Information
Value of Work That can be undertaken
What is your maximum contract value AED:
Do you have a minimum contract value?if Yes state what is AED:
Details of largest project executed:
Description & location:
Main product/ trade Involved:
Approximate Date Contract Started:
Approximate Date Contract Finished:
Value AED:
Year
(most recent 3 years available ) / Current Financial
Year (Forecast) / Last Year / Previous Year
Annual Turn Over
Total Assets
- Environment
A. Policy & System
5.1.Does your company have a documented environment policy? Yes / No
If the answer is YES, please attach a copy of your Policy Statement.
5.2.Do you sub-contract works? Yes/ No
If the answer is YES provide of how sub-contractors are assessed, approved and managed.
B. Trainings, Awareness and Competence for Employees and Subcontractors
5.3.Do you have a programme in place for assessing and meeting the environmental training needs of staff? YES / NO
6. Health and Safety
A. Policy and Procedures
6.1. Please provide a copy of your Health and Safety Policy Statement (it is a legal requirement for companies with 5 or more employees to have a Health and Safety policy).
6.2. Is your company accredited to an HSE standard? Yes / No Expiry Date :
If the answer is YES attach a copy of the certificate, and detail the scope of the accreditation .
Do you produce Risk Assessments for your activities on site . YES/NO.
Do you develop safe systems of work . YES/ NO.
Do you require Subcontractor to produce risk assessment and sale system of work YES/ NO.
How do you assess the safety competency of your Subcontractor?
B. Organizational Structure & Responsibilities
6.3. Give the name, position and specific responsibilities of the person having ultimate responsibility for health and safety.
6.4 Do you have internal health an safety support (e.g. a Health and Safety Manager) ? YES / NO.
C. Accident/ Incident/ Near Miss Performance
6.5 Please complete the relevant boxes for the past 3 full years an the current year.
Put an “X” where not available and “ND” if not done. Include all staff (temporary and part- time) and subcontractors. If any non-zero entries are made in Rows B or C then provide details of each arising.
20__ / 20__ / 20___ / 20___A. Exposure Man-hours (typically the number of shifts worked per year multiplied by the average length of the shift in hours, multiplied by the number of staff working those shifts).
B. Total RIDDOR events
C. Accident/incident frequency rate per 100,000 hours worked.
D. Calculated this from the following : (B) x 100,000
(A)
D. Enforcements/ Prosecutions
6.6 In the last 3 years has your organization been subject to any enforcement action from the Government or Agency. Yes/ No
If the answer is YES please provide details of prosecutions, prohibition notices, improvement notices, warning letters, etc. Also provide details of corrective actions taken to prevent a reoccurrence.
7. Quality
7.1 Is your company accredited to ISO 9001 for the production of goods or the performance of services you want to provide to Land Securities (if “yes”, state which and provide a copy of your certificate)?
7.1.a Please provide Expiry Date of Accreditation : ______7.2. If your company is not accredited, is it working towards accreditation (If “yes”, state when accreditation is expected to be achieved)?
7.3. If your company is not accredited, does it operate a Quality Management System that complies with the requirements of ISO 9001?
Section 1 – Company Quality Representative
7. Name of Quality Manager or Representatives :
To whom does this person report:
Section 3–Professional Bodies
8. Professional Bodies Certified With:-
Name of Professional
Body:
Date of Registration
9. Are you Quality Assured to ISO 9001 YES/NO
10. If “NO” you must complete section 4 of this questionnaire.
11. If “YES” you must supply a copy of your Registration Certificate including the Appendix if applicable.
Section 4- Quality Questionnaire
12. Quality Management Systems. Are all elements of your Company controlled
by written quality procedures? YES/NO
13. If “NO” what quality systems do you operate?
14. Are Quality Performance Controls regularly checked? YES/NO
If Yes by Whom
15. Do you obtain your own supply of materials ? YES/NO
16. Are your supplies obtained only from sources approved by yourselves? YES/NO
17. Do you keep records of receipt and inspection and monitor supplier’s
performance? YES/ NO
18. Where applicable do you operate on a first in first out basis? YES/NO
19. Do you use Sub-Contractors? YES/NO
20. If “YES” what method do you use for approval and control?
21. Do you have procedures to identity, separate an rectify defective materials
and/or works operations ? YES/NO
22. Are records kept of the key action taken to rectify problems and prevent
re-occurrence? YES/NO
23. Do you have a system for the control and calibration of measuring and
test equipment if applicable? YES/NO
24. Do you have a system to control the issue/ change of drawings, specifications
and procedures ? YES/NO
25. Is it in a written form with control documents? YES/NO
26. Do you have system for responding to formal customer complaints? YES/NO
27. Questionnaire completed by (print name)
Signed:______Date: ______
SECTION 5-PUBLIC LIABILITY INSURANCE
28. Insurer
Address
29. Policy No.
30. Expiry
Date
31. Indemnity Limit (any one incident)
SECTION 6- EMPLOYERS PUBLIC LIABILITY INSURANCE
32. Insurer
33. Address
34. Policy No:
35. Expiry Date :
36. Indemnity Limit (any one incident)
SECTION 7 – CONTRACTORS “ALL RISKS” INSURANCE
37. Insurer
38. Address
39. Policy No:
40. Expiry Date:
SECTION 8 – SAFETY
41. Name of Director responsible for safety:______
Tel : ______
42. Do you have a current Health & Safety Policy signed by a Director of
your Company? YES/NO
43. Do you give your employees Site Induction and Orientation Training
and will records be made available to us ? YES/NO
44. Do all your plant operators have a 3rd party certificate of competence YES/NO
45. Do all plant and equipment have a 3rd party certificate YES/NO
46. Are your general Risk Assessments supported by specific safety method
statements? YES/NO
47. Do you have a formal procedure to record incidents affecting health
and Safety? YES/NO
48. Who investigate accidents within your Company? YES/NO
49. Do you prepare safety Method Statements in respect of your undertakings
both on and off site ? YES/NO
50. Are you a member of any safety groups? YES/NO
If “YES” enclose details
SECTION 9-AUTHORIZATION
I/We certify that the information given in this questionnaire is true and complete.
I/We undertake to notify you in the event of any change or cancellation
Signed :______PrintName:______
Position: ______Date: / /
For and behalf of ______
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Ghantoot Roads & Infrastructure Division 07/05/18