CONTRACTOR SELECTION QUESTIONNAIRE

It is the policy of the University to employ contractors who can effectively demonstrate their competence and compliance in relation to all legal, regulatory and health and safety operational requirements. Work will only be offered to contractors who have adequately completed this questionnaire.

The purpose of this questionnaire is to provide the University with sufficient evidence that you are qualified to carry out the type of work you are applying for, and can demonstrate you understand and can control the risks associated with those tasks. The questionnaire is general in nature and there may be areas which you don’t believe apply to your area of operation. In these instances please enter ‘not applicable’ against the question and provide the reason why it does not apply.

Smaller organisations may find the information and guidance provided by the Health and Safety Executive helpful when completing this document. http://www.hse.gov.uk/leadership/smallbusinesses.htm and http://www.hse.gov.uk/business/index.htm

If you are a current member of an SSIP scheme, you will already have provided enough evidence to satisfy the questions below, please provide a current copy of your certificate.

Failure to complete this form to a satisfactory level and provide the required documentary evidence to support your application may result in you not being placed on the University ‘approved contractor’ list. See Appendix 1 for a Documents Attachments List.

CONTRACTOR SELECTION QUESTIONNAIRE
Section 1 Company Information
Please provide the following details about your Company
Name:
Address:
Post Code / Tel No.
Email: / Web address:
Fax: / No of Employees:
Companies House Registration: / VAT Registration Number:
Contact name / position: / Company Type (sole trader, Limited Company, etc.)
Deputy contact name / position: / Hours of operation (24/7, limited times) Give Details
Are you part of a group or partnership of companies? If yes, please describe.
Please attach copies of your Employees Liability Insurance Certificate and your Public Liability Insurance Certificate.
a / Please describe the type of work you are planning to carry out (include relevant examples from previous similar jobs and any references)
b / What other activities does your company carry out not under consideration for this work
c / Is your organisation or any member of staff a member of any trade or professional organisation relevant to the type of work you are planning to carry out? If so please provide details of membership of any such organization and attach certificates where applicable
Section 2 Health & Safety Management
Please provide the names and job titles of those people in your organisation with the following responsibilities:
a / The person who is named as responsible for health and safety, (usually a director or the person who has signed the health and safety policy statement). / Name:
Job Title:
b / The person responsible for the day to day management aspects of on-site work:
Where possible please provide a copy of your organizational structure for health and safety.
/ Name:
Job Title:
Please provide copies of your current Health and Safety Policy.
c / If you employ less than five employees, please describe how you manage and communicate health and safety in your organization and attach supporting information.
d / Please tell us who is responsible for providing competent health and safety advice in your company.
Name:
Address:
Tel No: / Email:
Describe their health and safety qualifications, relevant experience and training, or attach their CV.
e
/ How do you monitor the activities of your staff when working off site and how do you ensure their safety whilst at work?
Do you use Sub-Contractors: Yes No
If Yes, How do you engage sub-contractors, assess their competence and monitor their performance?
f / Please supply examples of risk assessments and method statements for the types of activities you intend to carry out for the University.
e.g.
General Risk Assessments, as required by the Management of Health and Safety at Work Regulations 1992.
Assessments covering the use of hazardous and/or dangerous substances at work (eg COSHH, DSEAR)
Any other relevant assessment (eg manual handling, noise, lone working)
Section 3 Health & Safety Training and instruction
a / All operatives must be competent /qualified to carry out the tasks they are being engaged to do. Attach certificates where applicable or indicate how you ensure their capability to carry out the work to a satisfactory standard.
b / Does your Company provide written instructions for your employees eg: a safety manual? - attach copies of instructions relevant to proposed work. / : Yes No
c / Asbestos
Could the activities that your company engage in disturb the fabric of the building (e.g. drilling holes, removing /attaching to walls, floor, ceilings etc.)?
Have you trained your employees to recognise potential asbestos contain materials and the actions required should they discover such materials?
If YES , attach current certificates, or other evidence where the certificates are not available /
Yes No
Yes No
Section 4 Accident and Incident Reporting
a / Incidents reported to HSE under RIDDOR
Fatalities / Specified Injuries / Over 7 day injuries / Dangerous Occurrences / Non-reportable
This Year (year to date)
Last year (full calendar year)
Year before last
Describe how incidents arising from your work activities are investigated and reported.
b / Have any enforcement notices been issued or prosecutions been taken against your organisation by the enforcing authorities in the last 3 years?
If yes, please provide details and the action taken as result of the notice / prosecution / Yes No
Section 5 Inspection and Monitoring of the work
a / Do you have a process to monitor / review current activities and post-completion work?
If yes, please provide some relevant examples / Yes No
Section 6 The Environment
a / Has your company implemented a management system which meets the requirements of ISO 14001?
If yes please attach a copy of the certificate. /
Yes No
b / Is your company licensed by the Environment Agency as a Waste Carrier?
If yes please attach a copy of the current licence /
Yes No
Section 7 Declaration
To the best of my knowledge, the details contained in this application are correct.
I have read the University Code of Conduct document and I confirm that all work for or on behalf of the university will be carried out in full compliance with current health and safety legislation and best industry practice as set out in the guidelines. I understand that failure to meet my health and safety obligations in this regard may be construed as breach of contract and may result in termination of the contract. I also accept the University’s terms and conditions shall apply to all dealings, transactions and payments.
Signed: / Name:
Date: / Position:

Appendix 1 – Documents Attachments List

Section / Description / Attached
Yes / No / N/A
1a / Company references for similar work
1c / Trade / Professional body membership certificates
2b / Health and Safety Policy
Organisational Structure (if possible)
2d / Competent health and safety advice (CV)
2f / Example risk assessments / method statements for similar work
3a / Competencies of operatives (certificates where relevant)
3b / Work Instructions / safety manual relevant to work activity
3c / Asbestos awareness training certificates (Where applicable)
5a / Examples of work inspections – during and post-completion
6a / Environmental certification (where relevant)
6b / Waste Carrier licence (where relevant)