PREQUALIFICATION QUESTIONNAIRE
EOI No.: / Package Title:
THIS QUESTIONNAIRE IS TO BE COMPLETED BY VENDORS WHO ARE INTERESTED IN SUPPLYING EQUIPMENT, MATERIALS AND/OR SERVICES TO HUSKY ENERGY WHITE ROSE EXTENSION PROJECT (WREP) WELLHEAD PLATFORM (WHP).
THE INFORMATION PROVIDED IS STRICTLY CONFIDENTIAL.
COMPLETED QUESTIONNAIRE MUST BE SENT TO:
Mustang Canada, Inc.
17 Duffy Place
St. John's, NL Canada
A1B 4M7
Attention: Ms. Jaime Howard, P.Eng, Procurement Lead
Email:
Company Name:
The signatory of this Questionnaire guarantees the trust and accuracy of all responses given herein, and is an authorized officer or agent of the company.
Information submitted and completed by:
Name (Please Print)
Title
Signature
Date
To be completed by Mustang Canada, Inc.:
Date Received: / Procurement Rep:
Introduction
Health, Safety and Environmental (HSE), Quality and Competence Assurance Management are an essential part of the way we conduct our business and needs to be considered as an integral part of our business management. Therefore, this evaluation tool provides a performance assessment against Mustang Canada, Inc., HSE, Quality and Competence Assurance Management expectations. The assessment partially fulfils the business's commitment to Audit and Review.
For any “Yes” answer provided, Mustang Canada Inc. requires a documented reference to a policy/procedure/standard and a copy of that supporting documentation which can be referenced as evidence to validate any “Yes” answers. Any “Yes” answers not supported by documentation and appropriate references cannot be evaluated and may result in disqualification. All answers may be subject to further verification efforts by Mustang Canada Inc.
Objectives
· To provide an effective evaluation of scope of products and/or services provided.
· To provide Mustang Canada, Inc. with a consistent method of measurement and remove repetitive project supplier evaluations.
Company Name / Parent Company
Address
Postcode
Telephone / Facsimile
Email Address / Website
1.0 / General Section
1.1 / Full details of scope of service:
If Approval certificate(s) are held, please leave blank if copies are to be provided.
If you are not parent company with ownership and technical engineering support of the tools/equipment described in the scope of work (not acting as an agent, or as a third party supply of equipment) please provide details of the manufacturer/parent company and their capabilities in addition to your company capabilities.
1.2
/ Does the company carry out Manufacturing activities?1.3
/ Does the company carry out Service activities, including in remote regions? Are there personnel who are fully trained to maintain equipment and to travel offshore NL, Canada?1.4
/ Does the company carry out Repair activities, including in remote regions? Are there personnel who are fully trained to repair equipment and to travel offshore located in a local (NL) base of operations?1.5
/ What is the total number of employees?1.6
/ Does the company provide offshore capabilities as part of services? Please provide details.1.7 / Type of Company:
Type of Company
Sole Proprietor / Partnership
Corporation – Private / Corporation – Public
Other (please identify):
Please supply Certificate of Incorporation. If private ownership, please also identify the Principle Shareholders below.
Name
City / Province/State
Name
City / Province/State
Name
City / Province/State
1.8 / Total Number of Employees by Geographical Location
Newfoundland and Labrador
Other Canadian Provinces
International
1.9 / Declaration of Business Relations
Are you a relative or do you have a relationship with any Mustang Canada, Inc., Wood Group PSN or Husky Employee that would cause any real or perceived conflicts of interest?
1.10 / Annual Revenue & Operating Income (CDN$ in each of the last three (3) years):
Revenue / Operating Income
Year / $ / $
Year / $ / $
Year / $ / $
1.11 / Subcontracting
Please list any associated work that you would typically subcontract to other vendor(s) providing the following information for each: Specific type of work being subcontracted, Company name, address and contact information.
1.12 / Describe the process you have for evaluating, selecting and re-evaluating subcontractors and suppliers.
1.13 / Does the company have experience with similar project scope in harsh environments/cold climate experience, such as the East Coast of Canada? Any problems experienced with these conditions?
2.0 / Health, Safety & Environmental Section
2.1 / Who has overall responsibility for Health, Safety & Environmental management and protection matters in your organization?
Please provide name, title and organizational chart.
2.2 / Is there an HSE Policy Statement authorized by the senior executive and is it signed? Please supply a copy of your up-to-date signed HSE policy.
2.3 / How is the policy communicated throughout the organization? Please provide evidence of policy communication initiatives.
2.4 / What is the total number of individuals dedicated to HSE in your organization?
2.5 / Do you have a documented and implemented Health & Safety Management System?
If Yes, please state which model aligned to e.g. BS OHSAS 18001, ANSI Z10, CSA Z1000, HS (G) 65, E&P Forum, etc. Please provide a copy of the index of your H&S Management System manual.
2.6 / Has the Health & Safety Management System been certified by an accredited third party? Please provide copies of all certifications held.
2.7 / Do you periodically review the effectiveness of your Health & Safety Management System? Please provide details and the documented evidence of the review.
2.8 / Do you have a documented and implemented Environmental Management System?
Please state model EMS aligned to e.g. ISO 14001 or EMAS. Please provide a copy of the index of your Environmental Management System manual.
2.9 / Has the Environmental Management System been certified by an accredited third party?
Please provide copies of all certifications held.
2.10 / Do you periodically review the effectiveness of your Environmental Management System? Please provide details and the documented evidence of the review.
2.11 / Do you have a process in place for managing Emergency Response? Please provide details including when last tested.
2.12 / Do you implement an approved project HSE Plans? Please provide sample copies of previous project HSE plans.
2.13 / Have you implement an approved internal HSE audit program? If Yes, please provide details and include a status report of your current internal audit program.
2.14 / Have you implemented a process for HSE Management of Sub-Contractors? Please provide details of this sub-contractor HSE management process.
2.15 / Has an appropriate reporting procedure been established for all near misses/ incidents/ accidents? Please provide a copy of this procedure.
2.16 / Do all Incident/ Accident reports contain recommendations for the prevention of recurrence? If so please provide 2 examples.
2.17 / Is there a system in place to ensure compliance with regulatory requirements and codes?
Please provide a description of your process used to identify, evaluate and integrate regulatory requirements for your equipment and operations
2.18 / Are clear goals and specific objectives for the HSEQ Management System established?
Please provide a copy of your current HSEQ goals and objectives
2.19 / Is performance against HSEQ goals and objectives evaluated?
Please provide a copy of the most recent status report of your HSEQ goals and objectives evaluation
2.20 / Does the workforce actively participate in HSEQ processes?
Please provide a documented reference to how you engage the workforce in select aspects of your HSE management system and prevention initiatives
2.21 / Are hazard/risk assessments conducted in order to identify and address potential hazards to personnel, facilities, the public and the environment?
Please provide a description of your hazard and risk assessment process and a recent example of a hazard/risk assessment used in the execution of a recent work scope.
2.22 / Are management reviews of your HSEQ Management Systems conducted periodically to address the possible need for changes or improvements?
Please provide a copy of the minutes of your last documented management review
2.23 / Has the organization maintained records of incidents/ accident statistics for the last three (3) years?
If Yes, please provide the following details for each year.
Year:
Total number of man-hours worked?
Total number of fatalities?
Total number of first aid injuries?
Total number of lost workday cases?
Total number of medical treatment cases?
Total number of restricted work days?
2.24 / In the last 36 months has your Company been subject to any HSE prosecutions, stop work orders or regulatory violations?
If Yes, please provide details.
2.25 / Do you have an early and safe return to work policy? (For Canada vendors only operating in the province of NL, as required by the NL WHSCC (Workplace Health, Safety and Compensation Act, Clause 89.)
Please provide details
2.26 / Are you registered with your local workers health and compensation commission? “for Canada vendors only”
If yes, what is your current rating?
Note: The Workplace Health, Safety and Compensation Act require all employers performing or contracting work in Newfoundland and Labrador to register with the Commission.
Source: http://www.whscc.nf.ca/employers/Emp_RegisteringYourBusiness.whscc.
2.27 / Please supply a letter of good standing from your local workers health and compensation commission “for Canada vendors only”.
Or provide alternate proof of coverage for your jurisdiction for workers who may become injured on the job.
3.0 / Quality Section
3.1 / Who has overall responsibility for Quality Management matters in your organization?
Please provide name, title and organizational chart.
3.2 / What is the total number of individuals dedicated to quality in your organization? Specify split below.
QMS / QA / QC/ Inspection
3.3 / Please provide a copy of your Quality policy statement.
3.4 / Please provide a copy of the index of your Quality Management System manual.
3.5 / Please provide copies of your current quality audit procedure and schedule.
3.6 / Has your Quality Management System been certified by an accredited third party approval organization to ISO 9001:2008 or equivalent?
If Yes, please provide a copy of the certification including full scope and any applicable appendices.
If No, please advise if you intend to apply for certification and when this is planned to be completed. In not, please explain why certification is not being sought.
3.7 / Please provide details of your current arrangements for measuring customer satisfaction and demonstrating continuous improvement.
3.8 / Is work executed in conjunction with quality and inspection test plans, route cards etc and do they define hold, witness and review points?
Please provide copies of past quality and inspection test plans (ITP).
3.9 / Please provide details of how you control your documents and records.
Please provide a copy of your Control of Documents and Control of Records procedures.
3.10 / Briefly describe your records retention system and the normal records retained (or supplied to the client) as part of this product / service delivery. (Please make reference to records such as Material Test Reports, Non-destructive examination records, in process inspections, manufacturing record books and Factory Acceptance Tests.)
3.11 / CONTROL OF INSPECTION, MEASURING AND TEST EQUIPMENT
What processes does the Proponent employ to ensure that Inspection is performed and Measuring and Test Equipment is fully calibrated and functioning appropriately?
3.12 / Are quality assurance processes in place to ensure that facilities and materials meet design specifications?
Please provide an overview of your design verification and validation process.
3.13 / Do your design practices and standards meet or exceed applicable regulatory requirements?
Please provide an overview of how you identify and integrate applicable regulatory requirements into the design and development of your products or services?
3.14 / Briefly describe your records retention process and the normal records retained (or supplied to the client) as part of this product / service delivery. Please make reference to records such as Material Test Reports, Non-destructive examination records, in process inspections and Factory Acceptance Tests, etc..
3.15 / When products and/or services do not meet customer defined requirements or expectations, please describe the corrective action processes your company employs to ensure timely resolution of the problem? (including records generated of the problem and solution).
3.16 / Please describe the processes you utilize to ensure that inspection is performed and that measuring and test equipment is fully calibrated and functioning appropriately?
4.0 / Competence Assurance Section
4.1 / Are there job descriptions and defined competencies for all roles/personnel carrying out activities that may affect operational integrity?
Please provide evidence such as a sample job description and/or template.
4.2 / Is there a systematic approach for personnel recruitment, including fit for work assessments and pre-employment medicals, where appropriate?
Please provide evidence such as a sample of assessment standard/criteria
4.3 / Is there a process for screening, selection, placement and ongoing assessment of the qualifications and abilities of personnel to meet specified job requirements?
Please provide evidence such as copy of procedure and Example of competency assessments.
4.4 / Is there initial, ongoing and periodic refresher training to meet job and legal requirements?
Please provide evidence such as a training matrix or other supporting documentation.
4.5 / Does training courses set out clear deliverables that are established before training commences? (Training delivery includes mechanisms for assessing effectiveness and, where appropriate, demonstrated competence on the job).
Please provide evidence such a sample assessment criteria used and a sample of an in-house training program.
4.6 / Has a Competence Program been established and resourced to ensure that necessary levels of individual and collective demonstrated competence are maintained and carefully considered when personnel changes are made? (This Competence Program shall apply to all people undertaking critical work or having a responsibility in the HSEQ Management System).
Please provide evidence such as a document describing the program.
4.7 / Are periodic reviews conducted to ensure appropriate levels of personnel staffing is maintained to assure safe and efficient operations?
Please provide evidence such as reports on staffing levels and supporting statistics.
4.8 / Do new or transferred employees undergo appropriate site orientation and induction training? (At a minimum it shall include HSEQ rules, management systems and emergency procedures).
Please provide evidence such as the following: