Health & Safety Management Minimum Requirements

Health & Safety Management Minimum Requirements

Human Resources

This form is for a contractor or sub-contractor to complete as part of the pre-qualification process for contract work at the University of Canterbury.

Instructions:

• Complete each question by circling your response
• Where evidence is required,it must be completed using examples, (blank forms are not acceptable or verifiable evidence)
• Send your verification documents back to;
• University of Canterbury

• Once reviewed the University of Canterbury may request additional information.

Contractor Details

Business Name / Date
Project Name / Project No.
Name of Person with overall responsibility for Health & Safety in your organisation
Contact Details

Section 1 – Minimum Health & Safety Requirements

Safety Management System & Policy

1. Does your organisation have a formal documented Health and Safety System?

/ Yes No
If yes - please provide a copy / Attached

1. Is there a current, dated and signed Health and Safety Policy?

/ Yes No
If yes - please provide a copy / Attached

Section 2 – Minimum Health & Safety Requirements

Legislation

1. How does your organisation keep up with changes to Health & Safety Legislation (plus AS/NZ Standards and Industry specific requirements)and ensure all changes are incorporated in the work procedures and practises?

Please check:
Automatic updates; (e.g. Worksafe NZ, Safety Charter, Site Safe) are received and incorporated
Resources are allocated to keep up to date with changes manually
Memberships – e.g. Crane Association, SARNZ,
Reliant on individuals to keep up to date with changes
No updates in legislation are nominated/incorporated
Other - please specify
Please provide evidence to support the above / Attached

1. Has your organisation been prosecuted for any offence, received an infringement notice or warning or received an improvement or prohibition notice under the Health and Safety in Employment Act 1992 or any related legislation?

/ Yes No
If yes - please provide details for the last 5 years / Attached

1. Does your organisation have a procedure for “notifiable work” to Worksafe NZ

/ Yes No
If yes - please provide evidence / Attached

1. Does your organisation develop Health and Safety performance reports? e.g; Key performance indicators, leading and lagging,such as;

Total number of occurrences – incident, accidents, near miss, serious harm, illness etc.
No of medical treatment injuries (MTI’s)
No of Lost time injuries (LTI’s)
No of Lost time days (LTD’s)
Injury Frequency Rate
No of Site specific safety plans
No of Task Analysis/Safe Operating Procedures
No of workplace inspections
No of non-conformances
No of hazard inspections completed
No of health and safety meetings
No of completed induction’s
No of specific training’s completed
Other - please specify / Yes No
If yes - please provide a copy of the last five years / Attached

Section 3 – Minimum Health & Safety Requirements

Health and Safety Responsibilities

1. Has your organisation identified responsibilities for directors, management and employees?

/ Yes No
If yes - please check and provide documentation of where these are identified and committed;
its legal health and safety responsibilities
Individual employee health and safety responsibilities
Managers and Supervisor’s health and safety responsibilities
Directors responsibilities
Other - Please specify / Attached

Section 4 – Minimum Health & Safety Requirements

Certification/Self Audits/External Audits

1. Does your organisation have any H & S Management System certifications?

/ Yes No
If yes - please check and provide a copy of the certificate
ISO9001
ISO 14001 Standard
AS/NZ4801/OHSAS18001
Other - Please specify / Attached

1. Does your organisation conduct internal audits of its own operations?

/ Yes No
If yes - please provide procedure, competency of auditors and evidence of audits conducted / Attached

1. What is your organisation’s ACC Status?

Reimbursement Agreement
ACC Workplace Safety Management Practices Programme (WSMP)
ACC Accredited Employer Programme (AEP)
Other - Please specify
If yes provide supporting documentation / Attached

1. Is your organisation receiving ACC Experience Rating discounts? – No evidence required

/ Yes No

Section 5 – Minimum Health & Safety Requirements

Qualifications/Certifications/Licences/Competencies

1. Do any of your employees perform tasks that require special competencies or licences?

/ Yes No
If yes - please check and provide copies of training completion/competency certificates
Site Safe – Civil, Electrical, Building Construction Passports
First Aid
Forklift
Crane
Scaffolding
Powder Actuated hand tools
Working at Height/harness – US 15757/23229/17600
Trade Certificate (Electrical, Boilers, Rigging, Plumbing, Engineering, Carpentry, Other - Please specify)
Elevated Work Platform (EWP)
Excavation
Hazardous Substances – Approved Handler
Confined Space
Underground/Tunnels
Hot Work
Asbestos
Electrical Safety
Isolation & Danger Tagging
Traffic Management
Other Applicable to your work - Please specify / Attached

1. Do all employees attend a Health and Safety induction and training programme?

/ Yes No
If yes - please check areas of training covered and provide copies of completion
Organisational policy, commitment and rules
Hazard Identification
Fatigue
Driver/Operator Safety
Plant and equipment procedures
Personal Protective Equipment requirements
Accident/Incident/Near Miss/Serious Harm reporting
Emergency Procedures
Critical Incident Management
Employee participation programme/Health and Safety Committees and Rehabilitation information
Contractor Management (if required)
Task Analysis/Job Safety Analysis/Safe Operating Procedures / Attached

1. Have all Managers/Supervisors/Team Leaders/Project Managers completed training/certification?

/ Yes No
If yes - please check areas of training/certificationcovered
Organisational policy, commitment and rules
Site Safe Advanced Passport or Gold Card, Supervisor & Leadership Courses
Hazard Identification, assessment and control
Stress & Fatigue Management - Wellness
Development of Job Safety Analysis/Safe Operating Procedures/Site Specific Safety Plans
Accident/Incident/Near Miss/ Serious Harm reporting
Accident/Incident/Near Miss/ Serious Harm Investigation
Personal Protective Equipment requirements
Emergency Procedures
Critical Incident Management
Supporting Employee participation programme/Health and Safety Committees and Rehabilitation information
Other courses - Please specify / Attached

1. Does your organisation have a programme to supervise new or untrained employees?

/ Yes No
If yes – please check and provide a copy of the process, and evidence of these records / Attached

Section 6 – Minimum Health & Safety Requirements

Employee Participation & Communication

1. Does your organisation have a process to communicate with employees?

/ Yes No
If yes - please check andprovide a copy of process, and evidence of competed communications.
Please Check and provide copies
Written statement of communication requirements
Management Meetings
Health and Safety Committee meetings
Toolbox Talks, weekly meetings
Other
Please provide supporting documents / Attached

1. Does your organisation have a process to manage communications, information and training when English is not commonly understood or spoken

Please provide supporting documents / Attached

Section 7 – Minimum Health & Safety Requirements

Hazard Management

1. Does your organisation have a process to manage hazards?

/ Yes No
If yes - please check andprovide a copy of the process, and evidence of completed hazard management forms.
Please Check and provide copies
identification of hazards
assess hazards
control hazards
review hazards
Other
Please provide supporting documents / Attached

1. Does your organisation have a centralised hazard register?

/ Yes No
If yes; please check and provide a copy / Attached

1. Does your organisation have procedures and supporting documentation for the following high risk tasks?

Personal protective equipment in use and issue register
Certification programme for all electrical plant, machinery or equipment
Isolation and tagging procedures for sources of energy
Working at height
Trenching/Excavation Work
Confined Space/Underground activity
Hot Work
Asbestos Management
Construction/Demolition Work
Manual handling
Hazardous/Biological Substances
Working on Roads
Other

Section 8 – Minimum Health & Safety Requirements

Employee Wellbeing

1. Has your organisation read, understood and are prepared to commit to the University of Canterbury Smoke-free Campus Policy

/ Yes No

1. Does your organisation have a drug and alcohol policy?

/ Yes No
If yes provide supporting documentation of adherence to the policy / Attached

1. Does your organisation have a restriction on the number of hours or days an employee can work consecutively?

/ Yes No
If yes please provide supporting documents / Attached

1. Is your organisation able to provide access to adequate facilities and amenities at the work site?

/ Yes No

1. Does your organisation commit to health monitoring for employees?

/ Yes No
If yes please provide supporting documents / Attached

Section 9 – Minimum Health & Safety Requirements

Emergency Management

1. Has your organisation gotan Emergency Policy and Plan that identifies responsibilities and procedures to be followed?

/ Yes No
If yes - please check and provide supporting documentation / Attached

Section 10 – Minimum Health & Safety Requirements

Sub-Contractor Management

1. Do you intend to use sub-contractors on this site?

/ Yes No
If yes –go to Question 2
If no – End

1. How do you select sub-contractors?

Please check:
Sub-contractors are formally selected from a preferred list using a prequalification process
Sub-contractors are informally selected
Please provide supporting details of how you select sub-contractors (e.g. preferred list, formal/informal selection procedures / Attached
3.How do you assess a sub-contractors’ compliance with health and safety legislation?
Please provide supporting details of how you assess sub-contractors
4.How does your organisation communicate site requirements to sub-contractors?e.g; is there a requirement for them to participate in the following?
Please check and provide copies
Written statement of communication requirements
Project Management Meetings
Project Group meetings
Toolbox Talks, weekly meetings
Other
Please provide supporting documents / Attached
5.Does your organisation monitor/evaluate sub-contractors performance during and post contract? / Yes No
Please provide details
Completed monitoring/evaluation documents
Other / Attached
6.Do your sub-contractors have their own hazard identifications recording system for each job, e.g. Site Specific Safety Plans, site hazard board, toolbox meeting form, hazard reporting forms, determining significance and controls? / Yes No
If yes - please provide evidence / Attached

For University of Canterbury Use Only:

Contractor’s Health and Safety Plan is: / Satisfactory Unsatisfactory
Engagement is: / Recommended Not recommended
Post contract evaluation – continue as Preferred Contractor? * / Yes No
Evaluated by:
Signature:
Date:
Recommendations

* Before a contractor is removed from the preferred contractor list they will be given the opportunityto remedy any shortfalls in the University of Canterbury requirements.

Human Resources – hs_frm11Page 1 of 7Date issued: 26-Sep-14