Please Complete This Questionnaire and Return to Bridgeway Assurance Department

SUPPLIER QUESTIONNAIRE

PLEASE COMPLETE THIS QUESTIONNAIRE AND RETURN TO BRIDGEWAY ASSURANCE DEPARTMENT

FAILURE TO PROVIDE UPDATED AND ACCURATE INFORMATION MAY RESULT IN REMOVAL FROM OUR APPROVED SUPPLIER DATABASE

FOR BRIDGEWAY CONSULTING LTD USE ONLY

Name of Bridgeway employee requesting addition / Department
Reason for request if other suppliers are available on database
Will the supplier/subcontractor be working on the rail infrastructure? / YESNO
FOR CAT 3 ONLY:
Will they be Sentinel SPONSORED by Bridgeway?
Will they be working regularly (> 12 times per year)?
Are they working under our Insurance cover? STATE REASONS WHY / YESNO
YESNO
Departmental Director/Senior Manager Approval (Name & Signature) / Date

FOR BRIDGEWAY SUPPLIERS

AREA OF SUPPLY (Tick where applicable)

Note: Suppliers of Office Equipment, Consumables, General Building Materials or general small tools/plant not requiring product acceptance are not required to fill this form UNLESS specifically requested.

IMS OP08.4.1 FORM - Bridgeway Supplier Questionnaire – V10- Feb 2018Page 1 of 2

SUPPLIER QUESTIONNAIRE

PLEASE COMPLETE THIS QUESTIONNAIRE AND RETURN TO BRIDGEWAY ASSURANCE DEPARTMENT

FAILURE TO PROVIDE UPDATED AND ACCURATE INFORMATION MAY RESULT IN REMOVAL FROM OUR APPROVED SUPPLIER DATABASE

Tick / Service Provided
Boats / Marine Equipment
Bridge Examiners
Building / Construction
Calibration/Repair
Confined Spaces
Consultancy
Design
Diving Services
Engineering – General Civils
Engineering – Railway Civils
Engineering – Specialists (Structural etc)
Environmental / Ecology Data
Environmental / Ecology Services
Geomatics
Health, Safety, Quality & Environment
Healthcare Services
Lab Testing
Labour – General / Other
Labour – Rail Safety Critical
PASMA / Scaffolding
Plant / Equipment – General
Plant / Equipment – Rail
Plant / Equipment – Rail with Operator
Plant / Equipment – Specialist
Plant / Equipment - Specialist with Operator
PPE / Safety Supplies
Rope Access
Security
Site / Ground Investigations
Surveys – CCTV etc
Technical Reports
Traffic Management
Training – General
Training – Rail Safety
Training – Specialist (IPAF, LANTRA etc)
Vegetation Clearance
Vehicle Maintenance
Vehicles
Waste Management – Carrier / Skip Hire
Other:

IMS OP08.4.1 FORM - Bridgeway Supplier Questionnaire – V10- Feb 2018Page 1 of 2

SUPPLIER QUESTIONNAIRE

PLEASE COMPLETE THIS QUESTIONNAIRE AND RETURN TO BRIDGEWAY ASSURANCE DEPARTMENT

FAILURE TO PROVIDE UPDATED AND ACCURATE INFORMATION MAY RESULT IN REMOVAL FROM OUR APPROVED SUPPLIER DATABASE

GENERAL INFORMATION

2.1 / Company Type (Tick where applicable) / Public Listed Company / Limited Company / Sole Trader
2.2 / Company Name / Reg. No.
2.3 / Address
2.4 / VAT No. / UTR No. / DUNS No. / CIS No.
2.5 / Bank Name / Sort Code / Account
2.6 / Website
2.7 / Contacts / 1. / Manageror PRIMARY CONTACT / 2. / Customer Service / 3. / Accounts
Name
Email
Phone

I hereby certify that the answers given in this questionnaire describe the current status with respect to products / services.

I have received a copy of Bridgeway’s Supplier Code of Conduct and will abide by it.

I am aware that a VALID BRIDGEWAY PURCHASE ORDER NUMBER must be shown on all invoices raised by my company and that I will work to Bridgeway’s standard terms and conditions.

Name (Please print) / Signed
Position / Date

HEALTH / SAFETY / QUALITY / ENVIRONMENT

3.1ACCREDITATIONS(Tick where applicable) / SAFETY / QUALITY / ENVIRONMENT / OTHER
Certification obtained (PLEASE ENCLOSE COPIES OF CERTIFICATES) / OHSAS 18001 / ISO9001 / ISO14001
Using own documented management system

3.2QUALIFICATIONS & AFFILIATIONS(Tick where applicable or add to list. PLEASE ENCLOSE COPIES OF IN-DATE CERTIFICATES)

IMS OP08.4.1 FORM - Bridgeway Supplier Questionnaire – V10- Feb 2018Page 1 of 2

SUPPLIER QUESTIONNAIRE

PLEASE COMPLETE THIS QUESTIONNAIRE AND RETURN TO BRIDGEWAY ASSURANCE DEPARTMENT

FAILURE TO PROVIDE UPDATED AND ACCURATE INFORMATION MAY RESULT IN REMOVAL FROM OUR APPROVED SUPPLIER DATABASE

RISQS Qualified via Audit
RISQS Registered
Association of Diving Contractors (ADC)
IPAF / LANTRA
IRATA
Network Rail Plant Operator Scheme
Network Rail Principal Contractor Licence
NSAR
PASMA
SSIP / CHAS (or equivalent)

IMS OP08.4.1 FORM - Bridgeway Supplier Questionnaire – V10- Feb 2018Page 1 of 2

SUPPLIER QUESTIONNAIRE

PLEASE COMPLETE THIS QUESTIONNAIRE AND RETURN TO BRIDGEWAY ASSURANCE DEPARTMENT

FAILURE TO PROVIDE UPDATED AND ACCURATE INFORMATION MAY RESULT IN REMOVAL FROM OUR APPROVED SUPPLIER DATABASE

3.3COMPANY POLICIES(Tick available policies. PLEASE ENCLOSE COPIES OF POLICIES)

Quality / Alcohol & Drugs / Corporate Social Responsibility / General Data Protection Regulation
Health & Safety / Anti-Bribery & Corruption / Ethical Trading / Safe Hours Working
Environmental/Sustainability / Anti-Slavery & Human Trafficking / Equality, Diversity & Inclusion / Personal Protective Equipment
3.3.1 / Do you brief these policies to staff / subcontractors? / YES / NO
3.3.2 / Are you willing to work to Bridgeway’s policies and procedures if required? / YES / NO
3.3.3 / In the last three years, has any complaints or findings of unlawful discrimination or other offences been made against your organisation by a Court, Tribunal or Human Rights Commission? IF YES, PLEASE PROVIDE A SUMMARY OF THE DETAILS ON A SEPARATE SHEET. / YES / NO

3.4FURTHER QUESTIONS(Please circle your answers)

3.4.1 / Do you receive competent HSQE advice? IF YES, PLEASE ATTACH COPIES OF VALID CERTIFICATES. / InternalExternalNone
3.4.2 / Are your employees trained on compliance with the company HSQE policies and objectives? / YESNO
3.4.3 / Do you ensure your employees’ health, welfare and wellbeing? / YESNO
3.4.4 / Do you risk assess your work and put in measures to mitigate risks? / YESNO
3.4.5 / Do you ensure only competent staff are allocated for safety critical work? / YESNON/A
3.4.6 / Does your staff roster comply with the Working Time Limitations and/or the Network Rail Door-to-Door Guidance? / YESNON/A
3.4.7 / Do you operate a “Fair Culture” based Safety Management System? / YESNO
3.4.8 / Have you signed up to the Armed Forces Covenant? / YESNO

INSURANCE(Please tick the insurances you have and add in any other applicable insurance arrangements. PLEASE ENCLOSE COPIES OF IN-DATE CERTIFICATES)

Public Liability / Employers Liability / Other:
Product Liability / Professional Indemnity / Other:

ENFORCEMENT

5.1 / Have you been served with an enforcement action / prohibition notice from a regulatory body in the last five years?
(Includes environmental.IF YES, PLEASE PROVIDE DETAILS OF PROSECUTIONS / ENFORCEMENT ACTIONSON A SEPARATE SHEET.) / YES / NO

REFERENCES:(PLEASE PROVIDE AT LEAST ONE REFERENCE)

6.1 / Name / 1. / 2. / 3.
Company
Position
Email
Phone

FOR BRIDGEWAY CONSULTING LTD USE ONLY

Department / Check Items / Status / Signature / Name / Position / Date / Recommendations (Circle one) / Comments
COMMERCIAL / Credit Check /
Business Risk / HIGH RISK
MEDIUM RISK
LOW RISK / Acceptable
UNACCEPTABLE – State reason
FINANCE / Company Details
Tax Details
Bank Details / Approved
NOT APPROVED – State reason
HR
(CAT 3 Only) / Staff Details / Staff Entered in HR Engage
Used Less than 12 time/year - NotEntered in HR Engage
ASSURANCE / HSQE Accreditations Checks / No audit requirements
Audit requirements fulfilled
AUDIT / MONITORING RECOMMENDED – State reason
Enforcements, Improvement or Prohibition Notices
Insurance
Supplier Category: / CAT 1CAT 2CAT 3 / Date documents scanned and saved to supplier /stores system:
CAT 1 Suppliers who do not come into contact with work on site.
Suppliers of materials and equipment that do not directly affect Bridgeway contract requirements.
These suppliers may be assessed for suitability in accordance with Bridgeway Quality Management System but are not specifically assessed for their safety performance. / CAT 2 Subcontractors.
NETWORK RAIL WORK.

Network Rail Principal Contractor Licence / Plant Operators Scheme
RISQS Qualified subcontractors

Subcontractors with no Principal Contractor or Plant Operator’s Licence need to provide details of their Safety Management Systems and Network Rail approvals.
NON-NETWORK RAIL WORK.The subcontractor will be assessed for suitability based on the requirements of the work and their accreditation/qualifications.
SPECIALIST WORK.The subcontractor company may or may not have Network Rail / RISQS accreditation. Examples: diving, rope access, confined spaces, environmental, etc. The subcontractor company will be assessed for suitability based on the requirements of the work and their accreditation/qualifications/experience. / CAT 3 Subcontract suppliers of personnel. (5 staff and below)
Companies / Sole Providers providing suitably qualified staff. E.g. Divers, Rope access technicians, Confined spaces staff, Possession Support staff, Isolations staff, S&T staff, etc.
Individuals who are Sentinel sponsored by Bridgeway MUST BE entered onto the HR Engage database for HSQE compliance.
Approval MUST BE GIVEN by a Bridgeway Director or Senior Manager. May be safety audited and monitored by Bridgeway based on risk assessment and performance.

IMS OP08.4.1 FORM - Bridgeway Supplier Questionnaire – V10 - Feb 2018Page 1 of 2

Bridgeway House  2 Riverside Way  Nottingham NG2 1DP

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