Roscommon County Council
Pre-Qualification Questionnaire for PSCS
Rev 006
Pre-qualification Questionnaire for
Project Supervisors for Construction Stage
In order to enable Roscommon County Council (the “Client”) to evaluate whether candidates meet the qualification criteria relating to Health and Safety technical ability and track record, all tenderers are obliged to complete the Qualification Questionnaire for Project Supervisor Construction Stage (PSCS)
This questionnaire forms part of Roscommon County Councils Evaluation Process used for assessment of the role the PSCS and is to be completed by the company and submitted with their offer of services. The company will be required to verify their responses noted in their questionnaire by providing evidence of their ability and capacity in relevant matters.
Each Part of the questionnaire must be completed in full. Failure to answer all questions may adversely affect the evaluation process. Candidates are required to provide a sufficient response to each question or item set out in the questionnaire; the non-provision of any such response may be considered grounds for exclusion. We strongly advise that the person responsible for Health & Safety takes the time to either complete this questionnaire or review it before it is submitted for assessment. Each Section of this questionnaire must be passed in order to successfully pass the health and safety pre qualification process.
Presentation of Information
All answers to be enumerated as per this questionnaire and where any supporting documents are being used to provide the answers, reference is to be made to the specific page/s and subsections as applicable.
Acopy of all information shall be submitted in hard copy paper format.
Each copy must be:
- Signed and dated by the authorised representative of the Candidate
- Delivered in hard copy;
The completed questionnaire and any relevant documents that the tenderer wishes to attach to it must be placed in a sealed envelope separate to the other Tender Documentation and marked with the name and address of the tenderer and the contract for which it is submitted.
Note: You MUST include a Copy of your Safety Statement with this questionnaire. Failure to do so will lead to youfailing Section 1 of this questionnaire.
Monitoring Regime
Candidates are advised that the Client may implement a monitoring regime relating to PSCS health and safety performance on all contracts. The results of this monitoring will be recorded and a copy issued to the PSCS. Any serious non-compliances or persistent minor non-compliances will result in:
- Roscommon County Council may report the PSCS to the Health and Safety Authority.
- The contract may be withdrawn.
- Payments due may be withheld.
Certification of Competence
- This Company declares that it is competent to perform/provide the service as detailed in the Tender Agreement and has a thorough knowledge of the requirements of the current Safety, Health and Welfare at Work Act 2005 and Regulations and if appointed to do so, is insured and competent to perform the duties as detailed in Regulations 16 to 23 of the Safety, Health and Welfare at Work (Construction) Regulations, 2013 (S.I. N0. 291 of 2013)
- The information provided in this questionnaire is an accurate summary of the company’s Health and Safety Management System.
Registered Company Name: ...... …......
Nature of Service Provided: ...... …......
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...... …....………………………………….
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The year your Company was first Registered: …………..…………..
No. of Employees: ………….
Registered Company Address: ………..…..………………...………………………………………
Tel: ……..…….………… Fax: ………………… e-mail address: ……..…………………
Completed by
Signed:...... ……...... ……...... ……...... ………….. / Name: ...... ……......
Position...... ………….. / Date: ...... ……......
1.0 / OHS Policy and Management
In this section, the assessor seeks to establish how senior management demonstrates a firm and unequivocal commitment to provide a safe and healthy working environment and continuing education relating to the activities of the company. Your policy must be signed by the MD and recently dated. Also to determine if your company has assigned health and safety duties and responsibilities in a clear and understandable manner
1.1 / Is a copy of your organisation's Safety Statement included with this form?
Note: You MUST include a Copy of your Safety Statement in order to pass this section / Yes No
1.2 / Do you have a Management Structure (Organisation Chart) showing the names, the job title or position held of each person responsible for performing tasks that would be assigned to them on this project
Please Provide Details
Note: These details to include the allocation of duties, delegation of responsibilities the person who has day-to-day responsibility for the management of health and safety as they relate to the role of PSCS /
Yes No
/ 31.3 / Provide details of the experience and qualifications of the person named at 1.2 above. / Details enclosed:
Yes No / 3
1.4 / Provide details of the experience, qualifications, membership of professional bodies etc and arrangements for continuing professional development of key staff who will be employed on the project. / Details enclosed:
Yes No / 3
1.5 / Do you have a nominated Safety Officer? / Details enclosed:
Yes No / 3
1.0 / OHS Policy and Management Continued
1.6 / Provide details of your company’s experience in preparing, and monitoring compliance of PSCS/Contractors with the Preliminary Safety & Health Plan. / Yes No / 3
1.7 / Does your company have safety management meetings and at what frequency? / Yes No / 3
1.8 / Are there ‘end of project’ reviews carried out? / Yes No / 3
1.9 / Does the company have a formal safety management system in place? e.g. OHSAS 18001. If Yes, provide copy of certificate. / Yes No / 2
1.10 / Does the company have a Quality Management System certified by a recognized independent authority? E.g. ISO 9001. If Yes, provide copy of certificate. / Yes No / 2
2.0 / Project Supervisor for Construction Stage (PSCS)
The assessor will seek evidence of your company’s previous experience as an appointed PSCS and that your company has the competency and a clear understanding of the duties of the PSCS role.
2.1 / Have you previously been appointed PSCS in a project which is comparable in size and nature to this project? / Yes No / 2
2.2 / Provide examples of work carried out previously, which you have been appointed PSCS? / Details enclosed:
Yes No / 2
2.3 / Does your company have in-house expertise in Health & Safety in regards to the duties of the PSCS? / Yes No / 2
2.4 / Outline the names, qualification and experience of the individual/s within your organisation who will undertake the duties of PSCS on this project? / Details enclosed:
Yes No / 2
2.5 / If you answered ‘NO’ to 2.2, please provide the Company name, address, contact details, names of the individual/s who will undertake the day-to-day responsibility for the management of Health & Safety co-ordinator as it relates to the role of the PSCS on this project. / Details enclosed:
Yes No / 2
2.6 / How will you co-ordinate the activities of different contractors involved in this Project? / Details enclosed:
Yes No / 2
2.7 / How do you intend to manage, monitor and control health and safety issues during the construction stage of the project? / Details enclosed:
Yes No / 2
2.8 / How do you ensure, so far as is reasonably practicable, the control of risks during the constructions stage of the project e.g. production of site specific risk assessments, method statements etc / Details enclosed:
Yes No / 2
2.9 / How do you intent to ensure that all necessary Safety File information is provided to the PSDP / Details enclosed:
Yes No / 2
2.10 / What systems are in place to ensure that the client is informed of all health & safety issues? / Details enclosed:
Yes No / 2
3.0 / Construction Stage Safety and Health Plan
The assessor will seek evidence that your company has a clear understanding of the preparation of the Construction Stage Safety and Health Plan(in accordance with the Construction Regulations 2013) and can demonstrate an effective means of ensuring the implementation the plan by the PSCS.
3.1 / Provide details of your company’s experience in preparing, and monitoring compliance of contractors with the Construction Stage Safety and Health Plan / Details enclosed:
Yes No / 2
3.2 / Provide an example of a Construction Stage Safety and Health Plan previously prepared by your company Note: Ideally a plan prepared in accordance with the Construction Regulations 2013 should be provided. / Details enclosed:
Yes No / 2
3.3 / How will you ensure that the Construction Stage plan is reviewed and updated as necessary? / Details enclosed:
Yes No / 2
3.4 / Is it your intention to appoint a Health & safety Co-coordinator for the Project? / Yes No / 2
3.5 / Would your Construction Stage plan specify the procedure for the monitoring of subcontractors to determine conformance with the Project Plan? / Yes No / 2
4.0 /
Site Management
4.1 / Is your company willing to co-ordinate with the Client prior to work commencing and during the performance of the work? / Yes No / 54.2 / Do you have a competent supervisor/foreman to supervise the works on this project at all times.
Please provide details / Details enclosed:
Yes No / 5
5.0 / Safe Work Practices and Procedures
5.1 / Is there a documented Accident Investigation procedure in place? If Yes provide a copy of a standard accident report form / Yes No
Details enclosed:
Yes No / 2
5.2 / Are there procedures for maintaining, inspecting and assessing the hazards of plant & machinery operated on site / Yes No Details enclosed:
Yes No / 2
5.3 / Are there procedures in place for producing project/site specific Traffic Management Plans where works involves working on Roadways?
If Yes provide a sample traffic management plan / Yes No Details enclosed:
Yes No / 3
5.4 / Are there procedures for storing and handling hazardous substances? / Yes No Details enclosed:
Yes No
Yes No Details enclosed: Yes No / 1
5.5 / Are there procedures for identifying, assessing and controlling risks associated with manual handling? / Yes No Details enclosed:
Yes No / 1
5.6 / Are Safe Work Practices and Procedures communicated to staff? / Yes No / 1
6.0 /
Health & Safety Performance
6.1 / Over the past three years have you kept a record of all accidents/incidents reported within your company? / Yes No Details enclosed:
Yes No / 3
6.2 / Over the past three years, have your company’s employees been involved in any accidents, which were required to be reported to the Health & Safety Authority?
If yes, please attach details / Yes No
Details attached / 3
6.3 / Over the past three years, on a project where you acted as PSCS, were any of your subcontractors employees involved in any accidents, which were required to be reported to the Health & Safety Authority? If yes, please attach details / Yes No Details attached
Yes No / 3
6.4 / Over the past three years, has your company or individuals employed by your company, been prosecuted for any breaches of Health & Safety?
If yes, please attach details / Yes No
Details attached
Yes No / 3
6.5 / Has any prohibition, improvement or other enforcement notice/order been issued against your company within the past three years? If yes, please attach details / Yes No Details attached
Yes No / 3
Note: Existence of reportable accidents, enforcement/prohibition notices does not lead to automatic disqualification. However if a contractor is found to have provided inaccurate or false information, this may lead to termination of contract.
Health & Safety Training, Instruction and Information
7.1 / Is health and safety training relevant to the role of the PSCScompleted within your company?If yes, please attach details / Yes No
Details attached
Yes No / 2
7.2 / Have your employees including site supervisors and management received appropriate health and safety training for their work? If yes, please attach details / Yes No
Details attached
Yes No / 2
7.3 / Have all employees completed the Safe Pass Scheme.
If yes, please attach details / Yes No
Details attached
Yes No / 2
7.4 / If applicable have relevant employees completed the CSCS Scheme e.g. excavator/dumper operation, scaffolding, roofing etc. / Yes No
Details attached
Yes No / 2
7.5 / Is it your company’s policy to carry out site-specific induction training for all employees? / Yes No / 2
Marking Scheme
Total Potential Mark = 100 = 100%
Pass Rate = 60%
Note: Half a mark can be awarded in a number of questions e.g. if details are provided but they are not satisfactory
Section / Topic / Potential Mark / Pass
Mark / Actual Mark / Comments
1.0 / OHS Policy and Management / 25 / 15
2.0 / Project Supervisor for Construction Stage (PSCS) / 20 / 12
3.0 / Construction Stage Safety and Health Plan / 10 / 6
4.0 / Site Management / 10 / 6
5.0 / Safe Work Practices and Procedures / 10 / 6
6.0 / Health & Safety Performance / 15 / 9
7.0 / Health & Safety Training, Instruction and Information / 10 / 6
Total Mark / 100 / 60
QuestionnairePASS/FAIL
Assessment Completed by:Signed:...... ……...... ……...... ……...... ………….. / Name: ...... ……......
Position...... ………….. / Date: ...... ……......
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Rev 006 Reviewed: Nov2014