PRE-QUALIFICATION QUESTIONNAIRE / Project Number / File Number
Company:
PART A – GENERAL INFORMATION / Mechanical Contractor / Fabricator / Commodities
Electrical/Instrumentation Contractor / Pipeline / Other______
(Name)
1.0 / CORPORATE INFORMATION
1.1 / Complete Legal Name of Company:
Prepared by: / Date:
Title: / Telephone:
1.2 / Street Address:
1.3 / Mailing Address:
1.4 / Telephone No.: / Fax No.:
1.5 / Web Page:
1.6 / Email:
2.0 BUSINESS CLASSIFIACTION
2.1 Aboriginal Owned Company Yes No
2.2 100% Aboriginal Owned Yes No
2.3 Partnership / Joint Venture Yes No What percentage is aboriginal owned ? ______
2.4 Identify the length of time this business venture has been in place? ______
2.5 Is there a management or board level representation of the Aboriginal partner in the joint venture Yes No
2.6 If yes please provide information on the structure, nature and geographic restriction of the partnership / joint venture.
2.7 First Nations Yes No
If yes, which First Nations group? ______
2.8 Metis Yes No
If yes, which Metis group? ______
2.9 Does your company have an aboriginal engagement policy? Yes No
If yes, please indicate the methodology and current percentage of aboriginal inclusion
2.10 / Is your company affiliated or partnered with an aboriginal community? Yes No
If yes, please explain the nature of the relationship.
2.11 / Does your company have an aboriginal engagement strategy? Yes No
2.12 / Does your company have a training or development program for aboriginal employees? Yes No
2.13 / Does your company track monies spent on Aboriginal employees or contractors employed by your company? Yes No
2.14 / Does your company have experience working with local Aboriginal communities in with it operates? Yes No
If yes, Please explain.
2.15 / Does your company promote and provide cultural / aboriginal awareness training to employees? Yes No
2.16 / Does your company provide opportunities for apprentice or summer positions to Aboriginal community members? Yes No
3.0 / KEY PERSONNEL
3.1 / President and C.E.O / Direct Telephone:
3.2 / General or Operations Manager / Direct Telephone:
3.3 / Safety Officer or Manager / Direct Telephone:
3.4 / Business Development Manager / Direct Telephone:
3.5 / Engineering Manager / Direct Telephone:
3.6 / Quality Assurance Manager / Direct Telephone:
3.7 / Construction Manager / Direct Telephone:
3.8 / Financial / Administration Manger / Direct Telephone:
3.9 / Other: / Direct Telephone:
3.10 / Other: / Direct Telephone:
3.11 / Who will address inquiries? / Direct Telephone:
4.0 / CORPORATE FINANCIAL INFORMATION
4.1 / Date Company Established:
4.2 / Under Present Management Since:
4.3 / Type of Organization or Company: / Proprietorship / Partnership / Privately Owned / Limited Company / Corporation / Public
4.4 / If owned by a parent company, provide details of legal name, address and ownership.
4.5 / What is the authoritative and fiscal relationship between this company, the parent company, and affiliated companies?
4.6 / Bank / Financial Institution
Name:
Address:
Contact Name: ______/ Position: ______
Telephone: ______/ Fax: ______
4.7 / Insurance and Financial Performance Information
Attach a current Certificate of Insurance indicating all insurance coverage’s (i.e. general liability, employer’s liability, auto PL/PD (owned of non-owned), completed products and/or completed operations liability, professional liability, aircraft, cross liability and/or umbrella conditions, etc).
If No, Explain?
5.0 / RESOURCES AND OPERATIONS
5.1 / Number of permanent employees: / Provide organization chart if possible
5.2 / List all trade agreements / labour contracts to which you are presently signatory, including expiry date
5.3 / What are the normal days and hours of operation.
Head and Regional Offices:
Warehouse of Equipment Yard:
Field Locations (Preferred hours of work)
Other: name locations:
PART B – INDUSTRIAL CONTRACTOR
1.0 / SERVICES
1.1 / Do you provide?
a) Detail Design Engineering / Yes / No
b) Procurement / Yes / No
c) Fabrication / Yes / No
d) Inspection / Yes / No
e) Erection / Installation Supervision / Yes / No
f) Maintenance / Yes / No
g) Start-up Assistance / Yes / No
h) Emergency Assistance / Yes / No
i) Other: ______/ Yes / No
j) Other: ______/ Yes / No
If yes to Item c), provide the address and a Manufacturing / Fabrication Facility Survey Report will be forwarded at completion.
1.2 / During the past 3 years, indicate the type of Industry or Industries served and approximate percentage of total volume for each item.
Addition of all items must equal 100%
COMMENTS
a) Oil and Gas – Upstream / Yes / No / _____%
b) Oil and Gas – Midstream / Yes / No / _____%
c) Oil and Gas – Downstream / Yes / No / _____%
d) Petro Chemical / Yes / No / _____%
e) Refineries / Yes / No / _____%
f) Fertilizer Plants – Ammonia / Urea / Yes / No / _____%
g) Coal Fired Power Generating Facilities / Yes / No / _____%
h) Co-generation Power Generating Facilities / Yes / No / _____%
i) Tank Farm Terminals / Yes / No / _____%
j) Pulp and Paper Mills / Yes / No / _____%
k) Sawmills / Yes / No / _____%
l) Grain Handling Facilities / Yes / No / _____%
m) Mining / Yes / No / _____%
n) Pipeline – Mainline / Yes / No / _____%
o) Pipeline – Gathering / Yes / No / _____%
p) Food Processing / Yes / No / _____%
q) Other (specify) ______/ Yes / No / _____%
r) Other (specify) ______/ Yes / No / _____%
1.3 / Indicate specific services supplied and approximate percentage of overall volume for each item. Addition of all items must equal 100%.
a) Contractor – civil (gradework, lease preparation, road building etc.) / Yes / No / _____%
b) Contractor – civil (rebar, concrete, piling etc.) / Yes / No / _____%
c) Contractor – civil (structural steel, platforms, handrails, stairways) / Yes / No / _____%
d) Contractor – civil (prefab buildings, cladding) / Yes / No / _____%
e) Contractor – mechanical (piping) / Yes / No / _____%
f) Contractor – mechanical (vessels) / Yes / No / _____%
g) Contractor – mechanical (rotating equipment) / Yes / No / _____%
h) Contractor – mechanical (HVAC) / Yes / No / _____%
i) Contractor – electrical / Yes / No / _____%
j) Contractor – instrumentation / Yes / No / _____%
k) Contractor – controls systems / Yes / No / _____%
l) Contractor – communications / Yes / No / _____%
m) Contractor – insulation / cladding / Yes / No / _____%
n) Contractor – sandblasting / painting / Yes / No / _____%
o) Contractor – scaffolding / Yes / No / _____%
p) Contractor – other, detail ______/ Yes / No / _____%
q) Contractor – other, detail ______/ Yes / No / _____%
1.4 / Indicate the approximate fixed or lump sum dollar range (CDN) which you prefer and are currently able to bid. (i.e., $5,000.00 to $500,000.00) / ______
1.5 / List those portions or types of work services normally subcontracted by your firm to others.
1.6 / Supply of list of Key Field Supervisors and their resumes. Attached? Yes No
1.7 / Supply a list of equipment and Equipment Rates. Attached? Yes No
1.8 / Attach a resume of major projects completed by your firm within the last three (3) years. Include the following information in your resume.
Customer or Client Names
Order or Contract Dollar Value
Type of Work Performed
Year Order or Contract Completed
Customer / Client Contact Name and Phone Number
2.0 / LOSS MANAGEMENT CONTROL PROGRAM
2.1 / Does this company have an Environmental, Health and Safety program? Yes No
2.2 / Is this company currently registered with ISNetworld? Yes No
2.3 / Does this company have a Health and Safety manual? Yes No
2.4 / Does this manual have annual update reviews? Yes NoIf No, detail if and when? ______
2.5 / Is a copy of this manual available for review? Yes No
2.6 / Is the Health and Safety program registered with an outside agency? Yes NoIf yes, name agency: ______
2.7 / Is the Health and Safety program audited on a regular basis? Yes No
If yes, by whom? ______/ Frequency: ______
Comments: ______
______
______
2.8 / Detail the results of the last three audits (external).
a) Date: ______/ Results: ______
b) Date: ______/ Results: ______
c) Date: ______/ Results: ______
2.9 / During the last three years of operations including subcontractors, detail the following:
a) Year:
b) Number of Fatalities:
c) Number of Lost Time Accidents:
d) Number of Medical Aid Injuries:
2.10 / Does this company have a modified work program? Yes No
2.11 / Total number of man-hours worked in the last three years including subcontractors.
Year: ______Year: ______Year: ______
2.12 / Calculate the Recordable Injury Incidence Rate including subcontractors for the last 3 years. Calculation is as follows:
No. of Lost Time Accidents x 200,000
Total Employee Hours
Year: ______Year: ______Year: ______
2.13 / List your overall Alberta Workers’ Compensation Rating for the past three years. Attach a copy of the WCB summary.
Year: ______Year: ______Year: ______
2.14 / Has this company received an Alberta Labour – Occupational Health and Safety stop work order or an equivalent from another jurisdiction in the past three years?
2.15 / Name the highest ranking safety professional in the company.
Name:______/ Telephone: ______
Title:______/ Fax: ______
What is this individual’s authority and mandate within this company?
Who does this person report to? / Name: ______/ Title: ______
2.16 / Does this company provide a full time safety representative on site(s)? Yes No
If no, provide and explanation of site safety coverage: ______
2.17 / Does this Safety and Health program provide the following key elements?
a) Written policy statement committing management to Safety and Health? / Yes / No
b) Incorporation and Compliance with OSHA regulations? / Yes / No
c) Accountability and responsibility for managers, supervisors and employees? / Yes / No
d) Employee participation? / Yes / No
e) Management commitment and participation? / Yes / No
f) Employee Performance Award Recognition? / Yes / No
g) Employee Training and Upgrading? / Yes / No
h) Hazard Recognition and Control (WHIMIS)? / Yes / No
i) Periodic health and safety performance appraisals for the employees? / Yes / No
j) Scheduled meetings that encourage employee input and comments / Yes / No
k) Management meeting that review performance and set policy? / Yes / No
l) Required resolution of identified problems or hazards? / Yes / No
2.18 / Does the Health and Safety program include work practices and procedures such as:
a) Ground disturbance and Open Excavations? / Yes / No
b) Equipment Operating? / Yes / No
c) Confined Space Entry? / Yes / No
d) Fall protection? / Yes / No
e) Electrical Equipment Grounding Assurance? / Yes / No
f) Emergency Evacuation Plan? / Yes / No
g) Equipment Lockout? / Yes / No
h) Personnel Protective Equipment? / Yes / No
i) Vehicle and Equipment Safety? / Yes / No
j) Compressed Gas Cylinder Handling and Storage? / Yes / No
k) Waste Disposal? / Yes / No
l) Good Housekeeping? / Yes / No
m) Scaffold Tagging and Access? / Yes / No
n) Job specific Tasks? / Yes / No
o) Accident / Incident Reporting? / Yes / No
p) Unsafe Condition Reporting? / Yes / No
q) Inquiry and Illness Recording? / Yes / No
2.19 / Does this company have written policy and programs for:
a) Hearing Conservation and Protection? / Yes / No
b) Respiratory Conservation and Protection? / Yes / No
c) Substance Abuse
- Pre-employment testing? / Yes / No
- Random testing? / Yes / No
- Testing for cause? / Yes / No
d) Medical Conditions
- Pre-employment questionnaire? / Yes / No
- Pre-employment examination? / Yes / No
- Placement of employees based on medical conditions? / Yes / No
e) First Aid and CPR Testing? / Yes / No
f) H2S Alive Training? / Yes / No
g) WHIMIS Training? / Yes / No
2.20 / Project Safety Meetings and Orientations / Frequency
a) New Hire Orientation / Yes / No / ______
b) Project Orientation / Yes / No / ______
c) Subcontractor Orientation / Yes / No / ______
d) Visitor Orientation / Yes / No / ______
e) Toolbox (Tailgate) / Yes / No / ______
f) General Project / Yes / No / ______
g) Supervisors / Yes / No / ______
h) Are safety orientations recorded and signed by the employee? / Yes / No / ______
i) Are safety meetings minuted and signed by the attendees? / Yes / No / ______
2.21 / Does this company have a corrective action process for identified safety and health deficiencies? Yes No
If yes, briefly explain the process.
2.22 / Does this company have a corrective action process for employees or subcontractor employees that fail to comply with safe work practices?
Yes NoIf yes, briefly explain the process.
2.23 / Subcontractor Evaluation:
a) Are subcontractors evaluated on their ability to comply with OHSA regulations and this company’s Safety and Health program?
Yes No
b) Is the subcontractor’s S&H program audited by this company prior to its acceptance as a subcontractor?
Yes No
c) If the subcontractor fails an audit, detail this company’s procedure for acceptance or rejection of the subcontractor.
2.24 / Does this contractor maintain the following records
a) Employee Safety Training Certifications? / Yes / No
b) Employee Health and Safety Records / Yes / No
c) Supervisor Safety Training Records / Yes / No
d) WHIMIS Training Records / Yes / No
e) Corporate Safety Audits / Yes / No
f) Project Safety Audits / Yes / No
g) Accident / Incident Reports complete with resolutions / Yes / No
h) Site Inspection Reports / Yes / No
i) Tool and Equipment Inspection Reports / Yes / No
2.25 / List WCB Account Numbers:
Alberta:______/ Manitoba:______
British Columbia:______/ Other:______
Saskatchewan:______/ Other:______
2.26 / Does this company’s Loss Control Management Program include elements and provisions to address environmental issues? Yes No
2.27 / Does this company have a written policy statement for protection of the environment? Yes No
2.28 / Are written procedures in place for the following?
a) Adequate and specific waste containment receptacles. / Yes / No
b) Routine and regulated disposal of the receptacles. / Yes / No
c) Run off and waste water containment. / Yes / No
d) Hazardous Material Identification and Storage. / Yes / No
e) Fuel and Lubricant containment. / Yes / No
f) Inspection and monitoring of the work area. / Yes / No
g) Spill Reports complete with resolutions. / Yes / No
h) Site Inspection and Inspection Reports. / Yes / No
i) Emergency Contingency Plan. / Yes / No
3.0 / QUALITY ASSURANCE AND CONTROLS
3.1 / Organization (Provide organizational chart if possible)
a) Department Head: / Name: ______/ Title: ______
b) Telephone / Direct: ______/ Fax: ______/ Email: ______
c) Reports to: / Name: ______/ Title: ______
3.2 / Program / System
a) Does this company have a Quality Assurance Program? / Yes / No
b) Is a Quality Control Inspection System in effect? / Yes / No
c) Is there a Quality Manual? / Yes / No
d) Are there Quality Control Procedures? / Yes / No
e) Is a copy of the Quality Manual available upon request? / Yes / No
f) Does this company control copies of the Quality Manual? / Yes / No
3.3 / Fill in list of Approvals / Certification
Jurisdiction
(i.e., AB, SK) / Limits of Certification
(i.e., ASME Sect 1, B.31.1) / Jurisdiction Authority
(i.e, ABSA, CWB)
3.4 / Attach or enclose copies of Item 3.3 certifications if available.
3.5 / Supply a list of approved Welding Procedures applicable to Item 3.3 certifications.
3.6 / Is this company:ISO 9000 Compliant? Yes NoISO 9000 certified? Yes No
If yes, detail the present status of the program, or the level of the certification achieved.
4.0 / MATERIAL HANDLING AND CONTROL
4.1 / Who is the manager of, or who controls material handling?
Name: ______/ Title: ______/ Direct Telephone: ______
Email: ______
4.2 / How is the availability of materials determined before commencing a project?
4.3 / Describe the methods and procedures to ensure the right quantity, correct material grouping and specification adherence are consistently implemented when purchasing material.
4.4 / Describe the receiving procedure that are used to ensure the correct quantity is received, costs are tracked and correct, quality is assured and the correct storage procedures are employed.
4.5 / Are the suppliers used by this company pre-qualified to ensure acceptable quality assurance and service? Yes No
If no, describe the procedures used to ensure consistent products and service.
4.6 / Describe the procedures used for the transfer of material from storage or warehousing to the field installation location and the method used to ensure the correct material is installed.
5.0 / PROJECT PROGRESS AND PRODUCTIVITY
5.1 / How is the percentage complete calculated and evaluated? Is earned value calculated?
5.2 / How is the productivity measured, how often and by whom?
5.3 / What type of scheduling program does this company use and how does it identify potential slippages or ensure that the project remains on schedule? Who provides the information?
5.4 / How is the progress of the subcontractors measured?
6.0 / COST TRACKING AND MANAGEMENT
6.1 / What method of cost control is used by this company? Is it computerized?
6.2 / Detail in general terms the procedures to track labour, material, equipment and subcontractor costs compared with the estimated quantities? In conjunction with agreed progress on the project, how is it used to determine costs earned versus costs spent?
6.3 / How current to the project status is this cost tracking system?
7.0 / ADDITIONAL INFORMATION
7.1 / Enclose or attached additional information if you believe if will be helpful to this evaluation. Additional comments below.
Please have Key Manager responsible for enquiries complete the information below:
Name: ______Direct Line: ______
Title: ______E-Mail: ______
Signature: ______Date: ______