SF/4

Tier 1a (Winter) – Gritting Maintenance / Snow Clearance

FIELD TEAM/SUBCONTRACTOR QUESTIONNAIRE (SF4) TIER 1a

Ground Control Limited is a national company who undertake works in a number of land based sectors. This includes Grounds Maintenance, Arboriculture (including electrical and rail), Pest Control, Construction, Landscaping and Gritting/Snow Clearance. As part of our Health, Safety, Quality & Environmental Assurance systems we require the following information to assess your suitability to be one of our approved field teams/subcontractors.

Please complete all sections of this form; if there are any questions that are not applicable to you mark as N/A.

GENERAL REGISTRATION

Company Name:
Contact Details / Company Address
Contact Name:
Job Title:
Mobile:
Telephone: / City:
Email: / County:
Website: / Postcode:
Ground Control delivers regular safety information, alerts and Tool Box Talks to all approved teams via text and email.
Company Type / Sole Trader / Partnership / Limited Company / Other (specify)
Please indicate the works that you would like to be engaged in for Ground Control Ltd / Gritting Maintenance / Snow Clearance
What is your geographical area of work e.g. Counties covered?
Where did you hear about Ground Control?

FINANCIAL INFORMATION

Company Registration
Number: / Bank Name:
Unique Tax
Reference: / Account Name:
VAT Registration
Number: / Sort Code:
Account Number:

Please ensure that you have registered in the CIS scheme. If not, please call 0300 2003210 and request to join the scheme, all you will need is your UTR number along with your NI (if sole trader) Co Reg(if company) or Partnership No (if partnership) it will only take a few minutes of your time. This will then enable us to offer you extra works or construction work within your area when available.

INSURANCE INFORMATION

Liabilities covered must be at least £2million each

Public Liability Policy Number and Expiry Date: / PROVIDE A COPY
Employers Liability Policy Number and Expiry Date:
Professional Indemnity (if held):
Other (Please state):

NATURE OF BUSINESS/SCOPE OF WORK

Expected Winter Maintenance Rates (If you have checked the box above for Gritting / Snow Clearance Maintenance with an interest in providing this service, please complete below with your rates)

Rates
Variable Hourly Rates / Large Machines (e.g. Large Tractor/JCB 3CX/Gritting Lorry with Snow Plough) / Medium Machines (e.g. Compact Tractor/Bobcat) / Small Machines (e.g. Quad Bike/Mower with Snow Plough attachment) / Snow Clearing Operatives (e.g. Man with Shovel)
06:00 till 18:00 Monday to Friday
18:00 till 00:00 Monday to Friday
00:00 till 06:00 Monday to Friday
00:00 till 06:00 Saturday
06:00 till 18:00 Saturday
18:00 till 00:00 Saturday
00:00 till 06:00 Sunday/Bank Holiday
06:00 till 18:00 Sunday/Bank Holiday
00:00 till 06:00 Sunday/Bank Holiday
Minimum Number of Hours (this includes travel to sites)

SUPERVISION OF STAFF

Do your operatives ever work alone? / Yes / No
If yes, please explain your lone working process or provide a copy of your process if written: / PROVIDE A
COPY

OCCUPATIONAL HEALTH

Does your company have a procedure in place which sets out fitness to work and health surveillance standards? / Yes / No
Do you have an occupational health provider? / Yes / No
Do they provide face to face screening? / Yes / No

OPERATIVE LIST

Name / Date of Birth / Job Title / N I Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

DRIVER AUTHORISATION AND DECLARATION

I confirm that all driving licences submitted have been checked through the DVLA;
This will inform you of vehicles your staff are able to drive and penalty points and disqualifications.
Name:
Signature:

DECLARATION

I declare that the information provided in this application is true and correct to the best of my knowledge.
Name:
Signature:
Date:
Position:

Once complete, please return this questionnaire, and all supporting evidence, to Ground Control Ltd for review.

USEFUL LINKS TO HELP YOUR PQQ SUBMISSION

DVLA -

HSE -

NPTC / City & Guilds -

LANTRA -

Environment Agency -

Manual Handling online course link-

First Aid providers -

Issue No: 3.0Page 1 of 4Field Team/Subcontractor Questionnaire

Issuer: GPB / RB / EODIssue Date: March 2013

Document ref: SF/4 Tier 1a (Winter)Last Reviewed: September 2015