SUBCONTRACTOR HEALTH & SAFETY PRE-QUALIFICATION QUESTIONNAIRE

This questionnaire has been designed to make an initial assessment of your health & safety systems. Once received, your application will be reviewed and a decision taken with regards to an assigned status of approved or unapproved. No works are to be carried out unless you have received written confirmation that you have been added to the approved supplier list. Should the details you provide change significantly, please inform us as soon as possible. SECTION 1 GENERAL INFORMATION

Company name

Address (inc. Postcode)

Tel. No.

Email address

Contact name (in relation to this application)

Contact telephone No.

Please confirm the type of works for which your company wishes to be considered?

How many apprentices do you currently employ?

SECTION 2 HEALTH & SAFETY

Question

Yes

No

Comments

1. Does your company have a formal accredited Health & Safety Management system e.g. OHSAS 18001, Safe T Cert?

If yes, please provide copies of the following: Accreditation certificate H&S Policy Statement (signed) Index of H&S arrangements

and proceed to Question 4 If no, please proceed to Question 2.

2. Do you employ more than 5 people?

If yes, please provide a copy of your company Heath & Safety Policy. If no, please provide a copy of your Health & Safety Statement.

3. Provide details on how you manage Health & Safety in your company.

Enter details below or use a separate sheet if necessary.

4. Who in your company has OVERALL responsibility for Health & Safety?

Please provide details below.

Name: ____________________________________

Position: ________________________________________

Contact Number: ___________________ Email: __________________________________

5. Who in your company has DAY TO DAY responsibility for the management of Health & Safety?

Please provide details below.

Name: ____________________________________

Position: ________________________________________

Contact Number: ___________________ Email: __________________________________

Yes 6. Do you utilise an external Health & Safety consultant?

No If yes, please provide details below.

Name: ____________________________________

Position: ________________________________________

Contact Number: ___________________ Email: __________________________________

Yes 7. Have you been served any notices/prosecutions (including prohibition notices, improvement notices, etc.) in the last three years?

No If yes, please provide details below.

8. Incidents reportable under RIDDOR.

Please provide details below of all incidents reportable under RIDDOR which you have had in the last three years.

Yes 9. Does your company carry out risk assessments?

No If yes, please provide details below (including who will carry out these assessments and what training they have). Use a separate sheet if necessary.

10. Training of personnel e.g. CSR/CSCS/Safe pass Cards.

Note: Martin M&E must be in possession of all safety training cards, and relevant qualifications in relation to site grade for all your

employees prior to commencement of works on site.

Yes 11. Would you propose to subcontract any elements of the works?

No If yes, please provide details below of how this would be managed. A separate sheet may be used if necessary. Works may only be sublet with the prior written agreement of Martin M&E.

12. How do you assess the competence of your subcontractors?

Please provide details below. necessary.

Use a separate sheet if

Yes 13. Do you employ non English-speaking personnel?

No If yes, please provide details below of how you would manage this. Use a separate sheet if necessary.

IMPORTANT - Additional Information Required

You will be required to provide site-specific Risk Assessments/Method Statements prior to commencing work on a Martin M&E site. Please include examples of previous Risk Assessments/Method Statements with this application. Please also ensure that, where applicable, documents such as policy statements are signed prior to submission.