Contractor Occupational Health and Safety Management and Performance

CONTRACTOR OCCUPATIONAL HEALTH AND SAFETY and ENVIRONMENTAL QUESTIONNAIRE

As part of Curtin University of Technology’s Contractor Safety Management System, it is now a requirement for all contractors who wish to undertake work for the University to undergo an occupational safety and health and environmental evaluation process. This process assists the University with determining whether contractors take reasonably practicable steps to apply safe systems of work and comply with the requirements of the OSH Act (WA) 1984 (as amended) and relevant environmental legislation.

Please complete the following form, and where required, submit copies of the appropriate documentation. Return all documentation to the Safety Officer, Properties Department, Curtin University of Technology, GPO Box U1987, Perth, WA 6845.

COMPANY NAME COMPANY ADDRESS Street Address Postal Address

Telephone: Fax: Email: Web: COMPANY REPRESENTATIVES: Name Position Mobile No.

Company profile (including number of employees):

Curtin University Office space Past contracts

Current tender submission

Responsible Officer: Date:

OSH Evaluation checklist completed □ (circle) Satisfactory / Unsatisfactory

Information entered on Contractor List □ Contractor informed if unsatisfactory □ Date:

Contractor OSH and Environmental Questionnaire 1 of 4 February 2010 , Version 2 YES/NO Comments N/A OSH POLICY AND MANAGEMENT Is there a written company OSH Policy? If yes, provide a copy of the policy.

Does the company have a written OSH Management System? If yes, provide copy of the contents page.

Does the company hold third party OSH accreditation (eg WorkSafe Plan)? If yes, please provide details.

Are safety and health responsibilities clearly identified for all levels of staff, ie roles and responsibilities? If yes, provide details.

SAFE WORK PRACTICES AND PROCEDURES Has the company undertaken job safety analysis for work to be undertaken? If yes, provide an example.

Has the company prepared safe working procedures or specific safety instructions relevant to its operations? If yes, provide a summary listing of procedures or instructions.

Are there procedures for storing and handling chemicals (including fuels and paints), and for cleaning spills? If yes, provide details.

Is there a documented incident reporting and investigation procedure? If yes, provide a copy of a standard incident report form.

Are there procedures for identifying, assessing and controlling risks associated with hazards, especially in relation to manual handling?

Does the company have a Safety Officer who visits sites on a regular basis?

OPERATIONAL SAFETY Has the company been served any WorkSafe Notices (Improvement & Prohibition in the last five (5) years? If yes, please provide list:

Has the company been prosecuted by WorkSafe in the last five (5) years? If yes, please give details including outcome and fines.

INJURIES AND WORKERS COMPENSATION CLAIMS Has the Company experienced any work related fatalities or serious injuries leading to permanent disability and/or LTIs in the last ten (10) years. If yes, please provide details:

Contractor OSH and Environmental Questionnaire 2 of 4 February 2010 , Version 2 YES/NO Comments N/A INCIDENT MANAGEMENT AND EMERGENCY PREPAREDNESS Does the company have an incident management and emergency preparedness policy and procedure? If yes, please attach.

Indicate emergency management training offered, how frequent and include percentage of staff who have received this training. (first aid, confined space rescue, fire, spills, etc)

TRAINING/LICENCES Does the company provide OSH Training? Provide a list of training courses offered and attended by employees.

Have construction workers completed Construction Safety Awareness Training?

Are records maintained for all training and inductions? If yes, provide brief details?

Detail Licences that employees hold to operate machinery and equipment. [Where appropriate, Licences will be required to be sighted prior to commencement of any work at the University.]

CONSULTATION PROCESS Does the company have safety & health representatives?

Does the company have a safety committee?

Does the company have an issue resolution process?

SUB-CONTRACTOR SELECTION Does the company have a process to follow when selecting sub-contractors in respect of their OSH management and performance, including induction training? If yes, please provide details.

Has the company received and read a copy of Curtin University of Technology’s Contractor Safety Handbook?

Has the company made the Handbook available to employees likely to be working at the University?

Contractor OSH and Environmental Questionnaire 3 of 4 February 2010 , Version 2 YES/NO Comments N/A

Does the company understand the requirement for their employees to attend a Curtin University of Technology Contractor Induction prior to commencing work at the University?

ENVIRONMENTAL PRACTICES Are there procedures for waste management and stormwater management? If yes, provide details.

Has the company been served environmental fines/notices in the last five (5) years? If yes, please provide list:

Has the company been prosecuted by the Dept of Conservation and the Environment in the last five (5) years? If yes, please give details including outcome and fines

Does the company provide environmental training? Provide a list of training courses offered and attended by employees.

Does the company have a process to follow when selecting sub-contractors in respect of their environmental management and performance, including induction training? If yes, please provide details.

COMPANY SIGN-OFF

I acknowledge that the information provided in this Contractor questionnaire, as part of the Curtin University of Technology Contractor OSH and environmental evaluation process, is true and correct.

Company name: Name Position Signature

Contractor OSH and Environmental Questionnaire 4 of 4 February 2010 , Version 2