<p> SUB-CONTRACTOR APPROVAL QUESTIONNAIRE QMSFSCAQ-001 Instructions for completing questionnaire. a) Please use the adjoining column check box to indicate you have provided a response & have also provided documentation where required. b) Click on select response boxes to select response options or type in response in box below. c) Respond to all questions either with YES/NO/N/A & provide all copies of required documentation. If you cannot provide documentation provide details as to why this is the case. 1.0 Type of Company</p><p>PLC: ☐Ltd: ☐Partnership: ☐Sole trader:☐ 2.0 Person completing this questionnaire Role Tel: E-Mail: Fax:</p><p>Sub-Contractor (5 employees or more) ☐</p><p>Sub-contractor (4 employees or less and labour agencies) ☐</p><p>3.0 Services</p><p>What services are you intending to provide. ☐</p><p>☐</p><p>4.0 Company Details:</p><p>Company Trading Name: ☐</p><p>Company Registered address: ☐</p><p>Company Contact Email: ☐</p><p>Web-Site Address if applicable ☐</p><p>Name of Company Director/s ☐</p><p>Company Registration Number: ☐</p><p>Unique Taxpayer's Reference Number: ☐ Vat Registration No:</p><p>Are you registered with Click to Select Response Construction Industry Scheme ☐ (CIS)?</p><p>5.0 Labour Resources Name/s & Contact Number/s of Key Personnel who will manage site projects ☐</p><p>How many direct staff do you employ?</p><p>How many of your direct staff are office-based ☐</p><p>How many indirect staff do you employ?</p><p>Do you provide labour through Click to Select Response agencies: ☐</p><p>Do you intend to use agencies for the services you will provide for SB Electrical (IOW) Ltd</p><p>Click to Select Response If YES please list agencies below</p><p>Agencies:</p><p>Do you require agencies to check if all labour provided have the valid technical skills & relevant site cards & where appropriate DBS Checks</p><p>Click to Select Response If NO please provide details of how you check valid technical skills & site cards are valid for the services you ☐ intend to provide</p><p>☐</p><p>6.0 Bank & Financial Details</p><p>Bank Name: ☐</p><p>Bank Address: ☐</p><p>Sort Code: Account Number: ☐</p><p>Financial Security Have any company director been convicted or in the ☐ process of court proceedings of fraud/or any other financial</p><p>Document Reference: QMSFSCAQ-001 Revision 02 24/02/2015 Authorised by: Alan Bramley HSQE Manager Page 3 of 8 irregularities If YES please provide details</p><p>Click to Select Response ☐</p><p>7.0 Accounts</p><p>Company Turnover in last Financial Year £ ☐</p><p>Profit before tax £ ☐</p><p>8.0 Insurance:</p><p>Please provide insurance details Please attach certificates ☐</p><p>Insurance type Cover level Expiry date</p><p>Employers Liability:</p><p>Public Liability:</p><p>Products Liability: ☐</p><p>Professional Indemnity:</p><p>Contractors all Risks :</p><p>Others (please state):</p><p>9.0 Health and Safety:</p><p>Is your organisation certified to Safe Contractor, CHAS or other Safety Click to Select Scheme In Procurement SSIP Response ☐ If YES, Please provide copies</p><p>Do your site managers/supervisors undertake regular site Click to Select inspections Response ☐ If Yes please provide example copies of site inspection reports undertaken in the last two weeks</p><p>Do you either externally or internally audit your H&S management Click to Select system Response</p><p>☐ Who undertakes this H&S audit process? Have you previously carried out contracted works of comparable size Click to Select & nature to the works you intend to undertake Response ☐ If YES list two examples</p><p>Contracted Services provided Duration of Contract Number of site personnel ☐ employed</p><p>☐</p><p>☐</p><p>Do your Managers/Site Operatives who will be involved Click to Select Response in works at site level hold valid site CSCS/ECS Cards ☐</p><p>If response is YES please provide copies of site cards</p><p>Please provide a copy of your H&S Policy Policy is Mandatory if employing >5 staff ☐</p><p>Do you provide site specific Risk Assessments & Method Click to Select Response Statement (RAM’s) for works you undertake</p><p>If YES provide two copies of completed RAM’s ☐</p><p>If NO how do you intend to inform others on site of how your activities may affect their ☐ health, safety, welfare. Please provide detailed information. </p><p>☐</p><p>Please provide Year ☐ number of accidents/incident rates or reportable Non-reportable incidents in last 3 incidents years Non-reportable injuries </p><p>Document Reference: QMSFSCAQ-001 Revision 02 24/02/2015 Authorised by: Alan Bramley HSQE Manager Page 5 of 8 Riddor</p><p>Current reported ☐ accidents for this Year</p><p>Have you had or currently have any Improvement Click to Select Response or Prohibition Notices or any other H&S legal ☐ proceedings against you?</p><p>If YES provide details</p><p>Please indicate how you verify the competency of Please attach examples of your contractors/sub-contractors. completed ☐ inspections/questionnaires</p><p>Please provide a list of any significant hazardous substances you may use on site ☐</p><p>Significant Hazardous Substances:</p><p>What control measures have you in place for significant hazardous substances</p><p>☐</p><p>Please provide examples of health and safety training records including safety supervision training you provided for your site managers & site operatives Examples ☐ may include approved training i.e. PASMA, IPAF, SSSTS, SMSTS etc.</p><p>Please provide example arrangements for communicating to and consulting the workforce? ☐ Examples may include tool-box talks, safety briefing agendas Do you have access to H&S Professional advice? Click to Select Response ☐</p><p>Please detail the where this professional advice come from ☐</p><p>Competent Person/s responsible for company health and Safety?</p><p>Name/s: </p><p>Position/s: ☐</p><p>Qualification/s:</p><p>Please provide C.V.’s Quality</p><p>Are you a member of a relevant trade Click to Select Response or professional body? ☐ If YES provide copies of certs </p><p>Are you registered to ISO9001 or Click to Select Response similar? ☐ If YES provide copy of certificate </p><p>Do you have a quality policy? Click to Select Response</p><p>If YES provide copy ☐</p><p>Do you undertake internal audits? Click to Select Response</p><p>If YES please provide a copy of latest summary of audit report ☐</p><p>Do you have a complaints Click to Select Response procedure/policy? ☐ If YES please provide copy </p><p>Environment</p><p>Do you have an Environmental Policy Click to Select Response or Statement </p><p>If Yes please provide copy ☐</p><p>Document Reference: QMSFSCAQ-001 Revision 02 24/02/2015 Authorised by: Alan Bramley HSQE Manager Page 7 of 8 Are you registered to ISO14001 or Click to Select Response similar? If YES please provide copy </p><p>☐</p><p>Have you been prosecuted or have Click to Select Response you had any environmental incidents in the past 12 months? If so, please ☐ provide details of these and describe the measures now in place to prevent them re-occurring. </p><p>☐</p><p>10.0 DSB Checks</p><p>Where the site involves unsupervised & direct contact with children/vulnerable adults will the sub-contractor arrange for site managers & operatives to undertake basic disclosure checks</p><p>Click to Select Response</p><p>Please provide copies of DBS Checks if appropriate</p><p>11.0 Auditing by SB Electrical</p><p>Do you agree to the SB Electrical auditing any of the Click to Select Response responses provided in this questionnaire ☐</p><p>How much notice do you require prior to an audit being ☐ arranged with you? Who do we need to contact to arrange this? ☐</p><p>Person completing this questionnaire: </p><p>Print Name:</p><p>Signed:</p>