<p>SF/4</p><p>Tier 4 – Pest Control FIELD TEAM/SUBCONTRACTOR QUESTIONNAIRE (SF4) TIER 4</p><p>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.</p><p>Please complete all sections of this form; if there are any questions that are not applicable to you mark as N/A.</p><p>GENERAL REGISTRATION</p><p>Company Name:</p><p>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.</p><p>Company Type Sole Trader Partnership Limited Company Other (specify)</p><p>What is your geographical area of work e.g. Counties covered?</p><p>Where did you hear about Ground Control?</p><p>FINANCIAL INFORMATION</p><p>Company Registration Bank Name: Number: Unique Tax Account Name: Reference: VAT Registration Sort Code: Number: Account Number: Last 3 Years Year Ending: Year Ending: Year Ending: Turnover Turnover: Turnover: Turnover: 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.</p><p>INSURANCE INFORMATION Liabilities covered must be at least £2million each</p><p>Public Liability Policy Number and Expiry Date: PROVIDE Employers Liability Policy Number and Expiry Date:</p><p>Issue No: 1.0 Page 1 of 8 Field Team/Subcontractor Questionnaire Issuer: RB / AH / EOD Issue Date: October 2015 Document ref: SF/4 Tier 4 Pest Control Last Reviewed: SF/4</p><p>Tier 4 – Pest Control Professional Indemnity (if held): A CURRENT Other (Please state): COPY</p><p>NATURE OF BUSINESS/SCOPE OF WORK Please indicate values of work undertaken £501 - £1001 - 24 Hour Up to £100 £101 - £500 £5000+ £1000 £5000 availability? Pest Control Other services (Specify)</p><p>Expected ‘in hours’ rate per man: £ Expected ‘out of hours’ rate per man: £ What are your ‘in hours’? What are your ‘out’ hours? If you have separate rates for weekends/Bank Holidays please specify: £ After the first hour of work we assume that you then (Specify) charge on a quarter hourly basis. If this is not the case please confirm your best options? Examples of Clients Private: Commercial</p><p>REFERENCES Contact: Contact: Contact: Company: Company: Company: Address: Address: Address:</p><p>City: City: City: County: County: County: Postcode: Postcode: Postcode: Tel: Tel: Tel: MANAGEMENT OF STAFF</p><p>How many people do you employ? How many teams do you have?</p><p>PROVIDE A COPY OF What is your management structure? YOUR ORGANOGRAM</p><p>SUPERVISION OF STAFF</p><p>Do you use trainees or young people? Yes No For example: A Young person is anyone under the age of 18 years old</p><p>Are trainees directly supervised at all times by a person competent in the works being undertaken? For example: When a trainee (holding PA1) is applying pesticides using a hand held Yes No N/A applicator a qualified and competent operator (holding PA1 and PA6) must act as the supervisor at all times.</p><p>If you have supervisory staff do they (Specify) receive any additional safety training? Issue No: 1.0 Page 2 of 8 Field Team/Subcontractor Questionnaire Issuer: RB / AH / EOD Issue Date: October 2015 Document ref: SF/4 Tier 4 Pest Control Last Reviewed: SF/4</p><p>Tier 4 – Pest Control</p><p>Do you use overseas workers? Yes No For example: Overseas workers whose first language is not English</p><p>(Specify) If you do use overseas workers or young persons, what additional arrangements are in place, e.g. training assessment, visual aids?</p><p>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</p><p>Do you use subcontractors or labour only resource for all or part of your work? Yes No Using subcontractors is not permitted for field teams working on behalf of Ground Control unless specifically authorised.</p><p>If yes, please explain when / why (Specify) you would use subcontractors?</p><p>Do you provide drinking water, sun block, toilet facilities, etc for your employees Yes No while on site?</p><p>PROVIDE A Do you provide a mentoring process for new staff? Yes No COPY (Specify)</p><p>OPERATIVE LIST</p><p>Name Date of Birth Job Title N I Number</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>Issue No: 1.0 Page 3 of 8 Field Team/Subcontractor Questionnaire Issuer: RB / AH / EOD Issue Date: October 2015 Document ref: SF/4 Tier 4 Pest Control Last Reviewed: SF/4</p><p>Tier 4 – Pest Control 9</p><p>10</p><p>11</p><p>12</p><p>13</p><p>14</p><p>15</p><p>WASTE MANAGEMENT</p><p>What are your arrangements for the disposal (Specify) of waste generated by your work?</p><p>PROVIDE A Do you hold a Waste Carrier’s Licence? Yes No CURRENT COPY</p><p>What is your process for disposing of (Specify) pests i.e. squirrels (if applicable)</p><p>ACCIDENTS AND INCIDENTS</p><p>PROVIDE LAST Do you record and investigate accidents / Yes No INCIDENT / incidents? ACCIDENT COPY</p><p>Who is responsible and carries out accident Name: Position investigations within your company and what documentation is produced?</p><p>How many Near Misses/Close Number: Details: Calls have been reported during the past 12 months?</p><p>Has your company received any HSE, Environment Agency or SEPA enforcement notices and/or prosecutions, improvement or prohibition notices in Yes No the past three years? If yes, provide details:</p><p>EQUIPMENT AND PPE</p><p>Please select the types of equipment Sprayer Pesticides/ Full PPE you will have available should you be Rodenticides Issue No: 1.0 Page 4 of 8 Field Team/Subcontractor Questionnaire Issuer: RB / AH / EOD Issue Date: October 2015 Document ref: SF/4 Tier 4 Pest Control Last Reviewed: SF/4</p><p>Tier 4 – Pest Control successful Traps Chippers Other NB: Full PPE would include respirators, safety eyewear, Hi Vis, gloves, boots, hard had etc. Specify any other equipment not listed above:</p><p>How often do you Pre-Start 6 Monthly PROVIDE COPIES OF undertake equipment COMPLETED inspections? Annual Random CHECK LISTS</p><p>PROVIDE COPIES OF Do you use any lifting and lowering equipment e.g. ropes, Yes No CURRENT LOLER harnesses, lanyards etc? CERTIFICATION</p><p>How do you issue and (Specify) PROVIDE COPY OF replace Personal COMPLETED Protective Equipment (PPE) RECORD OF ISSUE</p><p>COMPANY ACCREDITATIONS</p><p>AA Approved CHAS Safe Contractor Does your company hold Contractor PROVIDE any external COPIES OF Construction Other accreditations? ISO’s None Line (specify) CERTIFICATES Please specify any other accreditations held that are not listed above:</p><p>TRAINING AND COMPETENCE OF STAFF</p><p>Ground Control requires that operatives carry their competency cards and records at all times. Teams are subject to random audits and inspections.</p><p>Please provide evidence of all training and/or competence for all employees that will be working on Ground Control contracts, e.g. copies of certificates of competence, BPCA / PROVIDE COPIES RSPH Level 2, CSCS Cards (front and back of card), ROLO, LANTRA & NPTC OF certificates CERTIFICATES For Pest Control work operatives must be BPCA / RSPH level 2 accredited.</p><p>(Specify) If you are unable to provide formal training certificates please explain staff experiences and how many years practical experience they each have. </p><p>Do you have a register of training, qualifications and experience for your staff? Yes No</p><p>DBS (Disclosure & Barring Service) and CRB (Criminal Records Bureau) None Basic</p><p>We sometimes carry out work which may be classed as a regulated activity and requires a disclosure. Please indicate if Standard Enhanced you and your staff have any of the following?</p><p>Issue No: 1.0 Page 5 of 8 Field Team/Subcontractor Questionnaire Issuer: RB / AH / EOD Issue Date: October 2015 Document ref: SF/4 Tier 4 Pest Control Last Reviewed: SF/4</p><p>Tier 4 – Pest Control If ‘no’, would you and your team be willing to complete checks if Yes No required? This is a requirement for some of our clients. </p><p>POLICY AND ORGANISATION</p><p>Health & Safety Environmental PROVIDE COPIES Please indicate which company OF SIGNED & policies you have in place? Quality Equal Opportunities DATED POLICIES</p><p>Who is responsible for Health and Name: Position: Safety, Environment and Quality in your company?</p><p>Who provides competent Name and company: Qualifications: Health and Safety advice to your company?</p><p>Who provides competent Name and company: Qualifications: Environmental advice to your company?</p><p>HEALTH & SAFETY ARRANGEMENTS</p><p>Does your company have an induction PROVIDE COPY Yes No process for new starters? OF PROCESS</p><p>How do you communicate safety (Specify) messages to your staff?</p><p>How do the on-site staff access (Specify) safety and environmental information?</p><p>RISK ASSESSMENTS AND METHOD STATEMENTS (RAMs)</p><p>Do you carry out your own risk PROVIDE Yes No assessments / Method Statements? EXAMPLE COPY</p><p>Please indicate what types of RAMs you have (you may select Generic Bespoke both options if applicable)</p><p>How do you tell your staff about (Specify) risk assessments and method statements?</p><p>How do you know where your (Specify) teams are each day?</p><p>Explain how you manage (Specify) occupational health risks, e.g. noise, vibration, stress.</p><p>OCCUPATIONAL HEALTH</p><p>Issue No: 1.0 Page 6 of 8 Field Team/Subcontractor Questionnaire Issuer: RB / AH / EOD Issue Date: October 2015 Document ref: SF/4 Tier 4 Pest Control Last Reviewed: SF/4</p><p>Tier 4 – Pest Control Does your company have a procedure in place which sets Yes No out fitness to work and health surveillance standards?</p><p>Do you have an occupational health provider Yes No</p><p>Do they provide face to face screening? Yes No</p><p>ADDITIONAL INFORMATION</p><p>(Specify) Please provide details of any other supporting information relevant to the questions you have answered in this application</p><p>DRIVER AUTHORISATION AND DECLARATION</p><p>I confirm that all driving licences submitted have been checked through the DVLA; https://www.viewdrivingrecord.service.gov.uk/driving-record/licence-number This will inform you of vehicles your staff are able to drive and penalty points and disqualifications. Name:</p><p>Signature:</p><p>DECLARATION</p><p>I declare that the information provided in this application is true and correct to the best of my knowledge. Name:</p><p>Signature:</p><p>Date:</p><p>Position:</p><p>Once complete, please return this questionnaire, and all supporting evidence, to Ground Control Ltd for review.</p><p>USEFUL LINKS TO HELP YOUR PQQ SUBMISSION</p><p>DVLA - https://www.viewdrivingrecord.service.gov.uk/driving-record/licence-number</p><p>HSE - http://www.hse.gov.uk/ </p><p>NPTC / City & Guilds - https://www.nptc.org.uk/</p><p>LANTRA - http://www.lantra.co.uk/</p><p>Issue No: 1.0 Page 7 of 8 Field Team/Subcontractor Questionnaire Issuer: RB / AH / EOD Issue Date: October 2015 Document ref: SF/4 Tier 4 Pest Control Last Reviewed: SF/4</p><p>Tier 4 – Pest Control Environment Agency - https://www.gov.uk/government/organisations/environment-agency</p><p>Manual Handling online course link- http://www.promanualhandling.co.uk/en/signup http://www.hse.gov.uk/msd/manualhandling.htm </p><p>First Aid providers - https://www.sja.org.uk/sja/first-aid-training-courses.aspx http://www.redcross.org.uk/What-we-do/First-aid/First-aid-training </p><p>NPTA (National Pest Technicians Association) – http://www.npta.org.uk/ </p><p>BPCA (British Pest Control Association) – http://www.bpca.org.uk/ </p><p>RSPH (Royal Society for Public Health) - https://www.rsph.org.uk/ </p><p>Issue No: 1.0 Page 8 of 8 Field Team/Subcontractor Questionnaire Issuer: RB / AH / EOD Issue Date: October 2015 Document ref: SF/4 Tier 4 Pest Control Last Reviewed:</p>