If Yes to Q1, Please Enter the Date of Expiry of Your Certificate

Company Information
Registered Company Name:
Registered Company Address: / Trading Address
(If Different):
Contact Name: / Contact Telephone Number:
Fax Number: / Contact email address:
Type of Works Undertaken: / Date Completed:
Each question should be answered and supporting statements and evidence where necessary should be provided in bound form or electronically with the index or file name cross referenced to the appropriate question number. Completed assessments and supporting evidence should be returned to Oceans ESU Ltd, Barnsley Business and Innovation Centre, Innovation Way, Wilthorpe, Barnsley, S75 1JL or by email to
SAFEContractor Third Party Accreditation / Information Required

1. Does your company currently hold SAFEContractor, CHAS, or equivalent Health and Safety certification status?

/ Yes / No / If accredited, enclose a copy of your current certificate and schedule
See note below

1. If Yes to Q1, please enter the date of expiry of your certificate

/ DD/MM/YYYY
IMPORTANT NOTE: IF YOU HAVE ANSWERED YES TO Q1 AND ENCLOSED A COPY OF YOUR VALID CERTIFICATE AND SCHEDULE, THEN YOU ARENOT REQUIRED TO COMPLETE THE REMAINDER OF THIS QUESTIONNAIRE. SIMPLY SIGN THE DECLARATION AND RETURN THIS FORM WITH YOUR CERTIFICATE AND SCHEDULE IN ACCORDANCE WITH THE INSTRUCTIONS ABOVE.

1. Are you accredited for any other organisations, e.g. Gas Safe Register, CSCS cards?

/ If yes, please identify:______/ Please enclose certificates where applicable
Health & Safety Policy, Organisation and Arrangements / Information Required

1. How many people does your company employ?

/ Provide number of staff and company structure

1. Do you have a health and safety policy that is regularly reviewed and signed by the most senior person within the organisation

/ Yes / No / If yes, a signed current copy of the company policy indicating when it was reviewed

1. Does your company operate a formal safety management system

/ Yes / No / If yes, the Contents/Index page from safety management system

1. If Yes to Q5, is the system accredited to any recognised standard?

/ Yes / No / If yes, provide a copy of accreditation certificate

1. Who provides your company with health and safety advice?

Name:
Qualifications: / Provide an example of advice given within the last twelve months, and the action taken

1. Do you have a process to develop and communicate suitable and sufficient risk assessments for all work activities?

/ Yes / No / If yes, provide 2 examples of complete risk assessments for work activities & evidence of communication

1. Do you develop method statements for activities that present significant risks that require to be controlled?

/ Yes / No / If yes, provide 2 examples of completed method statements for work activities

1. Do you develop COSHH assessments for hazardous substances used by your company?

/ Yes / No / If yes, provide 2 examples of completed COSHH assessments for hazardous substances

1. Do you assess the risks arising from hand arm vibration exposure to your employees? (if vibrating tools or equipment is used)

/ Yes / No / If yes, provide an example of a HAVS assessment

1. Do you assess the risks arising from noise exposure to your employees?

/ Yes / No / If yes, provide and example of completed noise assessment

1. Do you have arrangements in place for health and safety training at all levels in your company?

/ Yes / No / If yes, headline training records/ matrix, programme and examples of certificates of attendance etc.

1. Do you have arrangements in place for passing relevant health and safety information to your employees?

/ Yes / No / If yes, description of the arrangements

1. Provide the % of your employees who have passed the CITB-CSCS touch screen test or equivalent, such as CCNSG assessment

/ % / Certificate of compliance or other relevant evidence
Health & Safety Policy, Organisation and Arrangements / Information Required

1. Do you undertake works with gas installations?

/ Yes / No / None

1. If Yes to Q16 provide your company’s CORGI Registration Number

/ REG No. / Provide copy of company CORGI registration certificate

1. Do you have arrangements in place to monitor, audit and review your arrangements for health and safety?

/ Yes / No / If Yes, provide sample inspection reports and details of monitoring frequency

1. Do you have arrangements in place for consulting with your workforce on matters of health and safety?

/ Yes / No / If yes, evidence of consultation such as H&S committee meeting minutes

1. Do you have arrangements in place for the investigation of accidents and incidents arising from your work activities?

/ Yes / No / If yes, detail of accident investigation process

1. Do you let work to sub-contractors?

/ Yes / No / None

1. If Yes to Q21, do you have arrangements in place to assess and monitor the competence of sub-contractors?

/ Yes / No / If yes, provide 2 sample assessments and details of monitoring

1. Do you have arrangements in place for co-operation and co-ordination with other contractors or workers?

/ Yes / No / If yes, evidence of how the company co-ordinates with other trades

1. Do you have arrangements in place to ensure that all your employees have access to suitable welfare facilities?

/ Yes / No / If yes, description of arrangements e.g. reference to H&S policy etc.

1. Is your company familiar with the roles of the duty holders contained within the Construction (Design and Management) Regulations?

/ Yes / No / None

1. Do you have arrangements in place for the proper selection, use and maintenance of plant and equipment?

/ Yes / No / If yes, provide details of arrangements and sample maintenance record, if available

1. Do you provide all employees with free issue personal protective equipment?

/ Yes / No / If yes, provide evidence of issue of PPE such as issue register, copy invoice, del notes etc.
Enforcement Action / Information Required

1. Has your company been prosecuted for breach of health and safety legislation in the last five years?

/ Yes / No / If yes, provide details of prosecution and actions taken in response

1. Has your company been issued with any prohibition or improvement notices within the last five years?

/ Yes / No / If yes, provide details of the circumstances and of actions taken in response

1. Please enter the number of RIDDOR reportable incidents for each of the last three years:-

YEAR:
MANHOURS WORKED:
FACILITIES:
MAJOR INJURIES:
OVER THREE DAYS INJURIES:
REPORTABLE INJURIES INVOLVING MEMBERS OF PUBLIC:
DANGEROUS OCCURENCES:
Declaration (This declaration must be signed by a director or senior manager of the Company)
I confirm that the information provided in the preceding sections of this assessment and supporting evidence are true and that no relevant information has been deliberately withheld.
Signatory
(In block capitals) / Position in company / Signature

4.5_F2 SubContractor H&S QuestionnaireIssue No: 3Print Date: Sept 2016