Supplier Competency Approval Form

Note: To assess ability to carry out works, competence and resources of potential contractors or suppliers, this form must be fully completed, together with the appropriate training evidence, certificates etc (in paper or electronic format).

Please attach continuation sheets if necessary. Please note, no contract will be awarded without this document being returned and vetted by our Procurement department.

1
Company Name:
Address:
Telephone No:
Fax No:
Email address:
VAT No:
Company Reg No:
UTR:
Signature:
Date:
Print name and initials:
Position:
2
Please indicate the type of work you carry out and products or services you provide (attach additional documentation if required):
3
Accreditations (tick if applicable)
3.1
If you have this accreditation, please state the following:
Certificate number:
Certificate expiry date:
Certification body:
3.2
If you have this accreditation, please state the following:
Certificate number:
Certificate expiry date:
Certification body:
3.3
If you have this accreditation, please state the following:
Certificate number:
Certificate expiry date:
Certification body:
3.4
If you have this accreditation, please state the following:
Certificate expiry date:
3.5
Any other certification (please give additional information below)
3.6
Are you a member of any professional organisations?
If so, please give additional information below:
3.7
Do you carry waste?
If yes, and you are an Environment Agency waste carrier, please provide your details:
Registration number:
Expiry date:
4.0
Please give the name and job title of the person with overall responsibility for health and safety.
Name:
Job Title/Position:
Please give details of the H&S training the above person has attended and enclose relevant certificates:
4.1
Do you employ more than 4 people?
If yes, please attach a signed copy of your policy on health and safety at work
Attached:
5.0
Please give the name and job title of the person with overall responsibility for Quality.
Name:
Job Title/Position:
Please attach a signed copy of your policy on Quality if available.
Attached:
6.0
Please give the name and job title of the person with overall responsibility for Environmental issues.
Name:
Job Title/Position:
Please attach a signed copy of your Environmental policy if available.
Attached:
7.0
If you do not have environmental and / or quality controls in place, do you agree to abide by Pexhurst's policies (these can be viewed on our website www.pexhurst.co.uk)
Please select:
8.0
Please give details of any action taken against your company by any Health and Safety or Environmental Enforcing Authority within the last three years:
9.0
Are you an equal opportunities employer?
Please select:
10.0
Monitoring, auditing and reviewing
Please describe your arrangements for monitoring your procedures on site, for auditing at periodic intervals and for reviewing them on an on-going basis. Where systems include formal written reports, please attach a copy of a completed document.
11.0
Workforce involvement
Please describe how employees are consulted with on health and safety matters. Supporting documents from formal health and safety committee meetings, informal briefings, safety tours, safety representatives etc should be included.
12.0
What efforts are you making to increase sustainability within the Construction Industry?
13.0
Please attach copies of your insurance certificates with policy number, expiry date and amount insured, for:
Attach documents:
Employers liability:
Public liability:
Professional indemnity:
Confirm attachment:
Employers liability:
Public liability:
Professional indemnity:
14.0
What are the maximum and minimum contract values which you have been involved with?
15.0
Turnover – last 3 years:
Year 1:
Year 2:
Year 3:
16.0
Please give details of anyone who provides you with competent assistance on health and safety.
Name(s):
Company/Consultant(s):
Contact Details:
17.0
How do you assess the health and safety competence of any staff and sub-contractors you appoint?
18.0
Risk Assessment leading to a safe method of work
You should have procedures in place for carrying out risk assessments and for developing and implementing safe systems of work / method statements. Evidence showing how the company will identify significant health and safety risks and how they will be controlled. Sample risk assessments / safe systems of work / method statements should be provided including supporting information such as COSHH, work at height, manual handling, vibration, dust control. If you employ less than five persons and do not have written arrangements, you should be able to describe how you achieve the above.
19.0
Accident investigations and records – please complete:
 
This year
Last year
Year Before
Employees
Contractors
Employees
Contractors
Employees
Contractors
Average No. Employed
Over 3 day Injuries
Major Injuries
Fatalities
Dangerous Occurrences
Please attach a copy of your accident investigation form. If you have indicated accidents during the past 3 years, you should include copies of 2 No. completed accident investigation forms, including details of any action taken to prevent re-occurrence.
If not clearly described in your policy, please describe the procedure for investigating and reporting accidents, dangerous occurrences and occupational illness.
20.0
Please provide two references relating to similar projects and written/signed consent that they maybe contacted for a competency reference.
Name:
Company:
Address:
Tel:
Name:
Company:
Address:
Tel:
Attach additional files:
Additional File 1:
Additional File 2:
Additional File 3:
Additional File 4:
Additional File 5:
Additional File 6:
Additional File 7:
Additional File 8:
21.0
I hereby confirm that all of the above information is correct, and that I have read the enclosed Pexhurst Environmental and Quality policies.
Signed by:
Print name:
Dated:

FOR OFFICE USE ONLY:

22.0
All of the above information has been checked and entered on the Pexhurst data systems
Name:
Dated:
Additional comments:

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