Supplier Competency Approval Form

Address:

Please indicate the type of work you carry out and products or services you provide (attach additional documentation if required):

Accreditations (tick if applicable)

Any other certification (please give additional information below)

Are you a member of any professional organisations?

Do you carry waste?

Please give the name and job title of the person with overall responsibility for health and safety.

Please give details of the H&S training the above person has attended and enclose relevant certificates:

Do you employ more than 4 people?

If yes, please attach a signed copy of your policy on health and safety at work

Attached: YesNo

Please give the name and job title of the person with overall responsibility for Quality.

Please attach a signed copy of your policy on Quality if available.

Attached: YesNo

Please give the name and job title of the person with overall responsibility for Environmental issues.

Please attach a signed copy of your Environmental policy if available.

Attached: YesNo

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: YesNo

Please give details of any action taken against your company by any Health and Safety or Environmental Enforcing Authority within the last three years:

Are you an equal opportunities employer?

Please select: YesNo

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.

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.

What efforts are you making to increase sustainability within the Construction Industry?

Please attach copies of your insurance certificates with policy number, expiry date and amount insured, for:

What are the maximum and minimum contract values which you have been involved with?

Turnover – last 3 years:

Please give details of anyone who provides you with competent assistance on health and safety.

How do you assess the health and safety competence of any staff and sub-contractors you appoint?

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.

Accident investigations and records – please complete:

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.

Please provide two references relating to similar projects and written/signed consent that they maybe contacted for a competency reference.

Attach additional files:

I hereby confirm that all of the above information is correct, and that I have read the enclosed Pexhurst Environmental and Quality policies.