Safety Assessment Scheme Questionnaire (V19 20/02/17)

Transcription

1 Safety Assessment Scheme Questionnaire (V19 20/02/17) Assessment Required Contractor Principal Contractors Non - Construction Consultant Principal Designer Designer Group Please contact us for information and pricing Work Undertaken: Company Name: Street Address : City: County: Postcode: Phone Number: Name of primary contact within the company: Address: Number of Staff: Trade Memberships: Employees: Labour Only Subcontractors: Sub-Contract Companies: Please submit copies of relevant memberships: Contractors, Consultants and Non-Construction to complete section A Principal Contractors to complete sections A & B Designers to complete sections A & C Principal Designer to complete sections A, C & D

2 Section A - (To be completed by all) Question 1 Health and Safety Policy Statement of Intent Please submit a signed copy of the company s Statement of Intent: Statement of intent signed by: Position within the company: Date of last review Or The company have less than 5 employees and does not have a written Statement of Intent. Question 2 Health and Safety Policy Document Please submit a copy of the complete H&S Policy (Inc. Responsibilities and Arrangements). The company have less than 5 employees and does not have a written H&S Policy. Question 3 Reviews, Monitoring and Audits Please submit copies of formal H&S reviews, audits and/or site inspections etc. Please submit management actions taken in response to site inspections and/or audits etc. Or The company has less than 5 employees and works under large PCs/Clients on all occasions, procedures are regularly assessed and non-conformances/recommendations are actioned. Question 4 Contract Assessment, Monitoring and Reviewing. Does the company use labour only sub-contractors? If yes, please submit a completed copy of a questionnaire used and the procedure followed to assess and monitor labour only sub-contractors. Does the company use sub-contractor companies? If yes, please submit a completed copy of the questionnaire used and the procedure followed to assess and monitor sub-contract companies. Y / N Y / N Question 5 Construction Phase Health & Safety Plan Under the CDM Regulations 2015 if you are working as a main contractor or are the only contractor appointed on any commercial/domestic project you are legally required to produce a Construction Phase Health & Safety Plan. Please submit a recent example of a Construction Phase Health & Safety Plan. Or We do not perform either of the above stated roles.

3 Question 6 Method Statements, Risk and CoSHH Assessments Please submit two copies of site specific method statements from the previous 12 months. Please submit two copies of site specific Risk Assessment from the previous 12 months. Please submit two copies of CoSHH Assessments from the previous 12 months. Or the company does not use any hazardous substances. Question 7 Training Qualifications for Chief Executives, Directors, Proprietors and Partners Please submit copies of training certificates/ cards and complete the table below. Name Position Trade Qualifications NEBOSH CITB / IOSH Directing Safely First Aid Training SMSTS SSSTS CSCS/CPCS/CIRSRS Asbestos Training Other H&S Training

4 Question 8 Training Qualifications for Managers, Supervisors and Foremen. Please submit copies of training certificates/ cards and complete the table below. Name Position Trade Qualifications NEBOSH IOSH Managing Safely First Aid Training SMSTS SSSTS CSCS/CPCS/CIRSRS Asbestos Training Other H&S Training Question 9 Training Qualifications for Employees. Please submit copies of training matrix and/or training plans. Please submit copies of training certificates/ cards and complete the table below Name Position Trade Qualifications IOSH Working Safely First Aid Training SMSTS SSSTS Health & Safety Awareness CSCS/CPCS/CIRSRS Asbestos Training Other H&S Training

5 Question 10 Enforcement Action Has the company had any enforcement actions taken against it in the previous 5 years? If yes, please submit copies of the enforcement action taken and management responses. Question 11 Accidents / Incidents (RIDDOR) Please submit copies of accident and near miss reporting procedures. Please submit copies of accident statistics. (Statistics of all accidents must be provided). Has the company had any RIDDOR reportable accidents or incidents within the previous 3 years? If yes, please submit copies of RIDDOR reportable accidents/incidents and management responses. Question 12 Welfare Facilities Please submit copies of completed Site Welfare Checklists and/or procedures regarding site facilities. This maybe evidenced within your method statements or H&S Policy. Question 13a Consultation and Communication Is the company small (less than 5 people) & communication verbal? If no, please complete at least one of the following: Please submit copies of Method Statements with completed signature blocks. Please submit copies of Safety Meeting Minutes. Or - Please submit copies of completed Toolbox Talks. Question 13b External Communication (Co-operation & co-ordination with other organisations?) Is the company small (less than 5 people) & communication verbal? If no, please complete at least one of the following: Please submit copies of the company s communication procedures. Please submit copies of Safety Meeting Minutes. Please submit copies of safety messages/briefings. Other documents as specified have been submitted.

6 Question 14 Health and Safety Advice Person internally responsible for H&S. How does the internally responsible person keep abreast of H&S legislation/updates? What qualifications does the internally responsible person have? Please submit copies of the above mentioned qualifications. Does the company use an external consultancy company to assist with Health and Safety matters? Name of organisation. Phone Number/ Website. Address. Please submit a copy of the company s contract with the H&S Consultant, if applicable. Please submit copies of the consultant s qualifications/c.v. Question 15 Appropriate Insurances Level Insured Valid Until Employers Liability Public Liability Professional Indemnity (PI) Contractors All Risk Insurance (PC Only) Please submit copies of Insurance Certificates and Schedules.

7 Section B - (Principal Contractors Only) Question 16 Principal / Main Contractor Does the company undertake the role of Principle Contractor? If yes, please submit a completed copy of a Construction Phase H&S plan (CPHSP) used within the last 12 months. Please see the below list of topics that should be covered within your CPHSP: Description of project. Details of key members of the project team along with key dates. Health & safety aims for the project. Site rules. Arrangements to ensure cooperation between project team members & coordination of their work, e.g. regular site meetings. Arrangements for involving workers. Arrangements for monitoring & reviewing your H&S management systems Site induction. Welfare facilities. Site security Selection of competent contractors. Fire & emergency procedures. Y / N

8 Section C - (Designers Only) Question 17 Competence Please provide evidence of how the company ensures that appropriate capabilities (knowledge / experience) are in place; enabling the discharging of legal duties under health and safety legislation e.g. qualifications, training plans and C.V s etc. Question 18 Co-ordination and co-operation Please provide recent evidence detailing how the company ensures co-operation and co-ordination of design work within the design team with other designers/contractors. Question 19 Design Risk management Please provide recent evidence detailing how the company ensures hazards are eliminated and show how remaining risks are managed, (with reference to buildability, maintainability and use). Question 20 Workplace structures Please provide recent evidence detailing how the company ensures that any structure that will be used as a workplace will meet relevant requirements of the Workplace (Health, Safety and Welfare) Regulations Question 21 Design change Please provide recent evidence or alternatively a written procedure explaining how the company has or will manage design change and liaise with others.

9 Section D - (Principal Designer) Question 22 H&S Advice & assistance Please provide evidence of who provides the company with construction related H&S advice, this individual may be direct employee or an external consultant. Is this the same individual/company as Q14? Question 23 Competence & Qualifications. Please submit evidence of training and experience enabling the Principal Designers to fulfil the role. Please provide copies of training certificates/membership cards. Name Position CIAT CIBSE CIOB ICE IET RICS RIBA ICE IMechE IStructE Question 24 Co-ordination & Communication Please provide recent worked examples detailing how you coordinate designers and oversee design decisions e.g. written instructions, minutes of meetings etc. Please provide recent examples showing how you communicate with the Principal Contractor. Question 25 Notifying the Client Please provide worked examples/procedures to ensure that you make Clients are aware of their duties under the CDM Regulations Additionally please provide recent evidence demonstrating how you assist the client in the provision of the Pre-Construction information e.g. Asbestos survey, contaminated land and storage of hazardous substances etc. Question 26 Health & Safety File Please provide recent worked examples of H&S files which have been provided to Clients on the completion of projects.

10 Name of person completing application Role within the company Mobile Number Signature Date of completion