HEALTH & SAFETY ASSESSMENT SCHEME CONTRACTOR & PRINCIPAL CONTRACTOR APPRAISAL QUESTIONNAIRE

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HEALTH & SAFETY ASSESSMENT SCHEME CONTRACTOR & PRINCIPAL CONTRACTOR APPRAISAL QUESTIONNAIRE The purpose of the health and safety questionnaire is to provide Clients with assurances that all companies on their list of suppliers have: 1. The competence and commitment to manage safety 2. The appropriate safety management systems in place 3. Demonstrated the effective implementation of their health and safety management systems 4. The necessary competence to carry out the required work 5. The ability and willingness to allocate adequate resources to the project. You will need to: 1. Ensure the person completing the application understands the Health and Safety Management Process 2. Complete all of the questionnaire, if there is any element you consider not applicable you must state this and explain why 3. Provide all supporting information for the assessment to be carried out including worked examples and practical evidence 4. Ensure payment is made prior to the assessment Please Note: 1. The standards required are deemed as a minimum standard to be achieved by all companies 2. Should help be required for the completion of the form, HSAS will provide clarification but will not provide advice 3. Companies with fewer than 5 employees (or labour only sub-contractors) are not legally required to provide written documentation but for the purposes of this review they must provide their company details, training details and proof of how information is passed to employees and others on site including how risks are assessed 4. Principal Contractors must answer the questions in blue and the additional questions in Orange 5. Designers must answer the questions in blue and the additional questions highlighted in RED 6. Principal Designers must answer the questions in blue and the additional questions highlighted in RED (for Designers) and also in Green 1

Company Name Address: Telephone No. Facsimile No.: Contact Position E-Mail Address Number of Employees: Directly Employed: Self Employed (Labour Only): Number of Sub Contractors: Name and Email address of your Health & Safety Advisor Number of Directors Number of Supervisors Number of Plant operatives Number of Managers Number of Administration staff Number of Trades Describe the work carried out by your company: State the name of your client Does this involve Temporary Work: (Please the appropriate box) and give a brief description of the Temporary Work element: Yes No Temporary Works include: Earthworks - trenches, excavations, temporary slopes and stockpiles. Structures - formwork, falsework, propping, façade retention, needling, shoring, edge protection, scaffolding, temporary bridges, site hoarding and signage, site fencing, cofferdams. Equipment/plant foundations - tower crane bases, supports, anchors and ties for construction hoists and mast climbing work platforms (MCWPs), groundworks to provide suitable locations for plant erection, e.g. mobile cranes and piling rigs. 2

Name of Temporary Works Coordinator(s) Name of Temporary Works Supervisor(s) Does Your Company Have a Current SSiP Certificate Yes No State which SSiP scheme If you do have a current certificate there is no need to proceed with the rest of this form just complete this front page and enclose a copy of your certificate Certificate Assessment Category Tick ( ) category to be assessed Contractor Principal Contractor Designer Principal Designer 3

Stage 1 Assessment Health and safety policy and organisation for health and safety Arrangements You are expected to have and implement an appropriate policy, regularly reviewed, and signed off by the Managing Director or equivalent The policy must be relevant to the nature and scale of your work and set out the responsibilities for health and safety management at all levels within the organisation. These should set out the arrangements for health and safety management within the organisation and should be relevant to the nature and scale of your work. They should set out how the company will discharge their duties under CDM2015. There should be a clear indication of how these arrangements are communicated to the workforce. (please tick). (please tick). Indicate in the boxes below where the information relating to the topic can be found Topic Policy Manual/Written Instructions/Risk Assessments Work at height Asbestos Health Surveillance Noise Vibration Hazardous Substances PPE Temporary Works Fire Confined Spaces Manual Handling Work Equipment Display Screen Equipment Training Certs/Inspections/ Documentation Not Applicable Environment Competent advice corporate and constructionrelated Your organisation, and your employees, must have ready access to competent health and safety advice. The advisor must be able to provide general health and safety advice, and also (from the same source or elsewhere) advice relating to construction health and safety issues.. 4

Training and information You should have in place, and implement, training arrangements to ensure your employees have the skills and understanding necessary to discharge their duties as contractors or Principal Contractors. You should have in place a programme for refresher training, for example a Continuing Professional Development (CPD) programme or life-long learning which will keep your employees updated on new developments and changes to legislation or good health and safety practice. This applies throughout the organisation - from Board or equivalent, to trainees.. Individual qualifications and experience Employees are expected to have the appropriate qualifications and experience for the assigned tasks, unless they are under controlled and competent supervision Monitoring, audit and review You should have a system for monitoring your procedures, for auditing them at periodic intervals, and for reviewing them on an ongoing basis Workforce involvement You should have, and implement, an established means of consulting with your workforce on health and safety matters Accident reporting and enforcement action; followup investigation You should have records of all RIDDOR (the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013) reportable events for at least the last three years. You should also have in place a system for reviewing all incidents, and recording the action taken as a result. You should record any enforcement action taken against your company over the last five years, and the action which you have taken to remedy matters subject to enforcement action. N.B. The threshold of accident reporting was extended in 2013 from over 3 day accidents to over 7 days Sub-contracting/consulting procedures (if applicable) You should have arrangements in place for appointing competent sub-contractors/consultants. You should be able to demonstrate how you ensure that sub-contractors will also have arrangements for appointing competent sub-contractors or consultants. You should have arrangements for monitoring subcontractor performance. 5

Risk assessment leading to a safe method of work (contractors only) You should have procedures in place for carrying out risk assessments and for developing and implementing safe systems of work/method statements Method Statements You should have method statements in place that contain detailed description of how the task is conducted and information regarding hazards associated with the task. Safe systems of work which describes the supervision, training and emergency procedures in place to confirm the task will be conducted in a controlled and safe way by qualified persons. Co-operating with others and co-ordinating your work with that of other contractors (contractors) You should be able to illustrate how co-operation and co-ordination of your work is achieved in practice, and how you involve the workforce in drawing up method statements/safe systems of work. Welfare provision (contractors) You should be able to demonstrate how you will ensure that appropriate welfare facilities will be in place before people start work on site PRINCIPAL CONTRACTORS (Answer all previous sections in blue plus the following questions specific to Principal Contractors) Construction Phase Plan (Principal Contractor) Evidence the PC plans, manages and monitors the construction phase and coordinates matters relating to health and safety Projects that have more than one contractor are required to develop a construction phase health and safety plan. The plan must demonstrate that you manage health and safety, identify and control risks, communicate and pass information to others and provide welfare facilities and have emergency procedures in place. Minutes of meetings, evidence of health and safety performance monitoring Design, technical and organisational aspects are being decided in order to plan the various items or stages of work which are to take place simultaneously or in succession Designs relating to health and safety eg temporary works designs, risk registers, design risk assessments and programs of work 6

Organise cooperation between contractors (including successive contractors on the same construction site): Inductions, tool box talks, minutes of meetings, written instructions, The necessary steps are taken to prevent access by unauthorised persons to the construction site; General Arrangement drawings detailing fencing and other security arrangements The principal contractor must liaise with the principal designer for the duration of the principal designer s appointment Pre-construction information, minutes of meetings and other evidence of liaison DESIGNERS (Answer previous questions in blue plus the following questions specific to Designers) Project Set Up Provide evidence on how you make sure the client is aware of their duties Maintaining Professional Standards (Deisigners) Records of CPD program or training and development plans (which may include in-house training) Please provide evidence of how your organization obtains H & S information, including how you Maintain your technical knowledge and understanding of developments in construction. Provide commentary on how you match individual capabilities with the work undertaken Compliance with the CDM Regulations Please provide examples for each showing how risk was reduced through design. NOTE Emphasis should be on practical measures that reduce particular risks arising from the design, not on lengthy procedural documentation highlighting generic risks. Provide evidence that shows co-operation and co-ordination of design work within the design team and with other designers/contractors; 7

Provide evidence that shows hazards are eliminated and show how remaining risks are managed, (with reference to buildability, maintainability and use); Provide evidence that shows that any structure that will be used as a workplace will meet relevant requirements of the Workplace (Health, Safety and Welfare) Regulations 1992; Provide evidence that shows how your organization manages design changes Check, review and where necessary improve your organisations H & S performance? Provide evidence that your organization has in place and implements, an ongoing system for monitoring H&S procedures and for periodically reviewing and updating that system as necessary for example through project design review (during and postcompletion). PRINCIPAL DESIGNERS (Answer previous questions in blue and red plus the following questions specific to Principal Designers) Assist with compiling the pre-construction information: Provide evidence on how you assist the client in identifying, obtaining and collating pre-construction information Co-ordinate the preconstruction phase: Provide evidence on how you co-ordinate designers Provide evidence on how you oversee design decisions Provide evidence on how you communicate with the client Liaise during the construction phase Provide evidence of how you prepare the preconstruction information 8

Provide evidence on how you communicate with the principal contractor Prepare the health and safety file: Provide evidence on how you prepare and handover the health and safety file Qualifications and experience Provide evidence of experience in managing construction project safety Provide evidence of qualifications in construction health and safety Stage 2 Assessment Work experience You should give details of relevant experience in the field of work for which you are applying Where there are significant short falls in previous experience or there are risks associated with the project you have not managed before an explanation is needed of how these shortcomings will be overcome 9

Enclosures: Company Health & Safety Policy Statement, Organisation and Arrangements) Yes No Company Safety Manual Yes No Risk Assessments Yes No Fire Risk Assessment Yes No Manual Handling Assessment Yes No Method Statements Yes No Noise Assessments Yes No COSHH Assessments Yes No Training Records Yes No Employers Liability Insurance Yes No Professional Indemnity Insurance Yes No Details of any enforcement notices or prosecutions served on your company within the last 3 years and actions taken (if applicable) Yes No Statutory Inspection registers Yes No Evidence of Testing and Examination of equipment Yes No Details of the competent Health and Safety Advisor Yes No Evidence of consultation with employees Yes No Accident reports Yes No Sub-Contractor assessment procedure Yes No Other documents you feel will enable an accurate assessment of the company health and safety management procedures to be made: 10

Additional Information Principal Contractor Details of your arrangements for consulting with overseas workers (those with limited knowledge of the English language) and practical evidence illustrating this Yes No Evidence of how you ensure good co-operation and co-ordination of your work activities Yes No Details of your arrangements for welfare provision and practical evidence illustrating this Yes No Details of your arrangements which ensure you plan, manage and monitor work during the construction phase of a project. Yes No Example of a recent construction phase plan prepared by your business Yes No Temporary Works Designs, risk registers, design risk assessments Program of works Yes No Inductions, tool box talks, minutes of meetings, written instructions Yes No Security Arrangements Yes No Evidence of Liaison with the Principal Designer Yes No Additional Information Designer Provide evidence on how you make sure the client is aware of their duties Yes No Evidence of CPD Yes No Details of your arrangements for obtaining health and safety information Yes No Details of how risk was reduced through design Yes No Example of cooperation and coordination with designers Yes No Evidence showing elimination of hazards and how remaining risks are managed Yes No Evidence showing compliance with the Workplace Regulations 1992 Yes No Provide evidence on how you manage design changes Yes No Evidence of review and updating H&S procedures Yes No 11

Additional Information Principal Designer Provide evidence on how you assist the client in identifying, obtaining and collating pre-construction information Yes No Provide evidence on how you coordinate Designers Yes No Provide evidence on how you oversee design decisions Yes No Provide evidence on how you communicate with the Client Yes No Provide evidence on how you prepare Pre-Construction Information Yes No Provide evidence on how you communicate with the PC Yes No Provide evidence on how you prepare and hand over the Health and Safety File Yes No Provide evidence of experience in managing project health and safety Yes No Evidence of Construction health and safety qualifications Yes No Signed: Name: (please print) Position: Date: 12