ࡱ> 3 %bjbj&& 7DhDh!D D 8"|AJJ"lllJ1~141}AAAAAAA$C^FA2 />J122AllA4848482Fll}A482}A4848:<to=l^2~= iAA0A=R&G38&Go=o=&&G=224822222AA6 222A2222&G222222222D X : We are required under the Health at Work Act 1974 Construction (Design & Management) Regulations 2015 to check the knowledge, ability and resources of the Principal Contractors, to this end the following questionnaire has been prepared. Company Details:1Name: Registered Office: Company No: Post Code: VAT No: 2Telephone Number (s) Mobile Number (s)3 E-mail address 4Who to contact, title (s) and direct line number (s) in the event of any query regarding completed questionnaire information. NameTitleTelephone Numbers   5 Give details of the number of people you employ. (include trades and if self employed) Contractor Insurance and Construction Industry Tax Scheme6Do you have the following insurance cover? (If YES, please enclose a copy of your valid Insurance Certificate(s))  Employers Liability Insurance Yes No  Public Liability Insurance (please attach copy) Yes No  Professional Indemnity Insurance - design duties Yes No N/A 7Is your company a Supply & Fit / Fit only? What is your companys tax status? Is your Company CHAS Accredited or holds an accreditation affiliated to any SSIP Member? If yes, please go to Q. 178 Is your company affiliated to a trade association? If Yes, please enclose a copy of your certificate. Health and Safety Responsibilities:9Do you have a written Health and Safety Policy as required by section 2 of the Health & Safety at Work Act, 1974? If Yes, please enclose a copy of your current, signed Policy Statement. 10Who in your company is responsible for providing advice about health and safety matters? 11 Do you use the services of Health and Safety consultants? (If Yes, please enclose details of the company, services provided by them and their CV and professional certificates.) 12Has your Company been prosecuted, or served with improvement or prohibition notices by the Health and Safety Executive, or other enforcing authorities, e.g. fire or local authorities, within the last 3 years? If Yes, please enclose full details including dates. 13 Is your Company a member of a safety group or organisation? If Yes, please enclose a copy of your certificate(s) Safe System Of Work:14State how you ensure your site personnel are aware of (direct and sub-contract employed) the health and safety requirements for your work, including Risk assessments, COSHH Assessments, Method Statements etc Please enclose a copy of a recent Method Statement, Risk Assessments & COSHH Assessments. 15How do you ensure that your employees comply with your Safe Systems of Work? Accident & Incident Reporting (R.I.D.D.O.R):16 Please provide details of accidents or incidents during the last 3 years which have been reported as required by RIDDOR (The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013) Last Year Previous Year Year before that Notifiable/Reportable Accidents a) No of Employees b) Equal Opportunities - Policies and Procedures17 Do you have a written Equal Opportunities Policy If yes, please enclose a copy of your current Policy. If yes, please explain below how this policy is disseminated to all your employees. Training:18 Do you provide Health and Safety training within your company ? If Yes, please enclose your training matrix/records applicable to your Operatives; Supervisors and Management. CSCS Cards:19Do any of your Operatives, Supervisors and Management hold current CSCS Health and safety cards or equivalent health and safety training? If so please enclose a copy of all cards and list names and card numbers below: (Operatives are required to present their cards on site)Sub-Contractors:20Does your company employ Sub-Contractors? If Yes, how do you assess the competence of your sub-contractors? D.B.S. Checking:21.Have all of your Operatives had a Disclosure and Barring Service (DBS) check carried out during the last three years? Quality Assurance:22 Is your company registered for Quality Assurance e.g. ISO 9001? (If Yes, please enclose copy of certification.) 23Is there a person responsible for coordination of your Quality Assurance? Environmental Policy & Procedures:24Do you have a written Environmental Policy and/or Procedures If yes, please enclose a copy of your current Policy. If yes, please explain how this policy and/or procedures are disseminated to all your employees. Person In Charge:25The Principal Contractor will be required to be represented on site at all times by a competent Person-in Charge. This Employee of the Principal Contractor shall act as primary site contact for the Client and Design Team. Please provide the name(s) and relevant experience of the proposed site operative(s) that would be place in charge of the Construction Works. Community Benefit: 26NOT REQUIRED AS A CONTYRCAT CONDITION BUT CAN BE OFFERED State below how you would approach/satisfy a requirement for Community Benefit in connection with the development. Projects Of A Similar Nature:27Have you undertaken projects similar in nature to this development? (if Yes) Please provide details of three projects and advise which, if any, could be visited by the client to inspect the workmanship and quality of finish. Financial Standing:28Please provide the accounts for the past three years. If the accounts have not been finalised for this year then please provide a balance sheet.  Any further information you wish to submit to support your Principal Contractor Competency Questionnaire:  Documents Enclosed : (Tick as Enclosed) 6. 9. 11. 11. 14. 17. 18. 19. 22. 24. 28. Insurance(s) Health & Safety Policy Statement  CHAS, SMAS or other SSIP certificate  Consultants CV & Professional Qualifications  Recent RAMS for past project  Equal Opportunities Policy Training Matrix / Records Copy of all CSCS Cards Quality Assurance Certificate Environmental Policy Company Accounts Please ensure all requested documentary evidence is enclosed with your questionnaire or your questionnaire will be returned Approved: Yes Signed: No Date:  Many thanks for completing this Questionnaire.     Buckle Chamberlain Partnership Ltd. 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