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  5. LIVE: PQQ Form - 5 or more employees

LIVE: PQQ Form - 5 or more employees

Supplier Evaluation Questionnaire
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Exit Survey
 
 
1. YOUR COMPANY DETAILS
 
 
 
Q 1.1 - Company Name
   
 
 
 
Q 1.2 - Registered office & full address including post code:
   
 
 
 
Q 1.3 - Company Registration Number:
   
 
 
 
Q 1.4 - Date of Registration:
   
 
 
 
Q 1.5 - VAT Registration Number:
   
 
 
 
Q 1.6 - Type of organisation - e.g. public limited company, limited company, partnership, sole trader, other:
   
 
 
 
Q 1.7 - Contact Name for response to this questionnaire:
   
 
 
 
Q 1.8 - Email Address for main contact:
   
 
 
 
Q 1.9 - Contact Number(s) for main contact:
   
 
 
 
Q 1.10 - Please describe in detail the nature of your company's business and highlight its core functions:
   
 
 
 
Q 1.11 - Please state the TOTAL number of employees in your company (including all staff, managers, directors etc):
   
 
 
 
2. HEALTH AND SAFETY INFORMATION
 
 
 
Q 2.1 - Please upload a simple diagram of your Company structure chart showing responsibilities for Health & Safety:
 
 
 
Q 2.2 - The Health & Safety at Work Act 1974 requires all companies with 5 or more employees to have a documented Health and Safety Policy. Please attach a full copy of your company's Health & Safety policy including arrangements section below. (Note: If your file is too large to upload, please send the attachment as a separate email to [email protected]).
 
 
Q 2.3 - Is the policy reviewed and updated where appropriate?
 
Yes
 
No
 
 
Q 2.4 - When was the last review carried out?
   
 
 
Q 2.5 - Who within your company has responsibility (at senior management level) for health and safety?
   
 
 
 
Q 2.6 - Is your company a member of the Safety Schemes in Procurement Forum through accreditation with CHAS, Safe-Contractor or Construction-line?
 
Yes
 
No
 
 
Please attach certificate / confirmation letter as applicable (1):
 
 
Please attach certificate / confirmation letter as applicable (2):
 
 
Please attach certificate / confirmation letter as applicable (3):
 
 
 
Q 2.7 - Does your company have access to competent Health and Safety Advice in accordance with regulation 7 of the Management of Health & Safety at Work Regulations 1999?
 
Yes
 
No
 
 
If yes to Q 2.7, please give details below of the person providing advice , whether they are an in-house employee or an external consultant. Please also provide details of the qualifications of this person or information about their training / experience which makes them competent to deliver this role:
   
 
 
Please upload any relevant Health & Safety certificates (1):
 
 
Please upload any relevant Health & Safety certificates (2):
 
 
 
Q 2.8 - Have you and your employees received adequate training in health and safety? Please provide example certificates/training records below:
 
Yes
 
No
 
 
Please attach example certificates/training records (1):
 
 
Please attach example certificates/training records (2):
 
 
Please attach example certificates/training records (3):
 
 
 
Q 2.9 - Does your company have a procedure for producing risk assessments, safety method statements & COSHH assessments?
 
Yes
 
No
 
 
Please upload an example of a recent Risk Assessment:
 
 
Please upload an example of a recent Method Statement:
 
 
Please upload an example of a recent COSHH assessment:
 
 
Q 2.10 - Please describe how the above important safety information is passed on to your employees to ensure that they are aware of hazards, risks and controls prior to starting work :
   
 
 
Q 2.11 - Does your organisation provide occupational health monitoring for its workers?
 
Yes
 
No
 
 
If yes, please upload an example of an occupational health monitoring record for a worker.
 
 
 
Q 2.12 - Please describe the arrangements your company has in place to control the risks to your workers arising from Manual Handling activities:
   
 
 
Please upload an example of a recent Manual Handling Risk Assessment (using the LITE procedure: Load, Individual, Task, Environment)
 
 
Q 2.13 - Please describe the arrangements your company has in place to control the risks to your workers arising from Working at Height:
   
 
 
Please upload an example of a recent Working at Height Risk Assessment:
 
 
 
Q 2.14 - If applicable to your activities, please describe the arrangements your company has in place to control the risks to your workers arising from Exposure to Noise:
   
 
 
Please upload an example of a recent 'Control of Exposure to Noise' Risk Assessment:
 
 
 
Q 2.15 - If applicable to your activities, please describe the arrangements your company has in place to control the risks to your workers arising from Exposure to Vibration:
   
 
 
Please upload a recent example of a 'Control of Exposure to Vibration' Risk Assessment.
 
 
 
Q 2.16 - What arrangements/training does your company have in place to control the risks associated with exposure to Asbestos? Note: If there is even the smallest risk for your employees to come across asbestos or suspected asbestos containing materials during the course of their work they must be given relevant instructions about what to do if they find it and adequate training to help them to identify it.
   
 
 
Please upload example Asbestos Awareness Training certificates/records (1):
 
 
Please upload example Asbestos Awareness Training certificates/records (2):
 
 
 
Q 2.17 - Will your company (now or in the future) subcontract any part of it's work activities on Astound Facilities Group projects? If yes, prior approval MUST be obtained in writing from Astound Facilities Group.
 
Yes
 
No
 
 
If yes to 2.17, please describe how your company assesses the competence of their subcontractors:
   
 
 
If you use subcontractors it is important you ensure they have the relevant insurance and the necessary competence, training and skills to undertake the work you are employing them to do. You may take up references; check training and skills certification and look at examples of previous work. You can also check if they are registered with a scheme recognised by the Safety Schemes in Procurement (SSIP) Forum (go to http://www.ssip.org.uk/ for more information about SSIP Forum). Having used a subcontractor over a long period during which they have had a good safety record may be enough. You will need to keep records of all subcontractor competence checks & safety records, together with records of insurance cover as you will be asked to produce these records to Astound Facilities Group as part of our regular audit process.
 
Please tick to indicate your acceptance of these requirements.
 
 
 
Q 2.18 - Is your company a member of any professional organisations? (For example, Gas Safe, NICEIC, NAPIT etc.) If yes, please attach example certificates below:
 
Yes
 
No
 
 
Upload your certificate (1)
 
 
Upload your certificate (2)
 
 
Upload your certificate (3)
 
Q 2.19 - Please provide details below of the training and qualifications you and/or your employees have that make you/them competent to deliver the work that your organisation will undertake for Astound Facilities Group. Please provide copies of all relevant training certificates / qualifications or registration numbers where applicable (for example Gas Safe, City & Guilds 2382, BS7671 (2008 17th Edition) CSCS Cards, Asbestos Awareness, IPAF, manual handling etc.):
Name Training/Qualifications Certificates Available?
1
2
3
4
5
6
 
 
 
Q 2.20 - Does your company (or will they in the future) employ anyone under the age of 18? Note: Under the Management of Health and Safety at Work Regulations 1999, an employer has a responsibility to ensure that young people employed by them are not exposed to risk due to: - lack of experience - being unaware of existing or potential risks and/or - lack of maturity. An employer must consider: - the layout of the workplace - the physical, biological and chemical agents they will be exposed to - how they will handle work equipment - how the work and processes are organised - the extent of health and safety training needed - risks from particular agents, processes and work.
 
Yes
 
No
 
 
If yes, please describe the arrangements your company has in place to ensure that the requirements described above are met:
   
 
 
 
Q 2.21 - What arrangements does your company have in place for keeping your workers qualifications up to date & identifying further training needs?
   
 
 
 
Q 2.22 - How does your company monitor health and safety on site?
   
 
 
 
Q 2.23 - Describe how your company provides First Aid facilities for your workers whilst on site:
   
 
 
 
Q 2.24 - Describe your arrangements for the issue / use of Personal Protective Equipment for your workers:
   
 
 
 
Q 2.25 - Describe how you ensure that the work equipment used by your company is maintained (PAT) & fit for purpose:
   
 
 
Please upload copies of recent PAT testing certificates
 
 
 
Q 2.26 - Has your company (whilst operating under the above name or previous trading names) or any directors or individuals employed by the organisation, been prosecuted for any breach of health and safety legislation or received any enforcement or prohibition notices?
 
Yes
 
No
 
 
If yes, please provide full details:
   
 
 
 
Q 2.27 - Does your organisation have an accident / dangerous occurrence reporting procedure?
 
Yes
 
No
 
 
 
Q 2.28 - Please provide statistics of all accidents / incidents reported by your organisation to the Health and Safety Executive over the last three years.
   
 
 
 
Q 2.29 - Is your organisation fully aware of its responsibilities under the CDM regulations? Describe how your organisation achieves this, if applicable. Please attach any relevant information.
   
 
 
Upload your file here:
 
 
 
3. ENVIRONMENTAL & QUALITY MANAGEMENT SYSTEMS:
 
 
 
Q 3.1 - Does your organisation have a registered Environmental Management System?
 
Yes
 
No
 
 
If yes, please confirm assessment body:
   
 
 
Please provide your certificate number:
   
 
 
Please provide a photocopy of the certificate and scope of registration:
 
 
 
Q 3.2 - Is your company a carrier of waste products? If yes, please provide below a certified copy of your Waste Carrier Registration Certificate. In addition, provide below copies of any Environmental Permits you are required hold due to your company's activities.
 
Yes
 
No
 
 
Please upload certificate / permits (1):
 
 
Please upload certificate / permits (2):
 
 
Please upload certificates / permits (3):
 
 
 
Q 3.3 - Does your company have an Environmental Policy?
 
Yes
 
No
 
 
If yes, please provide a copy of the policy.
 
 
 
Q 3.4 - Does your company operate a Quality Management System (QMS)?
 
Yes
 
No
 
 
If the QMS is registered and certified, please give the name of the assessment body (BSI, Lloyds etc.):
   
 
 
If the QMS is certified, please provide Certificate No:
   
 
 
Please provide a photocopy of the certificate and scope of registration:
 
 
 
4. INSURANCES:
 
 
 
Q 4.1 - Please provide brief details (including value of cover and copy certificates) of your current business insurance cover. COPY INSURANCE CERTIFICATES MUST BE PROVIDED WITH THIS APPLICATION.
   
 
 
Upload your insurance certificate here (1):
 
 
Upload your insurance certificate here (2):
 
 
• Public Liability value of cover: (Min £5,000,000)
   
 
 
• Employer Liability, value of cover: (Min £10,000,000)
   
 
 
 
5. REFERENCES:
 
 
 
Q 5.1 - Please provide details of a previous Client for whom you have carried out similar works:
   
 
 
Please describe the nature of services provided to the above client:
   
 
 
 
Please provide details of a second client for whom you have carried out similar works:
   
 
 
Please describe the nature of services provided to the above client:
   
 
 
Have you any objections to AFG contacting the above Clients:
 
Yes
 
No
 
 
 
6. CONSTRUCTION INDUSTRY SCHEME DETAILS (CIS):
 
 
Please complete this section if you work within the Construction Industry:
 
 
Enter the exact name under which you are registered in the CIS Scheme:
   
 
 
National Insurance No (Sole Traders):
   
 
 
National Insurance No (Partnerships):
   
 
 
Company No (registered (Companies only):
   
 
 
UTR Number:
   
 
 
If you work within the Construction Industry and you are not registered for the Construction Industry Scheme, please enter your reasons for believing you have an exemptions status:
   
 
 
 
7. CONFIRMATORY STATEMENT:
 
 
This statement must be approved by a director or senior member of your company's management team:

Please confirm that in supplying us with the foregoing information, you agree that we will be notified in writing of any changes in your company insurances; structure and / or method of operation that may affect the delivery of the service(s) you have identified in this Supplier Evaluation Questionnaire.

In addition, please confirm the staff you provide (or are likely to provide) to carry out any future works on our behalf, are suitably vetted, and are competent to carry out their designated task(s). They should also be familiar with the types of equipment on the site, possess the technical knowledge necessary and have sufficient experience to avoid danger that may be presented by the works being undertaken. Upon request, AFG will require documentary evidence of your employee’s competency, or confirmation of your employees vetting as a pre-requisite for appointment as an approved sub-contractor / supplier.
Tick to Confirm
Please tick to confirm the above statement
 
 
Name
   
 
 
Title
   
 
 
Date
   
 
 
 
Upload any further documentation to support your application (1):
 
 
Upload any further documentation to support your application (2):
 
 
Upload any further documentation to support your application (3):
 
 
 
Upload any further documentation to support your application (4):
 
 
 
Upload any further documentation to support your application (5):
 
 
 
Upload any further documentation to support your application (6):