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  5. TEST: General COMPANY PQQ Form

TEST: General COMPANY PQQ Form

Supplier Evaluation Questionnaire
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Exit Survey
 
 
1. YOUR COMPANY DETAILS
 
 
 
Company Name
   
 
 
 
Registered office & full address including post code:
   
 
 
 
Company Registration Number:
   
 
 
 
Date of Registration:
   
 
 
 
VAT Registration Number:
   
 
 
 
Type of organisation (e.g. plublic limited company, limted company, partenership, sole trader, other:
   
 
 
 
Contact Name for response to this questionnaire:
   
 
 
 
Email Address for main contact:
   
 
 
 
Contact Number(s) for main contact:
   
 
 
 
Please describe in detail the nature of your organisation's business and highlight its core functions:
   
 
 
 
Please state the total number of staff in your organisation:
   
 
 
 
If you are a sole trader, please give brief information regarding your experience and the number of years you have worked in your trade:
   
 
 
 
2. HEALTH AND SAFETY INFORMATION
 
 
 
Please upload a simple diagram of your Company structure chart showing responsibilities for Health & Safety:
 
 
 
Does your organisation have a documented Health and Safety Policy as required by the Health and Safety at Work Act 1974 - Section 2(3) for companies with 5 or more employees? If yes, please attach a full copy with your application.
 
Yes
 
No
 
 
2.2 If no to Q2.1, because you have less than 5 employees, please select to approve the statement below :

THIS IS MY COMPANY’S COMMITMENT TO HEALTH & SAFETY
• To provide adequate control of the health, safety and welfare risks arising from our work activities which may affect our employees or others
• To consult with our employees on matters affecting health and safety
• To provide and maintain safe plant and equipment
• To ensure safe handling and use of substances
• To provide information, instruction and supervision for employees
• To ensure all employees are competent to do their tasks, and to give them adequate training
• To prevent accidents and cases of work related ill health
• To maintain safe and healthy working conditions
• To ensure sufficient funds are available to implement this statement and
To review and revise this statement as necessary at regular intervals not exceeding 12 months.

Please select the appropriate boxes below to confirm your acceptance of this:
 
You are a director or partner in the business
 
You have authority to confirm the above
 
You agree to the above Health & Safety statement

 
 
 
2.3 Is the policy reviewed and updated where appropriate?
 
Yes
 
No
 
 
 
2.4 If YES when was the last review carried out?
   
 
 
 
2.5 Who within your organisation has responsibility (at senior management level) for health and safety?
   
 
 
 
2.6 Is your organisation registered with CHAS, Safe-Contractor or Constructionline?
 
Yes
 
No
 
 
2.7 If your organisation is registered with one of the above please provide registration number & expiry date & attach certificate as applicable:
 
 
 
2.8 Does your organisation have access to competent Health and Safety Advice in accordance with regulation 7 of the Management of Health & Safety at Work Regulations 1999? State whether in-house employee, external consultant or other (such as yourself, using HSE website or other safety advice lines (British Safety Council, etc)?
 
Yes
 
No
 
 
If YES to 2.8, please give details below of the person and their qualifications:
   
 
 
 
2.13a Have you and your employees received adequate training in health and safety?
 
Yes
 
No
 
 
2.13b Please provide details & enclose any certificates:
 
 
 
2.14 Does your organisation have a procedure for producing risk assessments, safety method statements & COSHH assessments?
 
Yes
 
No
 
 
Please upload an example of your Risk Assessment
 
 
Please upload an example of your Method Statements
 
 
Please upload a COSHH assessment if applicable
 
 
2.15 Please describe how the information above is passed on to your employees:
   
 
 
 
2.16 Does your organisation provide occupational health monitoring for its workers? If yes, please attach a recent example.
 
Yes
 
No
 
 
Please upload an example of occupational health monitoring for worker.
 
 
 
2.17 Please describe the arrangements your organisation has in place to control Manual Handling activities & provide copies of any recent risk assessments:
   
 
 
Please upload Manual Handling Risk Assessments (if available)
 
 
 
2.18 Please describe the arrangements your organisation has in place to control the risks to your employees associated with working at height & provide copies of recent risk assessments:
   
 
 
Please upload Working at Height assessments (if available)
 
 
 
2.19 If applicable, please describe the arrangements your organisation has in place to control exposure of noise to your employees & provide copies of any recent risk assessments:
 
Yes
 
No
 
 
Please upload Control Exposure of Noise assessments (if available)
 
 
 
2.20 If applicable, please describe the arrangements your organisation has in place to control exposure of vibration to your employees and provide copies of any recent risk assessments:
   
 
 
Please upload Control Exposure of Vibration assessments (if available)
 
 
 
2.21 What arrangements/training does your organisation have in place to control the risks associated with exposure to Asbestos?
   
 
 
 
2.22 Does your organisation subcontract any part of their work activities?
 
Yes
 
No
 
 
2.23 If yes to 2.22, describe how your organisation assesses the competence of their subcontractors:
   
 
 
 
2.24 Are you a member of any professional organisations? (For example, Gas Safe, NICEIC, NAPIT etc.) Please provide details and attached any relevant certificates / supporting documentation / information:
 
Yes
 
No
 
 
Upload your certificate (1)
 
 
Upload your certificate (2)
 
 
Upload your certificate (3)
 
 
2.25 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
 
 
 
2.26 Does, or will, your organisation employ anyone under the age of 18? If yes, please provide details:
   
 
 
 
2.27 What arrangements do you have in place for keeping your / your employees qualifications up to date & identifying further training needs?
   
 
 
 
2.28 How does your organisation monitor health and safety on site?
   
 
 
 
2.29 Describe how your organisation provides First Aid facilities for your employees whilst on site:
   
 
 
 
2.30 Describe your arrangements for the issue / use of Personal Protective Equipment for you/ your employees:
   
 
 
 
2.31 Describe how you ensure that the work equipment used by your organisation is maintained (PAT) & fit for purpose. Please enclose copies of recent PAT testing certificates:
   
 
 
Please upload copies of recent PAT testing certificates
 
 
 
2.32 Has your organisation (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 to 2.32 please provide full details:
   
 
 
 
2.33 Does your organisation have an accident / dangerous occurrence reporting procedure?
 
Yes
 
No
 
 
2.34 Please provide statistics of all accidents / incidents reported by your organisation to the Health and Safety Executive over the last three years.
   
 
 
 
2.35 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:
 
 
 
3.1 Does your organisation have a registered Environmental Management System?
 
Yes
 
No
 
 
If yes to 3.1, please confirm assessment body:
   
 
 
Please provide your certificate number:
   
 
 
If yes to 3.1 (Please provide a photocopy of the certificate and scope of registration).
 
 
 
3.2 Is your organisation a carrier of waste products?
 
Yes
 
No
 
 
If yes to 3.2, please provide a certified copy of your Waste Carrier Registration Certificate. In addition, provide copies of any Environmental Permits you are required hold due to your organisations activities.
 
 
 
3.3 Does your organisation have an Environmental Policy?
 
Yes
 
No
 
 
If yes, please provide a copy.
 
 
 
3.4 Does your organisation operate a Quality Management System (QMS)?
 
Yes
 
No
 
 
3.5 If the QMS is registered and certified, name the assessment body (BSI, Lloyds etc.):
   
 
 
3.6 If the QMS is certified, please provide Certificate No:
   
 
 
(Please provide a photocopy of the certificate and scope of registration).
 
 
 
4. INSURANCES:
 
 
 
4.1 Please provide brief details (including value of cover and copy certificates) of your current business insurance cover. COPY INSURANCE CERTIFICATES MUST BE ENCLOSED WITH THIS APPLICATION.
   
 
 
Upload your insurance Certificate here
 
 
• Public Liability value of cover: (Min £5,000,000)
   
 
 
• Employer Liability, value of cover: (Min £10,000,000)
   
 
 
 
5. REFERENCES:
 
 
 
5.1 Please list two previous Clients for whom you have carried out similar works, CLIENT 1:
   
 
 
Please describe the nature of services provided to the above client:
   
 
 
 
5.1 Please list two previous Clients for whom you have carried out similar works, CLIENT 2:
   
 
 
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:
 
 
To be approved by a senior member of your organisations 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