1.       

Company name, address, telephone and fax numbers:

1a.

No. of employees in the company:

2.

Please attach a copy of the company’s:

Attached Y/N?

(if no please state reason)

¨       Health & Safety Policy

Y/N

¨       Public liability/ third party insurance policy

Y/N

¨       Employers liability policy document

Y/N

¨       Risk Assessment

Y/N

¨       COSHH Assessment

Y/N

¨       Method Statement

Y/N

2a.

If you are a scaffolding company below is an agreement and procedure to be followed before and after erecting any scaffold for use by any NHH employees

Scaffold agreement procedure;

¨      All erectors to have (as a minimum) a basic current and valid Construction Industry Scaffolders Record Scheme card, and to carry their card with them while carrying out work for NHDC.

¨      All erectors to wear the appropriate personnel protective equipment whilst at work for NHH

¨      Do not park where you will cause an obstruction

¨      If there are any Health and Safety problems on site contact your NHH supervisor for the works.

¨      Ensure the site / work area is clean and tidy when work has been completed, all fittings and tubes to be removed from site.

¨      Do not block any entrances or emergency  (e. g. bedroom windows) access routes to and from any properties when erecting scaffolding.

¨      The scaffold company to supply a hand over certificate when the scaffold has been completed.

¨      The scaffolder to inform the Health & Safety Advioser (mobile: 07798 630 511) before the work is completed to inform him of a requirement for inspection.

¨      The Health and Safety Adviser to inspect the scaffold and to record the results.

¨      The Health and Safety Adviser to communicate those results to the appropriate NHH employee in control of the works

¨      The NHH employee in control of the works to ensure that any matters which give rise to any health and safety risks recorded  on the scaffold inspection form are to be rectified before any NHH employees work from the scaffold

¨      All work to be carried out and to comply with B.S.5973 / E. N. 12811 and to SG4: 00

3.

Has your company worked for North Hertfordshire Homes before? Please list the type of work and duration.

4.

Give the name of the competent person appointed to be responsible in the company for Health and Safety matters in accordance with the Management of Health and Safety at Work Regulations.

Name:

Job Title:

4a.

Provide details of the experience and qualifications of the person named at 4.

5a.

What percentage of their time is spent on Health and Safety in your company?         

5b.

Please provide details of how often and by whom regular safety inspections will be carried out for any work you undertake.  Are the findings of the safety inspections recorded?

6.

Name of contact for day to day communication on health and safety.

Name:

Job Title:

Contact Number:

7.

How is your Health and Safety Policy communicated to your employees?

8.

How will you ensure that your employees are complying with your safety requirements?

9.

Please advise of any professional safety advice or safety consultant that you employ.

Name:

Address:

Contact Name:

Tel:

10.

Please give details of any formal health and safety training received by your management.

Name(s).                     Type of Training                             Training Provider.

11.

Please give details of any training received by your operatives.

Name(s).                     Type of Training                             Training Provider.

12.

Please describe your procedures for dealing with unsafe working acts by your employees.

13.

Has your company or any of your employees been prosecuted under any health and safety legislation? Have any improvement or prohibition notices issued by the HSE   (if yes, provide details).

13a.

Provide details of any accidents/incidents reported by, or on behalf of, your organisation to the Health and Safety Executive during the last 3 years (as required by the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (SI 1995/3163).

13b.

Provide an example of a health and safety plan, which you have previously prepared at the tender stage.  If you do not have one available, outline the methods you would adopt to format a reply to the pre-tender health and safety plan prepared by the planning supervisor.

(any queries on this call 07798630511)

14

Do you intend to employ any sub-contractors for work that you may carry out for NHH? If yes, provide details of the procedures you will use to ensure they are competent and managed correctly.

14a.

If you do, then a copy of this form must be given to and filled in by the company or person/s you employ and returned to your initial contact at NHH before any work is carried out by them.

14b.