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Service Provider Name: Service Provider Location: Date of Assessment: Name of Person Completing Form
Service Provider Name: Service Provider Location: Date of Assessment: Name of Person Completing Form
DATE OF ASSESSMENT:
Company Particulars
To ensure that ALPHA & GODMAN ENGINEERING SERVICES LTD retain its corporate and international Health, Safety, Environmental & Quality
(HSEQ) management system to maintain a safe working environment in all areas this contractor assessment process is designed to provide DOL with
an overview of contractors and to assist them in objectively assessing their HSEQ Management System and their approach to managing associated
risk.
A fundamental element of effective safety management is risk assessment. The use of this guide can assist the contractor in demonstrating to AGESL
that risks have been identified, analysed, and reduced to a level which is ‘As Low As Reasonably Practicable’ (ALARP).
All Service Provider Must complete Sections 1 & 2, All Sections must be completed.
Once completed, the assessment is to be returned to AGESL and will be reviewed by AGESL Management.
On completion of a review of the submitted assessment and any supporting documentation AGESL will consider whether a further audit of the company
management is required to meet AGESL obligations in managing Suppliers/service providers.
COMPANY PARTICULARS
Company Name:
Address:
Contact Person:
Telephone Number:
Fax Number:
Email Address:
Operating Areas(s):
Number of Employees:
Affiliations/Joint Ventures:
SCOPE OF WORK (Mandatory)
SECTION 1 –FINANCIAL CHECKS
Please enter answer here
1 Are your organisation’s bank details attached to facilitate a credit account?
7 Number of employees:
Clerical
Production
Q.A/Q.C
SECTION 3 - ENVIRONMENTAL MANAGEMENT SYSTEM
1 Is the organisation certified to ISO 14001? If yes please attach current
certificate.
3 Who has overall responsibility for Health and Safety within your
organisation? Please provide company Organisational chart.
6 Is there a formal induction policy for new recruits? If Yes provide sample
document. If No, why Not?
8 Provide details of the last 3 years incident and accident statistics which
must include details of Environmental incidents.
On-going Performance
Date Comments – continue overleaf
If the aforementioned information does not give a representative HSEQ assurance profile of your operation, then please
give a more appropriate outline on a separate sheet on your company headed paper, together with your signature,
position within the company and the date.