ESH T*AT*AGEMENT
Tender ESH Management System Questionnalre Engio€ring Depstn 8r - SiRe frqrby Plcnt*irn sdn- BhC.
This questionnaire {orms part of the tender evaluation process. The questionnaire is lo be completed by the contractor tendering and
submrtted wiih their tender ofier. The objecti'+e of the question-,raire is to provide an *verview of i!:e status of the contract*t's ESH
management syslern. Contractors will be required to verify their ;esponses nsted in their questionnaire by providing e-vidence of their
ability and capacity in relevant matters.
Please note that all questions may not be relevant to the ccntract. The Contract Manager should highlight guestians that are
mandatory.
Please be advised that if your tender is successful you may be required to provide:
eA risk assessmentforthe project
rA site safeg plan
eJob Safety Assessments or Safe Work ivlethod Statements for individual activities thai have a high hazard level.
Certification: The information provided in tlris questionnaire is an accurate sumrnary of the cornpany's Envircnmeniai &
0ccupati0nal safety and health
Company Name:
Signeil. Namer
Posrtion: UdtU,
Contract Details: ?eti,6'(U[ COIV C@? eQ UL. LNntrL /rfflZ rtz-
Contract FJame. 0 Contract Number: €P/4 t tt / fon/*L.L- I sJl7'rr'{{
CoflLql-kfiNo oF P€ tp?uPtz cuvJ &w or relevant to the this contract
uuesitonnalre Yes tio illA
1 ESH Policy and Management
1.1
ls there a written company health and safety policy?
,: ras tr;;- : .dc a .'r1 cI t::!it,
,'
t/
ls there a company 0HS Managemeni System manuai or pian?
1.2
lf yes provitle a capy of contents pagefs).
12 Are health and safety responsibilities clearly identified for all levels of staff?
a sanpleis).
0ther Cornmentsl
2 Safe lt\lork Practices and Procedures
Has the company prepared Safe Work Method Statements, Safe Operating Procedures or specific
2.1 safety instructions relevant to the contract?
tf a sumnary listing of procedures or instruc{ions.
V
if iiie worx iequires use cf Ferrilils and isclalilir Picceijuies,
2.2 is the company famiiiar with Perrnits and isolairon Procecures?
lf yes, provide evtdence such as training, aperating instructlons etc.
A1e there liocedures f6i maintaining. inspeeting and ass=ssing ihe hazards of Dlant operaieciiovitted
t.3
iy ine compan,v?
tf Yes. provide details and samples (evidence of completed maintenance logs. pre-starl daily safety
t/
assessmenls, safe working nethod
Are there prccedures for storing and handling hazardous substances?
L.4
lf Yes, provide details
V
Are lhere procedures lor identifying, assessing and controlling risks associated with manual handling?
lf Yes. piovide delails
/
1
Tender ESH Management System Questionnaire
Questionnaire Yes No N/A
Othef Comiiients:
Describe how e;',rpioyees are inducted in your company. (CiDB Green Card Training orequivalent)
3.1
Provide copy of induction program
V
Describe hcw health and safety training is conducled in your company
Frovide copy af training pragram relevant lo the contract work.
ls a record maintained of all training and induction programs undertaken for employees in your
3.3 company?
liYes, pravide exarcples af safety training recads
/
Do your empioyees hold all applicable licences I cefiificales and are appropriateiy experienced for this
3.4 work?
:f l.s pieait :la:,:l-tl 3e:,ii:'n 7
Other Comments:
4 Health and Safety Workplace lnspections
Are there regular heaith and safety inspections at worksites undedaken?
4.1
lf Yes, pravide details of thek frequency
A |,} Are the health and safely inspections at worksites docurnented?
/f Yes, prci,ide exanDles of forms and conpleted inspecfion reoods \/
i,s lhei-e a pnceduie h;; rvhicn hazaras are iepofiec by empicyees and foilcwed up?
4.3
lf Yes, provide copy of procedure or similar evidence V
Other CcJmments:
{ ESH Perfrrmanc* Monitcrlng
Has the company ever been convicied of any occupational health and safety or environmental
5.'1 offences in the last five years, 0r have any proceedings undenuay or pending?
lf Yes, 1:rc''ride ie ia;is
1/
Has the company had any government safety or environrrental inspec{or nolices issued in last 12
5.2 months? e.g. prohibition or improvement notices? /
lf Yes. provlde defail-q
b Certificates / Licences / lndustry Training: Please provide copies or samples
LicencelCeriificate: Licensee: Licence l.lo Expiry Date: i"lctes
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