CONTRACTORS SAFETY, HEALTH, ENVIRONMENTAL & QUALITY
(SHEQ) ASSESSMENT FORM
No of Employees:
Company Name:
Address:
Main Contact
Telephone:
Position:
Mobile:
Tel:
Fax:
Health & Safety Management
Clarification
Yes/No/N/A
Question:
1.
Do you have a Health & Safety Policy?
 Does it make clear who is responsible for what?
 Does it have appropriate procedures for health & safety management?
 How do you tell employees about it?
NB – Please provide supporting evidence
2.
Who advises you on health & safety matters?
 What exactly do they do for you?
 How do you keep up-to-date on health & safety matters?
 Who investigates accidents and checks safety at sites?
 Are you a member of any safety group or trade association?
NB – Please provide supporting evidence
3.
Do you have a summary of accidents for the last three years?
 Give details of any prosecutions of your Company or individuals?
(in the last 3 years.)
 Give details of any Prohibition or Improvement Notices?
(in the last 3 years.)
 Give details of any safety award(s) received?
(in the last 3 years.)
4.
Give details of your experience of this type of work.
NB – Please provide supporting evidence
5.
Give details of all general health and safety training of your employees.
 Give details of any training of your employees related to specific tasks or
risks, e.g., Working at Height.
 Describe how you carry out induction training of new employees.
NB – Please provide supporting evidence
6.
How do you assess sub-contractors or self-employed tradesmen?
7.
Do you have any consultative arrangements with your employees?
8.
Give details of your insurances, such as employers’ liability, public
liability, contractors all risks & professional indemnity
 Do they fully cover the specific jobs to be done here?
PLEASE NOTE! Green Deal Solutions Ltd requires ALL site based personnel (including
sub contractors staff) to be in possession of relevant CSCS Card(s) and/or Gas Safe,
NICEIC Cards, etc.
GDS HS029 Ver 1.0 - 20/10/11
Environmental Management
Clarification
Yes/No/N/A
Question:
1.
Do you have an Environmental Policy?
 Does it make clear who is responsible for what?
 Do you have a documented Environmental Management System
(EMS)?
 Does it have appropriate procedures for environmental management?
 How do you tell employees about it?
 Is your EMS accredited by a 3rd Party (e.g., ISO 14001)?
(If yes, please provide a copy of your certification)
NB – Please provide supporting evidence
2.
Do you produce, transport, treat and/or store waste as a result of your
activities?
(If yes, please provide copies of relevant licences, e.g., Waste Carriers,
etc.)
3.
Have you received any prosecutions or other enforcement actions (for
breaches of environmental legislation) in the last 3 years?
(If yes, please provide details)
4.
Have you provided environmental awareness training for your site staff?
(If yes, please provide details)
5.
Do you have emergency procedures in place in the event of an
environmental incident occurring (e.g., leak, spillage, etc.)?
(If yes, please provide details)
Quality Management
Clarification
Yes/No/N/A
Question:
1.
Do you have a Quality Management Policy?
 Does it make clear who is responsible for what?
 Do you have a documented Quality Management System (QMS)?
 Does it have appropriate procedures for quality management?
 How do you tell employees about it?
 Is your QMS accredited by a 3rd Party (e.g., ISO 9001/2008)?
(If yes, please provide a copy of your certification)
2.
Can you provide evidence (where appropriate) of Final Inspection,
Supplier/Contractor Assessment?
(If yes, please provide details)
3.
Can you supply certification (where appropriate) for Materials,
Conformity to Specification, Calibration of inspection/test equipment?
(If yes, please provide details)
PLEASE NOTE! IN ADDITION TO THE ABOVE, AND IF SUCCESSFUL WITH YOUR
APPLICATION, YOU WILL BE REQUIRED TO PROVIDE CRB CHECKS FOR ALL SITE
BASED STAFF.
GDS HS029 Ver 1.0 - 20/10/11
FURTHER DETAILS:
Please provide any further evidence you feel relevant to support your application
including example risk assessment(s) and method statement(s) for your work activities:-
GDS HS029 Ver 1.0 - 20/10/11
PLEASE NOTE! THE COMPLETED FORM (AND APPLICATION TO CONTRACT FORM)
& SUPPORTING INFORMATION SHOULD BE RETURNED TO:Mr. Stephen Davis (Health, Safety & Quality Manager)
Green Deal Solutions Ltd
150C Holland Street
Denton
Manchester
M34 3GG
Alternatively, please email to stephen.davis@greendealsolutions.net
Should you have any questions with regards to completing the form, please contact
Stephen Davis - Tel: 0844 477 0995.
GDS HS029 Ver 1.0 - 20/10/11