CONTRACTOR MONITORING RECORD
FORM REF NO: CYC/HS/F8D (FEB 10)
MINOR RISK CONTRACTOR ASSESSMENT FORM (F8D)
NAME OF CONTRACTOR:
ADDRESS:
DESCRIPTION OF
ACTIVITIES CONTRACTOR
TO CARRY OUT:
DATE OF
COMMENCEMENT:
DATE OF REASSESSMENT:
(Annual)
POLICY AND PROCEDURES
YES
NO
COMMENTS/DETAILS
YES
NO
COMMENTS/DETAILS
YES
NO
COMMENTS/DETAILS
1) Do you have a written health and safety policy?
Please attach
2) Do you have access to competent advice on
health and safety, if so who
3) Do you have a policy on provision of health and
safety information, instruction and training for your
employees?
4) Do you have a procedure for the investigation and
reporting of accidents, incidents and dangerous
occurrences?
5) Do you have Employers Liability and Public
Liability Insurance (please provide details)
RISK REDUCTION MEASURES
6) Have you identified health and safety
hazards/risks? Please attach any relevant risk
assessments
7) Do you communicate information on hazards and
risks to your employees? If Yes, how?
8) Do you ensure that employees understand the
content of risk assessments and follow your safe
systems of work? If Yes, how?
9) Do you ensure that work equipment is safe and fit
for the purpose? If Yes, how?
ENFORCEMENT ACTION/CIVIL
LITIGATION
10) Has your organisation been the subject of action
from any enforcement authority in the last five
years?
If you have any questions relating to this document please contact the
Health & Safety Help Line on 01904 554131
CONTRACTOR MONITORING RECORD
FORM REF NO: CYC/HS/F8D (FEB 10)
11) Has your organisation been the subject of civil
litigation and/or claims for compensation for ill
health/injuries received at work in the last five
years?
MANAGEMENT OF SAFETY RISKS
FOR THIS CONTRACT
YES
NO
PLEASE INDICATE
12) Have you identified the main risks to health and
safety of your employees and others who may be
affected by your work for this contract? Please
attach a copy of your risk assessment if
applicable.
13) Have you identified how you intend to
control/manage the risks you have listed in
relation to 12 (above)? If Yes, how?
ANY ADDITIONAL COMMENTS/SUPPORTING MATERIAL
Completed by:
Name:
Position:
Signed:
Dated:
I hereby certify that based upon the information provided, I conclude that the contractor named
above has demonstrated that they manage health & safety in such a way that I believe they are:
(tick one box below)
Aware of their Health & Safety
Not aware of their Health & Safety
responsibilities, which they
responsibilities, and they don’t manage
manage accordingly and as
health & safety to CYC’s required standard
such I deem them Competent
and as such I deem them NOT Competent to
to carry out work safely on
carry out work on behalf of CYC, until they
behalf of CYC
have implemented the actions below
Actions
1)
2)
3)
Once completed forward a copy of this form to CYC H&S Team
If you have any questions relating to this document please contact the
Health & Safety Help Line on 01904 554131