G General Pre-Selection Checklist for Contractors 1. Contractor Details Company / Business name: ABN (Australian Business Number): Street Address: Postal Address: Contact Person: Phone: Mobile Phone: e-mail: Fax: Brief description of contract: Period of contract: Time - from: to: 2. Fields of Expertise Examples of previous relevant experience: 3. Licence Requirements Building Work Contractor Electrical Contractor Electrical Worker Plumbing Contractor Plumbing Worker Gas Fitting Contractor Gas Fitting Worker ❒ ❒ ❒ ❒ ❒ ❒ ❒ Crane & Hoist Operator Forklift Truck Operation Load Shifting Cert. of Competence Appropriate Drivers Licence Scaffolding (Appropriate Class) Dogging ❒ ❒ ❒ ❒ ❒ ❒ Rigging Pressure Equipment Operation Asbestos Removal Work Blasters licence Explosives transport & storage EPA License ❒ ❒ ❒ ❒ ❒ ❒ 4. Insurance Requirements Workers Compensation and/or Personal Accident Insurance ❒ WorkCover Reg. No or Policy No: ❒ ❒ ❒ Public and/or Product Liability Insurance Professional Indemnity Insurance Vehicle, plant & equipment insurance Policy No : Policy No : Policy No : 5. Contractor OHS Management Select as appropriate to the task and the proposed contractor. OHS Policy Procedures for Hazard Identification, Assessment & Control Emergency Procedures ❒ ❒ ❒ ❒ ❒ ❒ Duties and Responsibilities defined Safety & Induction Training Task specific safe work procedures See over for direction to the task and contractor specific checklist for this contract Certification we, the undersigned, certify that all items indicated above have been checked and are correct. Quarry Manager Name: Signature Contractor Name: Signature Date Date P.T.O. SA Mining and Quarrying Occupational Health and Safety Committee Contractor Safety Checklists 7
