Visionstream Australia Pty Ltd
REQUEST FOR EXPRESSIONS
OF INTEREST DOCUMENT
FOR
NBN
PROJECTS
Page 1 of 34
EXPRESSION OF INTEREST NO: NBN
Title: Telecommunications Infrastructure
Installation and Maintenance
for the
NBN Project
Page 2 of 34
TABLE OF CONTENTS
1
2
3
4
LETTER OF INVITATION TO SUBMIT EXPRESSIONS OF INTEREST
INSTRUCTIONS TO COMPANIES
APPLICATION FOR REGISTRATION AS A PRE QUALIFIED COMPANY
PRE QUALIFICATION QUESTIONNAIRE
4
7
10
12
Page 3 of 34
1 LETTER OF INVITATION TO
SUBMIT EXPRESSIONS OF
INTEREST
Page 4 of 34
Ref:
1 October 2015
Attention:
Dear
RE:
INVITATION TO SUBMIT EXPRESSIONS OF INTEREST
Telecommunications Infrastructure Installation and Maintenance for the NBN Project.
Visionstream Australia Pty Ltd,(Visionstream) invites you to submit an expression of interest with regard
to providing Installation and Maintenance services for the above Project.
You are requested to respond to this expression of interest invitation for the purpose of being selected
and registered by Visionstream as a pre-qualified Company.
Your response to this expression of interest invitation will be evaluated to establish if your Company can
be selected and registered as a pre-qualified Company for the Project.
This invitation to submit an expression of interest is in reference to the following services associated
with the Project:
REFER BELOW FOR EXAMPLES OF SERVICES





Telecommunication Technicians Fibre Optics
Telecommunication Technicians Copper
Telecommunication Technicians HFC
Telecommunications Civil Works
Telecommunication Maintenance Services in multi technology Services
The documents attached to this invitation to submit an expression of Interest has been provided:

to assist you in determining whether or not you should submit an expressions of interest for the
Project, and
to assist you in assessing whether the scope of the services for the Project is within your
capabilities.
Please find attached the following expression of interest documents:
(a)
(b)
(c)
Instructions to Companies
Application for Registration as a pre-qualified Company
Pre-Qualification Questionnaire
To be considered as a pre-qualified Company, the “Application for Registration as a pre-qualified
Company” form and the “Prequalification Questionnaire” must be completed and returned, as soon as
practicable:
Page 5 of 34
Visionstream
NBN Field Services
Level 1, 10 Browning St, West End, QLD, 4101
Email; FS.EOI@visionstream.com.au
Should you propose to provide your services in a joint venture or by any other form of partnership you
are required to submit complete details of each party comprising the joint venture or partnership on the
“Application for Registration as a pre-qualified Company” form.
Visionstream is not committed contractually to any Company that submits an “Application for
Registration as a pre-qualified Company” or who may become selected and registered as a pre-qualified
Company.
In order that we can assess your overall company structure, capabilities and experiences with your core
business you must submit details as requested in the attached Pre-Qualification Questionnaire.
We also requires you to provide the resumes of your senior personnel who have experience on similar
projects, and who would be available for this Project.
You may also provide other information that you consider is pertinent to this Project.
Please note that requests for quotations / invitations to tender associated with the Project will only be
invited from companies that are registered as pre-qualified Companies.
All communications regarding this “Invitation to Submit Expressions of Interest” should be addressed to:
Email: FS.EOI@visionstream.com.au
Regards
Ken Swift
National Commercial Manager
Page 6 of 34
2 INSTRUCTIONS TO COMPANIES
Page 7 of 34
SUBMISSION OF EXPRESSION OF INTEREST
1.1
The Company must prepare its Expression of Interest (EOI) submission based on the requirements
described in the attached “Invitation to Submit Expressions of Interest” letter and these
“Instructions to Companies”. The Company must complete and submit the “Application for
Registration as a pre-qualified Company” and the “Pre-Qualification Questionnaire” with its
submission.
1.2
The EOI submission must be submitted in hard copy format, comprising the original EOI
submission. An electronic submission (email) of the completed EOI submission is acceptable,
provided the full EOI submission is also submitted in hard copy.
1.3
The EOI submission must be lodged no later than the date specified in the “Invitation to Submit
Expressions of Interest” letter.
1.4
The EOI submission must include the following:
1.4.1 the “Application for Registration as a pre-qualified Company” form.
1.4.2 the “Pre-Qualification Questionnaire” form
1.4.3 Any other information that will allow for a comprehensive review and assessment of the
Company and its capabilities.
COSTS TO PREPARE THE EOI SUBMISSION
2.1
The Company will be responsible for all of its costs and expenses incurred in the preparation and
submission of their EOI submission, including any costs and expenses associated with attending
meetings with Visionstream.
2.2
Companies may be required to provide additional clarifications and information and attend
meetings with Visionstream regarding their EOI submissions.
2.3
Visionstream will schedule and co-ordinate any meetings that are necessary regarding the EOI
submission.
REVIEW OF EOI SUBMISSIONS
3.1
The EOI submissions will be reviewed by Visionstream.
3.2
The review process will consider all of the information provided by the Company in its EOI
submission, including:









3.3
Specific expertise
Financial Structure
Occupational, Health and Safety record
capability – that includes relevance to the Project’s scope
Organization structure, resource and experience
Quality Assurance and Management
employee and industrial relations
environmental control
experience with similar projects
The approved Companies will be notified in writing of their registration as a pre-qualified
Company for this Project.
CONFLICT OF INTEREST POLICY
The offering of gifts, entertainment, payments, loans or other favours for the purpose of
obtaining favourable treatment is prohibited. Furthermore, it is Visionstream’s policy that in
the event that any Company is found to have offered or given a gratuity to obtain favourable
treatment, the Company involved may be refused further consideration for the Project
Page 8 of 34
CONFIDENTIALITY
All information provided by Visionstream, in connection with this EOI, including, without
limitation, all EOI documents, other technical information, reports, designs, plans, drawings,
models, specifications, processes, modes of operations, procedures, manuals and other
information obtained by the Company through the process of this EOI invitation are the sole
and exclusive property of Visionstream.
The Company must maintain strict confidentiality regarding this EOI. Failure to maintain this
confidentiality may be cause for rejection of the Company’s EOI submission. No publicity or
discussion of the Company’s involvement in the Project will be made by the Company unless
previously approved in writing by Visionstream.
RETURN OF DOCUMENTS
In the event the Company decides not lodge an EOI submission for the Project, the Company
must immediately return all EOI documents to the person named in the “Invitation to submit
Expressions of Interest”
AUSTRALIAN CONTENT
For Projects within Australia, Visionstream’s philosophy is to encourage employment and
business development firstly in the local area of the Project, secondly within the State of the
Project and thirdly within Australia.
Accordingly, the Company should endeavour to conform to this requirement.
SIGNATURE REQUIREMENTS
A duly authorized officer of the Company must sign the EOI submission. If the Company is a
corporation, the EOI submission must be signed by a duly authorized signing officer of the
corporation. The office held by the signing officer must be stated with the EOI submission.
REGISTRATION IN SKILL TYPES
The companies may register their interests in one or more of the Skill Types described in the
“Pre-Qualification Questionnaire”.
Page 9 of 34
3 APPLICATION FOR
REGISTRATION AS A PRE
QUALIFIED COMPANY
Page 10 of 34
I/We hereby make application for Registration as a pre-qualified Company for the above Project and
declare that all particulars as lodged with our Expressions of Interest submission are true and correct in
every detail.
I/We authorise Visionstream Australia Pty Ltd to effect any investigation to verify the statements and
documents lodged with our Expressions of Interest submission, and to obtain clarification and
information on the technical and financial aspects of this application.
Registered Business Name:
Trading Name:
ABN:
ACN:
Registered Business Address:
Phone Number:
Facsimile Number:
E-Mail address
Specific Names of relevant persons who may be contacted for further information:
Technical:
Commercial:
Business Development:
Signed:
Name and title of signatory:
For and on behalf of:
(The attached “Pre-qualification Questionnaire” must be completed and submitted with this
application)
Page 11 of 34
4 PRE QUALIFICATION
QUESTIONNAIRE
Page 12 of 34
PROJECT: NBN Field Services
Page 13 of 34
TABLE OF CONTENTS
1.0
OCCUPATIONAL HEALTH AND SAFETY PERFORMANCE
15
2.0
FINANCIAL STATUS OF THE COMPANY
18
3.0
INSURANCES
19
4.0
ORGANIZATION STRUCTURE
20
5.0
SYSTEMS
21
6.0
QUALITY ASSURANCE
22
7.0
ENVIRONMENTAL QUESTIONNAIRE
24
8.0
EMPLOYEE RELATIONS
25
9.0
INDIGENOUS AND LOCAL COMMUNITY PARTICIPATION
26
10.0
GOODS AND SERVICES TAX (GST)
26
11.0
INDUSTRIAL RELATIONS (“IR”)
27
12.0
REFEREES
30
Page 14 of 34
OCCUPATIONAL HEALTH AND SAFETY PERFORMANCE
1.1
The information provided by the Company will be used by Visionstream to determine the
occupational health and safety record of the Company.
1.2
The information provided will not relieve the Company from complying with the obligations
imposed by the occupational health and safety requirements for the Project in the future.
1.3
The safe completion of this Project is of overriding importance and the assessment of the
Company’s occupational health and safety performance will be crucial in the selection of prequalified Companies. A poor occupational health and safety record will be sufficient to preclude
any prospective Company from being registered as a pre-qualified Company for the Project.
1.4
Please provide details of the person primarily responsible for occupational health and safety within
your Company:
Name:
Position:
Qualification:
1.5
Please provide details of your Company’s representative for monitoring and controlling
occupational health and safety in relation to this Project.
Name:
Position:
Qualification
Experience:
1.6
Please provide annual injury details in accordance with AS1885.1 for your Company within Australia
and within each State of Australia. The figures shall be shown separately in the tables below:
AUSTRALIA
2011
2012
2013
2014
2015
No. of employees
No. of manhours worked
No. of First Aid Treatments
No. of Lost Time Hours
No. of Lost Time Injuries *
No. of Fatalities
* Do not include where lost time has been for less than one full shift.
NOTE: The following tables must be completed where the Company has performed services in
more than one State in Australia.
Page 15 of 34
A separate table must be prepared and completed for each State.
Provide and complete extra tables if necessary.
STATE OF …………………….
2011
2012
2013
2014
2015
2014
2015
No. of employees
No. of manhours worked
No. of First Aid Treatments
No. of Lost Time Hours
No. of Lost Time Injuries *
No. of Fatalities
* Do not include where lost time has been for less than one full shift.
STATE OF …………………….
2011
2012
2013
No. of employees
No. of manhours worked
No. of First Aid Treatments
No. of Lost Time Hours
No. of Lost Time Injuries *
No. of Fatalities
* Do not include where lost time has been for less than one full shift.
1.7
In accordance with the formulae in AS1885.1 – 1990, please complete the tables below:
AUSTRALIA
2011
2012
2013
2014
2015
Total Injuries
Incidence Rate (IR)
Frequency Rate (FR)
Average Time Lost Rate (ATLR)
Injury Illness Statistical Index (IISI)
(ie. ATLR x FR)
Page 16 of 34
NOTE: The following tables must be completed where the Company has performed services in
more than one State in Australia.
A separate table must be prepared and completed for each State.
Provide and complete extra tables if necessary.
STATE OF ………………………
2011
2012
2013
2014
2015
2011
2012
2013
2014
2015
Total Injuries
Incidence Rate (IR)
Frequency Rate (FR)
Average Time Lost Rate (ATLR)
Injury Illness Statistical Index (IISI)
(ie. ATLR x FR)
STATE OF ………………………
Total Injuries
Incidence Rate (IR)
Frequency Rate (FR)
Average Time Lost Rate (ATLR)
Injury Illness Statistical Index (IISI)
(ie. ATLR x FR)
1.7.1 Do you have a written occupational health and safety program?
Yes  No 
If YES, please provide as a minimum an Executive Summary with your submission.
1.7.2 Do you have an orientation program for new employees?
Yes  No 
If YES, please provide details with your submission.
1.7.3 Do you hold safety meetings for employees and floor supervisors?
If YES, how often?
1.7.4 Do you hold craft “toolbox” safety meetings?
If YES, how often?
1.7.5 Do you conduct safety inspections?
Yes  No 
…………………………………………
Yes  No 
………………………………………..
Yes  No 
If YES, who conducts this inspection?
Title:
How Often?
Page 17 of 34
1.7.6 Do you have a drug and alcohol education and random testing program?
Yes  No
If YES, please provide details with your submission.
FINANCIAL STATUS OF THE COMPANY
2.1
Company Structure
If a Company, state whether subsidiary or holding company
If a subsidiary company, state name of holding company
If a holding company, state names of subsidiaries
State date when Company commenced operations specific to
company’s core business
2.2
Company’s financial details
Closing date of company’s trading year: ……………………………………………………..
Attach audited and certified copies of the company’s financial details for the last three trading
years.
Has there been or is there likely to be any substantial change in the
financial affairs of the company since the closing date of the above
Accounts which might affect the ability of the company to successfully
carry out work?
Yes 
No
Yes 
No
If YES, please provide details with your submission.
2.3
Parent Company Guarantee
Will the holding company issue a Parent Company Guarantee?
2.4
2.5
Bank Guarantee/Bond
Limit of Bank Guarantee/Bond available to company:
………………………………
Limit of Bank Guarantee/Bond available on individual contracts:
………………………….
Company Bankers
Provide details of company’s bankers:
Bank Name:
Address:
Bank Name:
Address:
Provide and complete any further Bank details if applicable
Page 18 of 34
INSURANCES
3.1
Applicants are to indicate whether or not they have current cover for the insurances listed below
and are advised that, should they be under consideration following the submission of a tender
price, they will be required to provide proof and details of the insurances during a Pre- Award
Interview. Apart from Workers Compensation insurance which is MANDATORY for all applicants, a
“No” answer below will not necessarily preclude the applicant from being invited to submit a
tender, but the applicant will be expected to take out that insurance if required to do so by the
tender documents.
3.2
If the applicant is a sole trader and does not have workers/ employees compensation insurance,
then Accident Insurance and Income Protection Insurance should be provided to ensure that the
sole trader is adequately insured in the event of injury or illness.
3.3
The values noted as “Minimum Cover” are a guide only, and may vary dependent on individual
head contract or project requirements.
Insurance type
Applicant has current
cover
Minimum cover
Workers / employees compensation
 YES
- MANDATORY -
 NO
As per State Regulations
Public and product liability
 YES
 NO
Contract works
 YES
 NO
Professional indemnity
 YES
 NO
Not less than $20 million
Motor Vehicle
 YES
 NO
Market value plus $20m of third party
liability cover
3.4
Not less than $30 million in respect of
any one occurrence
If applicable please supply details of
Accident Insurance:
Income Protection:
Page 19 of 34
ORGANIZATION STRUCTURE
Provide details of the Company’s Organization Structure with your submission.
Details should include the holding company, all subsidiaries and the current numbers of employees.
4.1
EXPERIENCE AND RESOURCES
4.2
Specific Project Experience
4.2.1 Provide details of projects executed by your Company within the past five (5) years.
4.2.2 Please list the projects in chronological order, commencing from 2007, in the format of the table
below.
Client
Project
4.3
RESOURCES AND CAPABILITIES
4.4
company’s senior personnel
Scope of work
Approximate
Aust Dollars
Value
4.4.1 Provide details of the company’s senior personnel. Information to be included in attached table 1.
4.4.2 company’s employees
4.4.3 Provide details of the company’s employees and subcontractors available to provide services for
the project. Information to be included in attached table 2.
Page 20 of 34
SYSTEMS
5.1
Provide details of systems utilised by your company.
Description
Yes
No
Electronic copies and paper copies for all deliverables and
correspondence


Electronic Ticket of Works packages used.


Details and capabilities of systems used for Project Controls,
Planning, Scheduling, Programming, Procurement, Expediting,
Supplier Surveillance, Traffic and Logistics and Contracts
Management including sample report


Page 21 of 34
QUALITY ASSURANCE
6.1
Company’s QA representative
Do you have a company representative who is responsible for
monitoring, controlling and documenting quality?
Yes 
No
If YES please advise:
Name:
Position:
Reports To
Position
6.2
Company’s Quality Standard
6.2.1 Has your Company been assessed and certified against a
recognised Quality Standard?
Yes 
No 
If YES please advise:
Quality Standard and Level
Assessment Body / Organization:
Registration Number:
Approval Date:
Expiry Date:
Scope of Registration
Note: Supporting documentation should be submitted in respect of the above.
Note: If your answer to Clause 5.2 is YES, ignore Clause 5.3.
When providing the following information, please refer to the relevant clause or section number
in your Quality Manual, where applicable.
Do you operate a quality system?
Yes 
No 
Do you have and implement procedures based upon your quality
process?
Yes 
No 
Page 22 of 34
Procedure Title
Yes
No
Design Control


Inspection and Test Plans


Corrective Action


Documentation and change control


Control of
equipment
testing


Control of purchased material and
services


Control of purchaser supplied material


Control of special processes




Manufacture / construction


Quality audits


Packaging,
storage
measuring
shipping,
and
handling
and
How long are quality records maintained?
Has your company been audited for quality?
Company’s Procedure Section/Clause
Number
……………………………………
Yes 
No
If YES please advise:
When? Advise dates:
By whom?
Auditing Standard/Code
Page 23 of 34
ENVIRONMENTAL QUESTIONNAIRE
6.3
Does your company have an Environmental Policy?
Yes  No 
If YES, please provide details with your submission.
Please provide details of your company’s Environmental Training Procedures with your submission.
With your submission, please provide details of how your company’s Environmental Policy is
conveyed to your employees with your submission.
With your submission, please provide details of what hazardous substances or dangerous goods are
used in carrying out your activities.
Page 24 of 34
EMPLOYEE RELATIONS
7.1
The information provided by the company will be used by the Principal to make an assessment of
the company’s industrial relations record.
7.2
Please advise the name, position and qualifications (if any) of the person within your company who
is primarily responsible for employee relations.
Name:
Position:
Qualifications:
Please nominate Employer Organizations / Associations of which your company is currently a
member.
Please indicate the names of any Employment Agreements under which your company is currently
working or has worked in the last five years.
Please advise details of union coverage for your employee
DISCIPLINE:
UNION:
Page 25 of 34
INDIGENOUS AND LOCAL COMMUNITY PARTICIPATION
8.1
Preamble
8.2
The company acknowledges the Principal’s commitment to the employment of appropriately
qualified indigenous people in connection with specific Project requirements. The company is
encouraged to adopt a pro-active policy with respect to the employment of indigenous people.
Has your company had involvement in employment opportunities
with indigenous groups?
Yes 
No 
If YES, please provide details with your submission.
Have persons from indigenous groups ever been employed or
utilised on previous Agreements?
Yes 
No 
If YES, please provide details with your submission.
What is your company policy with this issue? Please provide details with your submission.
Does your company have a structured training and development
scheme for indigenous advancement?
Yes 
No 
If YES, please provide details with your submission.
GOODS AND SERVICES TAX (GST)
Is your company registered with the Australian Tax Office for GST?
Yes 
No 
Page 26 of 34
INDUSTRIAL RELATIONS (“IR”)
10.1 State and Federal Code Compliance
10.1.1The relevant State Code of Practice for the Building and Construction Industry (“State Code”)1,
and the Federal Building Code 2013 (“Building Code”), together with associated Guidelines, if
applicable, require Visionstream to ensure the workplace arrangements of potential
subcontractors and suppliers, in respect of their construction activities, comply with the State
Code and the Building Code.
10.1.2For this Expression of Interest to be considered, the applicant must:


Provide a copy of the applicant’s current industrial instrument to Visionstream for review; and
Complete the following questionnaire in full.
10.1.3
Has the applicant attached a copy of their current industrial instrument(s) for
review by Visionstream?
10.1.4
There is a requirement for all subcontractors on projects tendered under the
Building Code, to have Code compliant industrial instruments.
Has the applicant had their industrial instrument assessed by the Department of
Education, Employment and Workplace Relations (“DEEWR”) for Building Code
compliance?
 YES
 NO
 YES
 NO
 YES
 NO
If YES, you must attach a copy of the letter from the DEEWR.
If “NO”, please provide details why not and what steps you are taking to rectify
the situation in the space provided below.
10.1.5
If the applicant has an enterprise agreement, does that agreement include a
genuine dispute resolution procedure that allows for:
(a) employees to appoint a representative in relation to the dispute; and
(b) settlement of the dispute at the workplace level in the first instance, and in
the event that it is not settled there, to be referred to an independent third
party for mediation or conciliation, and if the dispute is still not settled, the
capacity for the third party to settle the dispute by a decision binding on the
parties?
If the answer to any of questions 7.1.1 to 7.1.4 above is ‘NO’, please provide details:
..........................................................................................................................
..........................................................................................................................
1
State Code means, to the extent applicable to the works the subject of the Expression of Interest, the Victorian Code of
Practice for the Building and Construction Industry, the New South Wales Code of Practice for Procurement or the Queensland
Code of Practice for the Building and Construction Industry, together with associated Implementation Guidelines.
Page 27 of 34
10.1.6
Has the applicant been sanctioned by the Australian Government or any other
State or Territory Government prior to the date the applicant submitted this
Expression of Interest for breaches of the Fair Work Act 2009, Workplace
Relations Act 1996 (as it then was), Building & Construction Industry
Improvement Act 2005 (as it then was), Building Code, State Code, pre-existing
National Code of Practice for the Construction Industry or any Implementation
Guidelines associated with any of those Codes etc (eg paying strike pay,
discriminating against industrial instruments etc)?
 YES
 NO
 YES
 NO
Does the applicant, or any Related Body Corporate of the applicant, have
workplace or enterprise agreements, policies or practices that would encourage
or discourage employees on a project site to join or maintain financial
membership with a relevant union or any industrial association, including the
provision of union application forms with induction packages and informing
prospective employees of their rights, obligations and benefits of union
membership?
 YES
 NO
Does the applicant have any requirements or practices that encourage, suggest
or pressure their subcontractors or suppliers to adopt or require any particular
form of industrial agreement or to adopt any particular terms and conditions of
employment?
 YES
 NO
Does the applicant use induction forms that require employees to identify their
union status or require subcontractors or suppliers to identify the union status
of employees?
 YES
 NO
Do union delegates undertake or administer any part of the applicant’s induction
process, or do they have access to the names of new staff, job applicants,
subcontractors or suppliers? Are unions or union delegates or other employee
representatives allowed to have unfettered access to pay or other employee
records?
 YES
 NO
Does the applicant have any arrangements where there is a requirement for the
employment of a non-working shop steward or job delegate, or other such
person, on the project site?
 YES
 NO
Is there any requirement for the payment by any person or enterprise of a
‘bargaining fee’, however described, to any industrial association?
 YES
 NO
Has the applicant had an adverse Court or Tribunal finding, order or penalty
against them (not including decisions under appeal) for a breach of a workplace
relations law, work health and safety law, workers’ compensation law, migration
law or competition and consumer law?
10.1.7
10.1.8
10.1.9
10.1.10
10.1.11
10.1.12
If the answer to any of questions 7.1.5 to 7.1.11 above is ‘YES’, please provide details:
..........................................................................................................................
..........................................................................................................................
Page 28 of 34
10.1.13
10.1.14
Has the applicant reviewed the issues covered in Items 7.1.1 through to 7.1.11
inclusive with their subcontractors and/or suppliers?
 YES
 NO
Are the subcontractors and/or suppliers Code compliant?
 YES
 NO
If the answer to any of questions 12.1.12 to 13.1.13 above is ‘NO’, please provide details:
10.2
COMPLIANCE WITH STATUTES
10.2.1Visionstream also has contractual and legal obligations to ensure that subcontractor employees
engaged on a project / site are paid and/or credited with all their legal entitlements. These
legal entitlements or obligations are those provided in statute and other legally enforceable
state or commonwealth legislation.
10.3
COMPLIANCE WITH LEGAL ENTITLEMENTS
Does the applicant provide wages and conditions in accordance with any relevant industrial
instrument or contractual arrangements?
Has the applicant attached an example payslip or employee payroll details as verification
(de-identified for privacy purposes) to Visionstream for review, with this Expression of
Interest?
10.4
 YES
 NO
 YES
 NO
 YES
 NO
 YES
 NO
SUPERANNUATION PROVISION
Does the applicant make contributions on behalf of eligible employees (as defined by the
Australian Tax Office) into a superannuation fund nominated by the employees?
Has the applicant attached proof of currency of superannuation contributions (deidentified for privacy purposes) to Visionstream for review, with this Expression of
Interest?
10.5 LONG SERVICE LEAVE
10.5.1Employers are required by State legislation to be registered with a portable long service leave
fund administered at a State level (see below) and are also required to register their employees
who carry out building or construction work within that State with the same fund.
10.5.2The state or territory and corresponding fund applying to this application is: (delete ALL that are
not applicable)
ACT
ACT Long Service Leave Authority
NSW
Long Service Corporation
QLD
Portable Long Service Authority (“QLeave”)
SA
Construction Benefit Services (“CBS”)
TAS
Tasmanian Construction Industry Long Service Scheme (“TasBuild”)
VIC
CoINVEST
WA
Construction Industry Long Service Leave Payments Board
NT
NT Build
Proof of the applicant’s registration with the relevant LSL fund must be attached with this application.
What is the applicant’s Employer Registration Number?
………………….
Proof of registration provided
 YES
 NO
Page 29 of 34
REFEREES
11.1
Please provide the names, positions and contact details of the independent people the principal can contact
as your referees regarding your company.
REFEREE
CONTACT DETAILS
Page 30 of 34
TABLE 1 – COMPANY’S SENIOR PERSONNEL
Note: the details below is only an example – the document to be issued must be prepared to address
the requirements of the project
Senior Personnel
Number of Personnel
Project Directors
Project Managers
Engineering Managers
Senior Process Engineers
Senior Design Engineers
Safety Managers
Quality Managers
Environmental Managers
Operations Managers
Manufacturing Managers
Other Relevant Senior Staff as listed below:-
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TABLE 2 – COMPANY’S EMPLOYEES
Note: the details below is only an example – the document to be issued must be prepared to address
the requirements of the project
Description of Work
Number of
Company’s
Employees
Number of
Subcontractor’s
Employees
Name of
Subcontractor
Project Management
Telecommunication Technicians
Fibre Optics
Telecommunication Technicians
Copper
Telecommunication Technicians HFC
Telecommunications Civil Works
Telecommunication Maintenance
Services in multi technology
Services
Plumbing
Electricians
Plastering
Traffic Control
Landscaping
Concreting
Building repair and maintenance
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TABLE 3 – COMPANY’S GEOGRAPHICAL LOCATIONS FOR DEPLOYMENT
Note: the table to be issued must be prepared to address the requirements of the project
NSW:
QLD:
VIC
NT
WA
SA
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TAS
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