NHS WIRRAL
CONTRACT FOR THE PROVISION OF A
SMOKING PREVALENCE SURVEY
PRE-QUALIFICATION QUESTIONNAIRE
Strictly Private and Confidential
From
Name of Organisation (Please Insert)
…………………………………………………………………………
Contract for the Provision of A Smoking Prevalence Survey – Pre-Qualification
Questionnaire
_____________________________________________________________________________________________________________
Instructions
1. NHS Wirral is seeking competitive tenders for the provision of a smoking prevalence survey. The
completion and submission of this Pre-Qualifying Questionnaire (PQQ) is part of the process and the
information you provide in this document will form part of the final bound contract, should your
organisation be successful. The questions in this PQQ are designed to give the PCT all the
information we need to assess whether your organisation can be included on the tender list for this
contract. If your organisation successfully passes the standards set in the evaluation process you will
be invited to tender.
2. The PQQ is in two parts, the first part is intended to gather information on the commercial and
administrative aspects of your organisation and the second seeks information which will be used to
evaluate operational practices and experience.
3. It is very important that you answer all the questions that apply to your organisation as fully as
possible. Please answer each question directly and do not rely on information given in a response to
another question or included in supporting documentation. Your application may be rejected if you do
not answer relevant questions. Please continue on a separate piece of paper clearly marked with the
name of your organisation and the number of the question to which it relates if there is insufficient
space in the PQQ .
4. Please enclose all supporting documents requested and ensure they are clearly marked with the
question number to which they refer and the name of your organisation. Documents will not be
returned therefore you may send photocopies rather than originals. Your application may be rejected
if you do not provide complete or adequate evidence, supporting documentation or details where
requested.
5. Please answer the questions specifically for your company not for the group, if you are part of a group
of companies.
6. Please note the term "organisation" refers to sole proprietor, partnership, incorporated company, cooperative, or voluntary organisation as appropriate.
7. No queries in connection with this questionnaire can be dealt with by telephone. If you do have
queries they must be sent by email to Caroline Baines at caroline.baines@wirral.nhs.uk All questions
and responses given will be anonymously shared with all organisations that have been sent the PQQ.
8. Please ensure that you complete the declaration at the end of the questionnaire.
completed your application may be rejected.
If this is not
9. Do not send any general marketing or promotional documents that are not in direct response to any of
the questions.
10. The provision of false or misrepresented information will result in your application being rejected.
11. All information provided in this PQQ will be kept commercially in confidence.
Contract for the Provision of A Smoking Prevalence Survey – Pre-Qualification
Questionnaire
_____________________________________________________________________________________________________________
12. TWO COPIES of the completed questionnaire with requested supporting documents, plus business
cases, one of which should be unbound, should be returned to:
Kim Ozano
Senior Health Improvement Adviser
NHS Wirral
Old Market House
Hamilton Street
Birkenhead
Wirral
CH41 5AL
to arrive no later than 5pm on Thursday 9th August 2012 Questionnaires received after this
time will not be considered. Faxed or e-mail copies of the form are not acceptable.
13. Organisations should not make contact with any officer or employee of the PCT or other authority or
statutory body in relation to this pre-qualification questionnaire without the PCT’s prior agreement.
14. Organisations should treat all information and documents issued by the PCT and their advisers as
private and confidential and should only be shared with other parties for the purpose of responding to
the PQQ or submission of a subsequent tender.
15. Organisations will prepare their responses to the PQQ at their own expense which will not be
reimbursed by the PCT.
Contract for the Provision of A Smoking Prevalence Survey – Pre-Qualification
Questionnaire
_____________________________________________________________________________________________________________
Declaration
When you have completed the application, please read and sign below
I certify that the information supplied is accurate to the best of my knowledge. I understand and accept that
provision of false information could result in my Organisation being excluded from any further consideration in
this tendering exercise..
Signed:
..........................................................................................
Name:
………………………………………………….. (block capitals please)
Position in Organisation ………………………………………………………………...
For and on behalf of:
..........................................................................................
Date:
................................................
This undertaking is to be signed by the Applicant, a Partner or authorised representative in her/his
own name and on behalf of the organisation.
Before returning this application please ensure that you have

Answered fully all questions appropriate to your application.

Enclosed all documentation and evidence required and cross referenced to the appropriate question. If
you have not provided this in full your application may not be considered

Signed the above undertaking.
____________________________________________________________________________________
Name of Organisation................................................................................................
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
NHS WIRRAL
CONTRACT FOR THE PROVISION OF A
SMOKING PREVLANCE SURVEY
PRE-QUALIFICATION QUESTIONNAIRE
PART 1
COMMERCIAL & ADMINISTRATIVE
Name of Organisation…………………………………………………………………………………….
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
Section 1
Contact & Company Information
1.1
Name of organisation in whose name a
tender(s) would be submitted – (the
business name of the firm or company)
1.2
Details of the contact person
responsible for the submission of this
questionnaire:
Please advise the PCT/ if any of these details
change following submission of your
questionnaire
1.2.1
Name
1
a
1.2.2
Designation
1.2.3
Address for correspondence
1.2.4
Telephone number
1.2.5
Fax number
1.2.6
Email Address
1.3
Trading name of organisation.
(if same as in1.1 state As Above)
1.4
Registered name of organisation.
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 1 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
1.5
Registered Office address.
Address
Telephone Number
Fax Number
1.6
Date organisation was formed or started
trading if different
1.7
Previous Names traded under within the
last two years:
(if none state none)
1.8
Please state the type of organisation





Tick the appropriate box
1.9
If applicable, please state the number
and date, and provide a copy of the
Certificate of Incorporation or
Registration (and change of name)
under the Companies Act 1985 or
Industrial and Provident Societies Acts
1965 to 1978.
Private limited company
Public limited company
Partnership
Sole Trade
Other,
please specify
Certificate Number:
Date:
Copy enclosed

Not Applicable

Tick the appropriate box
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 2 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
1.10
Is your organisation registered for VAT?
If yes, please provide the VAT
Registration Number.
1.11


Is your organisation notified under the
Data Protection Act 1998 as a Data
Controller?

If yes, please provide your DPA
Notification Number

No
Yes,
VAT Registration Number:
No
Yes,
DPA Notification Number:
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 3 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
Section 2
2.1.1
Business Probity
If your organisation is a company,
please confirm that:
no resolution has been passed or
Order of the Court made for the
Company's winding up otherwise
than for the purposes of bona fide
reconstruction or amalgamation

Not applicable

Confirmed

no receiver, or manager, or
administrator on behalf of a
creditor has been appointed in
respect of the company's business
or any part thereof

Not confirmed,
Details attached

The company is not currently the
subject of proceedings for any of
the above procedures.

Not applicable

Confirmed

Not confirmed,
Details attached

Tick the appropriate box.
2.1.2
If your organisation is a limited liability
partnership (LLP), please confirm that:

No resolution or decision has been
passed or Order of the Court
made for the LLP's winding up
otherwise than for the purposes of
bona fide reconstruction or
amalgamation

no receiver, or manager, or
administrator on behalf of a
creditor has been appointed in
respect of the LLP's business or
any part thereof, or is not currently
the subject of any proceedings for
any of the above procedures

the partnership is not the subject
of similar procedures under the
law of any other state.
Tick the appropriate box
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 4 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
2.1.3
If your organisation is a partnership
constituted under Scots Law, please
confirm that it has not granted a trust
deed or become otherwise apparently
insolvent, or is not the subject of a
petition presented for sequestration of
its estate.
Tick the appropriate box.
2.1.4

Not applicable

Confirmed

Not confirmed,
Details attached
If you are an individual, please confirm
that you:

are not bankrupt,

Not applicable

have not had a receiving order or
administration order made against
you,

Confirmed
have not made a composition or
arrangement or trust deed with or
for the benefit of your creditors, or



have not made any conveyance or
assignment for the benefit of your
creditors, or

have not had petition presented for
sequestration of your estate

do not appear to be unable to pay
or to have no reasonable prospect
of being able to pay a debt within
the meaning of the Insolvency Act
or

are not subject to any similar
procedure under the law of any EU
member state
Not confirmed,
Details attached
Tick the appropriate box.
2.2
List of the full names of every Director,
Partner, Associates and the Company
Secretary and indicate their title.
(if necessary continue on a separate sheet
clearly showing this question number)
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 5 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
2.3
List the names of any of the above who
are or have been employed by NHS
Wirral. Please give department and
dates.
(if necessary continue on a separate sheet clearly
showing this question number)
2.4
List the names of any of the above who
are or have been Non-Executive
Directors of NHS Wirral, please give
dates.
(if necessary continue on a separate sheet clearly
showing this question number)
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 6 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
2.5
Please give details of any of the above
who have a relative, partner or associate
who is employed by NHS Wirral at a
senior (Manager) level.
(if necessary continue on a separate sheet clearly
showing this question number)
2.6
List the names of any of the above who
have any involvement in other
organisations who provide services to
NHS Wirral and the nature of the
involvement.
(if necessary continue on a separate sheet clearly
showing this question number)
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 7 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
2.7
Please confirm that no Directors,
Partners, Associates or the Company
Secretary have been involved in any
organisation which has been liquidated
or gone into receivership.


Tick the appropriate box.
2.8
Please confirm that none of the
Directors, Partners, Associates or the
Company Secretary has been convicted
of a criminal offence relating to the
conduct of their business or profession.


Tick the appropriate box.
2.9
Please confirm that none of the
Directors, Partners, Associates or
Secretary has committed an act of
grave misconduct in the course of their
business or profession.


Tick the appropriate box.
2.10
Please confirm that all of the
organisation’s obligations relating to the
payment of taxes and social security
contributions under the law of any part
of the United Kingdom have been
fulfilled.


Confirmed
Not confirmed,
Details attached
Confirmed
Not confirmed,
Details attached
Confirmed
Not confirmed,
Details attached
Confirmed
Not confirmed,
Details attached
Tick the appropriate box.
2.11
Please confirm that there are no court
actions or industrial tribunal hearings
outstanding against your organisation


Confirmed
Not confirmed,
Details attached
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 8 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
Section 3
3.1
Economic and Financial Standing
If the organisation is a member of a
group of companies, please give the
names and address of the ultimate
holding company and all other
subsidiaries and associated companies
stating clearly the relationship.
(if necessary continue on a separate sheet clearly
showing this question number)
3.2
Would the group or ultimate holding
company be prepared to guarantee your
contract performance as its subsidiary?
Tick the appropriate box
3.3

Yes

No
Please state the name and title of the
person in the organisation responsible for
financial matters.
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 9 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
3.4
Please confirm that the PCT may obtain
references from your bankers and
provide their name, address, and if
possible the name and designation of a
contact person to whom a reference
request may be directed. Please provide
the PCT with a letter of authority for this
purpose.

Confirmed,

Not confirmed
Bankers Name
and Address
Tick the appropriate box
Name of Contact
Person
Designation

3.5
Has your organisation suffered
deductions for liquidated and ascertained
damaged for any contract within the last
three years? If yes, please provide
details.

Letter of authority enclosed
No

Yes
Details attached
Tick the appropriate box
3.6
Please enclose copies of the
organisation's audited accounts for the
past three years, to include:
Tick the appropriate box

Balance Sheet

Enclosed

Profit and Loss Account

Enclosed

Full notes to the Accounts

Enclosed

Director's Report

Enclosed

Statement of Turnover in respect of
similar services as those to be
provided under this contract.

Enclosed
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 10 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
3.7
If the Accounts you are submitting are for
a year ended more than 10 months ago,
please confirm that the organisation is
still trading and provide a statement of
turnover since the last set of published
accounts.

Confirmed,
Details attached

Not applicable
Tick the appropriate box
3.8
Please indicate the organisation’s
turnover in the last three financial years
in the provision of research. Please do
not include other or associated services.
Annual Turnover £
year ended
month/year
Annual Turnover £
year ended
month/year
Annual Turnover £
year ended
month/year
3.9
Public Liability (Third Party) Insurance
Please give the name of the organisation’s
insurer, policy number, expiry date and
amount of cover.
£5 million minimum required
Name of insurer:
Policy Number
Expiry date
Amount of cover:
Copy of policy enclosed
3.10
Employer’s Liability (Third Party)
Insurance
Please give the name of the organisation’s
insurer, policy number, expiry date and
amount of cover.
£5 million minimum required

Name of insurer:
Policy Number
Expiry date
Amount of cover:
Copy of policy enclosed

_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 11 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
3.11
Other Insurance(s)
Please give a description, the name of the
organisation’s insurer, policy number,
expiry date and amount of cover.
Proffessional Indemnity
£5million required
Type of cover:
Name of insurer:
Policy Number
Expiry date
Amount of cover:
Copy of policy enclosed

_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 12 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
Section 4
4.1
Health and Safety
Does the organisation have a written
Health and Safety Policy detailing the
Organisation’s commitment to Health and
Safety and Management responsibilities?


No
Yes
Copy of policy enclosed
(if yes please provide a copy)
Tick the appropriate box
4.2
Name of Director, Partner or other
person responsible for the
implementation and maintenance of the
organisation's safety policy. Please state
where this person is based and their
position in the organisation.
Name:
Location:
Position in organisation:
4.3
Please state who provides Health and
Safety advice to the organisation.
Please indicate whether this person is
employed directly by the organisation,
engaged as a consultant or under
another arrangement. If directly
employed, please provide an
organisation chart indicating the position
in the organisation of this person.
Name:

Directly employed,
organisation chart enclosed

Consultant

Other:
Please give details
Tick the appropriate box
Please indicate the qualifications and
experience of this person.
4.4
Please enclose a signed copy of your
Health and Safety Policy (covering
general policy, organisation and
arrangements) as required by section
2(3) of the Health and Safety at Work Act
1974.
Qualifications &
Experience:

Enclosed

Not enclosed
Tick the appropriate box
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 13 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
4.5
Please provide where available copies of
procedure documents or other written
material that outlines the organisation’s
arrangements to effectively meet it’s
responsibilities in the following areas:
a.
Relevant Codes of Practice and
Safe Operating Standards
4.5 a
 Enclosed
 Not enclosed
b.
Accident Reporting Procedures
4.5 b
 Enclosed
 Not enclosed
c.
COSHH
4.5 c
 Enclosed
 Not enclosed
d.
Manual Handling
4.5 d
 Enclosed
 Not enclosed
e.
Personal Protective Equipment
4.5 e
 Enclosed
 Not enclosed
f.
Health and Safety Training
4.5 f
 Enclosed
 Not enclosed
g.
Risk Assessments
4.5 g
 Enclosed
 Not enclosed
h.
Audit and Review
4.5 h
 Enclosed
 Not enclosed
i.
The use of Sub-Contractors
4.5 I
 Enclosed
 Not enclosed
Tick the appropriate boxes
4.6
Please enclose details of any
prosecutions or notices served on the
organisation by the Health and Safety
Executive or under the Health and Safety
At Work Act 1974.


None
Details Enclosed
Tick the appropriate box
4.7
Please confirm that no prosecution
involving Health and safety is
outstanding.

Tick the appropriate box

Confirmed
Not confirmed, details enclosed
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 14 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
4.8
4.9
Has the organisation been issued with an
Improvement or Prohibition Notice in the
last three years?
Has there been any major, noticeable or
dangerous occurrences (as defined
under the Reporting of Injuries, Diseases,
and Dangerous Occurrences Regulations
1985) in connection with the business of
the organisation in the last three years?




No
Yes, details enclosed
No
Yes, details enclosed
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 15 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
Section 5
Quality Management Systems
5.1
Name of Director, Partner or person
responsible for the implementation of the
organisation's Quality Assurance Policy.
5.2
Please describe how the organisation
measures service user satisfaction.
Please enclose a recent example with
results.
5.3
 Example and results enclosed
Please describe how the organisation
monitors and evaluates itself and
determines improvements to be made.
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 16 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
5.4
Please describe how the organisation
deals with complaints, including any
timescales used.
5.5
Please describe how the organisation’s
complaints procedure is promoted to
service users and enclose a copy of the
document given to them.
 Document enclosed
5.6
Has the organisation acquired Quality
Assurance registration to ISO
9001:2000?


Tick the appropriate box
Yes
Date achieved:
No
If your organisation has achieved ISO 9001:2000 please complete questions 5.7 to 5.8, if not please go to Question 5.9
5.7
Please give details of the scope of
registration, accrediting body, certificate
number and enclose a copy of the
certificate and most recent accreditation
report.
Tick the appropriate box
Scope of Registration:
Accrediting Body:
Certificate Number:
Copy of Certificate and recent accreditation report

Enclosed

Not enclosed
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 17 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
5.8
Please enclose
a.
a full copy of your quality
assurance policy
a.
 Enclosed
 Not enclosed
b.
the contents list and three
example extracts from your
quality manual
b.
 Enclosed
 Not enclosed
c.
a copy of your current audit plan
c.
 Enclosed
 Not enclosed
d.
minutes of last two quality
management reviews
d.
 Enclosed
 Not enclosed
Tick the appropriate box
Only if your organisation has not achieved ISO900:2000, please complete questions 5.9 to 5.13
5.9
Do you operate a quality system based
on the principles laid down in the
ISO9001:2000?
Tick the appropriate box
5.10
If yes, please indicate whether the
quality system is applicable to the
administration of research provision, or
to an allied service.




Yes
No
Research - Administration
Allied Service - Please specify what
Tick the appropriate box
5.11
Please provide documented evidence of
your quality system and its operation.
Tick the appropriate box
5.12
Do you intend to acquire registration to
ISO 9001:2000?
Tick the appropriate box
5.13
If yes to 5.12, please indicate the
expected date.




Enclosed
Not enclosed
Yes
No
Date:
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 18 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
5.14
Are you registered with CQC?
 Yes
Date Achieved:
Tick the appropriate box
 No
5.15
If no do you intend to acquire
registration to CQC?
 Yes
Tick the appropriate box
5.16
5.17
 No
If yes to 5.12, please indicate the
expected date.
Date:
Has the organisation acquired Quality
Assurance registration to ISO:14001
Environmental Standards?


Tick the appropriate box
Yes
Date achieved:
No
If your organisation has achieved ISO: 14001 please complete questions 5.18 to 5.19, if not please go to Question 5.20
5.18
Please give details of the scope of
registration, accrediting body, certificate
number and enclose a copy of the
certificate and most recent accreditation
report.
Tick the appropriate box
Scope of Registration:
Accrediting Body:
Certificate Number:
Copy of Certificate and recent accreditation report
5.19

Enclosed

Not enclosed
Please enclose
e.
a full copy of your quality
assurance policy
a.
 Enclosed
 Not enclosed
f.
the contents list and three
example extracts from your
quality manual
b.
 Enclosed
 Not enclosed
g.
a copy of your current audit plan
c.
 Enclosed
 Not enclosed
h.
minutes of last two quality
management reviews
d.
 Enclosed
 Not enclosed
Tick the appropriate box
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 19 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
Only if your organisation has not achieved ISO14001, please complete questions 5.20 to 5.24
5.20
Do you operate a quality system based
on the principles laid down in the
ISO:14001?
Tick the appropriate box
5.21
If yes, please indicate whether the
quality system is applicable to the
administration of reserach provision, or
to an allied service.




Yes
No
Research - Administration
Allied Service - Please specify what
Tick the appropriate box
5.22
Please provide documented evidence of
your quality system and its operation.
Tick the appropriate box
5.23
Do you intend to acquire registration to
ISO 14001?
Tick the appropriate box
5.24
If yes to 5.23, please indicate the
expected date.




Enclosed
Not enclosed
Yes
No
Date:
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 20 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
Section 6
6.1
Human Resources
Please enclose a copy of your
recruitment policy and procedure.


Tick the appropriate box
6.2
How does the organisation assess the
suitability and competence of potential
workers?
Tick the appropriate boxes






Enclosed
Not enclosed
Job Description
Person Specification
Application Form
 Sample enclosed
 Sample enclosed
 Sample enclosed
Interview
References
 Sample enclosed
Verification Checks
(please specify)



Personal
Recommendation
Trial period before
confirmation of
employment
CRB/POVA Checks

Tests ( please specify)

Other (please specify)
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 21 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
6.3
6.4
Please enclose a copy of the
organisation’s induction policy and
procedures
Please give details of the range and
grades of staff employed by the
organisation and describe the
management structure
Tick the appropriate box


Enclosed
Not enclosed
Senior managers
Home Managers
Support workers
Day services
Respite Care
 other
(please specify)
6.5
Please indicate whether or not the
organisation has gained Investors in
People status.
Tick the appropriate box





Yes
Date gained:
Copy of certificate/notification enclosed
In progress
Expected date to gain:
Under consideration
Planned date to gain:
Not considering
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 22 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
6.6
Please enclose a copy of your Training
Plan or another document showing the
training which took place last year and
the number of staff benefiting on each
occasion.

Enclosed

Not enclosed

No
Tick the appropriate box
6.7
Does the organisation have any
experience of implementing a transfer of
staff under the Transfer of Undertaking
Protection of Employment Regulations
1993 (TUPE)?

Yes
If Yes, please give details of the
organisation’s TUPE experience.
Please provide details of the numbers of
TUPE transfers during the last five
years, the source of the staff (NHS/local
authority/independent company etc) and
the number of staff transferred on each
occasion.
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 23 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
Section 7
7.1
Equalities
As an employer, does the organisation
comply with its statutory obligations under
the Race Relations Act 1976 and the
Race Relations (Amendment) Act 2000?


No


No


No

No

No
Yes
Tick the appropriate box
7.2
In the last three years, has any finding of
unlawful racial discrimination been made
against the organisation by any court or
industrial tribunal?
Yes
Details enclosed
Tick the appropriate box
7.3
In the last three years, has the
organisation been the subject of formal
investigations by the Commission for
Racial Equality on grounds of alleged
unlawful discrimination?
Yes
Details enclosed
Tick the appropriate box
7.4
As an employer does the organisation
comply with the Sex Discrimination Act
1975, the Equal Pay Act 1975 and the
Sex Discrimination (Gender
Reassignment) Regulations 1999?

Yes
Tick the appropriate box
7.5
In the last three years, has any court or
industrial tribunal found that the
organisation has discriminated against
someone because of their sex, sexual
orientation or the level of pay it gave
them?

Yes
Details enclosed
Tick the appropriate box
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 24 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
7.6
As an employer does the organisation
undertake to comply with the Disability
Discrimination Act 1995?

Yes

No

Yes

No
a. in instructions to those concerned
with recruitment, training and
promotion?

Yes

No
b. in documents available to employees,
recognised trade unions or other
representative groups of employees?

Yes

No
c. in recruitment advertisements or
other literature?

Yes

No

Enclosed

Not enclosed
Tick the appropriate box
7.7
In the last three years, has any court or
industrial tribunal found that the
organisation has discriminated against
someone because of their disability?
Tick the appropriate box
7.8
If yes to 7.2, 7.5 or 7.7 or in relation to
7.3 and the Commission made a finding
against the organisation, what steps did
you take as a result of that finding?
7.9
Is your policy on race relations set out:
Please enclose relevant examples of the
instructions, documents, recruitment
advertisements or other literature.
Tick the appropriate box
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 25 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
7.10
Do you observe as far as possible the
Commission for Racial Equality's Code
of Practice for Employment, as
approved by Parliament in 1983, which
gives practical guidance to employers
and others on the elimination of racial
discrimination and the promotion of
equality in opportunity in employment,
including steps that can be taken to
encourage members of ethnic minorities
to apply for jobs or take up training
opportunities?

Yes
Evidence enclosed

No
Tick the appropriate box
7.11
Please provide a copy of the
organisation’s Equal Opportunities
Policies in relation to Staff
Recruitment/Employment and Service
Delivery.

Enclosed

Not enclosed
Tick the appropriate box
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 26 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
7.12
Does the organisation provide services
for people from minority groups?

Yes

No
If yes, please describe any special steps
the organisation takes to recruit and
train employees who can provide these
services.
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 27 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
Section 8
Registration, Contracts and References
8.1
Please supply details of any trade or
professional associations to which the
organisation belongs
8.2
Please provide details of your
organisation’s main operating area(s)

National (Countrywide)

Regional (e.g. North West)

Cheshire & Merseyside

Wirral

No Conditions/Requirements
Tick the appropriate box
8.3
Please indicate whether or not in the last
twelve months the organisation has been
required by any NHS or local authority
body to implement, change or improve
any areas of its operation as a condition
of registration and/or as a result of
inspection.


Please specify
Conditions/Requirements imposed
Details enclosed
If conditions/requirements have been
made please enclose details.
Tick the appropriate box
8.4
Has any registering authority ever issued
a proposal for cancellation of registration
of yourself or any other person connected
with your organisation?

Yes
Details enclosed

No
Tick the appropriate box
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 28 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
8.5
Has any registering authority imposed
conditions for registration in respect of
yourself or any other person connected
with your organisation?


No


No

No
Yes
Details enclosed
Tick the appropriate box
8.6
Has a Court or Tribunal ever made an
Order or issued a decision cancelling or
suspending registration in respect of
yourself or any other person connected
with your organisation?
Yes
Details enclosed
Tick the appropriate box
8.7
Does the organisation have experience of
working under contract conditions with a
PCT?

Yes
Tick the appropriate box
If yes, please list starting with North-West
PCTs.
If the organisation has no experience of working under contract conditions please go to Question H11
8.8
Please confirm that the organisation has
never had a contract terminated under
the terms of that contract.
Tick the appropriate box
8.9
Please confirm that the organisation has
never had a contract not renewed due to
failure to perform to the terms and
specification of that contract.




Tick the appropriate box
Confirmed
Not Confirmed
Details enclosed
Confirmed
Not Confirmed
Details enclosed
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 29 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
8.10
Please give details of any outstanding
claims, arbitration or litigation against
the organisation. If none please write
‘NONE’.
8.11
Please give details of contracts or purchase arrangements of a substantial size under which the
organisation has been delivering research in the last three years. Please provide the name of the
organisation, the full address, the department, period of contract/arrangement, service user group, annual
value, the type of service(s) delivered and contact person details who would be able to provide a
reference.
Please use the grid on the following page.
Please note that we may request references from one or more of the PCTs or organisations listed in this
section as part of the evaluation of this applicati
_______________________________________________________________________________________
Name of Organisation................................................................................................
Page 30 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
Name, Address and Department of
PCT, or other organisation
Service
User
Group(s)
Brief Description of Service
Provided
Start and end
date of
contract/
arrangement
No. of
service
users
Annual Value
of Contract /
Arrangement
Name, address, email and
telephone of person in
local/health authority or
organisation who would
provide reference
_____________________________________________________________________________________________________________________________________
Name of Organisation................................................................................................
Page 30 of 41
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
NHS WIRRAL
CONTRACT FOR THE PROVISION OF A
SMOKING PREVALENCE SURVEY
PRE-QUALIFICATION QUESTIONNAIRE
PART 2
TECHNICAL ABILITY AND EXPERIENCE
Name of Organisation ………………………………………………………………………………………………………………………………….32
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
Section 1
1.1
Technical Ability & Experience
Please indicate which types of service
users and service types the organisation
has experience in providing in the last
two years
Tick the appropriate boxes




1.2
Does your organisation have any
experience of providing smoking
prevalence surveys?

Adults
Young people (aged 16-25 years)
People living in the most 20%
disadvantaged areas
Smokers
Yes

No
Tick the appropriate box
If yes, please complete the table below
Details of the
[description of service]
provided
Types of services
provided to that
community
Local Authority /
PCT where
service provided
Volume of work
undertaken in this
service
Annual cost
charged to the
PCT/Local
Authority to
deliver this
service
Name of Organisation ………………………………………………………………………………………………………………………………….33
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
1.3
Does your organisation have any
experience of providing culturally specific
care?

Yes

No
Tick the appropriate box
If yes, please indicate the nature by completing the table below
Details of the
Community served
e.g. Sikh, Chinese,
Moslem, Hindu ,
Somali, African,
Caribbean, etc.
Types of
services
provided to that
community
Tasks Performed
Were workers of
same ethnicity
matched with
service users?
(Give
percentages)
Local Authority / PCT
where service
provided
Name of Organisation ………………………………………………………………………………………………………………………………….34
Contract for the Provision of a Smoking Prevalence Survey – Pre-Qualification
Questionnaire
1.4
Does your organisation intend to work in
partnership or sub contract with any other
party for the provision of the required
services? Please list the proposed
partners or sub-contractors
Name of Organisation ………………………………………………………………………………………………………………………………….35