SAMPLE TEMPLATE - Amazon S3 · Web viewType of Organisation (Pty Ltd, Public Ltd, Partnership/Sole Trader) Number of Employees Please provide contact details within your Organisation

PROCEDURAL FORMPF-7-05-04 SUPPLIER PRELIMINARY QUESTIONNAIRE

1 ORGANISATION PROFILE

Will your organisation comply, if required, with Our Code and our Anti-Corruption policy? Yes No

Is your Company a Supplier Contractor

Registered Name

Postal Address

Post Code

ABN No.

Trading Name

Email Address

Name of Bank

BSB

Account Number

Type of Organisation (Pty Ltd, Public Ltd, Partnership/Sole Trader)

Number of Employees

Please provide contact details within your Organisation

Position Name Telephone Email Address

Manager

Sales/Estimating

Production/Construction

Accounts

Who is your contact for the Company?

Contact Name

Does your organisation have a minimum of 25% indigenous ownership? Yes No

2 INDUSTRY CLASSIFICATION

Select your Organisations primary business

Accommodation & Diners Business Services ConstructionCultural & Recreational Services Education & Training Finance & InsuranceHealth & Community Services Information Tech & Comm MiningManufacturing Plant & Equipment Retail TradeTransport & Storage Wholesale Trade Other (please specify)

document.docx 1 OF 9MODIFICATION: ADDED APPROVAL SECTION APPROVED BY: R.HARCOURT REV. DATE: 17.07.2015


Please detail your Organisation’s Work Type, i.e. if Construction, the Work Type may be concreting, or drilling etc.

3 LEGAL

Has your Organisation been prosecuted by a regulatory body? Yes No

If Yes, please provide further information

Is your Organisation involved in any bankruptcy or reorganisation proceedings? Yes No

If Yes, please provide further information

4 REFERENCES

Provide contact information for your current or previous 3 jobs

Name Referee 1 Referee 2 Referee 3

Client Name

Contact Name

Contact Details

Fax Number

Email Address

Value $

5 INSURANCES

Please complete and supply copies of current certificates of insurances in ALL INSTANCES

Insurance Type Insurer Policy Number Expiry Date Value

Workers Comp

Professional Indemnity

Public Liability

Motor Vehicle



Other - Marine Cargo Ins

6 REGISTRATIONS AND LICENCES

Provide details of, and expiry dates of all statutory Registrations and Licences held by your Organisation for example: Builders, Classified Plant, Painters, Registrations, Plumbing, Electrical, Gas, Dangerous Goods, Radiation, Explosives, Dewatering, Demolition Licences, etc.

S. No Registration Type Registration Number Expiry Date

1

2

3

4

Provide details of licences

S. No Licence Type Licence Number Expiry Date

1

2

3

4

7 ORGANISATIONAL STABILITY

How long has your Organisation been in business in Australia?

What percent of your Organisations business is repeat work from existing clients?

What is the number of years of Construction industry experience of your Organisation?

Has your Organisation ever been involved in legal proceedings with a Client?

Has any Partner, Principal or other person with an interest in the Organisation ever been associated with any other Organisation or any entity which has failed in the last 5 years to complete a Contract?

8 PERSONNEL QUALIFICATIONS

What is the average number of years of Construction industry experience of your workforce?

What percentage of your management team have recognised technical, tertiary and/or trade



qualifications?

What percentage of your field personnel have recognised trade certificates?

What percentage of your plant operators hold relevant National tickets to operate mobile plant?

9 PLANT & EQUIPMENT

What percentage of your plant & equipment is more than 5 years old?

Is your plant and equipment regularly serviced and maintained?

Is maintenance history/service records available for your plant and equipment?

What is the condition of your plant and equipment?

When bringing mobile plant on our site will you provide risk assessments and service records?

10 QUALITY

Is your Organisation accredited to ISO 9001 or equivalent standard? If you answer NO, go to Part B.

If yes provide details

Accreditation Standard

Accreditation Body

Certificate Number

Certificate Expiry Date

Date of Last Audit

No. of Non-conformances in last audit

Part B: If you Organisation is not accredited to ISO 9001 or equivalent standard, then answer following question

How many of the following checklists and controls are documented are in use in your Organisation?

Tender & Contract review

Resource Control

In-process Inspection

Non-Conformance Control

Purchasing Control

Incoming Inspection

Records Control



Calibration & Maintenance

Will you conform to our Quality Management System and site specific Quality Management Plan?

Yes No

11 OCCUPATIONAL SAFETY & HEALTH (OSH)

Is your Organisation accredited to AS 4801 or equivalent standard? If you answer NO, go to Part B.



Accreditation Body

Certificate Number


Date of Last Audit


Part B: If your Organisation is not accredited to AS 4801 or equivalent standard, then answer following questions

Does your Organisation have a documented OSH Policy?

Are employees involved in developing Job Hazard Analysis/SWMS?

Does your Organisation have a documented incident/accident investigation procedure?

Are Supervisors/Senior Management involved in incident/accident investigation?

Are Material Safety Data Sheets (MSDS) available to all employees for hazardous substances?

Does your Organisation have an Alcohol & Drugs Policy and procedures in place?

Are records maintained for all training and induction programs undertaken for your employees?

Does your Organisation conduct regular workplace inspections?

Does your Organisation have formal processes in place for handling workplace grievances

Has your Organisation had any fatalities or permanent disabilities accidents in the past 3 years?

Provide safety statistics for the last 3 years

S. No Year No. of Lost Time Accidents No. of Medically Treated Injuries



1

2

3

Will you conform to our OSH Management System and site specific OSH Management Plan? Yes No

12 ENVIRONMENT

Is your organisation accredited to AS/NZS ISO 14001 or equivalent standard?



Accreditation Body

Certificate Number


Date of Last Audit


If no, answer the following questions

Do you have procedures in place to ensure that project planning identifies environmental risks?

Do you establish environmental management plans that address identified project risks?

Has your Organisation been issued with any infringement notice by Environmental Protection Agency in last 2 years?

Will you conform to our Environmental Management System and site specific Environment Management Plan? Yes No

13 INDUSTRIAL RELATIONS

Does your Organisation have a documented Industrial Relations Policy?

Did your Organisation have any industrial disputes in the past 3 years?

What type of Industrial Instrument does your Organisation have in place?

If your Organisation is associated with any Unions, then provide name of the Union





DECLARATION

On behalf of our Organisation, I hereby certify that the information provided in this questionnaire is an accurate reflection of our Organisation and we will provide appropriate documented evidence if requested. I also confirm access will be permitted to our Organisation premises for audit if requested.

Name of Organisation

Name of Authorised Signatory

Position

Date

Signature

For office use only

Name of Assessor Date

Signature Rating Approved Review

Comments

Commercial Manager/System Manager approval:

Name Date

Signature




Documents

SAMPLE TEMPLATE - Amazon S3 · Web viewType of Organisation (Pty Ltd, Public Ltd, Partnership/Sole Trader) Number of Employees Please provide contact details within your Organisation