Your Name (required)

Company Name and Address (required)

Nature of Business

Your Email (required)

Telephone (required)

Have you got a Health and Safety Policy?
YesNo

If yes, please provide a copy

How many of the following you have reported under RIDDOR in the last 3 years: Specific Injuries, Over 7 Day Injuries, Dangerous Occurrences, Reportable Diseases?

Have you been served with any improvement notices within the last 3 years?
YesNo

If ‘Yes’ please provide details

Have you been prosecuted for a Health and Safety offence in the last 3 years?
YesNo

If ‘Yes’ please provide details

Please provide 2 examples of work carried out in the last 12 months, where the risks are comparable with those of the work for which you wish to be considered:

Are you a member of or accredited by a trade organisation?
YesNo

If ‘Yes’ please provide details

Please provide examples of site specific risk assessments completed in the past 12 months

Please provide examples of site specific method statements completed in the past 12 months

Please Provide copies of your insurance certificates/schedules or brokers letters for: Public Liability, Product Liability (where appropriate), Employers Liability (where appropriate), Professional Indemnity (where appropriate)

Please provide 2 references from similar jobs completed in the past 12 months

Please describe your onsite arrangements for monitoring your staff to ensure the task is completed to the specification

Please provide details and evidence of staff competencies, e.g. CSCS cards

Upload evidence

Please provide the name, qualifications and or experience of your internal Health and Safety Co-coordinator. If you also use and external source please provide full details

Please provide details of your co-operation and co-ordination arrangements when working on a multi-disciplined job with other trades.

Do you issue your staff with appropriate personal protective equipment for the job?
YesNo

If ‘Yes’ please provide issue records

If ‘No’ please justify the reasons for not adhering to the requirements of the Personal Protective Equipment at Work Regulations 1992 as amended.

How do you ensure all equipment used on site is well maintained and safe for use?

Do you appoint sub-contractors?
YesNo

If ‘Yes’ please provide details of how you assess the competence of your sub-contractors prior to appointment

How do you monitor the performance of your sub-contractors?