Subcontractor Health And Safety Prequalification Form printable pdf download

Subcontractor Health And Safety Prequalification Form

Subcontractor Health and Safety Prequalification Form

General Information

Company Name:

Phone:

Fax:

Street Address

Mailing Address

Health and Safety Management

Highest ranking health/safety professional in company:

Name:

Title:

Phone:

FAX:

Email:

Certifications/Qualifications (CSP, CIH, etc):

Do you have or provide:

Fulltime Health/Safety Director (yes or no)?

Fulltime Health/Safety Supervisor (yes or no)?

Fulltime Job Health/Safety Coordinator (yes or no)?

Health/Safety Incentive Program (yes or no)?

Company paid Health/Safety Training (yes or no)?

Health and Safety Programs and Procedures

Do you have a written health and safety program (yes or no)?

Do you have a written program that address the following key elements:

Management commitment and expectations (yes or no)?

Employee participation (yes or no)?

Accountability and responsibility for managers, supervisors, and employees (yes or no)?

Resources for meeting safety and health requirements (yes or no)?

Periodic health and safety performance appraisals for all employees (yes or no)?

Hazard recognition and control (yes or no)?

Do you have a written program that satisfies your responsibility under the law for:

Ensuring your employees follow the safety rules of the facility/project location (yes or no)?

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Subcontractor Health And Safety Prequalification Form