Subcontractor Health And Safety Prequalification Form (Page 3 of 6) in pdf

Subcontractor Health And Safety Prequalification Form Page 3

Subcontractor Health and Safety Prequalification Form

Pre-placement (yes or no)?

Hearing Function – Audiograms (yes, no, or NA)?

Respiratory – Pulmonary Function (yes, no, or NA)?

List types and describe frequency of all medical examinations:

Do you have personnel trained to perform first aid and CPR (yes or no)?

Describe how you will provide first aid and other medical services to your employees:

Do you provide first aid kits (yes or no)?

Do you hold site health and safety meetings for:

Field Supervisors (yes or no)?

Employees (yes or no)?

New Hires (yes or no)?

Subcontractors (yes or no)?

Are safety and health meetings documented (yes or no)?

Is applicable/required PPE provided to your employees (yes or no)?

Do you have a program to assure PPE is inspected and maintained (yes or no)?

Do you have a corrective process for addressing individual safety deficiencies (yes or no)?

Do you have programs and process that address equipment and material issues including:

Specifications for acquisition of material/equipment (yes or no)?

Inspections of equipment to assure regulatory compliance (yes or no)?

Routine maintenance to assure safe and compliant equipment (yes or no)?

Maintenance of equipment inspection/maintenance/certification records (yes or no)?

Do you use subcontractors (yes or no)

If you answer yes, answer each of the following questions:

Do you use health and safety performance criteria in selecting subcontractors (yes or no)?

Do you evaluate subcontractor health and safety compliance capability during selection (yes or no)?

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

Do you include your subcontractors in your:

Health and Safety Health Orientation (yes or no)?

Health and Safety Meetings (yes or no)?

Equipment Inspections (yes or no)?

Safety Audits (yes or no)?

Page 3 of 6

Subcontractor Health And Safety Prequalification Form Page 3