Contractor Qualification Questionna

Contractor Qualification Questionnaire

All information provided will be treated in strictest confidence. Contractors are to provide all relevant details and documents as indicated.

Contractor Details

Contractor Name: ________________________ Contractor contact person: _________________________

Designation: ____________________________ Tel: ______________ Email: ______________________

Description of Contract: ________________________________________________________________________

S/No Items Answers *Points Remarks
1. Is an EHS Director or EHS Manager assigned directly to the company? Yes0
No 0
1 2 5 (Please provide details)
2. Is the EHS Director or EHS Manager part time or full-time position assigned for responsibilities? (Please describe.) Full 0
Part 0
1 2 3 (Please provide details)
3. What percentage (%) of supervisors has completed (EHS) safety related course certificates with the company? 1 2 3 (Please provide a copy of certificates)
4. Number of Project Managers with a Construction Safety Course Certification with the company? 1 2 3 (Please provide a copy of certificates)
5 Provide all (safety related) accident statistics on record for the last three (3) major projects undertaken. Information on statistics should include total man-hours worked, accident free man-hours, total number of accidents (RIR/recordable incidents), first aid cases, near miss cases, total man-days lost, number of lost time incidents (LTI), causes & specific nature of injuries and part of body injured for (Recordable Injuries), all fatalities with root cause of incident from each project. (Separate all EHS accident statistics by project to include name of project, location of project and dates of project duration) meaning show three separate projects with EHS accident data.
6. Total number of LTI’s (Lost Time Incidents) based on recent 3 major Projects (If worked on M+W Project, please use them). Combine project totals. 1 2 3 (Please provide details)
7. What is the Total (Recordable Injury Rate) on the last three major projects? Include M+W Projects if worked.
Rate = Cases X 200,000 ÷ Total employee hours 1 2 3 (Please provide details)
8. Average man days lost based on recent 3 major Projects (If worked on M+W Project, please use them).
(Lost workday case) injuries involving days away from work. Rate = Cases X 200,000 ÷ Total employee hours 1 2 3 (Please provide details)
9. Does company have EHS training programs and award programs for workers and supervisors? Yes 0
No 0
1 2 3 (Please provide details)
10. Clearly defined EHS responsibilities and accountabilities for managers, supervisors, and employees? Yes 0
No 0
1 2 3 (Please provide details)
11. Does company have an active EHS discipline policy? Yes 0
No 0
1 2 3 (Please provide details)
12. Does the company have Stop Work Policy for all employees on the project? Yes 0
No 0
1 2 3 (Please provide details)
TOTAL: of 35 points
S/No Items Answers *Points Remarks
13. Has the company received a “safety award” from an organization for EHS programs or achievements? Yes 0
No 0
1 2 3 (Please provide details)
14. Has the company obtained OHSAS 18001 and ISO 14001 certification? OHSAS 18001 is an Occupation Health and Safety Assessment Series (health and safety management systems). ISO 14001 is an International organization for standardization (environmental management systems) Yes 0
No 0
0 15 (Please provide a copy of certificates)
14a. If no, OHSAS 18001 and ISO 14001 certification:
15. Does the company have an EHS Policy? Yes 0
No 0
1 2 3 (Please provide a copy)
16. Is EHS included in the company organization? Yes 0
No 0
1 2 3 (Please provide company ORG chart)
17. Does the company have an EHS (safety) committee? Yes 0
No 0
1 2 5 (Please provide a copy of latest list participants)
18. Is the company EHS committee meeting conducted regularly? How often? Yes 0
No 0
1 2 3 (Please provide a copy of meeting minutes/schedule)
19. Does company have EHS rules and regulations available to employees? Yes 0
No 0
1 2 3 (Please provide a list and examples)
20. Is an EHS Inspection/Audit program active? Yes 0
No 0
1 2 3 (Please provide a copy of program)
21. Is a hazard identification and risk control method active? Yes 0
No 0
1 2 3 (Please provide a copy of form & risk matrix)
22. Is a written process to report, investigate, and record incidents active? Yes 0
No 0
1 2 3 (Please provide a copy of form/incident)

23. Does company use & understand the HES-related government and local regulations pertaining to your construction safety program? Yes 0
No 0
1 2 3 (Please provide a copy of all regulations/codes)
24. List all EHS related Vietnam Governmental and Ministry EHS regulations were obtained from. Yes 0
No 0
1 2 3 (Please provide a copy of the completed list)
25. Does the company require health exam & health insurance for every employee? Yes 0
No 0
1 2 3 (Please provide proof)
26. Total no. of employees employed within company? Please indicate here:
27. No. of foreign workers employed with company? What positions? Please indicate here: (List country & name of positions)
28. Percentage (%) of permanent EHS Personnel in the company with respect to total permanent staff. 1 2 3
TOTAL : of 56 points


S/No. Items Answers *Points Remarks
Other relevant supporting information:
29. Does company have an environmental policy? Yes 0
No 0
1 2 3 (Provide copy of document)
30. Does company provide EHS induction training? Yes 0
No 0
1 2 3 (Provide copy of training materials)
31. Does company require workers on site to wear PPE? Safety glasses, work boots, hard hat & high visibility vest? Explain details. Yes 0
No 0
1 2 3
TOTAL: of 9 points
OVERALL TOTAL SCORE % : of 100 points
Prepared by:
Name: Designation:
Date: Signature:


* Points column is for M+W use only



Evaluation

Comments by the Evaluator #1:






Evaluations done by: ____________________________________________________
Name/ Signature/ Date


Comments by the Evaluator #2:







Evaluations done by: ____________________________________________________
Name/ Signature/ Date

Kết quả (Anh) 1:

Contractor Qualification Questionnaire All information provided will be treated in strictest confidence. Contractors are to provide all relevant details and documents as indicated.Contractor DetailsContractor Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Contractor contact person: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Designation: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _: _ _ _ _ _ _ _ _ _ _ _ _ _ _: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Description of Contract: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _S/No Items Answers * Points Remarks1. Is an EHS Director or EHS Manager assigned directly to the company? Yes0 No 01 2 5 (Please provide details)2. Is the EHS Director or EHS Manager part time or full-time position assigned for responsibilities? (Please describe.) Full 0Part 01 2 3 (Please provide details)3. What percentage (%) of supervisors has completed (EHS) safety related course certificates with the company? 1 2 3 (Please provide a copy of certificates)4. Number of Project Managers with a Construction Safety Course Certification with the company? 1 2 3 (Please provide a copy of certificates)5 Provide all (safety related) accident statistics on record for the last three (3) major projects undertaken. Information on statistics should include total man-hours worked, accident free man-hours, total number of administering (RIR/recordable incidents), first aid cases, near miss cases, total man-days lost, the number of lost time incidents (LTI), causes & specific nature of injuries and part of body injured for (Recordable Injuries), all fatalities with root cause of incident from each project. (Separate all EHS accident statistics by project to include name of project, location of project and dates of project duration) meaning show three separate projects with EHS accident data.6. the Total number of LTI's (Lost Time Incidents) based on recent 3 major Projects (If worked on M + W Project, please use them). Combine project totals. 1 2 3 (Please provide details)7. What is the Total (Recordable Injury Rate) on the last three major projects? Include M + W Projects if worked.Rate = Cases X 200.000 ÷ Total employee hours 1 2 3 (Please provide details)8. the Average man days lost based on recent 3 major Projects (If worked on M + W Project, please use them). (Lost workday case) injuries involving days away from work. Rate = Cases X 200.000 ÷ Total employee hours 1 2 3 (Please provide details)9. Does the company have EHS training programs and award programs for workers and supervisors? Yes 0No 01 2 3 (Please provide details)10. Clearly defined EHS responsibilities and accountabilities for managers, supervisors, and employees? Yes 0No 01 2 3 (Please provide details)11. Does the company have an active EHS discipline policy? Yes 0No 01 2 3 (Please provide details)12. Does the company have Stop Work Policy for all employees on the project? Yes 0No 01 2 3 (Please provide details) TOTAL: of the 35 points S/No Items Answers * Points Remarks13. Has the company received a "safety award" from an organization for EHS programs or achievements? Yes 0No 01 2 3 (Please provide details)14. Has the company obtained OHSAS 18001 and ISO 14001 certification? OHSAS 18001 is an Occupation Health and Safety Assessment Series (health and safety management systems). ISO 14001 is an International organization for standardization (environmental management systems) Yes 0No 00 15 (Please provide a copy of certificates)14A. If no, OHSAS 18001 and ISO 14001 certification: 15. Does the company have an EHS Policy? Yes 0No 01 2 3 (Please provide a copy)16. Is included in the company EHS organization? Yes 0No 01 2 3 (Please provide company ORG chart)17. Does the company have an EHS (safety) committee? Yes 0No 01 2 5 (Please provide a copy of the latest list participants)18. Is the company EHS committee meeting conducted regularly? How often? Yes 0No 01 2 3 (Please provide a copy of the meeting minutes/schedule)19. Does the company have the EHS rules and regulations available to employees? Yes 0No 01 2 3 (Please provide a list and examples)20. Is an EHS Inspection/Audit program active? Yes 0No 01 2 3 (Please provide a copy of program)21. Is a hazard identification and risk control method of active? Yes 0No 01 2 3 (Please provide a copy of the form & risk matrix)22. Is a written process to report, investigate, and record incidents active? Yes 0No 01 2 3 (Please provide a copy of the form/incident)23. Does company use & understand the HES-related government and local regulations pertaining to your construction safety program? Yes 0No 01 2 3 (Please provide a copy of all regulations/codes)24. List all EHS related Vietnam Governmental and Ministry EHS regulations were obtained from. Yes 0No 01 2 3 (Please provide a copy of the completed list)25. Does the company require a health exam & health insurance for every employee? Yes 0No 01 2 3 (Please provide proof)26. Total No. of employees employed within the company? Please indicate here: 27. No. of foreign workers employed with company? What positions? Please indicate here: (List country & name of positions)28. Percentage (%) of permanent EHS Personnel in the company with respect to total permanent staff. 1 2 3 TOTAL: of 56 points S/No. Items Answers * Points Remarks Other relevant supporting information:29. Does the company have an environmental policy? Yes 0No 01 2 3 (Provide copy of document)30. Does company provide EHS induction training? Yes 0No 01 2 3 (Provide copy of training materials)31. Does the company require workers on site to wear PPE? Safety glasses, work boots, hard hat & high visibility vest? Explain details. Yes 0No 01 2 3 TOTAL: of 9 pointsOVERALL TOTAL SCORE% of 100 pointsPrepared by:Name: Designation: Date: Signature: * Points column is for M + W use onlyEvaluationComments by the Evaluator # 1:Evaluations done by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Name/Signature/DateComments by the Evaluator # 2:Evaluations done by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Name/Signature/Date

Kết quả (Anh) 2:

Contractor Qualification Questionnaire All information given below strictest confidence Will Be Treated print. Contractors are to the relevant details and documents cung all as indicated. Contractor Details Contractor Name: ________________________ contact person Contractor: _________________________ Designation: ____________________________ Tel: ______________ Email: ______________________ Description of Contract: ________________________________________________________________________ S / No Items Answers * Points Remarks 1. EHS is an EHS Manager or Director to the company gán trực? Yes0 No 0 1 2 5 (Hãy details) 2. Is the EHS Director EHS Manager or part time or full-time position for gán Responsibilities? (Please describe.) Full 0 Part 0 1 2 3 (Hãy details) 3. What percentage (%) of supervisors has completed (EHS) related safety course certificates with the company? 1 2 3 (a copy of certificates Hãy) 4. Number of Project Managers with a Construction Safety Certification Course with the company? 1 2 3 (a copy of certificates Hãy) 5 Provide all (safety related) accident statistics for the last record on three (3) major projects undertaken. Information on statistics shouldnt total man-hours worked include, accident free man-hours, total number of accidents (RIR / recordable incidents), First Aid Cases, near miss Cases, total man-days lost, number of lost time incidents (LTI) , Causes & nature of injuries and specific part of the body Injured for (Recordable Injuries), root-cause of all fatalities with incident from each project. (Separate all EHS accident statistics by the project to include the name of the project, location of project and Dates of project duration) nghĩa chia show three projects with EHS accident data. 6. Total number of LTI's (Lost Time Incidents) based on 3 major recent Projects (If M + W Project worked on, please use added). Combine project totals. 1 2 3 (Hãy details) 7. What is the Total (Recordable Injury Rate) on the last three major projects? M + W Projects Include if worked. Rate = Cases X 200,000 ÷ Total employee hours 1 2 3 (Hãy details) 8. Average man hours lost based on 3 major recent Projects (If M + W Project worked on, please use added). (Lost workday case) injuries involving days away from work. Rate = Cases X 200,000 ÷ Total employee hours 1 2 3 (Hãy details) 9. Does company have EHS training programs and award programs for workers and supervisors? Yes 0 No 0 1 2 3 (Hãy details) 10. Clearly defined Responsibilities and accountabilities for EHS managers, supervisors, and employees? Yes 0 No 0 1 2 3 (Hãy details) 11. Does company have an active policy EHS discipline? Yes 0 No 0 1 2 3 (Hãy details) 12. Does the company have the Stop Work Policy for all employees on the project? Yes 0 No 0 1 2 3 (Hãy details) TOTAL: 35 points of S / No Items Answers * Points Remarks 13. Has the company received a "safety award" from an organization for EHS programs or achievements? Yes 0 No 0 1 2 3 (Hãy details) 14. Has the company thu được OHSAS 18001 and ISO 14001 certification? OHSAS 18001 is an Occupation Health and Safety Assessment Series (health and safety management systems). ISO 14001 is an International Organization for Standardization (Environmental Management Systems) Yes 0 No 0 0 15 (a copy of certificates Hãy) 14a. If no, OHSAS 18001 and ISO 14001 certification: 15. Does the company have an EHS Policy? Yes 0 No 0 1 2 3 (Hãy a copy) 16. EHS is included in the company organization? Yes 0 No 0 1 2 3 (ORG company Hãy chart) 17. Does the company have an EHS (safety) committee? Yes 0 No 0 1 2 5 (a copy of Latest Hãy Participants list) 18. Is the company regularly Conducted EHS committee meeting? How Often? Yes 0 No 0 1 2 3 (a copy of meeting Hãy minutes / schedule) 19. Does company have rules and Regulations EHS available to employees? Yes 0 No 0 1 2 3 (Hãy a list and examples) 20. EHS is an Inspection / Audit program active? Yes 0 No 0 1 2 3 (a copy of program Hãy) 21. Hazard identification and risk is a active control method? Yes 0 No 0 1 2 3 (a copy of the form Hãy & risk matrix) 22. Written speaker is a process to report, Investigate, and record active incidents? Yes 0 No 0 1 2 3 (a copy of the form Hãy / incident) 23. Does the company use & HES-related hiểu and local government requirements Regulations pertaining to your construction safety program? Yes 0 No 0 1 2 3 (a copy of all Hãy Regulations / codes) 24. List all EHS related Vietnam Governmental and Ministry EHS Regulations là thu được from. Yes 0 No 0 1 2 3 (Hãy copy of the completed a list) 25. Does the company require health exam for every employee & health insurance? Yes 0 No 0 1 2 3 (Hãy proof) 26. Total no. trong company of employees employed? Please indicate here: 27. No. of foreign workers employed with company? What positions? Please indicate here: (List name of country & positions) 28. Percentage (%) of permanent EHS Personnel in the company with respect to total permanent staff. 1 2 3 TOTAL: 56 points of S / No. Items Answers * Points Remarks Supporting the relevant Other information: 29. Does company have an Environmental policy? Yes 0 No 0 1 2 3 (Provide copy of document) 30. Does EHS induction training cung company? Yes 0 No 0 1 2 3 (Provide copies of training materials) 31. Does company require workers to wear PPE on site? Safety glasses, work boots, hard hat high visibility vest &? Explain details. Yes 0 No 0 1 2 3 TOTAL: of 9 points OVERALL TOTAL SCORE%: of 100 points Prepared by: Name: Designation: Date: Signature: * Points column is for use only M + W Evaluation Comments by the Evaluator # 1: Evaluations done by: ____________________________________________________ Name / Signature / Date Comments by the Evaluator # 2: Evaluations done by: ____________________________________________________ Name / Signature / Date