COMPANY DETAILS
Company Name
*
Company Email
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example@example.com
Company Address
*
Company Postcode
*
Phone Number
*
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PERSON COMPLETING THIS FORM
Full Name
*
Job Title
*
Email Address
*
example@example.com
Phone Number
*
Number of Employees
*
Main Activity/s of company
*
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ARRANGMENTS
Who is Responsible for H&S within the company?
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Job Title
*
Qualifications
Attach a company H&S organogram if available
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Do you use an external H&S representative?
*
Please Select
Yes
No
Please provide their details
Does your company have a H&S policy?
*
Please Select
Yes
No
Please attach, signed & dated within the last 12mths
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Does your company have a H&S policy statement?
*
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Yes
No
Please attach, signed & dated within the last 12mths
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Does your company provide H&S training and issue guidance when required?
*
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Yes
No
Please attach training records/tool box talk sample
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Does your company carry out risk assessment & method statements and review these on an annual basis?
*
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Yes
No
Does your company provide suitable PPE free of charge to all staff?
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Yes
No
Please attach PPE issue log
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Does your company have a system for reporting, recording and investigating accidents, incidents, dangerous occurrences etc.?
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Yes
No
Does your company employ processes/use materials which are hazardous?
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Yes
No
(A) Do you complete and provide COSHH assessments?
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Yes
No
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(B) Do you have all the Material Safety Data Sheets (MSDS) on file?
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Yes
No
(C) Do you have written risk assessment and method statement (RAMS) for these materials and processes?
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Yes
No
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MONITORING
Does your company carry out worksite inspections?
*
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Yes
No
Please give the details of who carries out the inspections
Attach a sample inspection
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Does your company carry out work equipment inspections?
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Yes
No
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Service Quality
Rows
2020
2021
2022
Service Quality
Cleanliness
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SANCTIONS
Check all that apply please:
*
We verify whether any of our suppliers are owned, in full or in part, by any sanctioned individuals or any sanctioned entities
We verify whether any sanctioned individuals occupy any of our suppliers boards, or are appointed as senior officers of our suppliers companies (including suppliers’ parent companies)
We verify whether our supply chain features suppliers with headquarters in Russia, or suppliers who are owned (partially or wholly) by Russian companies or Russian nationals (incl. those not on any sanction list)
We verify whether our suppliers transact with any sanctioned financial institutions
We verify whether our suppliers utilise gas with origination in Russia in their production process/es
We are not currently undertaking any of these checks
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LEGAL
Please state the level of indemnity and public liability insurance
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Please attach a copy of the current policy
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Has the company, any of its subsidiaries or directors ever been served with an improvement or prohibition notice or been prosecuted by the HSE?
*
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Yes
No
Please give full dates and details
Has the company previously traded under a different name?
*
Please Select
Yes
No
What was the previous name?
DBS Checks
Some of our sites require DBS certification details to be provided.
Please confirm if you have up to date DBS checks for personal planned to work on our sites and if not that you are willing to get these background checks carried upon our request.
*
Yes (up to date DBS certification held)
No (we do not have up to date DBS certification)
On request we will obtain and supply DBS check certification
Please ensure you provide along with this questionnaire any relevant certifications and qualifications for your business.
Additional Comments & General Relevant Information
Upload any certificates or any other file that is relevant please:
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Signature
Please confirm that you will not further sub contract work which you have been contracted to carry out on behalf of J.C Watson Mechanical Ltd.
*
I agree
Name
*
Signature
*
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Office 2, Cecils Barn, Field House Farm, Dunnings Lane, Brentwood Essex, CM13 3HE
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