New Supplier Form

New Supplier Form

CF-019-03 New Supplier Form
Company name:*
Years in business:*

0 to 2 Years3 to 5 Years6 + Years
Full name of primary contact person:*
Email for remittances:*
example@example.com
Contact Number:

Area CodePhone Number
Mobile Number*
Office or warehouse address:*
Physical address is required. PO Boxes will not be accepted.
Upload Public Liability Insurance Certificate of Currency*

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Workers or Work Cover Insurance
This company has employees and I have a workers insurance policy.I am a sole trader and I have a personal accident or income protection policy.I do not have an applicable workers insurance policy
We cannot proceed with your application as it lacks the necessary workers' insurance coverage.
Upload Certificate of Currency of policy.*

Cancelof
Professional Indemnity Insurance

(Required if undertaking design work)
Upload Certificate of Currency

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ABN:*
Are you registered for GST?*

YESNo
Account name:*
BSB:*
Account number:*
Incident & Safety Information
Safety incidents in last 3 years?*

0 Incidents1-2 Incidents3-4 Incidents5+ Incidents
Please explain in detail these incidents, including the dates of the incidents.
Environmental incidents in last 3 years?*

0 Incidents1-2 Incidents3-4 Incidents5+ Incidents
Please explain in detail these incidents, including the dates of the incidents.
Lost Time Injuries in last 3 years?*

0 Injuries1-2 Injuries3-4 Injuries5+ Injuries
Please explain in detail these injuries, including the dates of the injuries.
Medical Treatment Injury in last 3 years?*

0 Injuries1-2 Injuries3-4 Injuries5+ Injuries
Please explain in detail these injuries, including the dates of the injuries.
Fatalities in last 3 years?*

0 Fatalities1+ Fatalities
Please explain in detail these fatalities, including the dates of the fatalities.
Do you use subcontractors?*

YesNo
Do you have a full-time Safety Manager?*

YesNo
Do you have a documented Safety Management System?*

YesNo
Copy of Safety Management System*

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All information submitted by an authorized representative of the business must be accurate, truthful, and substantiated by reasonable grounds. Any misleading statements or the provision of false information will be considered a breach of legal obligations and may result in penalties.
Calculation
Low Risk Score Range: 25–32 points
Description: Safety performance and systems are considered adequate. Standard contract conditions apply.
Medium Risk Score Range: 12–24 points
Description: There are some safety deficiencies or immature safety systems. Requires specific risk control actions before engagement.
High Risk Score Range: 0–11 points
Description: Unacceptable performance or system, or inadequate information. Not to be used without significant further assessment or clarification.
Should be Empty:

New Supplier Form

Workers or Work Cover Insurance

Professional Indemnity Insurance

Incident & Safety Information