Construction Contractor Assessment Form (FRM-GRP-007g)

1. Business Information

Business Type *

Company or Trust
Partnership
Sole Trader

Company or Trading Name (the Applicant) *

ABN or ACN *

Contact Person *

Email

Phone *

Street Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Is the Applicant's postal address the same as the street address?

Yes
No

Postal Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

2. NATURE OF WORK

2a. Does your business undertake any of the following activities for Hazell Bros utilising a heavy vehicle (greater than 4.5TGVM or GCM) on a road: (Check if applicable)

Contracting, directing or employing a person to drive a vehicle;
Contracting, directing or employing a person to carry out another activity associated with the use of the vehicle (such as maintaining or repairing the vehicle);
Consigning goods for transport using the vehicle
Scheduling the transport of goods or passengers using the vehicle
Packing goods for transport using the vehicle;
Managing the loading of goods onto or unloading of goods from the vehicle
Loading goods onto or unloading goods from the vehicle
Receiving goods unloaded from the vehicle.

If you ticked any of the above, you are required to communicate the Hazell Bros Chain of Management Plan to your employees/subcontractors. Click > HAZELL BROS CHAIN OF RESPONSIBILITY MANAGEMENT PLAN

2b. Does the Applicant have a scheduled maintenance program for vehicles/plant ? *

Yes
No

Periodically, Hazell Bros or its Auditors will request to view these records. Failure to produce will result in a non-conformance or suspension of services.

Provide evidence of current vehicle/plant maintenance

Click or drag a file to this area to upload.

2c. Are all vehicles and plant and machinery that access public roads registered? *

Yes
No

Periodically, Hazell Bros or its Auditors will request to view these records. Failure to produce will result in a non-conformance or suspension of services.

3. Employee and Subcontractor Information

Hazell Bros requires all contractors to ensure that they and their employees and subcontractors comply with Hazell Bros and/or site health and safety requirements as outlined in the CONTRACTOR HANDBOOK by clicking> CONTRACTOR HANDBOOK

3a. Is the work generally undertaken in a supervised environment? *

Yes
No
Sole Operator

3b. Does the applicant engage employees and/or subcontractors? *

No-sole trader
Yes-employees
Yes-subcontractors
Yes-subcontractors and employees

Choose one

3c. Approximate number of employees, including owners, who may directly undertake work for Hazell Bros

3d. Is the Applicant compliant with the Fair Work Act 2009 ? *

Yes
No
Not Applicable (no employees)

3b. Do all of the Applicant's employees hold current valid Australian issued qualifications/licences/tickets to undertake the work indicated above for Hazell Bros *

Yes
No

Periodically Hazell Bros or its Auditors may request to view these records. Failure to produce will result in a non-conformance or suspension of services.

3c. Do all of the Applicant's employees who will be undertaking work on a construction site for Hazell Bros hold White Cards *

Yes
No
N/A

Personnel cannot perform construction work without having successfully completed the General Construction Induction Training and hold a General Induction Construction Training Card – White Card

3d. I declare that the Applicant holds records of subcontractor insurances, licences, maintenance and vehicle registration numbers *

Yes
No

Periodically Hazell Bros or its Auditors may request to view these records. Failure to produce will result in a non-conformance or suspension of services.

4. Management Systems

4a. Does the Applicant have a Management System *

Yes
No. I hereby declare that the Applicant does not have its own Management System and will comply with Hazell Bros Management System and/or Site Requirements as described in the CONTRACTOR HANDBOOK which can be downloaded by clicking on the words CONTRACTOR HANDBOOK

Tick if any of the following are applicable:

Safety Management System Standard (e.g. AS 4801, OFSC)
Environmental Management System Standard (e.g. ISO 14001)
Quality Management System Standard (e.g. ISO 9001)

Certificate not currently available?

I will attach to separate email when available
See comment at end of form

Please attach Safety Management System Certification

Click or drag a file to this area to upload.

Please attach Environmental Management System Certification

Click or drag a file to this area to upload.

Please attach Quality Management System Certification

Click or drag a file to this area to upload.

4b. Has the Applicant had any Environmental incidents during the last three years, or received any environmental notices or prosecutions from any authority? *

Yes
No

Provide details

4c. Has the Applicant had any OH&S improvement and prohibition notices, or been prosecuted by any statutory authorities in the last three years? *

Yes
No

Provide details

5. Insurance Details

Does the Applicant have any of the following insurances: *

Public Liability ($20M)
Workers Compensation (Mandatory if the Applicant engages employees)
Commercial Motor Vehicle/Fleet (Mandatory for all vehicles undertaking work for Hazell Bros)
Plant & Equipment (Mandatory for all Plant & Equipment undertaking work for Hazell Bros)
Professional Indemnity
Industrial Special Risks
Cargo/Marine Transit

Certificate/s not currently available to upload?

I will attach to separate email when available
See comment at end of form

Attach copies if applicable:

Click or drag a file to this area to upload.

Public Liability

Attach copies if applicable:

Click or drag a file to this area to upload.

Workers Compensation

Attach copies if applicable:

Click or drag a file to this area to upload.

Motor Vehicle

Attach copies if applicable:

Click or drag a file to this area to upload.

Professional Indemnity

Attach copies if applicable:

Click or drag a file to this area to upload.

Plant & Equipment

Attach copies if applicable:

Click or drag a file to this area to upload.

Industrial Special Risks

Attach if applicable:

Click or drag a file to this area to upload.

Cargo

6. Contractor Declaration

Declaration 1 *

I hereby declare the information provided is a true and accurate reflection of the Applicant's Management Systems and processes. I agree to ensure compliance with the Applicant's business management systems and processes and instruction issued by Hazell Bros during the course of work. I understand my responsibilities as a contractor to Hazell Bros, and will communicate these to persons under my control.

Contractor Handbook Confirmation *

I confirm receipt of CONTRACTOR HANDBOOK

Click on CONTRACTOR HANDBOOK above to download.

Smoke-Free Workplace Policy Confirmation *

I confirm receipt of HAZELL BROS SMOKE FREE WORKPLACE POLICY

Click on SMOKE FREE WORKPLACE POLICY above to download.

Audit Confirmation *

I understand that periodically Hazell Bros or its Auditors may request to view documentation as noted throughout this form and that failure to produce will result in a non-conformance or suspension of services.

Binding Confirmation *

I confirm that I am authorised to bind the Applicant to the terms and conditions indicated.

Name of the person completing this declaration: *

Position held: *

Date: *

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