Industrial Services & Plant Hire Assessment Form - FRM-GRP-007C

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

What is the planned nature of the service/s to be provided to Hazell Bros? *

Driver/Operator Only
Plant & Equipment Hire
Transport Services

2. Fleet Information

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

Provide GVM details for trucks and trailers

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 which can be downloaded by clicking on the words CONTRACTOR HANDBOOK

3a. Does the Applicant engage employees and/or subcontractors? *

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

Choose one

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

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

Yes
No
Not Applicable (no employees)

3d. Do all of the Applicant's employed drivers/operators hold current valid Australian issued licences/tickets to operate plant and machinery to be used in undertaking work 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.

3e. Do all of the Applicant's employed drivers/operators who will be undertaking work for Hazell Bros hold White Cards

Yes
No

All drivers/operators entering a construction site are required to hold a White Card which they may be required to produce on request.

3f. 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

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

Please attach Environmental Management System Certification

Please attach Quality Management System Certification

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

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 ($20million Mandatory for all Contractors)
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:

Public Liability

Attach copies if applicable:

Workers Compensation

Attach copies if applicable:

Motor Vehicle

Attach copies if applicable:

Professional Indemnity

Attach copies if applicable:

Plant & Equipment

Attach copies if applicable:

Industrial Special Risks

Attach if applicable:

Cargo

Rates

Please provide your rates by uploading to the field below or typing directly into Rates area below

File Upload

Rates

6. Contractor Declaration

Confirmation *

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.

COR Confirmation *

I confirm receipt of HAZELL BROS CHAIN OF RESPONSIBILITY MANAGEMENT PLAN

Click on HAZELL BROS CHAIN OF RESPONSIBILITY MANAGEMENT PLAN above to download.

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 HAZELL BROS SMOKE-FREE WORK PLACE 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: *

Comments

Does the Applicant work or intend to work on (including delivering product to) a Hazell Bros construction site? *

Yes
No

If Yes, you are required to complete the following information; If No, go to Submit.

DECLARATION OF COMPLIANCE WITH THE CODE FOR THE TENDERING AND PERFORMANCE OF BUILDING WORK 2016

The Code for the Tendering and Performance of Building Work 2016 applies to the building work associated with Hazell Bros projects. By submitting an expression of interest in, or tender for, or being engaged to perform works on Hazell Bros building projects, you will become subject to the Code for the Tendering and Performance of Building Work 2016.

Name of Subcontractor *

ABN and ACN: *

Please confirm below statements by checking the box beside each statement *

1. The Subcontractor acknowledges that it and its Related Entities must comply with the Building Code in relation to all Building Work for which it has been engaged to perform for Hazell Bros.
2. The Subcontractor undertakes to ensure that it and its Sub-subcontractors, comply with the Building Code.
3. The Subcontractor acknowledges the powers and functions of the ABC Commissioner and the ABCC under the Act and the Building Code and undertakes to ensure that it and its Sub-subcontractors will comply with any requests made by the ABCC and the ABC Commissioner within those powers and functions, including but not limited to requests for entry under section 72 of the Act, requests to interview any person under section 74 of the Act, requests to produce records or documents under sections 74 and 77 of the Act and responding to requests for information concerning matters relating to the Building Code under subsection 7(c) of the Building Code.
4. The Subcontractor declares that where it proposes to sub-subcontract any of the Works, it will: a. not enter into a sub-subcontract with a Sub-subcontractor who: i. is covered by, or has Related Entities covered by, an Enterprise Agreement that does not meet the requirements of section 11 of the Building Code; ii. is subject to an Exclusion Sanction; or iii. unless approved otherwise by the ABC Commissioner, is excluded from performing Building Work funded by a state or territory government; and b. only enter into a sub-subcontract where: i. the Sub-subcontractor undertakes to only use products in relation to the Works that comply with the relevant Australian standards published by, or on behalf of, Standards Australia ii. the Sub-subcontractor has submitted a declaration of compliance, including the further information outlined in Attachment A to the declaration of compliance, in substantively the same form as the model declaration of compliance applicable to contractors and subcontractors in relation to the Building Code; and iii. the sub-subcontract with the Sub-subcontractor contains clauses in substantively the same form as the model contract clauses applicable to contractors and subcontractors in relation to the Building Code (located in Part 5 in the document titled Model Clauses Type B, available on the ABCC website (www.abcc.gov.au).
5. The Subcontractor declares that it has provided all of the further information required by Attachment A to this Declaration of Compliance.
6. The Subcontractor declares that: a. It, and its Related Entities, are not covered by an Enterprise Agreement that does not meet the requirements of section 11 of the Building Code (Subcontractor must complete Section Two of Attachment A); b. it is not subject to an Exclusion Sanction; c. it will only use products in relation to the Works that comply with the relevant Australian standards published by, or on behalf of, Standards Australia, should it be the successful Tenderer

Signed for and on behalf of the subcontractor by a person who is authorised to make this declaration *

Date *

ATTACHMENT A – INFORMATION REGARDING COMPLIANCE WITH THE CODE FOR THE TENDERING AND PERFORMANCE OF BUILDING WORK 2016

The following information must be provided as part of the Declaration of Compliance.

1. Does the Subcontractor, or its Related Entities, have an Enterprise Agreement that DOES NOT meet the requirements of section 11 of the Building Code? *

Yes - complete Section Two
No - answer Q. 2-5

2. Is the Subcontractor excluded from performing Building Work funded by a state or territory government? *

Yes
No

Details *

3. Has the Subcontractor within the preceding 3 years had an adverse decision, direction or order of a court or tribunal made against it for a breach of a designated building law, work health and safety law or the Migration Act 1958? *

Yes
No

Details *

4. Has the Subcontractor or its Related Entities within the preceding 3 years been required to pay any amount under an adjudication certificate (provided in accordance with a law relating to the security of payments that are due to persons in respect of Building Work) to a Building Contractor or Building Industry Participant? *

Yes
No

Details *

5. Has the Subcontractor or its Related Entities within the preceding 3 years owed any unsatisfied judgement debts to a Building Contractor or Building Industry Participant? *

Yes
No

Details *

Section 2. Does the Subcontractor, or its Related Entities, have an enterprise agreement(s) made or varied (in accordance with section 207 of the Fair Work Act 2009) on or after 25 April 2014 that cover the Subcontractor/Tenderer or its Related Entities in respect of building work? *

Yes -The Subcontractor must attach the ABCC letter of Compliance or Self-Declaration that relates to the project being tendered; and The Subcontractor must list all enterprise agreements made or varied (in accordance with section 207 of the Fair Work Act 2009) on or after 25 April 2014 that cover the Subcontractor or its Related Entities in respect of building work.

Upload ABCC letter of Compliance

Name of entity covered by the enterprise agreement *

Title of enterprise agreement that covers the Subcontractor or its Related Entities in respect of building work *

Date made or varied (in accordance with section 207 of the Fair Work Act 2009) *

Fair Work Commission Reference *

Does the entity have an ABCC Letter of Compliance (Determination) in relation to the agreement *

Yes
No

• Schedule 5 to the Building Code sets out a number of transitional matters that impact whether or not an enterprise agreement that covers a building contractor, a building industry participant, or a related entity of a building contractor or building industry participant, meets the requirements of the Building Code. An explanation of these matters can be located on the ‘Eligibility to Tender’ page on the ABCC website (www.abcc.gov.au). It is advisable to have regard to these matters when completing the table above.