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Transport & Plant Contractor Assessment Form (FRM-GRP-007d)
As part of our Contractor engagement and review process, Hazell Bros requires the attached form to be completed and returned together with copies of insurance certificates of currency and other documentation as applicable. Certificates of Currency should be obtained from your broker or insurer so that renewal is verifiable. If you do not have access to certificates at this time, they may be provided separately by replying and attaching them to the email that the link to this form was provided on. Note you cannot save the form and return to it later.
Please enable JavaScript in your browser to complete this form.
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
Click or drag a file to this area to upload.
Provide GVM details for trucks and trailers
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
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 tend 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.
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:
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
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 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:
*
Comments
Name
Submit
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