Company Name: *
ABN No: *
Current Year AUD: $
Previous Year AUD: $
Postal Address (if different from above)
Name of Principals / Directors:
Limit of Cover
Similar works (type and size) and previous works completed in Australia in previous 5 years
Contract name / Title
Type of Project:
Contract Name / Title
Type of Project
Value $ x 1000
Target Completion Date
Provide detials of any financing arrangements currently in effect which will materially affect yor financial standing if withdrawn (eg. Overdraft facilities, Director’s loans, debentures due for maturity)
Are any sections of the work package on our project to be sublet?
If "Yes", list which parts of the work package are to be let and to whom.
Does your company have a Health and Saftey Management System and/or Health and Saftey Procedures?
If “Yes”, attach to this questionnaire.
Does your company have a senior manager who is responsible for Health and Safety mangement?
If "Yes", Name:
Who is responsible for Health and Safety onsite?
What safety qualification does your Site Health and Safety representative have?
As a minimum you will be rquired to produce your own Health and Safety plan.
If your company does not have formal safety proccedures, yuou are expected to adopt and use the Principal Contractor procedures.
Has your company received any notices/breaches from the Department of Workplace Health & Safety in the last 2 years?
If “Yes”, state number and details of the following:
Has your company ever been prosecuted for breach of Health and Safety Acts or Regulations?
If "Yes", provide a brief description.
List any First Aiders that would be available.
What is the name, position and qualifications of the person within your company primarily responsible for employee/industrial relations?
What are the main unions your company deals with?
Does your company have a quality management system?
If “Yes”, please attach to this questionnaire.
Who is responsible for quality in your compnay?
If your company does not have a quality assurance program, you are expected to adobt and use the Principal Contractor systems.
Does your company have an environmental management system?
If “Yes”, please attach to this questionnnaire.
If your company does not have an environmental management system or program, you are expected to use the Principal Contractor’s systems.
Health and Safety Policy
1 + 4 = ? Please prove that you are human by solving the equation *