Contractor's Questionnaire

Agreement between Sign Foundry and:

Contractor Company Name *

Contractor Company Address *

Complying with Health and Safety *

Will your organisation and your employees, sub-contractors and agents agree to comply in all respects with the Health and Safety at Work Act 2015 and associated Regulations or codes or practice whilst working for Sign Foundry?

Serious harm or Notifiable Incidents *

Has your organisation had any workplace serious harm or Notifiable Incidents in the last 3 years?

Workplace deaths *

Has your organisation had any workplace deaths in the last 3 years?

Breaches of health and safety *

Has your organisation been prosecuted for breaches of health and safety in the last 3 years?

Provisional Improvement Notices *

Has your organisation been issued with any Provisional Improvement Notices or Infringement Notices in the last 3 years?

Identification of risks and hazards *

Does your organisation and your employees, sub-contractors, and agents agree to identify any risks / hazards and the controls for those risks/hazards that they are bringing onto Sign Foundry’s or our clients’ premises?

Safety inspections *

Does your organisation agree to conduct safety inspections to ensure your employees comply with all relevant safety procedures on Sign Foundry’s or our clients’ premises?

Regular review or risks and hazards *

Does your organisation agree to regularly review risks/hazards and advise Sign Foundry immediately if any risks / hazards change or new ones are reported?

Exposure of risks and hazards while at Sign Foundry *

Have you been informed of the risks / hazards that you will be exposed to whilst on Sign Foundry’s site including potential asbestos containing materials (if applicable)?

Development of emergency plans *

Will your employees be involved in development of any emergency plans required for the work activities / projects undertaken on our behalf?

Emergency plan identification *

Will the emergency plan identify all responsibilities and procedures to be followed?

Training in emergency procedures *

Will all of your employees and sub-contractors receive training in your emergency procedures for work carried out on our behalf?

Procedure for investigations *

Does your organisation have a procedure for investigation, reporting and follow-up of all accidents?

Results of investigations *

Are the results of any investigation communicated to employees?

Reporting accidents to Sign Foundry *

Does your organisation agree to immediately report all accidents and near misses to Sign Foundry (and our clients if appropriate)?

Training schedule *

Is Health & Safety training carried out on a regular basis?

Adequate training and supervision *

Will all your employees and sub-contractors undertaking work on Sign Foundry’s or our clients’ sites be given the proper training for the work required or will they be under adequate supervision by someone who is trained and / or experienced to do the job safely?

Management of sub-contractors *

Does your organisation have procedures in place for the selection and management of sub-contractors based on their health and safety performance?

Health and safety inductions *

Will your organisation induct all your sub-contractors into the safety requirements of the contract or in areas under their control?

Competency training register *

Click or drag files to this area to upload. You can upload up to 3 files.

Please provide a competency training register for your employees working on our site.

Insurance Certificates *

Click or drag files to this area to upload. You can upload up to 3 files.

Upload public liability insurance certificate
Upload professional indemnity insurance certificate

On behalf of the contractor, and on signing this form, I confirm that:

I am authorised to provide this information and sign this form
The information provided in this form is true and correct
I understand that if the information I have provided is not true and correct, Sign Foundry may withdraw the contractor’s health and safety approval, and take any other action available to it
I understand that the contractor will be liable for anything Sign Foundry has done or omitted because it has reasonably relied on the accuracy of information provided in this questionnaire

As contractor to Sign Foundry we agree to abide by the requirements of the Health and Safety at Work Act 2015 and any other relevant Regulations. We understand that the contract may be terminated if there is non-compliance with this document and/or any provisions of the Health and Safety at Work Act 2015

I furthermore declare that, in my professional opinion, all works that we undertake on behalf of Sign Foundry, will be completed in accordance with best practice guidelines and in accordance with relevant Regulations, Codes and practices (e.g. NZ Building Code and any other applicable requirements)

Contractor representative’s full name: *

Contractor representative’s position: *