ࡱ> rtqY bjbjWW B==]jjj~~~~8$,~(L$-jIz$IIIRRj~~In I hH"jt ~~'"t Issued by (for TEi Ltd):Date:To (Company):For the attention of:FAX NUMBER1Company/ Vendor/ supplier Name in full: 2Business Activity/ Product description/ Scope of supply: 3Head Office Address:  Please complete the questionnaire on page 2 onwards (questions 4 19) For TEi use only Company Name in full:  Reviewed and assessed by:DepartmentsigndateCommercialSafety/environmentalQualityApproval status Comments:Vendor type:Commodity code(s):Grade: 4State other locations involved 5State Invoice or payment address 6Date Established:7Principals: Name or Attach Organisation chart for Senior Personnel/ Top Management8Telephone No: 9Fax No:10e-mail address:11Name/Address of Ultimate Owner: 12Company Registration No. 13V.A.T. No. 14Please provide details and copies of Insurance held, as appropriate. Also provide details of Construction Industry Tax Deduction Scheme (CIS) certification as listed below: Insurance Insurance Company NameExpiry DateValue Covered14aEmployers Liability (ELI) (photocopy required)14Public Liability (PLI) (photocopy required)14cContractors All Risks (CAR) (photocopy required)14dOthers (Please State) (photocopy required)14eCIS Scheme UNIQUE TAX REFERENCE (UTR) REQUIRED The Health and Safety at Work etc Act 1974 and the Construction (Design and Management) Regulations 1994 impose a duty on those placing contracts to make reasonable enquiries regarding the suitability of contractors whom they employ. Such enquiries include checks of knowledge and the allowance of adequate resources for Health and Safety. To assist with the assessment would you please provide the following information: 15a YOUR ACCIDENT AND ENFORCEMENT STATISTICS Please provide your accident statistics for the past 3 years.Last YearPrevious YearYear before thatEmployee Sub- contractorEmployeeSub- contractorEmployeeSub- contractorNo. of fatal accidents a) No. of reportable Injuries (RIDDOR 1999) b)No. of Employees c)Incidence Rate (a-b x 1000) cNo. of RIDDOR Injuries to publicNo. of RIDDOR Dangerous occurrencesNo. of RIDDOR ill health reportsII Please give details of any improvement notices, prohibition notices or prosecutions served upon your Company by any Enforcing Authority within the last three years. 15bOHSAS18001 Safety Management System certificate No / Certified By:(Please attach copy with your reply) Expiry Date:NOTE Questions 15c to 15i are intended for businesses operating in the construction industry and hold either CIS 5 and or CIS 6 certificate(s). For these businesses where the company has a certified safety management system (OHSAS 18001) the completion of 15c 15i is not mandatory.  15c HEALTH AND SAFETY POLICY STATEMENT (Applies if you employ five or more persons) I Please attach your latest Health and Safety Policy statement and summary of organisation and arrangements as required by Section 2(3) of the Health and Safety at Work etc. Act 1974. II Please provide the name, initials and job title of the person having executive responsibility for Health and Safety in your Company.Name:Job Title: 15d HEALTH AND SAFETY ASSISTANCE Please advise us whether you have the services of a professional Safety Adviser or Consultant, or the name of your competent person appointed to assist with Health and Safety measures as required by Regulation 6 of the Management Health and Safety at Work Regulations 1998.Name:Job Title:Qualifications:Employed By:Telephone No: 15e HEALTH AND SAFETY INSTRUCTION AND TRAINING Please give details of any Health and Safety Instruction and Training given to your Managers, Supervisors and Operatives within the last three years.  15f SAFE SYSTEMS OF WORK I How do you carryout Risk Assessments and prepare Safety Method Statements.II State how you bring to the notice of your site personnel and contractors the requirements of your system of work on sites, including Risk Assessments, COSHH Assessments, Safety Method Statements etc.III How do you ensure that your employees and contractors comply with your safe systems of work? 15g SUB-CONTRACTORS (if applicable) State how you assess the Health and Safety record and competence of Companies with whom you place contracts. 15h INSPECTIONS AUDITS AND MONITORING How do you monitor performance on Health and Safety matters of the works under your control? 15i OTHER RELEVANT INFORMATION Any other information which you wish to make us aware of in connection with these enquiries, eg, Membership of Health and Safety Groups, receipt of Safety Awards, incentive schemes, health surveillance, technical support etc. 16aISO9000 Quality Assurance Certificate held.(Please attach copy with your reply) Expiry Date:16bIf no certificate is held describe how product or service quality is assured:  17aISO14001 environmental Certificate held.(Please attach copy with your reply)(if a certificate is held 17b,c,d need not be answered) Expiry Date: 17bIf no certificate is held do you have an environmental policy(if yes attach copy) 17cIf no certificate is held do you have an environmental procedures (if yes attach list of procedures held) 17dPlease provide information regarding the environmental effects of your company activities, e.g. emissions to air, water or land, waste, noise, nuisances, etc. If you have an environmental effects register please supply a copy 18Representative responsible for:NameTitlequality environment 19Confirmation of accuracy of details:NameTitleSignatureDate  TEi Limited Vendor/Supplier questionnaire Please complete and return with the information requested to: The Managing Director, TEi Limited, PO Box 80, Calder vale Road, Wakefield, West Yorkshire, WF1 5YS. Registered in England and Wales at the above address Reg 05236072 Fax No +44 (0) 1924 201901, Phone +44 (0) 1924 780000, email:  HYPERLINK mailto:general@tei.co.uk general@tei.co.uk TEi are committed to environment, health and safety and quality management Please view our policies and download our Terms and Conditions, and Subcontractor Rules and Requirements at:  HYPERLINK http://www.tei.co.uk www.tei.co.uk Page  PAGE 6 of 6  FILENAME App102 Vendor Questionnaire (Apr -08) "#23VW(*:;=Sq  56[\qrt$%CDTUX  IJ V W \  5 s C I c i {   GHIN5>*B*CJW>*CJ 56CJ6CJ6CJY!"#123IJUV@)$$l4&.'  A$$l4H &v  $$ 9r  v.' !"#123IJUVWYs()*;<=STUVWq|üL  M  N  Y  Z[  `  e  p                8VWYswo$ 9r >$$lF7 &    $$$A$$l*4H >&v  ()t}tjt  D!" ".'<$$lF7 &    $$$>$$lF7 &    )*;<=STUVWq|h$4$$l40 &   $$$($$l4&  $$ ".' <mdm0G$$l4\ A9!& $$E$$l4\ A9!&       }xtojea\YV                                & '   (   )  1   2  3   4   5  J   K !s@>$$l4F&.'  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