VICTORIAN 32 COUNCIL EASYBIZ EXTENSION CONSORTIUM
EasyBiz Project Web Services Framework Specification,
Contract No. CT060718
Closing date: Wed 06 Sep 2006 - 1400 Melbourne time
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SCHEDULE 5 - OCCUPATIONAL HEALTH AND SAFETY MANAGEMENT QUESTIONNAIRE
Index of Schedules - "Conditions of Tenders" File 9
Schedule 1 - Annexure to Tender Conditions 10-14
Schedule 2 - Tender Form, including all pricing information 15-18
Schedule 3 - Tenderer Information 19-26
Schedule 4 - Receipt of Addenda 27
Schedule 5 - Occupational Health and Safety Mgt Questionnaire - THIS PAGE 28-29
Schedule 6 - Statutory Declaration 30-32
Schedule 7 - Statement of Conformance 33-38
Schedule 5 - Occupational Health and Safety Management Questionnaire
SCHEDULE 5 - OCCUPATIONAL HEALTH AND SAFETY MANAGEMENT QUESTIONNAIRE
This questionnaire forms part of Council's tender evaluation process and is to be completed by
tenderers and submitted with their tender offer.
The objective of the questionnaire is to provide an overview of the status of the tenderers
OH&S management system.
Tenderers will be required to verify their responses noted in the questionnaire by providing
evidence of their ability and capacity in relevant matters.
Tenderers should note that if they have provided a response to this questionnaire when
tendering within the last 12 months, that response will satisfy this requirement.
Please advise last tender number: .................... Date: ..../..../....
The information provided in this questionnaire is to be an accurate summary of the company's
occupational health and safety management system.
1 OHS Policy and Management
1.1 Is there a written company health and safety policy? Yes No
Comments:..................................................................................................
....................................................................................................................
1.2 Does the company have an OHS Management System certified by a
recognised independent authority (eg. SafetyMAP)? Yes No
Comments:..................................................................................................
....................................................................................................................
1.3 Is there a company OHS Management System manual or plan?
If yes, provide a copy of contents page(s). Yes No
Comments:..................................................................................................
....................................................................................................................
1.4 Are health and safety responsibilities clearly identified for
all levels of staff? Yes No
If Yes, provide details: ................................................................................
....................................................................................................................
2. Safe Work Practices and Procedures
2.1 Has the company prepared safe operating procedures or specific safety
instructions relevant to its operations? Yes No
If yes, provide a summary listing of procedures or instructions.
Comments:..................................................................................................
....................................................................................................................
2.2 Does the company have any permit to work systems? Yes No
If yes, provide a summary listing or permits: ...............................................
....................................................................................................................
....................................................................................................................
2.3 Is there a documented incident investigation procedure? Yes No
If yes, provide a copy of a standard incident report form.
2.4 Are there procedures for maintaining, inspecting, assessing and
controlling the hazards of plant operated/owned by the company? Yes No
If yes, provide details: .................................................................................
....................................................................................................................
2.5 Are there procedures for storing and handling hazardous substances? Yes No
If yes, provide details: .................................................................................
....................................................................................................................
2.6 Are there procedures for identifying, assessing and controlling risks
associated with manual handling? Yes No
If yes, provide details: .................................................................................
....................................................................................................................
3. OHS Training
3.1 Describe how health and safety training is conducted in your company: Yes No
....................................................................................................................
....................................................................................................................
3.2 Is a record maintained of all training and induction programs
undertaken for employees in your company? Yes No
If yes, provide examples of safety training records: ...................................
....................................................................................................................
4. Health and Safety Workplace Inspection
4.1 Are regular health and safety inspections at worksites undertaken? Yes No
If yes, provide details: .................................................................................
....................................................................................................................
4.2 Are standard workplace inspection checklists used to conduct health
and safety inspections? Yes No
If yes, provide details or examples:.............................................................
....................................................................................................................
4.3 Is there a procedure by which employees can report hazards at
workplaces? Yes No
If yes, provide details: .................................................................................
....................................................................................................................
5. Health and Safety Consultation
5.1 Is there a workplace health and safety committee? Yes No
5.2 Are employees involved in decision making over OHS matters? Yes No
If yes, please provide details: .....................................................................
....................................................................................................................
5.3 Are there employee elected health and safety representatives?
Comments: .................................................................................................
....................................................................................................................
6. OHS Performance Monitoring
6.1 Is there a system for recording and analysing health and safety
performance statistics? Yes No
If yes, provide details: ................................................................................
....................................................................................................................
6.2 Are employees regularly provided with information on company health
and safety performance? Yes No
If yes, provide details: ................................................................................
....................................................................................................................
6.3 Has the company eve been convicted of an occupational health and
safety offence? Yes No
If yes, provide details: ................................................................................
....................................................................................................................
7. Company Reference
7.1 Please provide the following information for the three (3) most recent contracts
completed by the company.
Contract 1 Contract 2 Contract 3
Contract Description
Client
Contact
Phone No
Num lost time injuries
Number person days
on contract
Total days lost
due to injuries
RUBAC Electronic Information Management Methodology Copyright of Hamme Family Trust
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