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Pre-Qualification Questionnaire
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ACR is required under the terms of the Health and Safety at Work Act 1974 & the Construction Design Management Regulations 2015 to complete an assessment of all Contractors used on behalf of their clients, to ensure they are complying with current Health and Safety regulations. If your company has five or more employees, you must be aware of the duties placed upon employers by the Health & Safety at Work Act 1974, the Management of Health & Safety at Work Regulations 1999, and the Construction (Design and Management) Regulations 2015.
1. Contractor Details
Company Name
Is this a Limited Company?
Please select
Yes
No
Date of formation or registration
DD slash MM slash YYYY
Head Office Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
Email
Website
Social Media Links
Company Registration No.
VAT Registration No.
Companies House Office Address (If Different)
Street Address
City
State / Province / Region
ZIP / Postal Code
2. Banking Information
Full Bank Name
Bank Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Bank Account Name
Sort Code
Bank Account Number
IBAN (if appliable)
Swift (if appliable)
BIC
Upload: Bank Details
Please attach a copy your company’s bank details on letterhead paper and signed by authorised personnel.
Max. file size: 1 MB.
Credit Controller Contact Information
Name
Position
Office Phone Number
Mobile Phone Number
Email Address for Remittances
Email Address for Invoice Queries
3. Details of your Work
Please list the type of services your company provides
Please advise areas covered
Please advise the Number of Staff directly employed by you/ your company
Do you operate an out of hours service?
Please select
Yes
No
If yes, please provide the emergency number
Does your work require you to hold a Full F-Gas Certificate?
Please select
Yes
No
If yes, please attach the full F- Gas certificate.
Max. file size: 1 MB.
Does your work require you to hold a Gas Safe Certificate?
Please select
Yes
No
If yes, please attach the Gas Safe certificate.
Max. file size: 1 MB.
Does your work require you to hold a NICEIC Accreditation?
Please select
Yes
No
If yes, please attach the NICEIC accreditation.
Max. file size: 1 MB.
Does your work require you to hold a CHAS Accreditation?
Please select
Yes
No
If yes, please attach the CHAS accreditation.
Max. file size: 1 MB.
Does your work require you to hold a CSCS Card?
Please select
Yes
No
If yes, please attach the construction skills certificate.
Max. file size: 1 MB.
Do you / your company hold any Memberships or Accreditations which are not listed above?
Please select
Yes
No
If yes, please list and attach copies.
Drop files here or
Select files
Max. file size: 1 MB.
Does the company employ / use Sub-Contractors?
Please select
Yes
No
If yes, attach a copy of your own screening documents.
Max. file size: 1 MB.
Pre-Planned Maintenance Contact Information
Name
First
Last
Position
Office Phone Number
Mobile Phone Number
Email
Reactive Contact Information
Name
First
Last
Position
Office Phone Number
Mobile Phone Number
Email
4. Compliance (Safety)
Do you operate a Health and Safety Management System / Policy?
Please select
Yes
No
If yes, please attach a copy of your company’s Health and Safety Management System / Policy
Max. file size: 1 MB.
Do you hold a ISO18001 or Equivalent Accreditation?
Please select
Yes
No
If yes, please attach a copy of the ISO18001 certificate.
Max. file size: 1 MB.
Do you implement a Corporate Social Responsibility Policy?
Please select
Yes
No
If yes, please attach a copy of the Corporate Social Responsibility.
Max. file size: 1 MB.
Does your Employee Insurance cover a minimum of £2m?
Please select
Yes
No
If yes, please attach a copy of the insurance document.
Max. file size: 1 MB.
Does your Public liability Insurance cover a minimum of £2m?
Please select
Yes
No
If yes, please attach a copy of the insurance document.
Max. file size: 1 MB.
Does your Professional Indemnity Insurance cover a minimum of £2m?
Please select
Yes
No
If yes, please attach a copy of the insurance document.
Max. file size: 1 MB.
Have you/your company received any enforcement Notices regarding Health and Safety within the last 5 years?
Please select
Yes
No
If yes, please attach a copy of the notice.
Max. file size: 1 MB.
Have you/your company had any convictions for breach of Environmental legislations in the last 5 years?
Please select
Yes
No
If yes, please attach a copy of the convictions letter issued.
Max. file size: 1 MB.
Do you / your company provide Specific Risk Assessments?
Please select
Yes
No
If yes, please attach a copy of a specific risk assessment.
Max. file size: 1 MB.
Do you/ your company provide Specific Method Statements?
Please select
Yes
No
If yes, please attach a copy of a specific method statement.
Max. file size: 1 MB.
Do you / your company provide General Risk Assessments?
Please select
Yes
No
If yes, please attach a copy of a general risk assessment.
Max. file size: 1 MB.
Do you/ your company provide General Method Statements?
Please select
Yes
No
If yes, please attach a copy of a general method statement.
Max. file size: 1 MB.
Do you / your company hold Copies of Material Safety Data Sheets (MSDS) for products being used during contracted works?
Please select
Yes
No
If yes, please attach examples.
Drop files here or
Select files
Max. file size: 1 MB.
5. Health and Safety Contact Information
Name
First
Last
Position
Office Phone Number
Mobile Phone Number
6. Compliance (Environment)
Do you operate a Environmental System?
Please select
Yes
No
If yes, please attach a copy of your company’s Environmental System
Max. file size: 1 MB.
Do you hold a ISO14001 or Equivalent Accreditation?
Please select
Yes
No
If yes, please attach a copy of the ISO14001 certificate.
Max. file size: 1 MB.
Do you hold a Waste Carriers Licence?
Please select
Yes
No
If yes, please attach a copy of the waste carriers licence.
Max. file size: 1 MB.
Do you hold a Waste Management Licence?
Please select
Yes
No
If yes, please attach a copy of the waste management licence.
Max. file size: 1 MB.
Have you/your company received any enforcement Notices regarding Environmental within the last 5 years?
Please select
Yes
No
If yes, please attach a copy of the notice.
Max. file size: 1 MB.
Have you/your company had any convictions for breach of Environmental legislations in the last 5 years?
Please select
Yes
No
Do you operate a Quality Management System?
Max. file size: 1 MB.
7. Environmental Contact Information
Name
First
Last
Position
Office Phone Number
Mobile Phone Number
8. Compliance (Quality)
Do you operate a Quality Management System?
Please select
Yes
No
If yes, please attach a copy of your company’s Quality Management System
Max. file size: 1 MB.
Do you hold a ISO9001 or Equivalent Accreditation?
Please select
Yes
No
If yes, please attach a copy of the ISO9001 certificate.
Max. file size: 1 MB.
9. Quality Contact Information
Name
First
Last
Position
Office Phone Number
Mobile Phone Number
10. Procedural Requirements
There are set procedures in place between ourselves as Facilities Management provider and our Clients and you must follow these procedures in order to continue as an Approved Contractor.
The ACR Facilities Helpdesk will contact you on behalf of the client to arrange Reactive and Planned works.
If a client contacts you directly to request an engineer’s attendance, please e-mail
[email protected]
with the details of the request, and provide any supporting photographs and associated costs, as soon as possible after the event, so that we can register the job.
Job Sheets/Service Sheets
must be signed
by the client and submitted to
[email protected]
every time an engineer attends site. Outstanding or unsigned documents may cause delays in payment.
Invoices must contain either the clients Purchase Order Number or a Work Order Number provided by ACR (
[email protected]
).
Invoices must be made out to the Client (who is responsible for payment) but forwarded to
[email protected]
for initial processing and verification. Please do not send invoices directly to the client as this may result in payment delays.
All associated paperwork (Quotations, Contract Renewals, Service Sheets, Job Sheets, Risk Assessments, Method Statement etc.) should be addressed to the Client but sent to
[email protected]
for processing. Please do not send any documents directly to the Client.
We will require you to send your renewed Public Liability Insurance to
[email protected]
annually.
11. Declaration
It is a requirement that you, your employees and any others under your control, comply with the Health & Safety at Work Act 1974, the Management of Health & Safety at Work Regulations 1999 and the Construction (Design and Management) Regulations 2015.
I/We confirm the details given above are correct and that it is our duty to inform you immediately of any changes to the information.
Name
First
Last
Position
Signed
*
Date
*
DD slash MM slash YYYY
Email
This field is for validation purposes and should be left unchanged.
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+44 (0)1744 621 669
Email us:
[email protected]
