Contractor Approval Questionare

• Site conducted

  Select

• Conducted on

  Date

Contractor Details

• Contractor Company

• Job Reference

• Location

• Assessed by

• Date of Evaluation

Workers Compensation Information *

• Name of insurer

• Period of insurance

• Policy number

• Sum insured

Public Liability Information *

• Name of insurer

• Period of insurance

• Policy number

• Sum insured

Professional Indemnity Information * *Attach copies of all relevant certificates

• Name of insurer

• Period of insurance

• Policy number

• Sum insured

WHS Review

• Will you be performing physical works for EA Insurance?<br>If YES, proceed to 2.<br>If NO stop.

  Yes

  No

  N/A

• Will you be undertaking any high-risk tasks? YES/NO

  Yes

  No

  N/A

• Do you have safe work procedures for your work tasks? E.g. JSA/SWMS<br>If NO, detail how you ensure your work is conducted safely?

  Yes

  No

  N/A

• Do you have a safety management system? YES/NO

  Yes

  No

  N/A

• Have you been issued any government safety inspector notices e.g.<br>Prohibition or improvement notices in the last 12 months.<br>If YES detail how you have rectified this issue

  Yes

  No

  N/A

• Are your staff adequately trained for their job?<br>Please provide copy of necessary licenses/certificates at induction

  Yes

  No

  N/A