Contractor Monitoring & Evaluation (FORM-903)

• Site conducted

• Location

• Contracted Company Name

• Type of work being completed

• Conducted on

  Date

• Prepared by

• 1. Have all contractors been inducted to the Vapo / Myriad contractor Induction? (Check the records).

  Yes

  No

  N/A

• 2. Is the contractor taking all necessary steps to avoid disruption to the area?

  Yes

  No

  N/A

• 3. Are there or have there been any hazards generated by the Contractor?

  Yes

  No

  N/A

• 4. If ‘Yes’ to Q3, are they adequately controlled? Refer to the JSA or Permit to Work or SOP

  Yes

  No

  N/A

• 5. Is the risk being managed and documented on the correct risk assessment paperwork?<br>• Permit to Work (PTW) for. Hot Work / Work at height / 'Live’ electrical work<br>• JSA – for any other risks including, building, construction, electrical work & work at height<br>

  Yes

  No

  N/A

• 6. Was the contractor(s) wearing the required PPE for the type of work?

  Yes

  No

  N/A

• 7. Has there been any safety or environmental incidents (including near-miss) either to the contractors or causing injury or near-miss to other persons during the work?

  Yes

  No

  N/A

• 8. Have any injuries, incidents and near miss been reported by the contractor to Vapo / Myriad?

  Yes

  No

  N/A

• 9. Was anything observed during the observations that would normally be reported as an incident or near-miss?

  Yes

  No

  N/A

• 10. Have any of the reported incidents, near misses or observations suggested poor H&S practices by the contractor?

  Yes

  No

  N/A

• 11. Are all contractors adhering to the site rules? E.g. ‘no-smoking’, speed limits, using walkways, PPE, signing-in etc

  Yes

  No

  N/A

• 12. Is the contractor aware of any new hazards that they were exposed to whilst completing the work that were not considered prior to the work?

  Yes

  No

  N/A

• 13. Do contractors all have the required licenses or training certificates for the type of work they are completing? Examples:<br>• Asbestos removal license for any quantity of ‘friable’ asbestos or over 10m2 of ‘non-friable’.<br>• NZQA Forklift training (and license ‘F endorsement’ if using public areas)<br>• Digger / loader / roller / hopper - operator training<br>• NZQA Work at Heights training if using harnesses, mobile elevated platform, scissor lifts<br>• Welding training certificate <br>• Electrician registration

  Yes

  No

  N/A

• 14. Are the contractors’ portable electrical tools (with leads, not battery powered), power boards or extension leads ‘tested and tagged’ and have a current tag displayed on them?

  Yes

  No

  N/A

• 15. Has the contractor caused any disruption to Vapo / Myriad workers during the work (examples such as noise, dust, fumes, working above or very close to them, cutting off vital services (electricity/water etc)

  Yes

  No

  N/A

• 16. Was the work sub-contracted out without our prior knowledge and agreement?

  Yes

  No

  N/A

• 17. Has an apprentice or unqualified contractor completed the work when they should have been supervised?

  Yes

  No

  N/A

• 18. Is the Contractor failing to meet any aspects of the Agreement or are there any concerns whatsoever about the work, products or services?

  Yes

  No

  N/A

• 19. Overall, how would you rate the performance of the contractor based on these and other recent observations or dealings? Add score 1 to 5 (1=Poor; 5=Excellent)

• 20. General Comments - include any meetings with the contractor to resolve hazards / issues / performance. Include any remedial actions that are required. Include any contractors’ comments.

Sign-Off

• Signature of person completing this monitoring and evaluation.

  Sign