Water Market - Subcontractor Evaluation Summary

Subcontractor Evaluation Summary

• Project Name

• Project Number

• Evaluation Review Date

  Date

• Reviewed by

• Contractor

• Contact Name

• Contact Number

• Contractor Activities

Evaluation Summary

• Questionnaire Received

  Yes

  No

  N/A

• Documentation Reviewed

  Yes

  No

  N/A

• Documentation Requested

  Yes

  No

  N/A

• Documentation Received

  Yes

  No

  N/A

• Contractor Interviewed

  Yes

  No

  N/A

• Contractor Accepted

  Yes

  No

  N/A

Evaluation

• Loss Experience below Industrial Average

  Yes

  No

  N/A

• TRR/DART (past 3 yrs)

• Experience Modification Rates (1 or below)

  Yes

  No

  NA

  N/O

• EMRs (past 3 yrs)

• OSHA Activity

  Yes

  No

  N/A

• Comments

• Safety Program

  Yes

  No

  NA

  N/O

• Comments

• Field Safety Inspections

  Yes

  No

  N/A

• Comments

• Staff Professionals

  Yes

  No

  N/A

• Comments

• New Hire Orientation

  Yes

  No

  N/A

• Comments

• Training Programs Adequate

  Yes

  No

  N/A

• Comments (list key training needing completed)

• Disciplinary Procedures

  Yes

  No

  N/A

• Comments

• Accident Investigations

  Yes

  No

  N/A

• Comments

• HAZCOM

  Yes

  No

  N/A

• Comments

• Toolbox Talks/safety talks

  Yes

  No

  N/A

• Comments

• Drug Free Program

  Yes

  No

  N/A

• Comments

• Safety Planning (AHA/JHA/THA)

  Yes

  No

  N/A

• Comments

• Certificate of Insurance

  Yes

  No

  N/A

• Summary

• Health & Safety Manager

  Sign