9form ohsms prequalification questionnaire

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Power & Water Utility Company for Jubail and Yanbu (MARAFIQ Document ID No : MSSM-1-SF-002

Page 1 of 17

Rev. No.: 0

Date of issue: 2 Oct 2011

!CCUPA"I!#A$ %A$"% A#' AF"Y MA#A)M#" MA#UA$

FORM NO. 102

OHSMS PRE-QUALIFICATION QUESTIONNAIRE

MARAFIQ Power & Water Utility CompanyC!#"RAC"!R PR*QUA$IFICA"I!# QU"I!##AIR

C!MPA#Y

#AM

C!MPA#Y A''R +

C!#"AC" '"AI$

ubmitted by (PRI#",

Po-ition+'e-i.nation,

'ate ubmitted,

i.nature,("/e information pro0ided i-a11urate and .enuine

* listed in the evidence column indicates mandatory evidence to be provided.

Item Que-tion An-wer 0iden1eAtta1/ed

'etail- of 0iden1eAtta1/ed

Appro0al (Marafi2 u-e only("i13 & Initial

A. What are the companysmain activities? Tick box if

attached

REJECTED......................

REERRA!......................

A""R#$ED................. .....

D. %o& 'on( have yo) beenin b)siness? Tick box if

attached

REJECTED......................

REERRA!......................

A""R#$ED................. .....

*. Do yo) maintain ac)rrent +)a'ityAss)rance "ro(ramme?

Tick box ifattached

REJECTED......................

REERRA!......................

A""R#$ED................. .....

J. "'ease provide ,examp'es of &ork yo) Tick box if

REJECTED......................

REERRA!......................

PROPRIETARY NOTICETHIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MARAFIQ. ANYDISCLOSURE OR USE IS EXPRESSLY PROHIBITED EXCEPT UPON WRITTEN PERMISSIONBY MARAFIQ.

IMPORTANTOnly document with stamps are considered

ofcial.

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have carried o)t recent'yin -a)di Arabia?

attached A""R#$ED......................

. Are yo) prepared forarafi/ to approach

previo)s c'ients forreferences?

Tick box if

attached

REJECTED......................

REERRA!......................

A""R#$ED................. .....

". %o& many peop'e doyo) emp'oy? Tick box if

attached

REJECTED......................

REERRA!......................

A""R#$ED................. .....

-. %ave yo) ever had acontract ref)sed orterminated on %-E(ro)nds?

Tick box ifattached

REJECTED......................

REERRA!......................

A""R#$ED................. .....

$. Do yo) have a %-E"o'icy? Tick box if

attached 0

REJECTED......................

REERRA!......................

A""R#$ED................. ....

.1. Do yo) have a forma'-afety ana(ement-ystem 2--3 detai'in(the %-E arran(ements?

Tick box ifattached 0

REJECTED......................

REERRA!......................

A""R#$ED................. .....

A4. Do yo) have a %ea'th 5-afety Committee? 6f1es7 p'ease (ive detai'sof str)ct)re and a(enda?

Tick box ifattached

REJECTED......................

REERRA!......................

A""R#$ED................. ....



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.

AE. Who is the competentperson for theor(anisation?

Tick box ifattached

REJECTED......................

REERRA!......................

A""R#$ED................. .....

A%. What forma' %-E/)a'ifications do theyhave?


REJECTED......................

REERRA!......................

A""R#$ED................. .....

A8. %o& many %-E"ersonne' do yo)emp'oy7 p'ease (ivedetai's inc')din(/)a'ifications?

Tick box ifattached

REJECTED......................

REERRA!......................

A""R#$ED................. .....

A9. %as the company everbeen prosec)ted ors)b:ect to po'iceinvesti(ation for hea'thand safety matters?

Tick box ifattached

REJECTED......................

REERRA!......................

A""R#$ED................. ....

.A+. Do yo) have s)itab'e

ins)rance and have yo)comp'ied &ith anyins)rer re/)irements?


REJECTED......................

REERRA!......................

A""R#$ED................. .....

AT. Do yo) s)bscribe to anyind)stry or safety re'ated Tick box if

REJECTED......................

REERRA!......................



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or(anisations? attached A""R#$ED......................

AW. Are yo) a member of areco(nised ind)stry or

%-E specificor(anisation i.e. 6#-%766R- etc?

Tick box if

attached

REJECTED......................

REERRA!......................

A""R#$ED................. .....

A;. Where do yo) (ainaccess to )p to datehea'th and safetyinformation and bestpractice ()idance?

Tick box ifattached

REJECTED......................

REERRA!......................

A""R#$ED................. .....

4C. %o& often do yo) revie&yo)r %-E arran(ementsand ens)re )p


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any %-E trainin(re/)ired to meet there/)irements ofarafi/s --?

Tick box ifattached

REERRA!......................

A""R#$ED................. .....

4#. %o& do yo) revie& andmeas)re yo)r hea'th andsafety performance?


REJECTED......................REERRA!......................

A""R#$ED................. .....

4R. Do yo) have safety r)'esfor &ork activities? Tick box if

attached

REJECTED......................

REERRA!......................

A""R#$ED................. .....

4=. Can yo) provide arafi/&ith a %-E "'an forcompany activities orprevio)s &ork?

Tick box ifattached

REJECTED......................

REERRA!......................

A""R#$ED................. .....

4>. "rovide &orkedexamp'es of the

fo''o&in( < Risk Assessment

2specific3

ethod

-tatement2specific3

6nspection Report

2specific3

Tick box if

attached 0

REJECTED......................

REERRA!......................

A""R#$ED................. .....

CA. "rovide &orked REJECTED......................



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examp'es of %-E6nspections carried o)tby yo)r %-E personne'?


REERRA!......................

A""R#$ED................. .....

CD. "rovide detai'ed

information of theaccidents and incidentsin the 'ast , years2inc')de statistica'records3.


REJECTED......................

REERRA!......................

A""R#$ED................. .....

C*. What is yo)ror(anisations proced)refor reportin(7 recordin( 5investi(atin( accidents 5incidents?


REJECTED......................

REERRA!......................

A""R#$ED................. .....

CJ. "rovide detai's of yo)rirst Aid arran(ementsinc')din( trainin(provider information?


REJECTED......................

REERRA!......................

A""R#$ED................. .....

C. "rovide detai's of yo)rEmer(encyArran(ements &hen on ac'ients site?

Tick box ifattached

REJECTED......................REERRA!......................

A""R#$ED................. .....

C". Do yo) or any of yo)rs)b


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C-. Do yo) )se e/)ipmentthat co)'d present a riskd)rin( &ork activities? 6f1es7 provide detai's

Tick box ifattached

REJECTED......................

REERRA!......................

A""R#$ED................. ....

.C$. %o& do yo) ens)re the

competence and s)itab'eof hea'th and safetyperformance of s)b

9form ohsms prequalification questionnaire

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