Contractor ChecklistCompany DetailsTo be considered as an Approved Contractor for Box Moor Trust, please complete this checklist and upload current supporting documents for your business, employees and insurance. If you cannot complete the form online, please contact us at admin@boxmoortrust.org.uk.Company Name(Required)Trade(Required)Please detail the type of work your company undertakes.Company Address(Required) Street Address ZIP / Postal Code Primary Contact Name at Company(Required) First Last Position in Company Mobile Phone Number(Required)Office Phone Number (or alternative mobile)Contact Email Address(Required) Details of person completing form if different from above First Last Position in Company DocumentationPlease confirm you hold the documents below and upload current copies where applicable.Relevant trade, professional and statutory certifications(Required) Yes No N/AUpload copies of any certificates relevant to the work you undertake Drop files here or Select filesAccepted file types: jpg, gif, png, pdf, Max. file size: 128 MB, Max. files: 10.You can upload a maximum of 10 files here – if you have more to add you can email copies to admin@boxmoortrust.org.ukPublic Liability Insurance(Required) Yes NoUpload your current Public Liability Insurance certificateAccepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.Employers’ Liability Insurance(Required) Yes No N/A(Required where applicable)Upload your current Employers’ Liability Insurance certificate.Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.COSHH assessments(Required) Yes No N/A(Required where hazardous substances are used)Upload relevant COSHH assessments Drop files here or Select filesAccepted file types: jpg, gif, png, pdf, Max. file size: 128 MB, Max. files: 10.You can upload a maximum of 10 files here – if you have more to add you can email copies to admin@boxmoortrust.org.ukLOLER inspection records(Required) Yes No N/A(Required where lifting equipment is used)Upload current LOLER inspection records. Drop files here or Select filesAccepted file types: jpg, gif, png, pdf, Max. file size: 128 MB, Max. files: 10.You can upload a maximum of 10 files here – if you have more to add you can email copies to admin@boxmoortrust.org.ukPlease note: before any work is undertaken you must ensure the Box Moor Trust has a copy of your current LOLER Inspection Record.Enforcements and IncidentsDisclosure of any information in this section will not automatically mean exclusion from our list of Approved Contractors.Have you had any HSE enforcement action in the last 3 years?(Required) Yes NoIf yes please provide detail on enforcement action (we may need to discuss this with you).(Required)Have you had any RIDDOR reportable incidents in the last 3 years?(Required) Yes NoIf yes please provide detail on RIDDOR reportable incidents (we may need to discuss this with you).(Required)ConfirmationsHealth & Safety Policy(Required) I confirm the company has a current Health and Safety Policy where required by law and implements it in practice.Health & Safety Regulations(Required) I confirm the company and its workers comply with all health and safety law relevant to the work, including the Health and Safety at Work etc. Act 1974 and the Management of Health and Safety at Work Regulations 1999.Competence, Training and Supervision(Required) I confirm that workers engaged on Box Moor Trust work are competent, appropriately trained, and supervised for the tasks they undertake.Employment and Worker Compliance(Required) I confirm the company complies with employment law, does not engage in unlawful subcontracting, takes steps to prevent modern slavery in line with the Modern Slavery Act 2015, and carries out right to work checks in accordance with the Immigration, Asylum and Nationality Act 2006.Safe Systems of Work, Method Statements & Risk Assessments(Required) I confirm the company prepares suitable risk assessments, method statements and safe systems of work for the tasks undertaken and provides these to Box Moor Trust before work starts where required.PPE(Required) I confirm suitable personal protective equipment is provided, maintained and used where required.Equipment & Machinery(Required) I confirm all plant, tools and equipment used are suitable, maintained, inspected where required, and compliant with applicable law, including PUWER and, where relevant, LOLER.Working at Height(Required) I confirm that, where work at height is required, the safest reasonably practicable access method will be used and the Working at Height Regulations 2005 will be followed.Manual Handling(Required) I confirm the company complies with the Manual Handling Operations Regulations 1992 where applicable.Environmental Regulations(Required) I confirm the company complies with applicable environmental law and standards, including lawful storage, transport and disposal of waste.Waste Disposal(Required) I confirm all waste will be removed from site unless otherwise agreed with Box Moor Trust, and that waste will be managed lawfully. Where required, we hold a current Waste Carrier registration and will provide Waste Transfer Notes or other required waste documentation.Construction (Design and Management) Regulations 2015(Required)(Required where construction work is undertaken) I confirm that, where the work falls within CDM 2015, the company will meet its duties as a contractor, including planning, managing and monitoring the work, cooperating with other duty holders, and providing suitable welfare and safety information. N/AFinal Declaration(Required) I confirm all information I have provided is true and correct. I will update the Box Moor Trust should any of the company’s circumstances or information regarding any of the statements made in the form change.
