Contractor Checklist Company DetailsTo be an Approved Contractor for the Box Moor Trust we ask that you complete our Contractor Checklist. As part of the checklist we require copies of relevant certification for your business and employees, and copies of your insurance documents. If you are unable to complete this form online please contact us at admin@boxmoortrust.org.ukCompany Name(Required)Company Address(Required) Street Address ZIP / Postal Code Contact Name at Company(Required) First Last Mobile Phone Number(Required)Office Phone Number (or alternative mobile)Contact Email Address Name of Person Completing Form First Last Position in Company DocumentationPlease confirm you hold the documents below and upload an in date copy where appropriate.Please confirm you/your employees/your business holds appropriate certification for the business activities undertaken.(Required) Yes No N/A Please upload copies of any relevent certificates Drop files here or Select files Accepted 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.uk Please confirm you hold adequate Public Liability Insurance(Required) Yes No Please upload a copy of your Public Liability Insurance CertificateAccepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.Please confirm you hold adequate Employers Liability Insurance(Required) Yes No N/A Please upload a copy of your Employers Liability Insurance CertificateAccepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.Please confirm you have CoSHH Assessments if using hazardous substances.(Required) Yes No N/A Please upload copies of any CoSHH Assessments Drop files here or Select files Accepted 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.uk Please confirm you have a LOLER inspection record if using lifting equipment as part of your business activity.(Required) Yes No N/A Please upload a copy of your LOLER Inspection Record. Drop files here or Select files Accepted 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.uk Please 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 No 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 No 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 and conforms to a current Health & Safety Policy.Health & Safety Regulations(Required) I confirm the individuals working for and on behalf of the company understand and comply with all relevant Health and Safety Regulations applicable to the type of work being undertaken by the business.Environmental Regulations(Required) I confirm the company and all individuals working for and on behalf of the company will act in accordance with Environmental Regulations and Standards where applicable.Safe Systems of Work, Method Statements & Risk Assessments(Required) I confirm the company holds Safe Systems of Work covering tasks to be undertaken, and Method Statements and Risk Assessments will be completed by competent person. I confirm, if I employ more than 5 people, these will be written down and sent to the Box Moor Trust before any work is undertaken.PPE(Required) I confirm where appropriate PPE will be provided and worn.Equipment & Machinery(Required) I confirm, where appropriate, all legally required health and safety documentation is held for all equipment & machinery to be used by the company. I confirm the company, myself, or an associated individual maintains, and will maintain, equipment and machinery to the manufacturer’s specification, ensuring the continued safety of all equipment and machinery used by the company.Working at Height(Required) I confirm, where appropriate, should myself or any individual associated with the company be required to work at height, we will use the safest reasonable method of access , and ensure safe working practice and methods are followed. I confirm we will comply with the Working at Height Regulations at all times.Waste(Required) I understand and confirm all waste must be removed unless otherwise agreed. with a Box Moor Trust representative.Confirmation(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.
