Hazard information (such as Safety Data Sheets)? Yes No History: Have you received health and safety award/s? Yes No If yes provide details: Have you had HEALTH AND SAFETY related Yes No notice/warning/fine/prosecution? If yes provide details: Health and safety procedures: Do you have an emergency procedures plan? Yes No Are formal health and safety risk / hazard assessments carried Yes No out and recorded? Is there always an investigation into any accident that results in Yes No harm, or could have resulted in harm? Are key hazardous substances recorded? Yes No Are safety data sheets accessible for hazardous substances? Yes No Are and equipment regularly inspected, tested, examined and Yes No maintained? Long form Health and Safety Note: the following questions are based on the Department of Labour’s guide A principal’s guide to contracting to meet the Health & Safety in Employment Act 1992 (April 2010). For more information go to: www.osh.dol.govt.nz Health and safety management: Do you have a written health and safety policy? If so please Yes No provide a copy. Is the policy signed by the managing director (or equivalent)? Yes No How is the policy communicated to employees? Do you hold ISO or AS/NZS or other certificates for health and Yes No safety? If yes provide details: Do you have membership in health and safety organisation? Yes No If yes provide details:
Hazard information (such as Safety Data Sheets)? Yes No History: Have you received health and safety award/s? Yes No If yes provide details: Have you had HEALTH AND SAFETY related notice/warning/fine/prosecution? Yes No If yes provide details: Health and safety procedures: Do you have an emergency procedures plan? Yes No Are formal health and safety risk / hazard assessments carried out and recorded? Yes No Is there always an investigation into any accident that results in harm, or could have resulted in harm? Yes No Are key hazardous substances recorded? Yes No Are safety data sheets accessible for hazardous substances? Yes No Are and equipment regularly inspected, tested, examined and maintained? Yes No Long form Health and Safety Note: the following questions are based on the Department of Labour’s guide A principal’s guide to contracting to meet the Health & Safety in Employment Act 1992 (April 2010). For more information go to: www.osh.dol.govt.nz Health and safety management: Do you have a written health and safety policy? If so please provide a copy. Yes No Is the policy signed by the managing director (or equivalent)? Yes No How is the policy communicated to employees? Do you hold ISO or AS/NZS or other certificates for health and safety? Yes No If yes provide details: Do you have membership in health and safety organisation? Yes No If yes provide details:
rfx-response-form-optional-extras-government-model.docx