General Questions (Continued)
3. Do you have a written Health & Safety Policy?
Yes No
  If Yes, you will be asked to supply a copy
Do you have a designated person managing Health & Safety?
Yes No
  If Yes, who?
Do you use an external Risk Management Consultant?
Yes No
  If Yes, please supply name & address
Have you ever been prosecuted under the Health & Safety at Work Act or other statute or regulation?
Yes No
  If Yes, please give details
4. Are your premises in good state of repair, and are your ways, plant and machinery (at your own premises and all contract sites) properly fenced and guarded and otherwise in good order and condition?
Yes No
5. Do you undertake design work for     (a) your own contract
Yes No
                                                                  (b) other work
Yes No
6. Are all your employees contracts entered into in the United Kingdom?
Yes No
   If No, state number and nationality of foreign employees
7. Are any of the following used in connection with your business?
  (a) Woodworking or Power Driven Machinery
Yes No
  (b) Lifts, Cranes, Hoists or other Lifting Apparatus
Yes No
  (c) Slings or Cradles
Yes No
  (d) Scaffolding
Yes No
  (e) Any other Mechanical Plant
Yes No
  (f) Processes involving a noise level in excess of 85 dB(A)
Yes No
    If Yes, are noise assessments carried out
Yes No
  (g) Radioactive substances or other sources of ionising radiations
Yes No
  (h) Asbestos, Silica or PCB's
Yes No
   (i) Heat (oxy-acetylene or similar welding or cutting equipment, blow lamps, blow torches, flamed guns, hot air guns or other heat producing equipment)
Yes No
  (j) Explosives
Yes No
    If Yes, please give details
8. Are you involved in any form of railway work?
Yes No
9. Do you discharge any hazardous waste products (e.g. chemicals, gases, radioactive substances, dust, fumes or vapours) into the atmosphere, sewers, waterways or elsewhere?
Yes No
If Yes, please advise type of waste and give full details of:
  (a) Storage and Disposal Methods
  (b) Treatment of Waste
  (c) Disposal Licences Held
  (d) Landfill Sites
10. Do you carry out any manual work away from your own premises including outside of the UK?
Yes No
  If Yes, please give details
11. Do you design, give advice or prepare specification?
Yes No
  If Yes, please confirm separate Professional Indemnity cover
12. Do you supply any products that you do not manufacture?
Yes No
  If Yes, do you
  (a) Retain rights of recovery against the manufacture
Yes No
  (b) Alter, adapt or change any products?
Yes No
  Give details of imported products including source and use
  
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