1. Details of Contractor
Name of Company:
Company Address:
Phone Number: Fax Number:
Email:
This questionnaire should be completed as fully as possible; guidance is given in each section of the questionnaire on the type of evidence or information required.
2. Nature of Business
Please indicate the size, value and type of work/services you provide or for which you wish to be considered.
3. Insurance: To be Completed
Does the company hold employers liability insurance?
Insurer for employers liability
Policy number for employers liability:
Renewal date for employers liability:
Limit of indemnity for employers liability:
Does the company hold public liability insurance?
Insurer for public liability
Policy number for public liability:
Renewal date for public liability:
Limit of indemnity for public liability:
Does the company hold professional negligence insurance?
Insurer for professional negligence:
Policy number for professional negligence:
Renewal date for professional negligence:
Limit of indemnity for professional negligence:
Does the company hold contractors all risk insurance?
Insurer for professional negligence:
Policy number for professional negligence:
Renewal date for professional negligence:
Limit of indemnity for professional negligence:
Please detail all specific exclusions or qualifications to cover below:
4. How many years has your Company carried out the work described in question 2?
5. How many employees are within your Company?
6. Which other business or companies do you carry out work for on a regular basis?
7. Do you have a written Safety Policy?
If yes – please provide copy of the Statement of Intent, Organisation and Arrangement Sections.
7a. Does you Health and Safety Policy have a specific section setting out your health and Safety arrangements?
8. Do you have a Safety Officer, Advisor or Consultant?
If yes – please supply name and qualifications below
9. Do you provide Health and Safety training to all employees?
If yes – please upload example copies of certification
10. Do you have arrangements in place for proactive monitoring and audit of your work activities to ensure that identified standards are maintained?
If yes – please upload examples of inspection and audit records form the last month
11. Do you have arrangements in place for consultation and co-ordination with your employees at all levels on health and safety issues?
If yes please describe these arrangements:
12. Have you a procedure for reporting and investigating accidents, dangerous occurrences or occupational illness?
If yes – please upload a copy of the procedure:
13. Accident figures for the last 3 years
This year - fatal accidents
This year - major accidents
This year - accidents resulting over 3 days off work
This year - Dangerous occurrences
Last year - fatal accidents
Last year - major accidents
Last year - accidents resulting over 3 days off work
Last year - dangerous occurrences
Year before - fatal accidents
Year before - major accidents
Year before - accidents resulting over 3 days off work
Year before - dangerous occurrences
14. In the last 3 years have you had a prohibition notice issued against you or been subject?
15. In the last 3 years have you had an improvement notice issued against you?
16. In the last 3 years have you been prosecuted or awaiting pending prosecution by the HSE or Local Authority?
17. In the last 3 years have you been prosecuted or awaiting pending prosecution under the Environmental Protection Act?
If you have answered ‘yes’ to Questions 14, 15, 16 and 17, please detail the circumstances below:
18. Do you have procedures in place for risk assessment?
If yes – please upload 3 random copies of Risk Assessments for the type of work you carry out for ARCTICS LTD T/A IGLOO AUTOMOTIVE
19. Do you use method statements or documents Safe Systems of Work for the work activities that you undertake?
If yes – please upload 3 random copies of documents for the type of work you carry out for ARCTICS LTD T/A IGLOO AUTOMOTIVE
20. Do you have systems in place for maintaining your vehicles, plant, equipment, electrical tools etc?
If yes – please provide details
21. Do you hold registration with Construction Line, CHAS, NICEIC, ECA or other trade associations?
If yes – please provide details of your registration with registration numbers below:
22. Due to the nature of our work we do not allow for any works to be further sub-contracted without written permission from us. Please confirm that all works carried out on your behalf will be undertaken by your own employed personnel.
Sub contractor to complete:
I certify that the details given in this questionnaire are correct and accurate and also agree that if any accident or dangerous occurrence whilst working on site for ARCTICS LTD T/A IGLOO AUTOMOTIVE it will be reported to them on the day it occurs by the quickest possible means.
Name:
Position in the Company:
Telephone Number:
Date: October 16, 2026
