Contractor HSE Prequalification Assessment
Prequalify contractor health, safety, and environment readiness for upcoming work by providing company details, work scope, HSE controls, training, incident history, equipment readiness, and supporting documents.
Contractor Identification
Contractor company name
*
Primary contact name
*
Job title / role
Email address
*
example@example.com
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Company address or base location
Service type / trade
Please Select
Civil
Electrical
Mechanical
Plumbing
HVAC
Painting
Welding/Fabrication
Scaffolding
Rigging/Lifting
Earthworks
Instrumentation
Insulation
Cleaning/Janitorial
Security
Transportation/Logistics
Other
Business Scope and Work Details
Type of Work to Be Performed
*
Please Select
Civil Works
Mechanical Works
Electrical Works
Instrumentation and Control
Piping
Welding/Fabrication
Painting/Coating
Scaffolding
Civil/Structural Maintenance
Cleaning/Housekeeping
Logistics/Transport
Inspection and Testing
Other
Work Location / Site
*
Expected Start Date
*
 -
Month
 -
Day
Year
Date
Expected Duration / Contract Period
*
Number of Workers to Be Deployed
*
Will Subcontractors Be Used?
*
Yes
No
Subcontractor Names or Roles
HSE Management System
Written HSE policy exists
*
Not in Place
Partially in Place
Mostly in Place
Fully in Place
HSE responsibilities are assigned
*
Not in Place
Partially in Place
Mostly in Place
Fully in Place
Toolbox talks are conducted regularly
*
Not in Place
Partially in Place
Mostly in Place
Fully in Place
Hazard identification and risk assessment are performed before work
*
Not in Place
Partially in Place
Mostly in Place
Fully in Place
Incident reporting process exists
*
Not in Place
Partially in Place
Mostly in Place
Fully in Place
Stop-work authority is communicated to workers
*
Not in Place
Partially in Place
Mostly in Place
Fully in Place
Site supervision is provided
*
Not in Place
Partially in Place
Mostly in Place
Fully in Place
Training and Competency
Required Worker Training Status
*
Rows
Training Topic
Number Trained
Expiration / Renewal Status
General HSE
Job-specific hazards
Working at heights
Confined space
Electrical safety
Have workers received site-specific HSE induction?
*
Yes
No
Is task-specific competency verification completed?
*
Yes
No
Highest level of HSE training available among the crew
*
Please Select
Basic HSE Orientation
Site-Specific Induction
Task-Specific Safety Training
Advanced HSE Certification
Supervisor/Lead HSE Training
Other
Incident and Compliance History
Number of recordable incidents in the past 12 months
*
Number of lost-time injuries in the past 12 months
*
Any fatalities in the past 5 years?
*
Yes
No
Any regulatory notices, citations, or major nonconformances received?
*
Yes
No
Brief explanation of any yes answers
Equipment, PPE, and Emergency Preparedness
Is appropriate PPE provided for the work performed?
*
Yes
No
N/A
Is PPE inspected before use?
*
Yes
No
N/A
Are equipment maintenance and inspection checks carried out regularly?
*
Yes
No
N/A
Are emergency response procedures available and communicated to workers?
*
Yes
No
Is first-aid coverage available for the work site?
*
Yes
No
Which emergency controls are in place as applicable?
*
Spill control
Fire control
Rescue equipment
First-aid kit
Emergency eyewash
Emergency shower
Other
Main PPE items used
Emergency equipment available
Document Uploads and Verification
HSE Policy Document
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Supporting Compliance Documents
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Document Issue / Expiry Dates
Are all submitted documents current and complete?
*
Yes
No
Assessment Summary and Declaration
Overall HSE Readiness Rating
*
1
2
3
4
5
Additional Comments or Corrective Actions
Acknowledgment
*
I confirm that the information provided is accurate and complete to the best of my knowledge
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