Prequalification questionnaire



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Introduction

Health, Safety and Environmental (HSE), Quality and Competence Assurance Management are an essential part of the way we conduct our business and needs to be considered as an integral part of our business management. Therefore, this evaluation tool provides a performance assessment against Mustang Canada, Inc., HSE, Quality and Competence Assurance Management expectations. The assessment partially fulfils the business's commitment to Audit and Review.
For any “Yes” answer provided, Mustang Canada Inc. requires a documented reference to a policy/procedure/standard and a copy of that supporting documentation which can be referenced as evidence to validate any “Yes” answers. Any “Yes” answers not supported by documentation and appropriate references cannot be evaluated and may result in disqualification. All answers may be subject to further verification efforts by Mustang Canada Inc.

Objectives




  • To provide an effective evaluation of scope of products and/or services provided.

  • To provide Mustang Canada, Inc. with a consistent method of measurement and remove repetitive project supplier evaluations.




Company Name

     

Parent Company

     

Address

     

Postcode

     

Telephone

     

Facsimile

     

Email Address

     

Website

     






General Section

1.1

Full details of scope of service:

If Approval certificate(s) are held, please leave blank if copies are to be provided.

If you are not parent company with ownership and technical engineering support of the tools/equipment described in the scope of work (not acting as an agent, or as a third party supply of equipment) please provide details of the manufacturer/parent company and their capabilities in addition to your company capabilities.





     






1.2


Does the company carry out Manufacturing activities?

     

1.3


Does the company carry out Service activities, including in remote regions? Are there personnel who are fully trained to maintain equipment and to travel offshore NL, Canada?

     

1.4


Does the company carry out Repair activities, including in remote regions? Are there personnel who are fully trained to repair equipment and to travel offshore located in a local (NL) base of operations?


     

1.5


What is the total number of employees?

     

1.6


Does the company provide offshore capabilities as part of services? Please provide details.




     







1.7

Type of Company:




Type of Company




Sole Proprietor

     




Partnership

     







Corporation – Private

     




Corporation – Public

     







Other (please identify):

     











Please supply Certificate of Incorporation. If private ownership, please also identify the Principle Shareholders below.





Name

     




City

     

Province/State

     



















Name

     




City

     

Province/State

     



















Name

     




City

     

Province/State

     




1.8

Total Number of Employees by Geographical Location
Newfoundland and Labrador
Other Canadian Provinces
International



1.9

Declaration of Business Relations
Are you a relative or do you have a relationship with any Mustang Canada, Inc., Wood Group PSN or Husky Employee that would cause any real or perceived conflicts of interest?


1.10

Annual Revenue & Operating Income (CDN$ in each of the last three (3) years):





Revenue




Operating Income

Year




$




$




Year




$




$




Year




$




$






1.11

Subcontracting

Please list any associated work that you would typically subcontract to other vendor(s) providing the following information for each: Specific type of work being subcontracted, Company name, address and contact information.





1.12

Describe the process you have for evaluating, selecting and re-evaluating subcontractors and suppliers.


1.13

Does the company have experience with similar project scope in harsh environments/cold climate experience, such as the East Coast of Canada? Any problems experienced with these conditions?



2.0

Health, Safety & Environmental Section

2.1

Who has overall responsibility for Health, Safety & Environmental management and protection matters in your organization?

Please provide name, title and organizational chart.



     

2.2

Is there an HSE Policy Statement authorized by the senior executive and is it signed? Please supply a copy of your up-to-date signed HSE policy.



     

2.3

How is the policy communicated throughout the organization? Please provide evidence of policy communication initiatives.



     





2.4

What is the total number of individuals dedicated to HSE in your organization?

     





2.5

Do you have a documented and implemented Health & Safety Management System?

If Yes, please state which model aligned to e.g. BS OHSAS 18001, ANSI Z10, CSA Z1000, HS (G) 65, E&P Forum, etc. Please provide a copy of the index of your H&S Management System manual.



     

2.6

Has the Health & Safety Management System been certified by an accredited third party? Please provide copies of all certifications held.



     

2.7

Do you periodically review the effectiveness of your Health & Safety Management System? Please provide details and the documented evidence of the review.



     

2.8

Do you have a documented and implemented Environmental Management System?

Please state model EMS aligned to e.g. ISO 14001 or EMAS. Please provide a copy of the index of your Environmental Management System manual.



     

2.9

Has the Environmental Management System been certified by an accredited third party?

Please provide copies of all certifications held.

2.10

Do you periodically review the effectiveness of your Environmental Management System? Please provide details and the documented evidence of the review.



     

2.11

Do you have a process in place for managing Emergency Response? Please provide details including when last tested.



     

2.12

Do you implement an approved project HSE Plans? Please provide sample copies of previous project HSE plans.





2.13

Have you implement an approved internal HSE audit program? If Yes, please provide details and include a status report of your current internal audit program.



     

2.14

Have you implemented a process for HSE Management of Sub-Contractors? Please provide details of this sub-contractor HSE management process.



     

2.15

Has an appropriate reporting procedure been established for all near misses/ incidents/ accidents? Please provide a copy of this procedure.



     

2.16

Do all Incident/ Accident reports contain recommendations for the prevention of recurrence? If so please provide 2 examples.






2.17

Is there a system in place to ensure compliance with regulatory requirements and codes?

Please provide a description of your process used to identify, evaluate and integrate regulatory requirements for your equipment and operations


2.18

Are clear goals and specific objectives for the HSEQ Management System established?

Please provide a copy of your current HSEQ goals and objectives


2.19

Is performance against HSEQ goals and objectives evaluated?

Please provide a copy of the most recent status report of your HSEQ goals and objectives evaluation


2.20

Does the workforce actively participate in HSEQ processes?

Please provide a documented reference to how you engage the workforce in select aspects of your HSE management system and prevention initiatives

2.21

Are hazard/risk assessments conducted in order to identify and address potential hazards to personnel, facilities, the public and the environment?

Please provide a description of your hazard and risk assessment process and a recent example of a hazard/risk assessment used in the execution of a recent work scope.



2.22

Are management reviews of your HSEQ Management Systems conducted periodically to address the possible need for changes or improvements?

Please provide a copy of the minutes of your last documented management review

2.23

Has the organization maintained records of incidents/ accident statistics for the last three (3) years?

If Yes, please provide the following details for each year.





Year:

     

     

     

     

     





Total number of man-hours worked?

     

     

     

     

     





Total number of fatalities?

     

     

     

     

     





Total number of first aid injuries?

     

     

     

     

     





Total number of lost workday cases?

     

     

     

     

     





Total number of medical treatment cases?

     

     

     

     

     





Total number of restricted work days?

     

     

     

     

     





2.24

In the last 36 months has your Company been subject to any HSE prosecutions, stop work orders or regulatory violations?
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