承包商预先资格审查表

2014

Contractor prequalification questionnaire

承包商预先资质审核调查表

CONTRACTOR'S NAME 承包商名称______________________DATE 日期______________ ADDRESS地址________________________________________________________________ 1. Please consolidate your firm's injury data for the last three years and complete the following: 请把贵企业最近三个年度的工伤数据汇总后，完成以下内容： YEAR年: 2015 2016 a) Number of injury incident without lost workday 无损失工作日伤害事故数量 _____ _____ ______ b) Number of Light Injury Incident 轻伤事故数量 _____ _____ ______ c) Number of Serious Injury Incident 重伤事故数量 _____ _____ ______ d) Number of Fatality Incident 死亡事故数量 _____ _____ ______ e) Number of Significant Fatalities Incident 重大死亡事故数量 _____ _____ ______ f) Total number of company work hours 公司全部工作小时合计 _____ _____ ______ g) Total number of lost workdays 全部损失工作日合计 _____ _____ ______ 2． Do you maintain the following insurance as required by the Chinese Insurance Requirements. 根据中国保险的要求，参保以下的险吗？  Construction all Risk Liability Insurance Y是/ N否 Amount金额____________ 施工一切险  Third Party Liability Insurance Y是/ N否 Amount金额____________ 第三者责任险  Employer Liability Insurance Y是/ N否 Amount金额___________ 雇主责任险  Accident Insurance Y是/ N否 Amount金额___________ 人身意外保险 3. List any fatalities your firm has had in the last three years. Include location, cause and corrective action. (Use back of form if additional space required.) 列出贵公司近三年发生的死亡事故, 包括地点、起因和改善的措施（如果需要额外的描述可以写在后面表中的空白处） ———————————————————————————————- _______________________________________________________________ _______________________________________________________________ 4. How often do your field supervisors receive safety training? 贵公司的现场主管多久接受一次安全培训？ Weekly _________ Biweekly ________ Monthly _________ Other____________ 每周 每两周 每月 其它

5. How often do you conduct project safety inspections? _______________________ 贵公司多久进行一次现场的安全检查？ Who conducts these inspections (Title)? _________________________________ 谁进行这些安全检查（职位）？ __________________________________________________________________ 6. How are accident records and accident summaries kept? How often are they reported? 公司如何保管事故的记录和描述？它们汇报的频率如何？ Yes是 No否 Monthly月度 Annually年度 Are Accidents Totaled for the Entire Company? ___ ___ _____ _______ 事故是以整个公司为单位汇总的吗? Are Accidents Totaled by Project? ___ ___ _____ _______ 事故是以所做的项目为单位汇总的吗? 7. How are the costs of individual accidents kept? How often are they reported? 公司如何保管事故的费用记录？它们汇报的频率如何？ Yes是 No否 Monthly月度 Annually年度 Are Costs Totaled for Entire Company? ___ ___ _____ _______ 事故费用纪录是以整个公司单位汇总的吗？ Are Costs Totaled by Project? ___ ___ _____ _______ 事故费用纪录是以项目为单位汇总的吗？ 8. Describe your safety organization. List names, titles and safety training: 描述贵公司的安全组织结构。列出姓名、职位和安全培训名称： ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 9. Who has safety responsibilities at a specific jobsite? Give title and safety training: 谁承担某一特定工作现场的安全责任？请提供职位名称和安全培训名称： ________________________________________________________________ ________________________________________________________________ 10. Do you have a controlled substance and drug abuse program? YES是___NO否 ___ 贵公司是否有受控物质和严禁滥用药品的程序吗？(Please attach copy请提供复印件) 11. Do you have a written safety program? YES是_______NO否 _______ 贵公司有书面的安全程序吗？(Please attach copy请提供复印件) 12. Does your written safety program include the following? 贵公司书面安全程序是否包括下列内容 YES是 NO否 1). Policy Statements政策的陈述： a. Company Statements 公司的陈述 ____ _____ b. Substance Abuse 禁用物质 ____ _____ c. Rule/Program Enforcement 规则/程序执行力 ____ _____ 2). Safety/Health Procedures安全/健康程序：

a. Fall Protection 坠落预防 ____ _____ b. Scaffolding/Work Platform 脚手架/工作平台 ____ _____ c. Perimeter guarding/floor, wall and roof openings 边缘防护/地面、墙和屋顶开口 ____ _____ d. Mobile Equipment Safety 移动设备安全 ____ _____ e. Housekeeping 现场保洁 ____ _____ f. Fire Protection 消防 ____ _____ g. Injury Treatment Procedure, First-aid Facilities 工伤治疗程序，急救设施 ____ _____ h. Emergency procedures, Rescue, Evacuation 紧急响应程序、营救、疏散 ____ _____ i. Hazard Communication/MSDS 危害物质沟通/材料安全数据表 ____ _____ j. Toxic Substances 有毒物质 ____ _____ k. Trenching/Excavation 开挖/挖掘 ____ _____ l. Signs, Barricades, Flagging 标志、路障、警示 ____ _____ m. Electrical Safety 电器安全 ____ _____ n. Rigging/Crane Safety 搬运/起重安全 ____ _____ o. Confined Space Entry 密闭空间的进入 ____ ____ p. Welding/Burning Permit Procedures 焊接/燃烧批准程序 ____ _____ q. Hazardous Material(asbestos, lead etc)Abatement 有害物质（石棉、铅等）消除 ____ _____ r. Lockout/Tagout/Try 挂牌/上锁/验机 ____ _____ 3). Personal Protective Equipment Requirements个人防护用品的要求： a. Head Protection 头部防护 ____ _____ b. Eye Protection 眼部防护 ____ _____ c. Hearing Protection 听力防护 ____ _____ d. Foot Protection 足部防护 ____ _____ e. Respiratory Protection 呼吸防护 ____ _____ f. Chemical Protective Clothing 防化服 ____ _____ 13. Are all current employees trained in the above safety program? 目前所有的员工已经接受上面所列的安全程序的培训吗？ YES 是______ NO 否______ 14. Do you have a formal orientation program for all new hires on the above safety Program? 贵公司是否有针对以上安全程序的新入职员工的安全培训吗？ YES 是_______ NO 否________ (Please attach copy请提供复印件) 15. Do you have a written safety program for newly hired or promoted supervisors? 贵公司是否有针对新入职员工或晋升主管的书面安全程序？ YES 是_______ NO 否________ (Please attach copy请提供复印件) 16. If yes, does it include instruction on the following: 如果是，它是否包括以下的培训： YES 是 NO 否. 1. All elements of your written safety program 书面安全程序的所有要素 ____ _____ 2. Methods of safety supervision 安全监督的方法 ____ _____ 3. Emergency procedures 紧急响应程序 ____ _____ 4. First-Aid facilities 简单治疗设施 ____ _____ 5. Fire prevention/protection 消防 ____ _____ 6. New worker orientation 新员工的教育 ____ _____