Subcontract Questionnaire (KFQF 13 Iss 02 24.09.2015)

1. Company Name

2. Trading Name

3. Company Reg No

4. Date of Registration

5. Company Address

6. Registered Office Address

7. Telephone No

8. Email This question requires a valid email address.

9. Are you CIS Registered?

10. UTR No

11. VAT Registration No

12. Please list all relevant contacts within your Company

Space Cell	Full Name	Job Title	Contact Number	Email
1	Full Name	Job Title	Contact Number	Email
2	Full Name	Job Title	Contact Number	Email
3	Full Name	Job Title	Contact Number	Email
4	Full Name	Job Title	Contact Number	Email
5	Full Name	Job Title	Contact Number	Email

13. Are you classed as a SME (Small Medium Enterprise) (<50 employees and <£250m Turnover)

14. Does your Company hold the following Insurance Policies

Space Cell	Yes	Aggregate
Public Liability
Employers Liability
Contractors All Risk
Professional Indemnity
Hired in Plant

15. Please specify the following Limits and Renewal Dates for each of the Insurance Policies above

Space Cell	Limit	Renewal Date
Public Liability	Limit	Renewal Date
Employers Liability	Limit	Renewal Date
Contractors All Risk	Limit	Renewal Date
Professional Indemnity	Limit	Renewal Date
Hired in Plant	Limit	Renewal Date

17. Is your Company Accredited to any of the following? (If, yes, please send a copy to)

Space Cell	Yes	No	Working Towards
Achilies Building Confidence
Achilles Link-Up
Achilles UVDB
FPAL
CHAS
CHSG
ISO 9001
ISO 14001
ISO 18001
Enter another option
Enter another option

19. List your turnover for the last 3 years

Space Cell	Period End	Annual Turnover	Pre Tax Profit	Current Assets	Current Liabilities
This Year	Period End	Annual Turnover	Pre Tax Profit	Current Assets	Current Liabilities
Previous Year	Period End	Annual Turnover	Pre Tax Profit	Current Assets	Current Liabilities
Previous Year	Period End	Annual Turnover	Pre Tax Profit	Current Assets	Current Liabilities

Additional Comments

20. Types of work undertaken

21. Provide contact details for two client references

Space Cell	Client 1	Client 2
Full Name	Client 1	Client 2
Company	Client 1	Client 2
Contact Number	Client 1	Client 2
Email Address	Client 1	Client 2

22. Minimum Value of a Contract you can undertake

Minimum Value £
Maximum Value £

23. Indicate your areas of Operation

A - East of England
B - London
C - South East of London
D - South West

24. Please list figures for the last 3 years

Space Cell	This Year	Previous Year	Previous Year
Number of Employees	This Year	Previous Year	Previous Year
Total number of hrs Worked	This Year	Previous Year	Previous Year
Number of Employees that have had H&S Training	This Year	Previous Year	Previous Year
Number of Certified 'First Aiders' at work	This Year	Previous Year	Previous Year
Number of Fatalities on your sites (RIDDOR)	This Year	Previous Year	Previous Year
Number of major injuries (RIDDOR)	This Year	Previous Year	Previous Year
Number of over 7-day injuries (RIDDOR)	This Year	Previous Year	Previous Year
Number of dangerous Occurrences (RIDDOR)	This Year	Previous Year	Previous Year
Number of HSE Prosecutions	This Year	Previous Year	Previous Year
Number of H&S prohibition notices	This Year	Previous Year	Previous Year
Number of H&S improvement notices	This Year	Previous Year	Previous Year
Number of Environmental Offences	This Year	Previous Year	Previous Year
Number of Environmental notices	This Year	Previous Year	Previous Year

25. Percentage of Employees holding CSCS cards (or recognised equivilents) This question requires a valid percent format.

26. Percentage of Employees holding CPCS cards This question requires a valid percent format.

27. Does your company have the following policies? If 'YES' please send a copy to supplychain@kellyformwork.co.uk

Space Cell	Yes	No
Health & Safety Policy
Quality Policy
Equal Opportunities Policy
Anti Bribery Policy
Environmental Policy
Sustainability Policy

29. Attachment Checklist

Space Cell	Yes	N/A
A fully completed Questionnaire	Yes	N/A
Copies of all Insurance Policies	Yes	N/A
Health & Safety Policy	Yes	N/A
Environmental Policy	Yes	N/A
Quality Policy	Yes	N/A
Copies of all awards, recognition's, memberships & affiliations	Yes	N/A

30. I/We hereby certify that the information given is in good faith and can further be substantiated if required. By Signing this declaration, we commit our company to work in accordance with the Kelly Group's work ethics and ethos

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Job Title

Subcontract Questionnaire (KFQF 13 Iss 02 24.09.2015)

Company Details