Contractor Safety File Checklist

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Contractor Information

Contractor Company Name: {{contractor_company_name}}

Contact Person: {{contractor_contact_person}}

Contact Number: {{contractor_contact_number}}

Email Address: {{contractor_email}}

Project/Scope of Work: {{project_scope}}

Date of Assessment: {{date_of_assessment}}

Part A: Statutory Compliance Documentation

Please provide copies of the following valid and current documents:

1. Registration with the Compensation Fund (COID Act, as applicable in South Africa). Document provided: Yes / No / N/A (attach copy)

2. Letter of Good Standing with the Compensation Fund. Document provided: Yes / No / N/A (attach copy)

3. Public Liability Insurance Certificate (minimum cover {{currency}} {{public_liability_amount}}). Document provided: Yes / No / N/A (attach copy)

4. Professional Indemnity Insurance Certificate (if applicable, minimum cover {{currency}} {{professional_indemnity_amount}}). Document provided: Yes / No / N/A (attach copy)

5. Company Registration Documents (e.g., CIPC documents). Document provided: Yes / No / N/A (attach copy)

Part B: Health and Safety Management System

Please confirm the following and provide supporting evidence where requested:

1. Does the contractor have a documented Health and Safety Policy? Yes / No (attach copy)

2. Does the contractor have a dedicated Health and Safety Officer/Representative? Yes / No (Name: {{safety_officer_name}}, Contact: {{safety_officer_contact}})

3. Does the contractor conduct risk assessments for all anticipated work activities? Yes / No (attach example)

4. Does the contractor have a procedure for reporting and investigating incidents/accidents? Yes / No (attach copy)

5. Does the contractor provide health and safety induction training to all employees? Yes / No (attach evidence)

6. Does the contractor have a Fall Protection Plan (if working at heights)? Yes / No / N/A (attach copy)

Part C: Personnel Competency and Training

Please provide evidence of the following:

1. General Health and Safety Induction records for all personnel. Document provided: Yes / No / N/A

2. Specific training records relevant to the scope of work (e.g., First Aid, Fire Fighting, Scaffold Erection, etc.). Document provided: Yes / No / N/A

3. Medical fitness certificates for personnel undertaking high-risk tasks. Document provided: Yes / No / N/A

4. Qualifications and competency certificates for skilled trades (e.g., electricians, welders). Document provided: Yes / No / N/A

Part D: Equipment and Tools

Please confirm the following:

1. All machinery, plant, and equipment are regularly inspected and maintained. Yes / No (provide inspection records)

2. All lifting equipment has valid load test certificates. Yes / No / N/A (attach copies)

3. All electrical equipment is regularly inspected and certified safe for use. Yes / No (attach certificates)

4. Personal Protective Equipment (PPE) is provided, maintained, and used by all employees. Yes / No (describe types of PPE: {{ppe_types}})

Part E: Environmental Management System (if applicable)

1. Does the contractor have an environmental policy? Yes / No (attach copy)

2. Does the contractor have procedures for waste management and disposal? Yes / No (attach copy)

3. Does the contractor have a spill prevention and response plan? Yes / No / N/A (attach copy)

Declaration by Contractor

I, the undersigned, duly authorised representative of {{contractor_company_name}}, hereby declare that the information provided in this Contractor Safety File Checklist is accurate and complete to the best of my knowledge. I understand that any false or misleading information may result in the termination of our contract.

Name: {{contractor_signature_name}}

Position: {{contractor_signature_position}}

Date: {{contractor_signature_date}}

Signature: __________________________

Review and Approval by {{company_name}}

Reviewed By: {{reviewer_name}}

Position: {{reviewer_position}}

Date of Review: {{review_date}}

Safety File Approved: Yes / No

Comments/Conditions for Approval: {{approval_comments}}

Signature: __________________________

Signature Block

__________________________

Name: {{authorised_name}}

Title: {{authorised_title}}

Date: {{current_date}}