Subcontractor Supply Chain Questionnaire - I-MEX (M&E) Ltd

Section 1 – Company Information

Registered Company Name *

Trading As (if different from above)

Company Registration Number *

VAT Registration Number

Company UTR Number

Registered Company Address *

Trading Address (if different from above)

Contact Name *

Contact Email Address *

Contact Telephone Number *

Company Organisation Chart *

YesNo

Upload Company Organisation Chart *

Description of Works Undertaken *

Section 2 – Financial Details

Order Number *

All applications must reference the relevant I-MEX order number.

Name of Bank *

Account Name *

Sort Code *

Account Number *

Published Accounts

Please provide copies of your last three years' published accounts.

Current Year Accounts *

Last Year Accounts *

Previous Year Accounts *

Financial Information

	Current Year	Last Year	Previous Year	Projected Next Year
Turnover £
Net Profit £
Net Assets £
Number of Employees

Trade References

Please provide contact details for a minimum of two references.

Reference 1

Contact Name *

Company *

Address *

Telephone *

Email *

Services Provided *

Value of Works Completed £ *

Reference 2

Contact Name *

Company *

Address *

Telephone *

Email *

Services Provided *

Value of Works Completed £ *

Section 3 – Health and Safety

How many direct employees do you have? *

Health and Safety Contact

Name *

Job Title *

Contact Number *

Contact Email Address *

Health and Safety Qualification Held *

If you employ more than five people, is a copy of your Health and Safety Policy Statement included? *

YesNoN/A

Health and Safety Policy Statement *

Have you had any accidents or incidents in the last three years? *

YesNo

Please provide details *

Is an example of a site-specific Risk Assessment included? *

YesNo

Upload Risk Assessment *

Is an example of a site-specific Method Statement included? *

YesNo

Upload Method Statement *

Is an example of a site-specific COSHH Assessment included? *

YesNo

Upload COSHH Assessment *

Is evidence of safety training and competency for managers and employees included? *

YesNo

Upload Training / Competency Evidence *

Has the company or any Director ever been prosecuted as a result of a Health and Safety incident or accident? *

YesNo

Please provide details *

Has the company or any Director ever been issued a Prohibition Notice by the HSE? *

YesNo

Please provide details *

Is the company registered with any Health and Safety accreditation schemes, for example CHAS, Constructionline or Achilles? *

YesNo

Please provide details *

Section 4 – Quality Assurance, Policies and Procedures

Quality Assurance Contact

Name *

Job Title *

Contact Number *

Contact Email Address *

Quality Assurance Qualification Held *

Do you have a Quality Assurance System? *

YesNo

Please provide details *

Is your Quality Management System certified to BS EN ISO 9001:2015? *

YesNoN/A

If you do not have a Quality Management System, are you willing to work within and to the requirements of a third-party system? *

YesNo

Is your company a member of any trade accreditation bodies, for example Gas Safe, NICEIC or F-Gas? *

YesNo

Please provide details *

Does your company have an Environmental Management System? *

YesNo

Please provide details *

Is your Environmental Management System certified to BS EN ISO 14001? *

YesNoN/A

Does your company have an Equality and Diversity Policy? *

YesNo

Please provide details *

Does your company have an Anti-Bribery and Corruption Policy? *

YesNo

Please provide details *

Section 5 – Modern Slavery

Modern Slavery / Labour Rights Contact

Name *

Job Title *

Contact Number *

Contact Email Address *

Do you have an Anti-Slavery / Human Rights Policy? *

YesNo

Please provide a copy of the policy *

Legal Compliance

Do you comply with relevant laws concerning Forced Labour? *

YesNo

Do you comply with relevant laws concerning Child Labour? *

YesNo

Do you comply with relevant laws concerning Minimum Wage? *

YesNo

Do you comply with relevant laws concerning Working Hours? *

YesNo

Do all employees have employment contracts which they have agreed to and signed under their own free will? *

YesNo

Do you conduct due diligence on labour providers? *

YesNo

Certifications

Sedex / SMETA Audit *

YesNoN/A

SA8000 *

YesNoN/A

Fairtrade *

YesNoN/A

ISO 37200 *

YesNoN/A

Do you carry out Right to Work checks on new employees? *

YesNo

Please provide details *

Do you have a Supplier Code of Conduct covering labour standards? *

YesNo

Please provide details *

I/we confirm that the information detailed above and included with this application is accurate to the best of our knowledge.

Name *

Position *

I confirm that I am authorised to submit this questionnaire on behalf of the organisation and that the information supplied is accurate to the best of my knowledge.

Become a Supply Chain Partner

Section 1 – Company Information

Section 2 – Financial Details

Published Accounts

Financial Information

Trade References

Reference 1

Reference 2

Section 3 – Health and Safety

Health and Safety Contact

Section 4 – Quality Assurance, Policies and Procedures

Quality Assurance Contact

Section 5 – Modern Slavery

Modern Slavery / Labour Rights Contact

Legal Compliance

Certifications

Section 6 – Insurances

Public and Products Liability

Employers' Liability

Contract Works Insurance

Professional Indemnity Insurance

Declaration