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Prequalification Submission
Mark Elias
2024-10-11T13:29:10+00:00
General Information
Company Name
*
Years In Business
*
Number of Employees
*
Street Address
Apartment, suite, etc
City
State/Province
ZIP / Postal Code
Contact Information
Name
*
Primary Contact
Email Address
*
Phone
*
Name
*
Secondary Contact
Email Address
*
Phone
*
Health and Safety Performance
Hours Worked in 2024
*
Hours Worked in 2023
*
Hours Worked in 2022
*
Number of Fatalities in 2024
*
Number of Fatalities in 2023
*
Number of Fatalities in 2022
*
Lost Time Injuries in 2024
*
Lost Time Injuries in 2023
*
Lost Time Injuries in 2022
*
Medical Aids in 2024
*
Medical Aids in 2023
*
Medical Aids in 2022
*
First Aids in 2024
*
First Aids in 2023
*
First Aids in 2022
*
Documents
WSIB Clearance Certificate
*
Choose File
No file chosen
Delete uploaded file
Upload a copy of the company's current WSIB Clearance Certificate (required).
Expiry Date
*
WSIB Expiry Date
Certificate of Insurance
*
Choose File
No file chosen
Delete uploaded file
Upload a copy of the company's current COI (required).
CGL Insurance $2,000,000 per occurrence
Automotive Third-Party Coverage $1,000,000 per occurrence
For consulting services, Professional Liability $1,000,000 per claim
For handling of hazardous materials Environmental Impairment Insurance $1,000,000 per occurrence
Certificate of Insurance with Super Sucker listed as additionally insured
Expiry Date
*
COI Expiry Date
WISR (Workplace Injury Summary Report)
*
Choose File
No file chosen
Delete uploaded file
Upload a copy of the most recent WISR (Workplace Injury Summary Report) (required).
Health and Safety Policy Statement
*
Choose File
No file chosen
Delete uploaded file
Upload a copy of the company's current Health and Safety Policy Statement (required).
COR (Certificate of Recognition)
Choose File
No file chosen
Delete uploaded file
Is your company COR (Certificate of Recognition) certified? If yes, upload a copy of your certificate.
Health and Safety Manual
Choose File
No file chosen
Delete uploaded file
Upload a copy of the company's Health and Safety Manual (if too large, upload Table of Contents).
Does your company have/do the following?
Health and Safety Orientation Program
*
Yes
No
Scheduled Safety Meetings
*
Yes
No
Workplace Violence and Harassment Policy (must upload copy)
*
Yes
No
If YES, please upload a copy of your WV&H Policy
Choose File
No file chosen
Delete uploaded file
Accident/Incident Investigation Procedure
*
Yes
No
Workplace Inspection Procedure
*
Yes
No
Substance Abuse Policy (must upload copy)
*
Yes
No
If YES, please upload a copy of your SA Policy
Choose File
No file chosen
Delete uploaded file
Note: Do not provide any privileged information regarding these following questions:
Do you have any workers who may interact with SSHV, its service providers, clients, or other associates:
*
With a history of violence or harassment?
With a history of impairment at work?
Currently participating in a substance abuse program?
None of the above
Have all employees received the following training?
Health and Safety Orientation
*
Yes
No
Site/Specific Training (i.e. Working at Heights, Lock Out Tag Out, etc.)
*
Yes
No
Trade Specific Certification (if applicable)
*
Yes
No
Health and Safety Awareness Training (4 Step for Workers, 5 Step for Supervisors)
*
Yes
No
WHMIS 2015
*
Yes
No
Workplace Violence and Harassment
*
Yes
No
Are workers' training records maintained and copies kept by the company?
*
Yes
No
Form Section
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