Subcontractor
Pre-qualification Form

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

1. Contact Information

First Name*

Last Name*

Company Name*

Email*

Phone Number*

Website*

Address*

Street Address Address Line 2 City State Zip Code Country

Company Type*

Residential

Commercial

Retail

Hospitality

Years in Business*

Trade Description (i.e. Electrical, Plumbing, etc.)*

Please upload images of your most recent/ relevant work or your portfolio:*

Drop files here or

Max. file size: 50 MB, Max. files: 10.

2. Insurance Information

Certificate of Insurance will be required as proof of insurability.

Name of Insurance Company*

3. References

Please provide at least 3 job references including project name, location and general contractor

Reference #1*

Reference #2*

Reference #3*

Main Bid Contact (Please include full name, cell phone # and email)*

4. Locations where you work

Main Location*

Other Locations*

5. Risk Control

INSTRUCTIONS: Complete all requested information blocks. If you fail to provide the information as requested, it may affect your ability to bid on this project. If you feel the information requested is not applicable to your company, put N/A in the information block and explain on a separate sheet of paper your reason for this. The asterisk indicates that supporting documentation needs to be attached.

List your firm’s interstate Experience Modification Rate (EMR) for the last 6 years*

Current Year

2024

2023

2022

Use your OSHA logs to provide the following information

Total man-hours worked including overtime (in 000’s)*

Current Year

2024

2023

2022

Total number of OSHA recordable cases*

Current Year

2024

2023

2022

Number of lost workdays*

Current Year

2024

2023

2022

Number of lost workdays*

Current Year

2024

2023

2022

Number of cases with job transfer or restriction*

Current Year

2024

2023

2022

Number of days of restricted work activity*

Current Year

2024

2023

2022

Number of fatalities*

Current Year

2024

2023

2022

If any fatalities are listed, please explain circumstances:

How often are accident report summaries (Loss Runs/OSHA Logs) sent to the following people?

President/CEO*

Monthly

Quarterly

Annually

Never

VP/Manager of Construction*

Monthly

Quarterly

Annually

Never

Field Supt./Site Managers*

Monthly

Quarterly

Annually

Never

If accident report summaries are sent, upload report examples from the two most recent periods*

Drop files here or

Max. file size: 50 MB, Max. files: 2.

Do you hold on-site safety meetings with your field superintendents?*

Yes

If yes, how often?*

Weekly

Every Two Weeks

Monthly

Less often, as needed

If yes, upload agendas from the two most recent meetings of this type*

Drop files here or

Max. file size: 50 MB, Max. files: 2.

Does your company have a safety officer / department?*

Yes

Do you conduct project safety inspections?*

Yes

If yes, who conducts these inspections? (Title)*

If yes, how often?*

Weekly

Every Two Weeks

Monthly

Quarterly

If yes, upload two safety inspection reports or other documentation of inspections of this type*

Drop files here or

Max. file size: 580 MB, Max. files: 2.

Are accident records and cost summaries kept?*

Yes

How often are accident reports updated and reported.

Accidents totaled for all company*

Monthly

Annually

Not at this level

Accidents totaled by project*

Monthly

Annually

Not at this level

Accidents subtotaled by foreman*

Monthly

Annually

Not at this level

Costs totaled for all company*

Monthly

Annually

Not at this level

Costs totaled by project*

Monthly

Annually

Not at this level

Costs subtotaled by foreman*

Monthly

Annually

Not at this level

Upload one example of each type of accident report where provided*

Drop files here or

Max. file size: 50 MB, Max. files: 2.

List the names and expected positions of at least two key personnel you expect to use on this project and the safety performance (one or more of the last three columns below, if calculated) for the last three projects they worked on.

Name

Position on this project

Last 3 projects (name)

Position on last 3 projects

Claim cost / employee hour

OSHA Recordable Case IR

OSHA DART Case Rate

Upload documentation of safety performance from client or company reports*

Drop files here or

Max. file size: 50 MB, Max. files: 2.

Do you have a written safety program?*

Yes

Upload a copy of the safety program, including a mission or loss control statement*

Drop files here or

Max. file size: 50 MB, Max. files: 2.

Do you have an orientation program for new hires? (New hires would include those persons who are new to each specific job site, not just those who are new to the company.)*

Yes

Does the orientation include instruction / training on the following?

	Yes	No	N/A
Eye/face protection
Head protection
Hearing protection
Respiratory protection
Personal fall protection device
Foot protection
Hand protection
Scaffolding
Perimeter guarding
Housekeeping
Fire protection
First aid procedures
Emergency response
Hazard communication as per 1926.59
Trenching and excavation
Signs, barricades and flagging
Substance abuse – alcohol & drug screening
Lock out/tag procedures
Electrical safety
Rigging and crane safety
Accident reporting
Competent person requirements

Upload a summary of the materials used in orientation for the last two projects*

Drop files here or

Max. file size: 50 MB, Max. files: 2.

Do you have a training program for newly hired or promoted foremen?*

Yes

Does the program include instruction / training on the following?

	Yes	No	N/A
Safe work practices
Job hazard analysis
New hire safety orientation
First aid
Emergency response procedures
Accident investigation procedures and techniques
Chemical hazard communication
Fire protection and fire prevention
Conducting tool box safety meetings
OSHA standards applicable to your company operations

Upload a summary of the materials used in foreman training*

Drop files here or

Max. file size: 50 MB, Max. files: 2.

Are tool box safety meetings held?*

Yes

How often are tool box safety meetings held?*

Weekly

Every 2 Weeks

Monthly

Less Often

Upload agendas, minutes or other dated material used in at least three tool box meetings from two recent projects*

Drop files here or

Max. file size: 50 MB, Max. files: 2.

Do you have a formal substance / drug screening program that covers all construction workers?*

Yes

Within the geographic area of this project, are you a party to union collective bargaining agreements?*

Yes

If yes, please identify the unions and the expiration date of the agreement.

Union

Expiration Date

6. Signature

The attached information was compiled from the records that are available to me at this time and I declare that the information is true and accurate within the limitations of those records.*