JSW STEEL LTD - VIJAYANAGAR WORKS

Contractor Pre-Qualification Questionnaire

1. Scope: This assessment is used by JSW to assess the extent its contractor’s development and commitment to Safety. The questionnaire considers a
wide range of issues pertinent to Safety. Based on the response, JSW will determine if the contractor will qualify and be registered as an “Approved
Contractor”.

2. Contractor Details
Name:

Postal Address:

Contact Person:
a) Designation
b) Name
c) Mobile No
d) Email ID

3. Contractor Profile

Contractors Type of Work (Description of service):

4. Past Experience - Jobs handled

Please provide a list of at least the top three (3) recent clients of your company, with whom you have contracts for scopes of work similar to that covered by
this pre-qualification process. Provide the following information for

Department Scope of Job - Description Value in Lakhs Contract Period Client Contact Name
(From - To) with Mobile No.

5. Company Manpower :
Total No. of Employee Attach details of Key personnel and Safety officer/Supervisor Qualification & Experience
Technical Staf
General Staf
Skilled Employee
Unskilled Employee
No.of Supervisors

6. Facilities & Infrastructure :

Please provide a description of the facilities & infrastructure which your company would utilize in provision of the subject services, if applicable. Please clarify
whether the facilities & infrastructure which you are describing are currently utilized by your company. Please provide complete details with photographs.
7. Questionnaire :

Sl.No. Description Yes / No / NA SCORE

I Statutary legal requerements

Does your company ensure all the workers engaged are medically examined and fit before
1 deployment on the job ? 5

Does your company have insurance policy for your workmen applicable before
commencement of work as per the statutory requirement [Employees to be covered under
2 ESI Compulsorily (If wages are less than 21,,000/-) OR Workmen Compensation policy (If 5
wages are more than 21,000/-)]

Does your company have covered all your engaged workmen under Provident Fund (PF) Act
3 1952 5

4 Do your have Labour License for your workers ? 5

All lifting equipments/machinary, tools and tackles are tested by competent person as per
5 Karnataka factory rules 1969 5

6 Does your company electricians have supervisory/wire man licence ? 5

Does your company have all vehicles valid registration, insurance, Fitness & Inspection
record as per the standard checklist in conformance with Motor Vehicle Act & Rules and
always keep copies of valid documents in the vehicle (Driving license, registration, 5
insurance, Fitness, identity card & contact details)

II Requirements of training

Does your company have a formal New employee Safety induction program ?
1 5

Does your company provide Job Specific Trainings to the engaged workforce before
2 deployment on the job ? 5

Does your company Maintain training records and licenses/certificates of operators, driver,
3 etc. 5

4 Have your employees been trained in PPE correct usage and maintenance ? 5
5 Have your employees been trained in Emergency preperness and first aid treatment ? 5
Does your Vehicle drivers are trained in Defensive Driving to follow all Road Safety Rules
6 inside the plant premises ? 5

III Equipments safety Requirements

When using equipment (leased, hired, borrowed etc.), do you have systems in place to
1 ensure that: (Attach list of equipment which you will use during engagement) 10

a Equipment is fit to be used ? & Have checked equipment/machine as per checklist ? 10

Employees who are to operate the machinery and equipment are trained for safety
b aspects ? 10

c Employees have the relevant licenses and/or certificates to operate the equipment? 10
 Does your company have system for recording regular inspections and maintenance of
hand tools, machinery (cranes, vehicles, boom lifts, hoists/lifting tools, etc.) and electrically
2 operated equipment? 10

IV Safety Performance Statistics of Previous finacial year

Number of Incidents (Injury/Fire) recorded against the Contractor:

First aid / Minor Fire Incident : -5 point/case
MTC, RWC / Medium Fire Incident : -7.5 points / case
1 LTI / Major Fire Incident : -20 points / case
Fatal : Contract Termination

Total Number of Violations (Yellow / Red Notice) recorded against the Contractor: Yellow :
2 -5 / notice & Red : -20/notice

3 Number of times penalty imposed : -5 points / penalty

Total Number of Road Safety Violations recorded against the Contractor:
4 -1 / violation

5 Does your company received any safety related award/rewards: 20

V Requirements of Safety Systems

1 Does your company have an Incident reporting and investigation process system? 10
Does your company have a system to evaluate the Hazards associated with the job and
2 control measures implementation at site ? 10

Does your company conducts Tool Box talk to the engaged work force before start-up of job
3 on daily basis ? 10

4 Does your Company maintain First Aid Box and its record ? 10
7 Does your Company have deployment of Safety Officers 10
8 Does your company have system of reporting near miss incidents 10
Does your Company provide PPE to all employees as per Job requirements without any
9 charge ? 10
Does your company have system safety measures during hot jobs (Welding, Gas cutting,
10 Grinding, etc) 10

VI Does your Company have and follow Safety Standards & procedures for the following :

Working at Height
Confined Space Entry
Lock Out Tag Out
Permit To Work
Electrical Safety Standards
Machine Guarding
a PPE 20
Conveyor Safety
Scafolding
Lifting & Handling
 Hazard identification &Risk Assessment
Welding Safety
Gas Cylinder Safety
Grinding Safety
Lifting Tools & Tackles
Pre start up Safety Review
b Falling of objects 20
Gassing & Asphyxia
Chemical Safety
Fire Extinguisher Standard

Total 255
Other Relevant Information
If there is any other information we should have to help us in the assessment of your
capabilities to work efectively on Occupational Health & Safety (OH&S) and technical
training; please include it here.

Conditions
All Contractors, sub-contractors and their employees are expected to comply with JSW
Safety Standards & Procedures.

Contractor / Represented signature

Full Name & Designation

JSW Evaluation

Pre-Qualification / Re-Qualification

Recommended as an “JSW, Approved Contractor”

Authorised Signatory
Type of Work Approval

Note : If requirements are not fulfilled by the contractor, the concerned HOD has to decide for consideration of Contractor after obtaining an
undertaking from the Contractor to follow JSW standards and requirements within a target time frame.