Shell Retail Network Development Programme - CONTRACTOR (VENDOR) PREQUALIFICATION

NOTE: ONLY GREY CELLS TO BE FILLED BY CONTRACTORS

Contact for this Prequalification:
Contact person: Abdul Khadir Title: Cost Mngr & Contracts Description of Works:
E-mail: [email protected];
Telephone: +91 8046464 116 Date Issued:
[email protected]
Fax: Country:India
PART 1 - GENERAL INFORMATION

A. SUPPLIER INFORMATION

A.1 Name of Company (Full Legal Name)

Certificate of Registration
A.2
Please submit copy of your Company Certificate of Registration with this Questionnaire
submission.

A.3 Company Address (Operation Office)

Contact Person
Title
A.4 Telephone No: Fax No:
Email:
Company Number:

Banking Details
Provide your Company's banking details in the following form.
A.5 a) Bank (Name & Location)
b) Branch Code
c) Swift Code

A.6 Banking details - please complete the attached GSAP Requirement document.

A.7 Website

Corporation or Company
Subsidiary
Business Type
Division
A.8 Complete the table on you type of business. Select and highlight those that are appropriate
Partnership
for your Company
Proprietorship
Any other type?

Parent Company
A.9 Where a parent company exist please provide the name and location of the parent
company

Affiliated Companies
A.10
Provide the name and location of affiliated companies

Construction Services
Manufacturer / Fabricator
Nature of Business
Assembly Workshop
Complete the table on the nature of your business
A.11 Distribution Supplier
Select ALL those that are relevant:
Technical Services
General Services
Other

Business Background
A.12
Date of Business established: (format is DD/MM/YYYY)

Your company have M.S.M.E certificate? Please attach document and also
confirm fall under which of the following category?
A.13 a) MICRO
b) SMALL
c) MEDIUM

Please inform if any recent or past communication had with Shell or related to
Shell project for any works or services?
A.14 a) Direct with Shell Company
b) Through L2 Partners other than Meinhardt
c) With Meinhardt

B. FINANCIAL and LEGAL INFORMATION

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 Insurance
Provide insurance coverage such as but not limited to the following:
Attached copy of the Insurance coverage documents.
Employer's Liability Insurance - Amount (USD): NA
Insurer:
Validity:
B.1 General 3rd Party Insurance (Public) - Amount (USD): NA
Insurer:
Validity:

3rd Party And Passenger Liability Insurance - Amount (USD): NA

Insurer:
Validity:

Proposed (Estimated): 2018-19

Annual Turnover (for the last 3 years)
Year 1 (actual): 2015-16
B.2 Provide details of your Company's Annual turnover for the last 4 years in the following
format; Year - Value INR per Annum Year 2 (actual): 2016-17
Attached audited Financial Statements (FS)
Year 3 (actual): 2017-18

Company Registration of government regulatory requirement

B.3
Attached registration certificate (Tax, Employee benefits and etc.)

Certificate of contribution for any government mandatory benefits for employees.

B.4
Attached certificate of contribution.

C. COMPANY EXPERIENCE AND PERSONNEL

Period of Current Ownership

C.1
Please provide details in years.

Number of employees
C.2
in full time equivalent

Organogram (organisation Chart)

C.3
Attached organisational chart - Company wide

a) Managing Director

b) Sales Manager

c) Engineering Manager
Senior Company Personnel
For the following personnel, please provide details on Role and Contact Numbers. Include
C.4 d) Safety Manager
copies of the resume for the above personnel

e) Quality Manager

f) Project Manager

g) Site/ Service Manager

Subcontractor and Supplier

List of subcontractors or suppliers normally used

Provide details on the Subcontractors your company normally uses in the following form:
C.5 a) Company Name
b) Type of Service
c) Value of Credit (INR)

Attached list of Subcontractors & Sub-suppliers

D. TECHNICAL EXPERTISE
Industry of Code Certification (include validity)
Provide detail on all industry certification and Industry Code your Company has
D.1 accreditation with

Attached Certificate Copy

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 Quality Assurance
Please advise if your Company is certified to work requiring QA/QC program such as ISO
D.2 accreditation on any quality accreditation.

Provide details on Standard, Certificate body and Expiry date

Track Record
a) Client name
b) Service provided
c) Site Location
D.3
d) Project Value in USD
e) Date completed or expected completion date

Attach list of clients and projects

PART 2 - SAFETY / HSSE (Health, Security Safety and Environment)

NOTE : ASSESSMENT TO BE COMPLETED BY MEINHARDT' HSSE FOCAL
A. HSSE PRE-SCREENING QUESTIONNAIRE
A.1 CONTRACTOR SAFETY STATISTICS

Number of Fatalities? 1 year ago NIL

Number of Fatalities? 2 years ago NIL
5.1
Number of Fatalities? 3 years ago NIL
Number of Fatalities? 3 years average NIL
Number of Total Reportable Cases? 1 year ago NIL
Number of Total Reportable Cases? 2 years ago NIL
5.2
Number of Total Reportable Cases? 3 years ago NIL
Number of Total Reportable Cases? 3 years average NIL
Number of Exposure Hours? 1 year ago 78000
Number of Exposure Hours? 2 years ago 62400
5.3
Number of Exposure Hours? 3 years ago 60840
Number of Exposure Hours? 3 years average 67080
Total Reportable Case Frequency (TRCF)? 1 year ago NIL
Total Reportable Case Frequency (TRCF)? 2 years ago NIL
5.4
Total Reportable Case Frequency (TRCF)? 3 years ago NIL
Total Reportable Case Frequency (TRCF)? 3 years average NIL
Number of incidents involving environmental damage?* 1 year ago NIL
Number of incidents involving environmental damage?* 2 years ago NIL
5.5
Number of incidents involving environmental damage?* 3 years ago NIL
Number of incidents involving environmental damage?* 3 years average NIL

TOTAL REPORTABLE CASES (TRC) - If a contractor is injured at work and needs medical treatment from a doctor, this is classified as a Total Reportable Case (TRC). Other incidents classified as a TRC are fatalities;
disabilities resulting from the injury; injuries resulting in time off work (Lost Time Injuries - LTI) and injuries resulting in restricted working. Injuries requiring first aid are not classified as a TRC.
Definition

EXPOSURE HOURS - Total number of hours worked during the year by all employees.
TOTAL REPORTABLE CASE FREQUENCY (TRCF) - Number of TRC incidents per million hours worked (expressed as "exposure hours"). For example, 2 TRCs and 1.3 million exposure hours would be recorded as:
2 divided by 1.3 = 1.54 TRCF

A.2 CONTRACTOR SAFETY STATISTICS Tick Yes/No

6.1 Does your company have a HSSE manual or written working HSSE practices, procedures and instructions? ✘ Yes No

Does your company have a process in place to ensure that plant and equipment used by your employees are maintained in a safe Yes No
6.2 ✘
working condition?
✘ Yes No
Does your company have arrangements in place to assess the HSSE awareness and competency level of your employees, in
6.3
particular those that undertake high risk work activities?

6.4 Does your company have a written procedure for the investigation, reporting and follow up of HSSE incidents? Yes ✘ No

✘ Yes No
6.5 Does your company have a process in place to identify and control hazards in the workplace?

6.6 Does your company provide Personal Protective Equipment (PPE) to all workers as appropriate for the job task? ✘ Yes No

6.7 Does your company employ competent HSSE Specialist? ✘ Yes No

B Contractor HSSE CAPABILITY QUESTIONNAIRE, Stage 2(a)

B.1 Leadership and Commitment

Commitment to HSSE through leadership

a) How are senior managers personally involved in HSSE management? a) By having regular audit on HSSE and regular monitoring of the workers involvement appart from the supervisor
B.1.1 b) Provide evidence of commitment at all levels of the organisation? b) All personals in our organization are given award based on HSSE fail identification
c) How do you promote a positive culture towards HSSE matters? c) Providing cash award and other prices to labours and workes based on the performances of HSSE
Submit all the evidences

B.2 Policy and Strategic Objectives

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 HSSE policy documents
a) Does your company have an HSSE policy document? If the answer is YES please
attach a copy.
a) Yes, Please refere attachment
b) Who has overall and final responsibility for HSSE In your organisation?
B.2.1 b) All person in our organization has equal responsibility on HSSE and Project Manjor and MD have the final responsibility
c) Who is the most senior person in the organisation responsible for this policy being
c) MD
carried out at the premises and on site where his employees are working? Provide name,
title and experience.
Submit all the evidences

Availability of policy statements to employees

a) Itemise the methods by which you have drawn your policy statement to the attention of a) Leader Ship at all level for HSE, leader ship in their contribution to improve HSE, Understanding and comply with the HSE
B.2.2 all your employees? requirment as per the requirment, Leadership in performing regular review of the HSE management.
b) What are your arrangements for advising employees of changes in the policy? b) Providing awareness regarding the changes and share roles and responsibilities on a regular basis.
Submit all the evidences

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 Organisation, Responsibilities, Resources, Competence, Standards and
B.3
Documentation

Organisation - commitment and communication

a) How is management involved in HSSE activities, objective-setting and monitoring? a) Develop action plans to achieve the defined goals in project with HSE as important, including specifying responsibilities,
b) How is your company structured to manage and communicate HSSE effectively? timeframe and resource requirements
B.3.1 Provide your company organogram. b) Please refere attachment
c) What provision does your company make for HSSE communication meetings? c) Daily tool box talk on the work to be performed on the day with risk and its hazard
Submit all the evidences

Competence and Training of managers/ supervisors/senior site staff/ HSSE

advisers
a) Have the managers and supervisors at all levels who will plan, monitor, oversee and
carry out the work received formal HSSE training in their responsibilities with respect to a) Yes, all supervisor are trained on HSE with their responsibility and HSE officer are responsible for their training and
B.3.2 conducting work to HSSE requirements? communication
If YES please give details. Where the training is given in house, please describe the
content and duration of courses.
Provide competence/training matrix.
Submit all the evidences

Competence and General HSSE training

a) What arrangements does your company have to ensure new employees have
knowledge of basic industrial HSSE, and to keep this knowledge up to date?
a) We make sure by his past experience and give him proper training based by our HSE office.
b) What arrangements does your company have to ensure new employees also have
b) Once new empolyee training is completed with the policy and HSE practice, assesment is consucted based on the training he
knowledge of your HSSE policies and practices?
attended. If cleared will be moved further and if not cleared again training will be given
c) What arrangements does your company have to ensure new employees have been
c) As per the HSE traing, all the hazard raised out of nature will be explained by the HSE officer and the same will be monitored
B.3.3 instructed and have received information on any specific hazards arising out of the nature
regularly by Project manager andHSE officer
of the activities?
d) HSE officer will be updated regularly based on any new actuvity to be performed.
d) What arrangements does your company have to ensure existing staff HSSE knowledge
e) Before starting a activity, all risk involved in the activity identified by the supervisor and the same will be elabrated as pe the
is up to date? (If training is provided in-house please give details of content)
HSE managment
e) What arrangements does your company have to ensure job competency for those jobs
involved in managing HSSE hazards and risks.
Submit all the evidences

Specialised training
a) How have you identified areas of your company's operations where specialised training a) By educating on radiation, pressure extremes (high pressure or vacuum), noise, stress, violence, slipping/tripping hazards,
is required to deal with potential hazards? (Please itemise and provide details of training inappropriate machine guarding, equipment malfunctions or breakdowns with proper usage og PPE
B.3.4 given). b) Physical inspection of the work location for identification of various hazard, prepration of job safety method statment in
b) If the specialised work involves radioactive, asbestos removal, chemical or other coordination wiht export or client, providing proper barriers to avoide insident with porper training to workers on usage of
occupational health hazards, how are the hazards identified, assessed and controlled? apparatus and PPE.
Submit all the evidences

HSSE qualified staff - additional training

Does your company employ any staff who possess HSSE qualifications that aim to
B.3.5 a) yes, our staffes are well qualified and if required we are giving addition trainiing in authorized institution
provide training in more than the basic requirements?
Submit all the evidences

Assessment of suitability of Subcontractors/ other companies a)

a) How do you assess: i) As per our HSE policy we will give the required traing even they are experience and will conduct give permit
i) HSSE competence of subcontractors? ii) Based on the pojects they handled and incident at work place against their total manhours and Numbers of
B.3.6 ii) HSSE record of the subcontractors and companies with whom you place contracts? staffes with proper training and particularly with HSSE officer.
b) Where do you spell out the standards you require your subcontractors to meet? b) All HSSE requirment will be spelled in the PO or the contract to the subcontractor
c) How do you ensure these standards are met and verified? c) Regular audite conducted by our HSSE officer or Project manager
Submit all the evidences

Standards
a) Where do you spell out the HSSE performance standards you require to be met? a) At our HSE policy and the pre tendering document
b) How do you ensure these are met and verified? b) By monitering on regular basis and conducting audites
B.3.7 c) How do you identify new industry or regulatory standards that may be applicable to your c) Based on the labour act and industrial safety
activities? d) Yes based on the above and also the clinets requirment
d) Is there an overall structure for producing, updating and disseminating standards?
Submit all the evidences

B.4 Hazards and Effects Management Process (HEMP)

Hazards and effects assessment

What techniques are used within your company for the identification, assessment, control
B.4.1
and mitigation of hazards and effects?
Submit all the evidences

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 Exposure of the workforce
What systems are in place to monitor the exposure of your workforce to chemical or
B.4.2 physical agents?
Submit all the evidences

Handling of chemicals
How is your workforce advised on potential hazards (chemicals, noise, radiation, etc.)
B.4.3
encountered in the course of their work?
Submit all the evidences

Personal protective equipment

What arrangements does your company have for provision and upkeep of protective
B.4.4
equipment and clothing, both standard issue, and that required for specialised activities?
Submit all the evidences

Waste management
What systems are in place for identification, classification, minimisation and management
B.4.5
of waste?
Submit all the evidences

Drugs and alcohol

Do you have a drugs and alcohol policy in your organisation? If so, does it include pre-
B.4.6
employment and random testing?
Submit all the evidences

B.5 Planning and Procedures

HSSE or operations manuals

a) Do you have a company HSSE manual (or Operations Manual with relevant sections on
HSSE) that describes in detail your company approved HSSE working practices relating to
your work activities? If the answer is YES please attach a copy of supporting
B.5.1
documentation.
b) How do you ensure that the working practices and procedures used by your employees
on-site are consistently in accordance with your HSSE policy objectives and arrangements?
Submit all the evidences

Equipment control and maintenance

How do you ensure that plant and equipment used within your premises, on-site, or at
other locations by your employees are correctly registered, controlled and maintained in a
B.5.2 safe working condition?
Provide a short overview of your preventative maintenance system. Is HSSE Critical
equipment specifically identified and included in your preventative maintenance system?
Submit all the evidences

Road Safety Management

B.5.3 What arrangements does your company have for combating road and vehicle incidents?
Submit all the evidences

B.6 Implementation, Monitoring & Reporting

Management and performance monitoring of work activities

a) What arrangements does your company have for supervision and monitoring of
performance?
b) What type of performance criteria are used in your company?
B.6.1 c) What arrangements does your company have for passing on any results and findings of
this supervision and monitoring to your:
- Base management?
- Site employees?
Submit all the evidences

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 HSSE performance achievement awards
B.6.2 Has your company received any award for HSSE performance achievement?
Submit all the evidences

Statutory notifiable incidents /dangerous occurrences

Has your company suffered any statutory notifiable incidents in the last five years (safety,
B.6.3 occupational health and environmental)? (Answers with details including dates, country,
most frequent types, causes and follow-up preventative measures taken).
Submit all the evidences

Improvement requirement and prohibition notices

Has your company suffered any improvement requirement or prohibition notices by the
relevant national body, regulatory body for HSSE or other enforcing authority or been
B.6.4
prosecuted under any HSSE legislation in the last 3 years?
(If your answer is YES please give details).
Submit all the evidences

HSSE performance records

a) Have you maintained records of your incidents and HSSE performance for the last five
years? If YES, please provide the following for each year:
• Number of Fatalities
• Lost Time Injuries
• Lost Workday Cases
• Medical Treatment Cases
• Restricted Work Day Cases
B.6.5
• Fatal Accident Rate
• Lost Time Injury Frequency
• Total Recordable Case Frequency (TRCF)

b) How is health performance recorded?

c) How is environmental performance recorded?
d) How often is HSSE performance reviewed? By whom?
Submit all the evidences

Incident investigation and reporting

a) Who conducts incident investigations?
b) How are the findings following an investigation, or a relevant incident occurring
B.6.6
elsewhere, communicated to your employees?
c) Are near miss safety learning reported?
Submit all the evidences

B.7 Audit

Auditing
a) Do you have a written policy on HSSE auditing?
b) How does this policy specify the standards for auditing (including unsafe act auditing)
and the qualifications for auditors?
B.7.1 c) Do your company HSSE Plans include schedules for auditing and what range of auditing
is covered?
d) How is the effectiveness of auditing verified and how does management report and
follow up audits?
Submit all the evidences

B.8 Company Specific Information

Memberships of Associations
Describe the nature and extent of your company's participation in relevant industry, trade,
B.8.1
and governmental organisations?
Submit all the evidences

Additional features of your HSSE management

Does your company have any other HSSE features or arrangements not described
B.8.2
elsewhere in your response to the questionnaire?
Submit all the evidences

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B.9 Company Specific Information

Company Specific Information

Provide any other information you believe is relevant to this Supplier & Contractor HSSE
B.9.1
prequalification
Submit all the evidences
Title Print Name

Certification of Response
B.9.2 I hereby agrees the information given above is true and gives permission to the evaluator to Date Electronic Signature (if Available)
use the above information for the purpose of this prequalification evaluation.

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