Contracting Organization Health and Safety QuestionnaireBy Jennifer Filgate / July 2, 2025 This questionnaire will determine how you fit into your contracting organization’s health and safety management system. Meet with your contracting organization’s contact and determine the answers to the questions. If they answer “No” to any of the questions, you will have to implement systems to deal with the item. While completing this form take notes, ask for copies, ask for examples, ask how often, etc. Small Employer Name: NEXTGEN ELECTRICAL SERVICESNEXTGEN ELECTRICAL SERVICES Representative QUESTIONS TO ASK THE CONTRACTING ORGANIZATION - YES or NO (if "No", please explain)Do I/we have a contact person for health and safety issues? Yes (please list below)NoHealth & Safety Contact Name Will you be conducting safety inspections on the work that I do? YesNo (please explain below)No Safety Inspection Are there specific procedures for reporting hazards to you? YesNo (please explain below)No Procedures for Reporting Hazards Will I/we be notified when the hazards have been corrected? YesNo (please explain below)No Notification When Hazards Corrected Are there specific health or safety hazards we should be aware of on your site? YesNo (please explain below)No Specific Hazards Are there specific job procedures that we are required to follow? YesNo (please explain below)No Specific Job Procedures Are there site specific safety rules to follow? YesNo (please explain below)No Site Specific Rules Is there specific PPE required on this site? YesNo (please explain below)No Specific PPE Required Do you provide any PPE? YesNo (please explain below)No PPE Provided Are there specific emergency response procedures we need to follow? YesNo (please explain below)No Emergency Response Procedures to Follow Site evacuation procedures (responsibilities, signals, and communications)? YesNo (please explain below)No Site Evacuation Medical emergency evacuation procedures? YesNo (please explain below)No Medical Emergency Evacuations First aid procedures for serious injuries? YesNo (please explain below)No First Aid for Serious Injuries Do you require site health and safety orientation? YesNo (please explain below)No Site Health and Safety Orientation Do I/we require specific health and safety training on your site (H2S, WHMIS, confined space, etc.)? YesNo (please explain below)No Site Health and Safety Training Are we required to attend your safety meetings? YesNo (please explain below)Not Required to Attend Safety Meetings Are there specific procedures we must follow for accident/incident reporting? YesNo (please explain below)No Specific Procedures for Accident/Incident Reporting Contracting Organization Name Representative Name Contracting Organization Representative Signature Representative Phone Number Date NEXTGEN ELECTRICAL SERVICES Representative Signature Date MessageSubmit Save and Continue
