Get documents about "Proposed Change of Membership of Electrical & Mechanical
Document Sample
Application for Admission to the
Divisional Contractors Lists
for Biomedical & Electronics Engineering Services
Questionnaire
1. Application for Admission to the Contractors List of
2. Registered name of company/firm __________________________________
Under Business Registration __________________________________
Ordinance, Laws of Hong Kong ___________________________________
3. Registered address of company/firm _________________________________
in Hong Kong under Business __________________________________
Registration Ordinance, __________________________________
Laws of Hong Kong __________________________________
Telephone No. _________________________________
Facsimile No. __________________________________
4. Date of formation or incorporation _________________________________
under Companies Ordinance,
Laws of Hong Kong
5. Date of original registration under _________________________________
Business Registration Regulations,
Business Registration Ordinance,
Laws of Hong Kong.
6. Business Registration Certificate No. _______________________________
Date of Expiry under _______________________________
Business Registration Regulations,
Business Registration Ordinance,
Laws of Hong Kong.
Page 1 of 6
7. The company/firm is
* (a) a body corporate, registered under the Companies Ordinance, or
* (b) a partnership (unincorporated), or
* (c) a sole proprietorship (unincorporated).
8. Previous name(s) of company/firm with dates, if any.
9. Name(s) of ultimate holding company, parent company, subsidiary or associated
companies etc.
10. Names of directors/managers and length of service with the applicant
Name Designation Length of Service
11. Name and designation of person(s) who will sign contracts with Government
Name Designation
12. Banker(s) to whom reference may be made
Name Address
13. Address of trading office ___________________________________
(if different from registered ___________________________________
address) and approximate ___________________________________
area of office ___________________________________
Page 2 of 6
Telephone No. ___________________________________
Facsimile No. ___________________________________
14. Address and approximate area ___________________________________
of Workshop/Office ___________________________________
Telephone No. ___________________________________
Facsimile No. ___________________________________
15. (a) Name, qualifications, experience, training received, and length of service
of professional/ technical staff.
(b) Direct employed work-force.
Trade/Stream/Grade No.
16. Please provide details of development facilities and equipment including quantity
and make/model/capacity of each. For test equipment please also state where
and when they were last calibrated.
Item Description Quantity Make/Model Capacity Calibration
Where Date
1. Digital Voltage Meter (DVM)
2. Electrical Safety Tester*
3.
4.
5.
6.
* not applicable to central control and monitoring
Page 3 of 6
17. Relevant Projects Handled
The company/firm is required to state below briefly his previous experience in
execution of related projects (inclusive of supply / installation / maintenance
types) as well as particulars of the projects currently being executed. The projects
quoted here shall be located in the territories of Hong Kong and may be available
for inspection.
Description/Nature of Project Client Construction Period Contract Sum
18. Training
State whether training facilities are available – YES/NO *
If the answer to the above is YES, please state how training of Government
employees would be provided as part of a contract.
If the answer to the above is NO, please state if any alternative arrangement
could be made if training is required in a contract.
19. Documentation
Please state if detailed documentations, e.g. circuit diagrams, fault diagnostic
charts, operation flow charts, programme codes, etc. will be made available to
Government in respect of all equipment and software supplied and installed –
YES/NO*
If the answer to the above is NO, please state restrictions and limitations.
Page 4 of 6
20. Maintenance
Please state if the company/firm will be willing to take up maintenance works –
YES/NO *
If the answer to the above is YES, please state the number and grade of staff
deployed for maintenance activities.
If the answer to the above is NO, please state if any alternative arrangement
could be made to provide the maintenance services for the equipment and
software supplied in a contract.
21. Spare Holding Policies
Please state the policies on spare holdings relating to maintenance in terms of
the following :-
(a) For particular installations (quote examples)
(b) For general purposes
22. Quality, Environmental and OH&S
Please complete the Quality, Environmental and OH&S Checklist at Appendix
1.
23. Authorized Agency
Please state any authorized agency, or representation of the manufacturer; in
HKSAR Documentary proof such as authorized agency agreements shall be
enclosed.
Page 5 of 6
24. I certify that all information provided is true and complete to the best of my
knowledge. The following supporting documents are forwarded herewith :-
(i) A copy of the Business Registration Certificate.
(ii) * A copy of Memorandum and Articles of Association.
* A copy of Application for Registration of Business (Partnership)
* A copy of Application for Registration of Business (Sole Proprietorship)
under Business Registration Regulations.
(iii) * Details of works carried out and currently in hand.
(v) An organization chart.
(vi) Office layout plan with principal dimensions and positions of major
development facilities.
(vii) * A copy of the Certificate of Incorporation under Companies Ordinance
(viii) * Authorized Agency Agreement
(ix) Quality, Environmental and OH&S Checklist
Date ____________________ Signed ___________________________
Name ___________________________
Designation ___________________________
* -- Delete as appropriate
Page 6 of 6
EMSD - Health Sector Division (HSD)
Appendix 1
Contractor Evaluation Record
Part 1 – Quality, Environmental and Occupational Health &
Safety Checklist
(to be completed by contractor / supplier)
Please tick below one of the 4 descriptions which most closely fits
your current status; otherwise, please describe your current status
being asked for in the space under ”Remarks“.
Q1 □ 1 □ 2 □ 3 □ 4
Health and safety Health and Commit to Health and Sound health
policy safety policy comply with safety policy and safety
under HSD’s OH&S available and policy
preparation Policy commit to (fulfilling
comply with F&IU(SM) Reg.
HSD’s OH&S requirement)
Policy
Remarks Please attach a copy of Health and Safety Policy, if available
Q2 □ 1 □ 2 □ 3 □ 4
Health and safety Only Safety Under Safety plan Comprehensive
manual or plan Policy but no preparation available. health and
health and and draft safety plan
safety plan health and comply with
safety plan recognize
available. standard (e.g.
F&IU(SM) Reg.
or OHSAS 18001:
1999)
Remarks Please specify the standard to which the OH&S plan complies
with.
Q3 □ 1 □ 2 □ 3 □ 4
Safety organization Safety Safety Safety Safety
organization organization organizationorganization
included only included only included line
included line
line line supervision supervision
supervision supervision staff, staff,
staff staff & management management
management staff and staff, safety
staff company top profession and
management company top
management
Remarks Please attach a copy of organization chart, if available
Q4 □ 1 □ 2 □ 3 □ 4
Safety personnel Only Safety Assistant In addition, Full time RSO
Supervisor Safety Officer part RSO for the project
appointed on or full time employed for
for the Safety the project
project. Supervisor
appointed.
Remarks Please specify number of Safety Supervisor and Register Safety
Officer employed.
IMS-3 (Issue 6/02) Page 1 of 4
EMSD - Health Sector Division (HSD)
Appendix 1
Contractor Evaluation Record
Part 1 – Quality, Environmental and Occupational Health &
Safety Checklist
(to be completed by contractor / supplier)
Please tick below one of the 4 descriptions which most closely fits
your current status; otherwise, please describe your current status
being asked for in the space under ”Remarks“.
Q5 □ 1 □ 2 □ 3 □ 4
Occupational health Training is Only “Green In addition A training plan
& safety training to being Card” other relevant available, and
staff/worker arranged. Training. safety and relevant
health safety and
training health
provided to training to
staff/workers workers are
specified.
Remarks Please specify (a) Percentage of staff/worker with “Green Card”.
(b) Type of safety training other than Green Card,
if available
Q6 □ 1 □ 2 □ 3 □ 4
Past year accidents Only number of Accident Accident rate Accident rate
record accident statistic above their below their
recorded. available but target target
no target for accident rate accident rate
accident rate
Remarks Please specify number of accident in past 12 month and the target
accident rate.
Q7 □ 1 □ 2 □ 3 □ 4
Record of fatal More than one Detail In addition, No fatal
accident fatal accident investigation prompt accident
in the past 12 to identify the arrangement to record
months probable cause prevent
of the similar
accident. accident from
happening.
Remarks Please specify number of fatal accident in past 12 months, if
available
Q8 □ 1 □ 2 □ 3 □ 4
Conviction record in More than 3 Less than 3 but Only 1 No conviction
past 24 months convictions in more than 1 conviction in in past 24
related to violation past 24 months conviction in past 24 months months
of statutory and past 24 months
regulatory
requirements
including any
occupational health
and safety related or
environmental
related legislation
IMS-3 (Issue 6/02) Page 2 of 4
EMSD - Health Sector Division (HSD)
Appendix 1
Contractor Evaluation Record
Part 1 – Quality, Environmental and Occupational Health &
Safety Checklist
(to be completed by contractor / supplier)
Please tick below one of the 4 descriptions which most closely fits
your current status; otherwise, please describe your current status
being asked for in the space under ”Remarks“.
Remarks Please specify number and details of conviction in past 24
months, if available.
Q9 □ 1 □ 2 □ 3 □ 4
Job Hazard Analysis / Committed to A written JHA/RA would be Competent /
Risk Assessment comply with the procedure or conducted for Qualified
(JHA/RA) recommendation methodology high-risk person(s)
stated in for JHA/RA is activities. is/are
EMSD’s Risk available. employed to
Assessment conduct
Report JHA/RA.
Remarks Please provide procedure or methodology for JHA/RA, if
available.
Q10 □ 1 □ 2 □ 3 □ 4
Method Statement Committed to Only work Method Comprehensive
follow EMSD’s procedure Statement with Method
work breakdown detail work Statement
instructions. would be procedure would be
prepared breakdown with developed
safety and based on the
health control result of
measure would JHA/RA.
be prepared
Remarks
Q11 □ 1 □ 2 □ 3 □ 4
Quality Management Planning to Work has A quality A quality
System implement a commenced to management management
quality develop a system in system in place
management quality place, but not and has been
system management or not yet certified to a
system certified by recognized
accreditation standard, e.g.
body ISO 9001
Remarks Please specify the standard used to develop the quality
management system.
Q12 □ 1 □ 2 □ 3 □ 4
Environmental Planning to Work has An An
Management System implement an commenced to environmental environmental
environmental develop an management management
management environmental system in system in place
system management place, but not and has been
system or not yet certified to a
certified by recognized
IMS-3 (Issue 6/02) Page 3 of 4
EMSD - Health Sector Division (HSD)
Appendix 1
Contractor Evaluation Record
Part 1 – Quality, Environmental and Occupational Health &
Safety Checklist
(to be completed by contractor / supplier)
Please tick below one of the 4 descriptions which most closely fits
your current status; otherwise, please describe your current status
being asked for in the space under ”Remarks“.
accreditation standard, e.g.
body ISO 14001
Remarks Please specify the standard used to develop the environmental
management system.
Completed for and on behalf of the Contractor / Supplier by:
Signat :
ure
Name :
Title :
Date :
Company Chop
IMS-3 (Issue 6/02) Page 4 of 4
EMSD - Health Sector Division (HSD)
Appendix 1
Contractor Evaluation Record
Part 2: For EMSD Use Only
Summary of Marks
Marking Scheme:
Mark
0 1 2 3 4
For Not Answer Answer Answer Answer
questions answered with “1” with “2” with “3” with “4”
Q1 to Q12
For other Satisfac Excellen
Poor Fair Good
criteria tory t
Questions / Criteria Marks for Contractor / Supplier under
Evaluation
Q1
Q2
Q3
Q4
Q5
Q6
Q7
Q8 (a)
Q9
Q10
Q11 (b)
Q12 (c)
Experience / Competence
Reputation (d)
Lead Time / Delivery (e)
Cooperation / Attitude (f)
Total =
For Supplier only:
(a)+(b)+(c)+(d)+(e)+(f) =
Evaluation Result
IMS-3 (Issue 6/02) Page 5 of 4
EMSD - Health Sector Division (HSD)
Appendix 1
Name of Contractor / Supplier : _______________________________________
_______________
#
Evaluation Result : Satisfactory / Unsatisfactory* as Contractor /
Supplier*
# Conditions:
For Contractor, the total mark shall be at least 26 for “satisfactory”.
For Supplier , the sum (a)+(b)+(c)+(d)+(e)+(f) shall be at least 12
for “satisfactory”.
* Delete as appropriate
Evaluated by: ______________ _ __ __ Date: ________________
Approved by: _________ ____ _ Date: ________________
IMS-3 (Issue 6/02) Page 6 of 4
