Application for Registration as an
Accredited Contractor for Live
Sewer Construction Works
NOTE Inclusion on the Accredited Contractor List only entitles an Accredited Contractor to be considered to provide certain
categories of works and services.
Inclusion on the List does not in any way:
guarantee or suggest that the Accredited Contractor will be invited to tender for work or be engaged to undertake any
work or services;
 create any relationship between the Accredited Contractor and YVW in relation to the provision of any works or services
to the Water Company.
An Application for Registration as an Accredited Contractor for Live Sewer Construction work is not an application to
undertake any works for Yarra Valley Water as part of its capital works program.

Company Name
Australian Company
Number (ACN)
Business or Trading
Name (if applicable)
Australian Business
Number (ABN)
Contact Person for this Application
Name
Position
Mobile
Phone
Email
Declaration
To be completed by a partner, director or other senior manager who has the authority to do so.
I, as a partner, director or senior manager and authorised officer of the organisation, declare that the applicant organisation accepts
Yarra Valley Water’s Conditions of Accreditation and declare that the particulars shown herein and supplementary documentation are
true and correct in every detail.
Name:
Signed:
Position:
Date:
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
SECTION 1
Contact Details
1.1 General Business
Main Office
address
Postal address
(if different)
Phone
Company Email
address
Web address
SECTION 2
Business Profile
2.1
Date business established
2.2
Directors, Partners, Associates (Attach CV for each individual listed)
2.3
2.4
Name
Position
Victorian WorkSafe Authority
Certificate
Premium paid
Details of registration as an employer
pursuant to the provisions of the Accident
Compensation Act 1985
Expiry date
Public Liability Insurance
Name of Insured
Minimum cover of $20M is required
Sum insured
Qualifications
$
$
Insurance Company
Policy No.
Expiry date
2.5
Membership of Associations
List relevant associations (e.g. Civil
Contractors Federation, etc) with which
the business is currently affiliated
v1.0
2
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Section 3
Requested Categories of Work (for which accreditation is sought)
NOTE To be considered for accreditation in a category, the business must demonstrate clearly that all accreditation criteria are met or exceeded
Categories of Work
LS1
Date of last contract
Property Service Connections
Property Service Connection including:



LS2
installation of a new individual property service branch on
an existing live sewer gravity system ≤DN300
installation of an individual property service branch into an
existing live gravity sewer maintenance structure
installation of spur service branch on an existing live sewer
gravity system ≤ DN300
installation of service branch on an existing live sewer
gravity system; ≤ DN300
Minor Live Sewer Works
Minor Sewer Works includes YVW Capital Works and Land
Development projects required to service an individual property
including:-
SEWER





LS3
property service connection
installation and connection of short gravity sewer system
≤20m in length and ≤DN300
installation of new maintenance structures on existing live
gravity sewer system; ≤DN300
repair and/or modification of existing property service
connection on an existing live gravity sewer system
≤DN300, ie repair of damaged property service pipework,
property service re-lining/renewal
repair and/or modification of existing maintenance
structure(s) on an existing live gravity sewer system; ≤
DN300, ie change to M/H cover level
Major Live Sewer works
Major Live Sewer Works include YVW Capital Works and Land
Development projects including the following live sewer works;-
SECTION 4
4.1



property service connections

modification to existing live gravity sewer system, ie
pipeline re-alignment, maintenance structure modifications
etc
minor sewer works
connections of gravity sewer pipelines, ≤ DN300, to an
existing live gravity sewer
Business Capability
Capability Statement
[Please provide a statement defining the company’s core business and capability]
4.2
Resourcing
Average number of people employed on a permanent basis in the last 12 months within the
categories if work requested
Average number of apprentices and trainees employed in the last 12 months within the categories if
work requested
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3
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
4.3
Plant and Equipment
Provide a list of current plant & equipment owned, including service/maintenance history to the required standards
-
4.4
Including rick assessments
Training / Qualifications
Provide a list of employees training and qualifications relevant for the categories of work requested
4.5
Organisational Structure
Please provide a copy of your organisational structure, including functional reporting lines, in particular how the role of any
sub-contractors fit within your adopted structure
4.6
Access to Industry Standards
Please provide evidence of your access to the relevant MRWA Editions of the WSAA Codes, including Supplementary
manuals and MRWA Specifications
4.7
Key Personnel
Key Personnel include personnel, subcontractors or agents engaged as the development works construction site supervisor
or equivalent training and skills and hold qualifications, competencies necessary to carry out the specified key roles of the
Accredited Consultant undertaking land development works or services. Please nominate the company key personnel
Please complete Appendix 1 to nominate your company Key Personnel
4.8
Name
4.9
v1.0
Support Personnel (e.g. Contractors, Specialist Service Personnel)
Position/Title
Description Support Service
Areas of Specific Expertise / Specialisation
4
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Section 5
Applicant Work History - Recent Contracts & Customer References
List projects relevant to the Category types above [three (3) for each type and preferably completed in the Yarra Valley Water area]. Include the most recently completed project. A current project
may be included as well as projects of significance you wish to highlight. If necessary, include projects completed in other Water Company areas
Category
(Code)
v1.0
Client
Project name & Address
Project Value
Engagement
end date
5
Referee Name
Referee’s Phone
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Section 6
Occupational Health & Safety (OH&S) Questionnaire
Comments
PART A – Contractor accredited with Yarra Valley Water DO NOT need to completed Part A
ALL new Contractors need to complete this Part A
6.1
OH&S Policy & Management
6.1.1
Is there a written company OHS policy?
Yes
No
Yes
No
If Yes provide a copy of the policy
6.1.2
Does your company have an OH&S Management System
certified by a recognised independent authority (eg, AS4801,
Safety Map, CCF)?
If Yes provide details and a copy of the last 2 audit reports
(internal and external) together with the status of any nonconformances
6.1.3
Has the company instigated a process of review and continuous
improvement of their OH&S management system?
Yes
No
6.1.4
Is there a company OH&S Management System manual or plan?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
If Yes, a copy of the contents page is required
6.1.5
Are OH&S responsibilities clearly identified for all levels of staff?
If Yes provide a copy of the policy
6.1.6
Are personnel with relevant OH&S qualifications engaged or
employed to advise the contractor on OH&S matters available?
If yes, attach Curriculum Vitae of person(s) with relevant OH&S
qualifications engaged or employed to advise the contractor on
OH&S matters.
6.2
Safe Work Practices & Procedures
6.2.1
Has the company prepared safe operating procedures or specific
instructions relevant to its operations?
If Yes provide a summary listing of procedures or instructions
6.2.2
Does the company have any permit to work system? (eg. Hot
work, electrical isolation, working at height etc)
If Yes, provide a summary listing or permits:
6.2.3
Is there a documented incident/accident investigation procedure?
If Yes, provide a copy of a standard incident report form.
6.2.4
Are there procedures in place for maintaining, inspecting and
assessing the hazards of plant operated/owned by the company?
If Yes, provide details:…………………………………………………
…………………………………………………………………………..
6.2.5
Are there procedures for storing/handling hazardous
substances?
If Yes, provide details. ………………………………………………
…………………………………………………………………………..
6.2.6
Are there procedures for emergency response and employee first
aid and training?
If Yes, provide a copy of emergency response procedure and
first aid training
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Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Section 6
6.2.7
Occupational Health & Safety (OH&S) Questionnaire
Are there procedures for identifying, assessing and controlling
risks associated with manual handling?
Comments
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
If Yes provide details. ………………………………………………
…………………………………………………………………………..
6.2.8
Are plant risk assessments undertaken for hired plant /
equipment?
If Yes provide details. ………………………………………………
…………………………………………………………………………..
6.2.9
Is quick corrective action taken to control health and safety risks
revealed by workplace inspections and hazard reports?
If Yes provide details. ………………………………………………
…………………………………………………………………………..
6.3
OH&S Training
6.3.1
Is health and safety training conducted in your organisation?
Describe how health and safety training is conducted in your
company.
6.3.2
Is a record maintained of all employees training and induction
programs?
If Yes, provide examples of safety training records.
…………………………………………………………..………………
…………………………………………………………………………..
6.3.3
Do you have appropriate licences, permits in relation to required
safety competencies (eg. Plant, equipment)?
If Yes provide details. ………………………………………………
…………………………………………………………………………..
6.4
Health and Safety Workplace Inspection
6.4.1
Are regular health and safety inspections at worksites
undertaken?
If Yes provide details. ………………………………………………
…………………………………………………………………………..
6.4.2
Is there a procedure for employees to report hazards at
workplaces?
.
If Yes provide details. ………………………………………………
…………………………………………………………………………..
6.4.3
Are standard workplace inspection checklists used for OH&S
inspections?
If Yes provide details. ………………………………………………
…………………………………………………………………………..
6.4.4
Are employees consulted during workplace inspections?
If Yes provide details. ………………………………………………
…………………………………………………………………………..
6.5
v1.0
Health and Safety Consultation
7
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Section 6
6.5.1
Occupational Health & Safety (OH&S) Questionnaire
Is there a workplace health and safety committee?
Comments
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
If Yes provide details. ………………………………………………
…………………………………………………………………………..
6.5.2
Are employees involved in decision making over OH&S matters?
If Yes provide details. ………………………………………………
…………………………………………………………………………..
6.5.3
Are there employee elected health and safety representatives?
If Yes provide details. ………………………………………………
…………………………………………………………………………..
6.6
Sub-contracting
6.6.1
Does your company ensure that all sub-contractors you
understand and agree to comply with their legal responsibilities
under the applicable OHS legalisation and any other relevant
OHS requirements?
If Yes provide details. ………………………………………………
…………………………………………………………………………..
6.6.2
Is there documentation to ensure that the sub-contractor
understands and agrees to comply with all your health and safety
rules and procedures i.e how they inducted?
If Yes provide details. ………………………………………………
…………………………………………………………………………..
6.7
OH&S Performance Monitoring
6.7.1
Is there a system for recording & analysing OH&S performance
statistics?
If Yes provide details. ………………………………………………
…………………………………………………………………………..
6.7.2
Are other measure used to measure safety (for example hazard
inspections conducted, hazards identified, hazards rectified or
OHS training figures?
.
If Yes provide details. ………………………………………………
…………………………………………………………………………..
6.7.3
Has the company ever been convicted of occupational OHS
offences?
If Yes provide details. ………………………………………………
…………………………………………………………………………..
v1.0
8
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Section 6
Occupational Health & Safety (OH&S) Questionnaire
Comments
PART B – To be completed by ALL Live Sewer Contractors
6.8
Please confirm you have been able to locate, read and accept YVWs Access Permit
requirements as defined on the YVW website?
Yes
No
Yes
No
Yes
No
Click HERE to find YVW’s Access Permit requirements
6.9
**Land Development Only **
Please confirm you have been able to locate, read and accept YVWs Confined Space
Entry requirements as defined on the YVW website?
Click HERE to find YVW’s Confined Space Entry requirements
6.10
Please confirm you have been able to locate YVWs Access Permit application form on
the YVW website?
Click HERE to find YVW’s Application Form for an Access Permit
6.11
Please provide a copy of your Procedures for carrying out Live Sewer Works and/or
Confined Space Entry.
Copy of procedures needs to
be supplied as part of
application
6.12
Please provide a sample Safe Work Method Statement(SWMS) for live sewer works
A copy of SWMS needs to be
supplied as part of application
6.13
Please confirm you have read and are prepared to accept the Live Sewer
Accreditation Deed terms and conditions
6.14
Please provide a list of company Confined Space Trained Personnel
Name
v1.0
Registered Training Organisation
Yes
No
Copies of training certificates
or cards needs to be supplied
as part of application.
Certificate No.
Date of Expiry
9
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Section 7
Environmental Management System (EMS) Questionnaire
Comments
Contractor accredited with Yarra Valley Water DO NOT need to complete this Section
ALL new Contractors need to complete this Section
7.1
Certification under ISO 14001
7.1.1
Is the contractor’s EMS currently accredited by a certification
body in accordance with ISO 14001.
Yes
No
7.2.2
Has the Contractor indicated when the EMS was formally
implemented and provided evidence of its use on projects they
completed?
Yes
No
7.1.3
Has the contractor provided satisfactory evidence of implementation through:
7.1.3.1
 minutes of management review;
7.1.3.2
 internal audit reports;
7.1.3.3
 typical EMP.
7.1.4
Has the contractor provided a copy of the Certificate of
certification?
7.2
EMS Accreditation by the CCF
7.2.1
Is the contractor’s EMS currently accredited by the CCF?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
If yes when was the CCF IMS certified.
7.2.2
Has the contractor provided a copy of the CCF Contractor
Management Systems certification?
If yes, provide a copy of the Certificate of Certification
7.2.3
Has the contractor provided satisfactory evidence of implementation through:
7.2.3.1
 minutes of management review;
7.2.3.2
 internal audit reports;
7.2.3.3
 typical Environmental Management Plan (EMP).
Yes
No
Yes
No
Yes
No
7.2.4
Has the Contractor indicated when the EMS was formally
implemented and provided evidence of its use on projects they
completed?
Yes
No
7.3
Has any certification body withdrawn the contractor EMS
accreditation?
Yes
No
(If yes, give details.)
v1.0
10
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Section 8
Quality Management System (QMS) Questionnaire
Comments
Contractor accredited with Yarra Valley Water DO NOT need to complete this Section
ALL new Contractors need to complete this Section
8.1
Certification under ISO9001
8.1.1
Is the contractor’s Quality Management System currently
accredited by a certification body in accordance with ISO
9001? If Yes please provide details.
Yes
No
8.1.2
Has the contractors Indicated when the QMS was formally
implemented and provided evidence of its use on projects
completed?
Yes
No
.
For a recent completed project provide a copy of the Project
Management Plan used
8.1.3
Has the contractor provided satisfactory evidence of implementation through:
8.1.3.1
 minutes of management review
Provide evidence that recommendations of Management
reviews have been implemented
 internal audit reports;
Provide a copy of the last internal audit report.
 typical Project Management Plan (PMP).
Provide a copy of a typical Project Management Plan.
8.1.3.2
8.1.3.3
8.1.4
Has the contractor provided a copy of the Certificate of
Certification?
8.2
Quality Accreditation by the CCF
8.2.1
Is the contractor’s QMS currently accredited by the CCF?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
If Yes please provide details.
8.2.2
Has the contractor provided a copy of the CCF IMS Certificate of
certification?
Provide Copy of the Certificate of Certifications.
8.2.3
8.2.3.1
8.2.3.2
8.2.3.3
8.2.4
8.3
Has the contractor provided satisfactory evidence of implementation through:
 minutes of management review
Provide evidence that recommendations of Management
reviews have been implemented
 internal audit reports;
Provide a copy of the last internal audit report.
 typical Project Management Plan (PMP).
Provide a copy of a typical Project Management Plan.
Yes
No
Yes
No
Yes
No
Has the Contractor indicated when the QMS was formally
implemented and provided evidence of its use on projects
completed?
For a recent completed project provide a copy of the Project
Management Plan used
Yes
No
Has any certification body withdrawn the contractor QMS
accreditation?
Yes
No
.
.
(If Yes give details.)
v1.0
11
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Section 9
Checklist of Attachments
Copies of the following items must be supplied to support and complete this application
Section No.
Item
ATTACHED
2.1
Certificate of Business Registration
Yes
2.2
CVs - Directors, Partners, Associates
Yes
2.3
Current Victorian WorkSafe Authority Certificate
Yes
2.4
Certificate of Currency Public Liability Insurance ($20M, minimum cover required)
Yes
4.3
A list of currently owned plant & equipment
Yes
4.4
A copy of employees training register
Yes
4.5
A copy of your organisational structure, including functional reporting lines, in
particular how the role of any sub-contractors fit within your adopted structure
Yes
4.6
Evidence of your access to the relevant MRWA Editions of the WSAA Codes,
including Supplementary manuals and MRWA Specifications
Yes
Section 6, Part A – Contractors accredited with Yarra Valley Water DO NOT need to completed Part A
ALL new Contractors need to complete this Part A
6.1.1
Copy of OH&S Policy
Yes
6.1.2.
Evidence of certification of the company’s OH&S management system against
AS/NZS4801.
Yes
6.1.4
Copy of OH&S management system contents page
Yes
6.1.6
Copy CVs of personnel engaged or employed to advise on OH&S matters
Yes
6.2.1
List of company OH&S procedures and work instructions
Yes
6.2.2
List of company permits to work system
Yes
6.2.3
A copy of a completed company Incident/Accident report form
Yes
6.2.5
A copy of company procedures for storing/handling hazardous substances
Yes
6.2.6
A copy of company emergency response procedures
Yes
6.2.7
A copy of procedures for identifying, assessing & controlling project risks associated
with manual handling
Yes
6.4.2
A copy of a recently completed employee hazard report
Yes
6.4.3
A copy of a recently completed workplace inspection checklist
Yes
Section 6, Part B – Needs to be completed by ALL Contractors
v1.0
6.11
A copy of Live Sewer Entry/Confined Space Entry procedures
Yes
6.12
A copy of SWMS for Live Sewer Works
Yes
6.14
Copies of training certificates or CSE cards needs to be supplied as part of
application.
Yes
12
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Section 9
Checklist of Attachments
Copies of the following items must be supplied to support and complete this application
Section No.
7.1.2/7.2.2
Item
ATTACHED
Evidence of certification of the company’s environmental management system
against either ISO1401 or the Civil Contractors Federation Integrated Management
System
Yes
Section 7 - Contractors accredited with Yarra Valley Water DO NOT need to complete this Section
ALL new Contractors need to complete this Section
7.1.3 /
7.2.3
Objective evidence of applicant organisation EMS implementation and work
practices; preferably:



8.1.2/8.2.2
Yes
Environmental Management Plan for a recently completed project
a copy of the last internal audit report
a copy of minutes of management review
Evidence of certification of the company’s quality management system against either
AS/NZS 9001or the Civil Contractors Federation Integrated Management System.
Yes
Section 8 - Contractors accredited with Yarra Valley Water DO NOT need to complete this Section
ALL new Contractors need to complete this Section
8.1.3 /
8.2.3
Objective evidence of applicant organisation EMS implementation and work
practices; preferably:
Yes
Environmental Management Plan for a recently completed project
a copy of the last internal audit report
a copy of minutes of management review
(only for new contractors)
Appendix A
Complete Key Personnel Nominations
Yes
Copies of qualification & training certificates are required for all nominated Key
Personnel
Yes
Information – YVW Contact
Kevin Dawson - Phone : (03) 9872 1474;
Email : [email protected]
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13
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Appendix A – Key Personnel Nominations
v1.0
14
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Name
[please enter the name of nominated key
personnel]
Brief profile of
industry
experience
[please provide a summary of industry experience to support requested categories of work]
Live Sewer Categories of Work
[please select the relevant categories of work
for this person]
Position/Title
☐ LS1
[please enter position/title]
☐ LS2
☐ LS3
Qualifications and training certificates
[please select relevant qualifications, training achievements for this person]
☐
Relevant TAFE/Tertiary Qualification with industry experience or equivalent extensive relevant industry experience
☐
OHS Industry Induction (Red Card)
☐
Pipe laying Accreditation
☐
Confined Space Entry Certificate (Sewerage Works only)
☐
Trench Safety Awareness
☐
Traffic Management
☐
Fall form Heights
☐
Mobile Plant Operator, and/or Extensive demonstrated relevant experience working with mobile plant and mobile plant risk assessment.
☐
Successful completion of YVW new Contractor Induction Questionnaire (when available)
Competencies
Project Experience
[please provide a list key personnel project experience for requested category of work – a minimum of 3 projects is required for each category of work]
LS1

LS3

v1.0
LS2

15
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Name
[please enter the name of nominated key
personnel]
Brief profile of
industry
experience
[please provide a summary of industry experience to support requested categories of work]
Live Sewer Categories of Work
[please select the relevant categories of work
for this person]
Position/Title
☐ LS1
[please enter position/title]
☐ LS2
☐ LS3
Qualifications and training certificates
[please select relevant qualifications, training achievements for this person]
☐
Relevant TAFE/Tertiary Qualification with industry experience or equivalent extensive relevant industry experience
☐
OHS Industry Induction (Red Card)
☐
Pipe laying Accreditation
☐
Confined Space Entry Certificate (Sewerage Works only)
☐
Trench Safety Awareness
☐
Traffic Management
☐
Fall form Heights
☐
Mobile Plant Operator, and/or Extensive demonstrated relevant experience working with mobile plant and mobile plant risk assessment.
☐
Successful completion of YVW new Contractor Induction Questionnaire (when available)
Competencies
Project Experience
[please provide a list key personnel project experience for requested category of work – a minimum of 3 projects is required for each category of work]
LS1

LS3

v1.0
LS2

16
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Name
[please enter the name of nominated key
personnel]
Brief profile of
industry
experience
[please provide a summary of industry experience to support requested categories of work]
Live Sewer Categories of Work
[please select the relevant categories of work
for this person]
Position/Title
☐ LS1
[please enter position/title]
☐ LS2
☐ LS3
Qualifications and training certificates
[please select relevant qualifications, training achievements for this person]
☐
Relevant TAFE/Tertiary Qualification with industry experience or equivalent extensive relevant industry experience
☐
OHS Industry Induction (Red Card)
☐
Pipe laying Accreditation
☐
Confined Space Entry Certificate (Sewerage Works only)
☐
Trench Safety Awareness
☐
Traffic Management
☐
Fall form Heights
☐
Mobile Plant Operator, and/or Extensive demonstrated relevant experience working with mobile plant and mobile plant risk assessment.
☐
Successful completion of YVW new Contractor Induction Questionnaire (when available)
Competencies
Project Experience
[please provide a list key personnel project experience for requested category of work – a minimum of 3 projects is required for each category of work]
LS1

LS3

v1.0
LS2

17
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Name
[please enter the name of nominated key
personnel]
Brief profile of
industry
experience
[please provide a summary of industry experience to support requested categories of work]
Live Sewer Categories of Work
[please select the relevant categories of work
for this person]
Position/Title
☐ LS1
[please enter position/title]
☐ LS2
☐ LS3
Qualifications and training certificates
[please select relevant qualifications, training achievements for this person]
☐
Relevant TAFE/Tertiary Qualification with industry experience or equivalent extensive relevant industry experience
☐
OHS Industry Induction (Red Card)
☐
Pipe laying Accreditation
☐
Confined Space Entry Certificate (Sewerage Works only)
☐
Trench Safety Awareness
☐
Traffic Management
☐
Fall form Heights
☐
Mobile Plant Operator, and/or Extensive demonstrated relevant experience working with mobile plant and mobile plant risk assessment.
☐
Successful completion of YVW new Contractor Induction Questionnaire (when available)
Competencies
Project Experience
[please provide a list key personnel project experience for requested category of work – a minimum of 3 projects is required for each category of work]
LS1

LS3

v1.0
LS2

18
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Name
[please enter the name of nominated key
personnel]
Brief profile of
industry
experience
[please provide a summary of industry experience to support requested categories of work]
Live Sewer Categories of Work
[please select the relevant categories of work
for this person]
Position/Title
☐ LS1
[please enter position/title]
☐ LS2
☐ LS3
Qualifications and training certificates
[please select relevant qualifications, training achievements for this person]
☐
Relevant TAFE/Tertiary Qualification with industry experience or equivalent extensive relevant industry experience
☐
OHS Industry Induction (Red Card)
☐
Pipe laying Accreditation
☐
Confined Space Entry Certificate (Sewerage Works only)
☐
Trench Safety Awareness
☐
Traffic Management
☐
Fall form Heights
☐
Mobile Plant Operator, and/or Extensive demonstrated relevant experience working with mobile plant and mobile plant risk assessment.
☐
Successful completion of YVW new Contractor Induction Questionnaire (when available)
Competencies
Project Experience
[please provide a list key personnel project experience for requested category of work – a minimum of 3 projects is required for each category of work]
LS1

LS3

v1.0
LS2

19
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Name
[please enter the name of nominated key
personnel]
Brief profile of
industry
experience
[please provide a summary of industry experience to support requested categories of work]
Live Sewer Categories of Work
[please select the relevant categories of work
for this person]
Position/Title
☐ LS1
[please enter position/title]
☐ LS2
☐ LS3
Qualifications and training certificates
[please select relevant qualifications, training achievements for this person]
☐
Relevant TAFE/Tertiary Qualification with industry experience or equivalent extensive relevant industry experience
☐
OHS Industry Induction (Red Card)
☐
Pipe laying Accreditation
☐
Confined Space Entry Certificate (Sewerage Works only)
☐
Trench Safety Awareness
☐
Traffic Management
☐
Fall form Heights
☐
Mobile Plant Operator, and/or Extensive demonstrated relevant experience working with mobile plant and mobile plant risk assessment.
☐
Successful completion of YVW new Contractor Induction Questionnaire (when available)
Competencies
Project Experience
[please provide a list key personnel project experience for requested category of work – a minimum of 3 projects is required for each category of work]
LS1

LS3

v1.0
LS2

20
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Name
[please enter the name of nominated key
personnel]
Brief profile of
industry
experience
[please provide a summary of industry experience to support requested categories of work]
Live Sewer Categories of Work
[please select the relevant categories of work
for this person]
Position/Title
☐ LS1
[please enter position/title]
☐ LS2
☐ LS3
Qualifications and training certificates
[please select relevant qualifications, training achievements for this person]
☐
Relevant TAFE/Tertiary Qualification with industry experience or equivalent extensive relevant industry experience
☐
OHS Industry Induction (Red Card)
☐
Pipe laying Accreditation
☐
Confined Space Entry Certificate (Sewerage Works only)
☐
Trench Safety Awareness
☐
Traffic Management
☐
Fall form Heights
☐
Mobile Plant Operator, and/or Extensive demonstrated relevant experience working with mobile plant and mobile plant risk assessment.
☐
Successful completion of YVW new Contractor Induction Questionnaire (when available)
Competencies
Project Experience
[please provide a list key personnel project experience for requested category of work – a minimum of 3 projects is required for each category of work]
LS1

LS3

v1.0
LS2

21
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Name
[please enter the name of nominated key
personnel]
Brief profile of
industry
experience
[please provide a summary of industry experience to support requested categories of work]
Live Sewer Categories of Work
[please select the relevant categories of work
for this person]
Position/Title
☐ LS1
[please enter position/title]
☐ LS2
☐ LS3
Qualifications and training certificates
[please select relevant qualifications, training achievements for this person]
☐
Relevant TAFE/Tertiary Qualification with industry experience or equivalent extensive relevant industry experience
☐
OHS Industry Induction (Red Card)
☐
Pipe laying Accreditation
☐
Confined Space Entry Certificate (Sewerage Works only)
☐
Trench Safety Awareness
☐
Traffic Management
☐
Fall form Heights
☐
Mobile Plant Operator, and/or Extensive demonstrated relevant experience working with mobile plant and mobile plant risk assessment.
☐
Successful completion of YVW new Contractor Induction Questionnaire (when available)
Competencies
Project Experience
[please provide a list key personnel project experience for requested category of work – a minimum of 3 projects is required for each category of work]
LS1

LS3

v1.0
LS2

22
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Name
[please enter the name of nominated key
personnel]
Brief profile of
industry
experience
[please provide a summary of industry experience to support requested categories of work]
Live Sewer Categories of Work
[please select the relevant categories of work
for this person]
Position/Title
☐ LS1
[please enter position/title]
☐ LS2
☐ LS3
Qualifications and training certificates
[please select relevant qualifications, training achievements for this person]
☐
Relevant TAFE/Tertiary Qualification with industry experience or equivalent extensive relevant industry experience
☐
OHS Industry Induction (Red Card)
☐
Pipe laying Accreditation
☐
Confined Space Entry Certificate (Sewerage Works only)
☐
Trench Safety Awareness
☐
Traffic Management
☐
Fall form Heights
☐
Mobile Plant Operator, and/or Extensive demonstrated relevant experience working with mobile plant and mobile plant risk assessment.
☐
Successful completion of YVW new Contractor Induction Questionnaire (when available)
Competencies
Project Experience
[please provide a list key personnel project experience for requested category of work – a minimum of 3 projects is required for each category of work]
LS1

LS3

v1.0
LS2

23
Application for Registration as an Accredited Contractor for Live Sewer Construction Works
Name
[please enter the name of nominated key
personnel]
Brief profile of
industry
experience
[please provide a summary of industry experience to support requested categories of work]
Live Sewer Categories of Work
[please select the relevant categories of work
for this person]
Position/Title
☐ LS1
[please enter position/title]
☐ LS2
☐ LS3
Qualifications and training certificates
[please select relevant qualifications, training achievements for this person]
☐
Relevant TAFE/Tertiary Qualification with industry experience or equivalent extensive relevant industry experience
☐
OHS Industry Induction (Red Card)
☐
Pipe laying Accreditation
☐
Confined Space Entry Certificate (Sewerage Works only)
☐
Trench Safety Awareness
☐
Traffic Management
☐
Fall form Heights
☐
Mobile Plant Operator, and/or Extensive demonstrated relevant experience working with mobile plant and mobile plant risk assessment.
☐
Successful completion of YVW new Contractor Induction Questionnaire (when available)
Competencies
Project Experience
[please provide a list key personnel project experience for requested category of work – a minimum of 3 projects is required for each category of work]
LS1

LS3

LS2

PLEASE Copy and paste blocks as required to include additional Key Personnel nominations
v1.0
24