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Contractor Pre-Qualification Questionnaire

For North America Contractors. All fields are required.

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Have you had had any safety, health, and/or environmental fines, penalties, and/or notices of violation within the past three years?

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Provide Required Proof of Insurance

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(PDF format only, up to 1MB file size).
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All contractors and staffing agencies must confirm maintenance of records for individuals who will be assigned to work at Energizer facilities which include the following:

  • Proof of eligibility to work in the country (I-9 forms in the US or equivalent)
  • Confirmation that the employee is fit for duty and can fulfill the required activities in a safe manner
  • Verification of work history
  • Criminal background checl

Do you maintain such records for individuals assigned to work at Energizer facilities?

Your company further understands and agrees to the following:

Will conform to all applicable safety and environmental rules, standards, procedures and requirements of Energizer, as well as all regulatory agencies.

Must ensure that each contract employee is trained in the work practices necessary to safely perform his/her job. Records of this training will be kept, and include 1) employee name(s), 2) date(s) of training, and 3) means used to verify that the employee understood the training.

Must ensure that each contract employee is aware of and follows the safety rules of the facility including safe work practices.

Must immediately report all incidents occurring on an Energizer site their Project Manager and/or the facility Safety Coordinator.

Must advise the employer of any unique hazards presented by the contract employer's work, or of any hazards found during the contract employer's work.

Must perform a pre-startup safety review for contract employees new to the facility.

Must perform a pre-startup job review with the Project Manager.

Must address/correct unsafe conditions and/or acts for which they have control.

Contractors, as well as contract employees are obligated to refuse to take any action they consider unsafe or to perform a task for which they have not been properly trained or do not have the proper tools.

Must immediately report to Energizer the existence of any known unsafe condition(s) or act(s) for which Energizer has control.

In situations where a waste is generated on an Energizer site, contractor must notify the Program Manager (to assist in determining the proper identification of material, and to properly manage it in accordance with all applicable requirements).

Must notify their Energizer Project Manager before bringing sub-contractors on site. Sub-contractors must be pre-qualified.

By clicking the submit button below, you confirm that the information contained here is true and correct to the best of your knowledge, and such action shall be valid as an original signature evidencing your agreement to the foregoing.

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Thank you. Someone from Energizer will be in touch regarding your submission.

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