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Subcontractor Prequalification Questionnaire
All questions contained in this questionnaire are strictly confidential.
Company Headquarters Information
Federal Tax ID:
*
Year Company Founded
*
Company Name:
*
*
Also Known As
Legal Name
Parent Corp.
Address:
*
Contact
*
Suite:
Phone
*
City:
*
Toll Free
State
*
Alabama
Alaska
Alberta
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland and Labrador
North Carolina
North Dakota
Northwest Territories/Nunavut
Nova Scotia
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
Fax
Zip
*
E-mail
*
Country
Branch Offices:
(Enter all your branch office(s) and bid contact names)
Branch Name
Address
Contact
*
Suite
Phone
City
Toll Free
State
*
Alabama
Alaska
Alberta
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland and Labrador
North Carolina
North Dakota
Northwest Territories/Nunavut
Nova Scotia
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
Fax
Zip
E-mail
*
Country
Remove Row
Add Row
Indicate what region your company does work in:
*
Select All Regions
Central
North
West
East
South
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Citations
- Please enter number of OSHA Citations received during that year (citations, not violations)
EMR
- Experience Modification Rate. Your Workers Comp carrier should have this information
RIR
- Recordable Incident Rate - Add columns I & J from the OSHA 300A form.
LTIR
- Lost Time Incident Rate - Column H from the OSHA 300A form
FHW
- Total hours worked by all employees - located on right hand side of OSHA 300A form
ANE
- Annual Number of Employees - located on right hand side of OSHA 300A
Fatalities
- Column G from OSHA 300A form
Password:
Confirm: