Kuwait Oil Tanker Company (S.A.

K)
CPC – Companies Pre-qualification Committee

Kuwait Oil Tanker Company (S.A.K)

A Subsidiary of Kuwait Petroleum Corporation

COMPANIES PREQUALIFICATION APPLICATION

Companies Pre-qualification Committee (CPC)

April 2014
Revision 0
 Kuwait Oil Tanker Company (S.A.K)
CPC – Companies Pre-qualification Committee

CONTENTS

A. APPLICANT’S COVERING LETTER 4

B. COMPANIES PRE-QUALIFICATION APPLICATION 7

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APPLICANT’S COVERING LETTER

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A. Applicant’s Covering Letter

Head of Vendor Evaluation Team (VET)
KUWAIT OIL TANKER CO. S.A.K.
A Subsidiary of Kuwait Petroleum Corporation
Shuwaikh Administrative Area,
Jamal Abdul Nasser Street, Block 4,
Head Office – 1st Floor
P.O. BOX 810, SAFAT 13009
Kuwait

Dear Sir,

Subject: Pre-qualification Application

1. We submit our completed pre-qualification questionnaire along with the additional

information required. We request to be included in the company's list of tenders for the
following category.

…………………………………..

2. We acknowledge that the company has absolute discretion in the selection of applicant
and is not required to provide any reason / justification should it decide not to include our
company on the above referred lists.

3. The authorized signatory of this questionnaire guarantees the truth and accuracy of all
statements and answers to interrogatories hereinafter made and that any depository,
vendor, or other agency herein named is hereby authorized to supply the Kuwait Oil
Tanker Company or its agents with any information to verify the statements made and
attached hereto.

4. Subject prior notification, we consent to any authorized representative of the Company

making any necessary visit to our Offices, facilities and work in progress for the purposes
of satisfactorily evaluating our submission. In the event of such visits taking place, we
shall provide whatever assistance necessary to the Company's authorized
representatives, in order to assist them in the evaluation of our application.

5. We hereby, authorize KOTC representatives to visit, seek opinion and inquire about us
from previous and current clients (stated as references herein) for the purposes of pre-
qualification. By this, we authorize referenced clients to divulge required information to
KOTC.

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6. We hereby, authorize KOTC representatives to visit and seek opinion from Applicant's
bankers for the purposes of pre-qualification. By this, we authorize referenced bankers to
divulge required Information to KOTC.

7. We hereby, undertake to immediately notify the KOTC of any significant changes in our
corporation legal. Financial, organizational and capabilities status that may affect ability
to perform the works as specifies under the categories applied for.

Name & Title of Authorized Signatory …………………………………

…………………………………

Signature …………………………………

Company Name …………………………………

Company Seal …………………………………

Note:-
 Attached copy of our Company Power of Attorney for Authorized signatory.

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COMPANIES PRE-QUALIFICATION APPLICATION

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B. Companies Pre-Qualification Application

Company Name …………………………………………………………………………………

Factory Address …………………………………………………………………………………

Registered Office Address …………………………………………………………………………………

Established Since …………………………………………………………………………………

Geographical Market Area …………………………………………………………………………………

Contact Person(s)

Name …………………………………………………………………………………

Title …………………………………………………………………………………

Telephone No. ……………………… Fax No. ……………………………….

E-mail ……………………… Website …………………………………

Please have this form signed by an authorized Director of the Company.

Notes:-

 All information supplied by the Applicant or, after approval by the Applicant, obtained by reference from a bank or
previous client shall be treated as strictly confidential.
 The request to issue this document does not constitute a commitment on the part of KOTC
 Attach copy of your Company Power of Attorney for Authorized signatory.

NOTES

1. The Vendor General, Finance and QA Questionnaires and the Annex Questionnaires are designed to allow
applicants to demonstrate their capability of fulfilling KOTC requirements in supplying particular Product
Class(es) / Sub-class(es).

2. The General, Finance and QA Questionnaires are to be completed by all applicants. Annex Questionnaires may
be completed depending on the product type of the Applicant and the relevant KOTC Product Class(es) / Sub-
class(es).

3. The questionnaires are designed to allow most of the answers to be filled in directly on the form. We
recommend that you read the instructions and questions carefully and be brief but complete with your answers.
General leaflets that give an impression of the activities and organization of your company will be welcome.

4. All information and data must be provided in the English language.

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5. Please submit two sets of Product Catalogues, if applicable.

6. Please ensure you have all of the following attachments and supplementary documents as you are unlikely to
be able to complete the questionnaires without them.

 Product Class(es) / Sub-class(es)

 Annex Questionnaires

7. Please ensure that your application includes the relevant attachments listed in Section 8.

8. Please submit completed applications along with all relevant Annex Questionnaires, attachments (Section 8),
Product Catalogues and any supporting documentation to:

Head of VET Team

KUWAIT OIL TANKER CO. S.A.K.
A Subsidiary of Kuwait Petroleum Corporation
Shuwaikh Administrative Area,
Jamal Abdul Nasser Street, Block 4,
Head Office – 1st Floor
P.O. BOX 810, SAFAT 13009, Kuwait

9. All companies who are qualified may be removed from the KOTC Approved Manufacturers List if any one of the
below applies:

 No response to requests for quotations or tenders on three consecutive occasions without adequate
explanation.
 Pre-Qualification data is older than 3 years.
 Company are identified through KOTC’s Performance Measurement System as not performing to KOTC
requirements.
 KOTC HSE violation.
 Failure to submit updated details / information as and when requested by KOTC.

10.The following documents are to be attached along with your application if you are a local contractor:

a) Copy of Article of Memorandum issued by Ministry of Justice (Attachment No.19)

b) Copy of Company License issued by Ministry of Commerce & Industry (Attachment No.20)

c) Copy of Central Tender Committee (C.T.C) registration card for the current year (Attachment No.21)

d) Copy of Kuwait Chamber of Commerce (K.C.C) registration card for the current year (Attachment No.22)

11. The following documents are to be attached by International contractors having local agents in Kuwait:

a) Documents listed under point No.11 are required from the appointed local agent.

b) Copy of valid agency certificate issued by Ministry of Commerce & Industry (Attachment No.23).

c) Copy of agency agreement (Attachment No.24)

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TABLE OF CONTENTS

SECTION SUBJECT
1-4 GENERAL
1 Structure and Organization
2 Scope of Services
3 References
4 Procurement and Contracting
5 FINANCIAL DATA AND COMMERCIAL TERMS
6 QUALITY MANAGEMENT, HEALTH, SAFTEY, SECURITY AND ENVIRONMENT
7 ATTACHMENTS

ANNEX QUESTIONNAIRES

Annex 01 - Pre-Qualification Questionnaire - Shipyard

Annex 02 - Pre-Qualification Questionnaire – Agents & Freight Forwarders

Annex 03 - Pre-Qualification Questionnaire – Manning

Annex 04 - Pre-Qualification Questionnaire – Bunker Fuel Oil Analysis

Annex 05 - Pre-Qualification Questionnaire – Riding Squad

Annex 06 - Pre-Qualification Questionnaire – Marine Lubricants

Annex 07 - Pre-Qualification Questionnaire – Marine Chemicals

GENERAL PART

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1. STRUCTURE AND ORGANISATION

1.1 Name and data of Parent Company, ultimate Holding Company, subsidiary Companies or branch
offices (if any) and local (Kuwaiti) Agent (if applicable):

a) Name of Parent Company ……………………………………………………………………………….

Registered office address ……………………………………………………………………………….

Postal Code …………………………. P.O.Box ………………………….

City …………………………. Country ………………………….

Telephone …………………………. Telefax …………………………..

E-mail …………………………. WWW …………………………..

b) Name of Holding Company ………………………………………………………………………………

Registered office address ………………………………………………………………………………..

Postal Code …………………………. P.O.Box ………………………….

City …………………………. Country ………………………….

Telephone …………………………. Telefax …………………………..

E-mail …………………………. WWW …………………………..

c) Name of Subsidiary Company and / or Branch Office………………………………………….

Registered office address ………………………………………………………………………………..
Postal Code …………………………. P.O.Box ………………………….
City …………………………. Country ………………………….
Telephone …………………………. Telefax …………………………..
E-mail …………………………. WWW …………………………..
(continue on an attached sheet if necessary)

d) Name of Local (Kuwaiti) Agent (if applicable)*………………………………………………………

(Please attach valid local agency certificate)
Registered office address…………………………………………………………………………………
Postal Code …………………………. P.O.Box ………………………….
City …………………………. Country ………………………….
Telephone …………………………. Telefax …………………………..
E-mail …………………………. WWW …………………………..

1.2 Does your Company established before three (3) years.

 Yes
 No

1.3 Approximate number of years’ experience in your particular market sector

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 <3  < 10
 <5  > 10 namely …………………

1.4 Total number of employees:

Office Staff:

 < 10  < 250

 < 50  < 500
 < 100  > 500 namely………………….

Skilled Workers:

 < 10  < 250

 < 50  < 500
 < 100  > 500 namely………………….

1.5 Please submit following documents:

Attachment No. 1: Organization Chart of your Company (incl. names of key personnel)
Attachment No. 2: Organization Chart of Parent Company (incl. names of key personnel)

Notes:

………………………………………………………………………………………………………………………...

………………………………………………………………………………………………………………………...

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2. SCOPE OF SERVICES

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2.1 Please state the Product Class(s) and Sub-Class(s) which you are applying for:
(Please refer to VET Index)

Product
Product Sub-class
Class

2.2 Please indicate your CORE business groups (Maximum two (2) fields).

 Shipbuilding  Ma n u f a c t u r i n g

 Ship Repair  Consultancy

 LPG Bottling  Ma n n i n g

 Marine Supplies  A g e n t s & F r e i g h t F o r wa r d e r s

 Other, namely ………………………………………………………………………

2.3 Please indicate your groups of work IN ADDITION to your core business (exclude fields selected
in question no. 2.2).

 Shipbuilding  Ma n u f a c t u r i n g

 Ship Repair  Consultancy

 LPG Bottling  Ma n n i n g

 Marine Supplies  A g e n t s & F r e i g h t F o r wa r d e r s

 Other, namely ………………………………………………………………………

2.4 Please indicate the activities normally performed with OWN resources to support 2.2 and 2.3

 Research & Development  Inspection

 Laboratory Facilities  E xp e d i t i n g
 Quality Assurance and control  Engineering and Design

 Other, namely ………………………………………………………………………

Notes:

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………………………………………………………………………………………………………………………...

………………………………………………………………………………………………………………………...

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3. REFERENCES
3.1 Please submit data as indicated in Attachment No. 3 of recently completed or current purchase orders performed for or
in combination with KOTC which are related to the product(s) you are applying for.

3.2 Please submit data as indicated in Attachment No. 3 covering purchase orders with oil & gas / petrochemical industries
(current and past 5 years) which are related to the product(s) you are applying for. Also indicate there if you have any
objection to KOTC contacting any of these clients. (copy of purchase orders to be attached showing owner's name,
location, value, duration and a short description is mandatory).

3.3 Please submit data as indicated in Attachment No. 3 covering purchase orders (Value > KD10,000) other than oil &
gas / petrochemical industries (current and past 5 years) which are related to the product(s) you are applying for. Also
indicate there if you have any objection to KOTC contacting any of these clients. (copy of purchase orders to be
attached showing owner's name, location, value, duration and a short description is mandatory).

3.4 Claims and Suits

If the answer to any of the questions is "YES", please attach

Yes No
details in Attachment No. 4.

a) Has your company ever failed to complete any Work

 
awarded to it?

b) Are there any judgments, claims, arbitration proceedings

 
or suits pending against your company or its officers?

c) Has your company filed any law suits or requested

arbitration with regards to construction Contracts within  
the last 5 years?

Notes:

………………………………………………………………………………………………………………………...

………………………………………………………………………………………………………………………...

………………………………………………………………………………………………………………………...

………………………………………………………………………………………………………………………...

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4. PROCUREMENT AND CONTRACTING

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4.1 Does your Company prequalify Sub-vendors.

 Yes
Please submit a copy of your relevant procedure (Attachment 5).
 No

4.2 Does your Company maintain a list of approved Sub-vendors

 Yes
 No

4.3 Please advise if you have any long-term supply agreements, partnering agreements, alliance
agreements or single source supply agreements with any Sub-vendors
 Yes
Please submit details (Attachment 6).
 No

4.4 Does your Company expedite sub-vendors

 Yes
Please submit a copy of your relevant procedure (Attachment 7).  No
4.5 Does your Company inspect sub-vendors
 Yes
Please submit a copy of your relevant procedure (Attachment 8).
 No

4.6 Does your Company competitively tender the award of purchase orders and / or contracts?
 Yes (Please submit a copy of your relevant procedure)
 No

4.7 Please advise if you would be willing to place Sub-orders and/ or Sub-contracts with KOTC approved suppliers.
 Yes
 No

Notes:

………………………………………………………………………………………………………………………...

………………………………………………………………………………………………………………………...

………………………………………………………………………………………………………………………...

………………………………………………………………………………………………………………………...
………………………………………………………………………………………………………………………...

5. FINANCIAL DATA AND COMMERCIAL TERMS

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5.1 Please provide audited statements of your company for the latest three (3) years which should include the following
as a minimum (Attachment No. 9):

 Auditor Report
 Balance Sheet
 Income Statement / Profit and Loss Statement
 Cash Flow Statements
 Notes of Accounts

Notes:
1. All Financial Statements, Auditor Report, Balance Sheets, Income Statements / Profit and Loss Accounts, Statement
of Cash Flows & Notes of Accounts shall be certified by a qualified auditing firm and prepared in accordance with
International Financial Reporting Standards (IFRS), OR Generally Accepted Accounting Principles (GAAP) in
English Language. Agencies or Organizations who fail to comply with the required financial information will not be
considered.

2. The Vendors / Contractors who are unable to provide the above information due to the small size of the organization
shall fulfill the following:

a. The Vendor / Contractor (Local / International) companies should have been established at least three years prior
submitting for KOTC pre-qualification.

Notes:

………………………………………………………………………………………………………………………...

………………………………………………………………………………………………………………………...

………………………………………………………………………………………………………………………...

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6. QUALITY MANAGEMENT, HEALTH, SAFTEY, SECURITY AND ENVIRONMENT

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6.1 Does your company have a written QMHSSE Program?

It is anticipated the program would include, but not be limited to, the following elements:

 Management commitment and expectations

 Employee participation including their training
 Accountabilities and responsibilities for managers, supervisors and employees
 Resources for meeting QMHSSE requirements
 Periodic QMHSSE performance appraisals
 Hazard and risk recognition and control

 Yes, please provide a copy of the index of your QMHSSE program (Attachment 10)
 No

6.2 Which national or international rules and regulations is your QMHSSE Program based on or does your company
comply with? ………………………………………………………………………………

6.3 Does your Company have a Certificate according to ISO 9001?

 Yes ................. Certifying Institute: .................................................................
Please submit a copy of certificate of certifying institute (Attachment No. 11).
 No

6.4 Is your company certified to ISO 14001 EMS standards?

 Yes, please attach valid copy of certificate (Attachment 12)
 No
6.5 Is your company OHSAS 18001 certified?
 Yes, please attach valid copy of certificate (Attachment 13)
 No

6.6 Is your company familiar with the requirements of the Kuwait Environment Public Authority (EPA)?
 Yes
 No

6.7 Does your Company have its own Quality Assurance organization for Engineering & Design,
Fabrication, Installation and Servicing?
 Yes
 No

6.8 Does your Company have its own Quality Control organization for Engineering & Design,
Fabrication, Installation and Servicing?
 Yes
 No
6.9 Please provide an organization chart of your QMHSSE Department including names of key personnel (Attachment 14)

6.10 Provide details of your company QMHSSE performance over the last three years by completing OSHA 300 & 300A
forms and Attachment No.15

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6.11 How do you ensure your contract and subcontract staff are aligned to QMHSSE targets? (Attachment No.16)

6.12 Is QMHSSE incorporated in your work preparation / planning program?

 Yes, please attach description of process (Attachment No.17)

 No

6.13 Please complete the Contractor QMHSSE Qualification form in Attachment No.18

6.14 If your Company is not certified, please answer the questions below:
Records
Does your Company: available
Yes No Yes No
a) Define management responsibility?    
b) Understand basic quality principles?    
c) Conduct internal quality audits?    
d) Conduct contract/order reviews?    
e) Operate any process controls?    
f) Inspect/test the product?    
g) Calibrate/control test and measuring equipment?    
h) Identify inspection and test status?    
i) Control non-conforming activities?    
j) Carry out corrective action?    
k) Procedures for handling, storage, packing and delivery?    
l) Maintain records of training/staff selection    
m) Control purchase/subcontract?    

6.15 How many years does your company keep information / data for purchased equipment

Notes:

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7. LIST OF ATTACHMENTS
 Please mark appropriate tick boxes
 Please mark appropriate tick boxes
 Please add relevant attachments at your choice
 Please mark each attachment with number as listed below

Attached Available Applicable

No Description
Y Y N N
1) Organization Chart of your Company (incl. names of key personnel)    
2) Organization Chart Parent Company (incl. names of key personnel)    
3) References (Copy as required)    
4) Claims and suits    
5) Sub-vendor Prequalification Procedure    
6) Long-term supply agreements, partnering agreements, alliance    
7) agreements or single source supply agreements with any
Sub- vendors or Sub-contractors    
8) Sub-vendor Expediting Procedure    
9) Sub-vendor Inspection Procedure    
10) Latest three (3) years financial audited statements    
11) Index QMHSSE Program    
12) Copy of Quality System Certificate ISO9001    
13) Copy of Quality System Certificate ISO14001    
14) Copy of Quality System Certificate OHSAS 18001    
15) QMHSSE department organization chart    
16) QMHSSE performance using OSHA 300 & 300A forms
and attachment No.16    
17) Commitment of contract / subcontract staff to QMHSSE targets    
18) Description of how QMHSSE incorporated in the work preparation /
planning program    
19) Contractor QMHSSE Qualification form    
20) Copy of Articles of Memorandum issued by Ministry of Justice    
21) Copy of Company License issued by Ministry of Commerce & Industry    
22) Copy of Central Tender Committee (C.T.C) registration card for
the current year    
23) Copy of Kuwait Chamber of Commerce (K.C.C) registration card for
the current year    
24) Copy of valid agency certificate issued by Ministry of Commerce
& Industry    
25) Copy of agency agreement    

Attachment No. 3 to General Part

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REFERENCE PROJECTS
(Please copy as required and mark as extra pages)
Attachment No. 3 for Question No.: 3.1  3.2  3.3  (Please tick applicable box)

1. Owner’s name …………………………………………………………………………..

Location …………………………………………………………………………..
Short description of the project …………………………………………………………………………..
…………………………………………………………………………..
…………………………………………………………………………..
…………………………………………………………………………..
…………………………………………………………………………..
Consultant / Engineering Contractor …………………………………………………………………………..
Size of (your) Contract (in US$)
Product Class / Sub-class …………………………………………………………………………..

Total man hours spent Duration……….months, Year of completion……..

Peak Manpower ………………Supervision / Labor Ratio………………

2. Owner’s name …………………………………………………………………………..

Location …………………………………………………………………………..
Short description of the project …………………………………………………………………………..
…………………………………………………………………………..
…………………………………………………………………………..
…………………………………………………………………………..
…………………………………………………………………………..
Consultant / Engineering Contractor …………………………………………………………………………..
Size of (your) Contract (in US$)
Product Class / Sub-class …………………………………………………………………………..

Total man hours spent Duration……….months, Year of completion……..

Peak Manpower ………………Supervision / Labor Ratio………………

3. Owner’s name …………………………………………………………………………..

Location …………………………………………………………………………..
Short description of the project …………………………………………………………………………..
…………………………………………………………………………..
…………………………………………………………………………..
…………………………………………………………………………..
…………………………………………………………………………..
Consultant / Engineering Contractor …………………………………………………………………………..
Size of (your) Contract (in US$)
Product Class / Sub-class …………………………………………………………………………..

Total man hours spent Duration……….months, Year of completion……..

Peak Manpower ………………Supervision / Labor Ratio………………

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Attachment No. 15 to General Part

WORKSITE QMHSSE PERFORMANCE INDICATORS

Please provide the following information:

Performance indicators LY-2 LY-1 Last Year (LY)

A Number of Lost Workday Cases (LWC)
B Number of Medical Treatment Cases (MTC)
C Number of Restricted Work Cases (RWC)
Number of Permanent Partial Disabilities (PPD)
D
Plus Permanent Total Disabilities (PTD)

E Number of Fatalities (FAT)

F Total work Site Exposure Hours

G Frequency Rate (FR) as calculated below for:
FR for LTI: (A+D+E) x 200,000/F
FR for RMC: 9B+C) x 200,000/F
FR for TRC:
(A + B + C + D + E) x 200,000/F

The different types of injuries can be explained and described as follows:

Type Description LTI RMC TRC

1 First Aid Case (FAC)

2 Medical Treatment Case (MTC)  

Restricted Work Case (RWC)  

3 Lost Workday Case (LWC)  

4 Permanent Total Disability (PTD)  

Permanent Partial Disabilities (PPD)  

Fatality  

Note: For definitions please see the following page

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Definitions:

Fatality (FAT)
Death resulting from an accident, within 30 days of the occurrence of the accident.

First Aid Case (FAC)

Anyone-time treatment and subsequent observation of minor scratches, cuts, burns, splinters, and so forth, which do
not ordinarily require medical care. Such treatment and observation are considered first aid even though provided by a
physician or registered professional personnel.

Lost Workday Case (LWC)

Any work injury other than a Permanent partial disability which renders the injured person temporarily unable to
perform any regular job or restricted work on any working day after the day on which the injury was received.

Medical Treatment Case (MTC)

Any work injury that involves neither lost workdays nor restricted workdays but which requires treatment by, or under
the specific order of a physician, registered personnel, or lay persons (Le. non-medical personnel). Medical treatment
does not include first aid treatment (one-time treatment and subsequent observation of minor scratches, cuts, burns,
splinters, and so forth, which do not ordinarily require medical care) even though provided by a physician or registered
professional employees.

Permanent Partial Disability (PPD)

Any work injury which results in the complete loss, or permanent use, of any member or part of the body or any
permanent impairment of functions of parts of the body, regardless of any pre-existing disability of the injured member
or impaired body function.

Permanent Total Disability (PTD)

Any work injury which incapacitates an employee permanently and results in termination of employment.

Restricted Work Case (RWC)

Any work injury that results in a work assignment after the day the accident occurred that does not include all the
normal duties of the person's regular job. The restricted work assignment must be meaningful and pre-established or a
substantial part of a regular job.

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Revision 0 Companies Prequalification Application
 Kuwait Oil Tanker Company (S.A.K)
CPC – Companies Pre-qualification Committee

ATTACHMENT NO.18 QMHSSE QUALIFICATION FORM

1. DOES YOUR QUALITY MANAGEMENT, HEALTH, SAFETY, SECURITY & ENVIRONMENTAL PROGRAM
ADDRESS THE FOLLOWING SUBJECTS?
YES NO N/A YES NO N/A
ARE FIRST AIDERS / DRIVERS
CORPORATE QMHSSE POLICY      
AVAILABLE?

ARE QMHSSE INSPECTIONS

IS THERE A CORPORATE HELD BY SUPERINTENDENTS
     
QMHSSE ADVISOR / CONSTRUCTION
MANAGERS?

IS THERE A PROCEDURE FOR

DOES CORPORATE
INCIDENT INVESTIGATION,
MANAGEMENT PERFORM      
REPORTING AND
QMHSSE INSPECTIONS?
REGISTRATION?

IS INFORMATION
IS THERE AN ACTION PLAN
   DISTRIBUTED ABOUT   
WITH REGARD TO QMHSSE?
HAZARDOUS SUBSTANCES?

ARE REGULAR INSPECTIONS

HAS A CORPORATE RISK BEING HELD FOR e.g
ANALYSIS / EVALUATION BEEN • HAND TOOLS   
MADE IN REGARD TO   
OCCUPATIONAL HEALTH AND • SCAFFOLDING & LADDERS   
SAFETY? • PERSONAL PROTECTION
  
EQUIPMENT

IS THE NECESSARY PERSONAL

ARE MEDICAL CONTROL
PROTECTION EQUIPMENT      
SYSTEMS IN PLACE?
AVAILABLE?

DO YOUR PERSONNEL HAVE A DOES YOUR PLAN ADDRESS

     
SAFETY CERTIFICATE? HOUSEKEEPING?

IS QMHSSE A NORMAL SUBJECT

DOES YOUR PLAN ADDRESS
FOR EVERY WORK RELATED      
TRANSPORT SAFETY?
MEETING?

IS THERE A QMHSSE ARE TOOLBOX MEETINGS

     
PROMOTION PROGRAM? REGULARLY HELD?

2. IS THERE A CORPORATE QMHSSE TRAINING PROGRAM IN PLACE FOR:

• NEW HIRES?  YES  NO
• UPDATE, MAINTAIN and IMPROVEMENT?  YES  NO

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Revision 0 Companies Prequalification Application
 Kuwait Oil Tanker Company (S.A.K)
CPC – Companies Pre-qualification Committee

ATTACHMENT NO.18 QMHSSE QUALIFICATION FORM

3. IS THERE A PROCEDURE FOR (JOB / TASK) RISK ANALYSIS PRIOR TO START OF WORK?
 YES  NO

4. HOW ARE INCIDENT / ACCIDENT RECORDS AND INCIDENT / ACCIDENT SUMMARIES REPORTED?
HOW OFTEN ARE THEY REPORTED?

YES NO MONTHLY QUARTERLY ANNUALLY OTHER

  TOTALED FOR ALL COMPANY    

  TOTALED BY PROJECT    

SUB TOTALED BY
     
SUPERINTENDNT

  SUB TOTAL BY SUPERVISOR    

  OTHER    

5. ARE INCIDENT / ACCIDENT REPORT SUMMARIES SENT TO THE FOLLOWING WITHIN YOUR COMPANY?
HOW OFTEN ARE THEY REPORTED?

YES NO MONTHLY QUARTERLY ANNUALLY OTHER

  PROJECT MANAGER    

  CONSTRUCTION MANAGER    

CORPORATE MANAGER OF
     
CONSTRUCTION

  MANAGING DIRECTOR    

  OTHER    

6. HOW ARE THE COSTS OF INDIVIDUAL INCIDENTS / ACCIDENTS KEPT? HOW OFTEN ARE THEY
REPORTED?

YES NO MONTHLY QUARTERLY ANNUALLY OTHER

COSTS TOTALED FOR ALL
     
COMPANY

  COSTS TOTALED BY PROJECT    

SUB TOTALED BY
     
SUPERINTENDENT

  SUB TOTALED BY SUPERVISOR    

  OTHER    

Page 23 of 23
Revision 0 Companies Prequalification Application