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TSA Contractor Pre-Assessment

* Indicates Required Information

*Organisation Name:
Organisation Structure:
*Organisation ABN:
*Address Line 1 (physical address):  
Address Line 2:  
*Suburb:
*Post Code:


Postal Address (if different):
P.0. Box No.:  
Suburb:
Post Code:


*Contact Name:
Job Title:
*Phone No. (not mobile):
Mobile No.:
*Contact Email:
Second Email:
*States in which you operate (please select all that apply):
The control key has to be held down while selecting multiple states.
States in which you have offices (please select all that apply):
The control key has to be held down while selecting multiple states.


Were you previously registered on the old Contractor Accreditation Services (CAS) system? 		Yes No

What was your CAS identity number (xxxx-xx): 		or Unknown

*Are you Third Party Certified for any of the following:
  Certificate No.Expiry
(DD/MM/YYYY)		Copy
Provided
a) OHS Management Systems to Australian Standard AS 4801 Yes
No
b) Quality Assurance to ISO 9001 Yes
No
c) Environmental Management Systems to ISO 14001 Yes
No


*Type of work performed:
How did you find The Safety Alliance?:



Insurance TypeInsurerPolicy No.Policy $Expiry DateCopy
Provided
Public Liability: Yes
No 
Professional Indemnity: Yes
No 
Workers Compensation: Yes
No 
Accident/Illness (ST): Yes
No 
Income Protection (ST): Yes
No 
Contracts Work: Yes
No 
Motor Vehicle: Yes
No 


Trade LicenceHolderLicence No.StatusExpiryCopy
Provided
Yes
No 
Yes
No 
Yes
No 
Yes
No 
Yes
No 
Yes
No 
Yes
No 


Are you a Principal Contractor? Yes No
How many employees do you have?
How many sub-contractors do you have?