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Dunedin City Council – Kaunihera-a-rohe o Otepoti

Approved Contractor Application - Prequal (Medium to High Risk)

Last updated: 20 Oct 2025 10:37am

Guidance

Complete this form if you:

  • - have been engaged to carry out work for the DCC
  • - have a current health and safety prequalification e.g. Impac pre-qual

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If you wish to save the answers you have entered and return to complete the form later then use the Save progress and exit option

Enter the email address for the link and password email to be sent to:

Safety Accreditation Pre-Qualification

What type of safety accreditation certification do you have? *(required) (select the option/s that apply)
Please upload a copy of your current certificate
(You can load up to 2 files by using the ‘Add more’ button. Each file must be a maximum size of 6.5MB. Files may only be of .doc, .docx, .jpg, .jpeg, .xls, .xlsm, xlsx, or .pdf type and no larger than 6.5MB in file size.)

General Company Information

Postcode Finder (new window)
(please type in a valid email address - name@domain, name.name@domain (eg name@name.co.nz, name.name@name.org etc)
(please type in a valid email address - name@domain, name.name@domain (eg name@name.co.nz, name.name@name.org etc)

Type of work

(750 words maximum)
Which department are you engaged to work for at the DCC? (select any option/s that apply)
(please provide the department name if it does not appear in the options list)
(750 words maximum)
Does your work involve any of the following high risk activities? (select any option/s that apply)
(please describe the high risk work if it does not appear in the options list. 750 words maximum)

Training, Competency and Supervision


Please supply a training matrix for all workers showing current training. Please note this must include expiry dates, NZQA standard where relevant, and current first aid.
(You can load up to 2 files by using the ‘Add more’ button. Each file must be a maximum size of 6.5MB. Files may only be of .doc, .docx, .jpg, .jpeg, .xls, xlsm, xlsx or .pdf type and no larger than 6.5MB in file size.)
(750 words maximum)

Incident Management Reporting

Have you or your workers had any work-related events (accidents/incidents or near misses) in the past 12 months that have led to positive changes or initiatives in how you undertake work
(500 words maximum)
Have you ever received any improvement/infringement/prohibitions notices, formal warnings from WorkSafe NZ or been prosecuted for breaches of health and safety legislation? (Within the last 24 months for renewal applications).
(Focus will be on your actions to improve after the infringement. 500 words maximum)

Please load Improvements/infringement evidence as a file if needed. Focus will be on your actions to improve after the infringement.
(You can load up to 2 files by using the ‘Add more’ button. Each file must be a maximum size of 6.5MB. Files may only be of .doc, .docx, .jpg, .jpeg, .xls, .xlsm, xlsx, or .pdf type and no larger than 6.5MB in file size.)
Have you had any Notifiable events that have been reportable to WorkSafe NZ within the previous 24 months?
(500 words maximum)

Please load Notifiable event evidence as a file if needed.
(You can load up to 2 files by using the ‘Add more’ button. Each file must be a maximum size of 6.5MB. Files may only be of .doc, .docx, .jpg, .jpeg, .xls, .xlsm, xlsx, or .pdf type and no larger than 6.5MB in file size.)

Contractor Management

Do you engage contractors or subcontractors
(500 words maximum)

Insurance

Public Liability Professional Indemnity Motor Vehicle Third Party
Policy Number
Insurer
Expiry Date
Sum Insured

 

Please upload copies of your insurance certificates. (You can load up to 4 files by using the ‘Add more’ button. Each file must be a maximum size of 4MB. Files may only be of .doc, .docx, .jpg, .jpeg, .xls, .xlsm, xlsx, or .pdf type and no larger than 4MB in file size.)

Declaration

General obligations *(required)

While a contractor is on the DCC Health and Safety Approved Contractors listing, the contractor must:

  • a) comply in all respects with New Zealand law governing Health and Safety including but not limited to:
    • i) the Health and Safety at Work Act 2015 (HSWA) and any amendments or replacement legislation;
    • ii) all regulations made under the HSWA; and
    • iii) all relevant codes of practice;
  • b) maintain their health and safety accredited pre-qualification during the term of their approval;
  • c) immediately advise Council of any pending investigations, possible enforcement action, prosecution or fines, or improvement or prohibition notices that have been issued by WorkSafe NZ; and
  • d) advise the Council of the outcome of any enforcement action undertaken against them by WorkSafe NZ.

Contractor Health and Safety handbook *(required)

Dunedin City Council Contractor Health and Safety Information Handbook

Information provided is true, complete and correct *(required)

Your privacy is important to the Dunedin City Council.  Our Privacy Policy sets out how and why the DCC collects and stores your personal information, what we will use it for and with whom we can share it - Dunedin City Council Privacy Policy.

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