Integrated Management System

(IMS) Questionnaire
Outside Services Questionnaire
For current and prospective consultants, contractors and suppliers

Mott MacDonald operates an Integrated Management System, which is certified to international standards. We use this form to assess the
corresponding practices of our consultants, contractors, and suppliers. Please answer the following questions in full. If there is insufficient
space on the form, and as requested, please attach supporting documents.

1 OrganizationContactCLICKHEREFORGUIDANCE

Organization:

Address:

Main Contact MainContactPhone/Fax:()/()

Name: MainContactEmail:
Servicesofferedbyyourorganization

2 OrganizationCommercialDetails

Status LimitedLiabilityCompany Corporation Partnership

Other(specify):Individual

Other(specify):Individual(Subconsultant)

CompanyRegistration:Place,Numberanddate: Notapplicable

Registration/Certi SmallBusinessEnterprise(SBE) WomanBusinessEnterprise(WBE) MinorityBusinessEnterprise(MBE)

fication: (ProvideRegistration) (ProvideCertificate) (Providecertificate)
Otherofficesandlocations(indicateheadofficeifdifferenttoabove):

EITHERListthelastthreeprojects(ifany)onwhichyourorganizationworkedwithusandyourcontact(s)withinourCompanyORProvide
attachmentsshowing:clientnames,projectnames,andservicesprovidedcompletedbyyourorganizationinthelastfiveyearswithsimilarservicesto
thoserequiredbyus.

3 QualityAssurance/QualityControl(QA/QC)

Ifavailable,attachacopyofyourQA/QCPlan.IfthePlanisnotavailable,nameyourLLCMembers,Partners,orCorporateOfficersresponsiblefor
QA/QC:

4 SafetyandRiskManagement

DoesyourorganizationmaintainaHealthandSafetyPlantoensurethatemployeescarryingouttasksareawareofworkrelatedhazardsandthe
measurestheyshouldfollowtoprotectthemselvesandothers?Yes/No

*HealthandSafetyPlantobesubmitteduponrequest(notrequiredatthistime).

5 SafetyandEnvironmentalPerformanceHistory

Doesyourcompanyemploymorethan10employees? Yes / No

Inthelastthreeyears,hasyourorganizationhadanyfatalaccidents,orcasesofoccupationalillnessthathaveresultedindeath Yes / No
(PleaseprovideacopyoftheIllnessandInjuryReport)?
Inthelastthreeyears,haveyouhadanyOSHAreportableinjuriesordocumentednearmisses(Pleaseprovideacopyofyour Yes / No
organizationsLogofWorkrelatedInjuriesandIllnessesandSummaryofWorkrelatedInjuriesandIllnesses)?

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 Integrated Management System
(IMS) Questionnaire
Outside Services Questionnaire
For current and prospective consultants, contractors and suppliers

HasyourorganizationeverbeenfinedbyOSHA? Yes / No
IfYes,pleaseattachdetailsforeachincident.

Pleaseprovidethefollowingdataforyourorganizationforthepastthreeyears:
1) LostWorkdayCaseRate:
2) TotalRecordableCaseRate:
3) TotalIncidentCaseRate:
4) ExperienceModificationRating:

6 Training

Bycheckingthisbox,youareconfirmingthatallrequiredH&StrainingforstaffengagedtoworkwithMottMacdonaldiscurrent.

7 SupplyChainAssessmentandControl

**Howdoesyourorganizationmonitorandassesstheperformanceofyoursubcontractors?

**ItisMottMacdonaldsviewthatyourorganizationisresponsiblefortheperformanceofyoursubcontractors.

8 Sustainability

Mott Macdonald is committed to the environment by striving to partner with subcontractors who believe in and use environmentally responsible
practices in delivering their services. Pleaseprovideasummaryofyourfirmssustainability credentials;initiativesordevelopmentprogramif
available:

9 Ethics

Mott Macdonald is committed to maintaining a strong record of ethical behaviour throughout the performance of our projects.

In the last 3 years, has your business or any of its principals been the subject of a criminal or civil proceeding in connection with the award or performance
of a contract? YES/NO, if YES, please explain

Please provide a summary of how your firm ensures that it conducts its business in an ethical manner

10 QuestionnaireCompletion

Name: Positioninorganization:

Signature: Date:

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 Integrated Management System
(IMS) Questionnaire
Outside Services Questionnaire
For current and prospective consultants, contractors and suppliers

11 MottMacdonaldReview

Name: PositioninMottMacdonald:

Signature: Date:

Recommendation:

12 MottMacdonaldApproval/ExecutedContractInformation

Name: PositioninMOTTMACDONALD:

Signature: Date:

ExecutedContractDateandStorageLocation:

Recommendation for addition to Outside Services Register: Yes / No; If no, explain: _______________________________

For internal use - Distribution:

1) Original to IMS Representative 2) Copy to the Project file / IMS folder

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