Page 1 of 1

Italy Contractor H&S / ITP Questionnaire

A. Supplier and proposed work

Q1.Legal name, registered office, tax code/VAT number and CCIAA/REA registration details

Q2.Named contact for this submission and named H&S contact

Q3.Describe the exact work/services, equipment used, proposed dates, locations and estimated duration.

Q4.Number and roles of personnel expected on site, including self-employed workers.

Q5.Will any subcontractor or self-employed worker be used?

A
B

B. Technical and professional suitability (ITP)

Q6.Upload current CCIAA company registration extract showing activities consistent with the proposed work.

Q7.Provide current DURC details/evidence, or explain why DURC is not applicable.

A
B

Q8.Confirm you possess the organisation, labour, equipment and technical capability required for the proposed work. Give brief supporting details.

A
B

Q9.Provide relevant experience from comparable occupied buildings and details of any required trade authorisations

Q10.List the equipment, plant, work equipment and PPE to be used and confirm legal conformity, inspection and maintenance.

Q11.Identify the employer, RSPP, competent doctor (where required), RLS/RLST and site supervisor/preposto relevant to the work.

Q12.Upload or provide evidence of the risk assessment/self-certification permitted by law and applicable H&S arrangements.

Q13.Provide workforce training, competence, medical fitness and authorisation records relevant to the tasks.

Q14.Provide current public/civil liability and workers/accident insurance evidence applicable to the work.

Q15.List any improvement, suspension or prohibition notices, serious H&S breaches or work-related fatalities in the last five years, with corrective action.

A
B

C. Work hazards and coordination information

Q16.Select all applicable activities

Q17.Provide task risk assessments and safe working method/procedure documents for the proposed scope.

Q18.List hazardous substances and upload current safety data sheets.

Q19.Describe required isolations, access restrictions, deliveries, storage, waste removal and emergency arrangements.

Q20.Identify risks your work may create for residents, employees, visitors or other contractors, and proposed controls.

Q21.Identify information you require about the property or other activities to work safely.

Q22.Confirm incidents, near misses, changes of personnel/scope and new hazards will be reported immediately.

D. Title IV and construction-site screening

Annex X of D.Lgs. 81/2008 covers construction and civil-engineering activities undertaken at temporary or mobile construction sites. This may include construction, maintenance, repair, demolition, renovation, transformation, installation, dismantling and related preparatory or finishing works. Please answer based on the proposed scope of work. If you are unsure whether the activities fall within Annex X, select “Unsure”. Orla’s appointed H&S representative will make the final applicability assessment.

Q23.Does the scope include construction or civil-engineering work, including construction, maintenance, repair, demolition, renovation, installation or dismantling activities potentially within Annex X?

A
B
C

Q24.Will more than one contractor or self-employed party be present at any stage, including sequentially?

A
B
C

Q25.Will you act as principal contractor/impresa affidataria or engage executing contractors?

A
B
C

Q26.If operating in a temporary or mobile construction site, provide Patente a Crediti details and current status, or the legal exemption and evidence relied upon.

A
B

Q27.Provide SOA classification evidence if relied upon as an exemption.

Q28.Upload the documents required from undertakings/self-employed workers under Annex XVII that apply to your role and scope

Q29.Confirm you will provide a POS where legally required and comply with the PSC and site coordination arrangements.

A
B

E. Declaration

Q30.Confirm the information and evidence are complete, accurate and current and that material changes will be notified before work continues.

A
B

Q31.Confirm workers and subcontractors will follow site rules, coordination measures, permits and emergency arrangements.

A
B
Signature