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PRE-QUALIFICATION SCHEMETRAFFIC MANAGEMENT SERVICES GROUP
TRAFFIC CONTROL SYSTEMS INSTALLATION AND MAINTENANCE
Self-Assessment Check List
This check list is created for contractors to conduct a self-assessment on their prequalification application that they intend to submit. It is based on the requirements for individual TRAFFIC MANAGEMENT SERVICES GROUP – CONTRACT levels and covers the information given in
Part A and Part B forms. Contractor is required to fill in the relevant fields and submit this check list as part of their prequalification submission.
New Application
Review
Company Name:Contact Name:Contact Number: Email:
Levels Applying For (Only tick levels being applied for):
Metro (and Rural by default) Traffic Signals Installation (STS1) Traffic Signals Maintenance (STS2) Public Lighting and Basic Electrical works (STCE1) Other On-Road Electrical ITS Devices) (STCE2) Specialist On-Road ITS Devices (STCE3) Communications (SCTV) Vehicle Detection Loops (SVDL) Supply of On-road Electronic Devices (SOED)
Rural Only Traffic Signals Maintenance (STS2)
Page 1 of 47 Rev. 2
APPLICATION FOR PRE-QUALIFICATION PART “A”
Company Details (VicRoads Use Only)
Australian Business Number (ABN): Australian Company Number (ACN):Business information provided: Yes No Evidence of Current Workcover Certificate Provided: Yes No Policy Number: Expiry Date:“Part A” Declaration Completed: Yes No
APPLICATION FOR PRE-QUALIFICATION PART BPage 2 of 47 Rev. 2
Management Systems (VicRoads Use Only)
System Quality OH&S EMS Industrial RelationsSystem Standard ISO 9001:2016
VicRoads Check List CCF code
Safety Map Level 1.AS4801:2001AS/NZ/ISO 45001VicRoads Checklist CCF code
ISO 14001:2016VicRoads Check List CCF code
VicRoads Self-Assessment Checklist and Signed Declaration Provided
Approval Type Registered by CCF3rd Party Certification Audited to VicRoads
Registered by CCF3rd Party Certification Audited to VicRoads
Registered by CCF3rd Party Certification Audited to VicRoads
Name of Approval OrganisationApproval DateExpiry DateRegistration No.
Comments
Pre-qualification Part A and Part B (VicRoads Use Only)Page 3 of 47 Rev. 2
Business Information Complies Does Not Comply Quality System Complies Does Not Comply OH&S Complies Does Not Comply EMS Complies Does Not Comply Financial Assessment – (Requested by VicRoads once all the documentation is submitted) Complies Does Not Comply
Page 4 of 47 Rev. 2
STS1
APPLICATION FOR PRE-QUALIFICATION “PART B” (Only complete the fields that are relevant to the levels the company is applying for)
“Part B” Declaration Completed YES NO
APPLYING FOR TRAFFIC SIGNALS MAINTENANCE (STS1) METRO - YES NO (Includes Rural by default) Relevant Work Undertaken
Traffic Signals Yes No Freeway Ramp Metering Yes No Overhead Lane Control Signals Yes No Direct Driven Peripheral Elec. Signage Yes No
Specific Eligibility Criteria Complies Minimum of two permanent full time employees that are holders of an Electrician’s Licence. Such
personnel shall be based at company’s office/depot; (Evidence that the staff are permanent such as payroll summary)
Yes No
Minimum of three years relevant field experience within the last six years within this area of competency; Yes No
Minimum number of four suitable vehicles. Yes No
Comments
Page 5 of 47 Rev. 2
STS1
PERSONNEL EXPERIENCE SUMMARYOnly provide personnel experience relevant to the levels company is applying for. The experience requirements for each level are described in Traffic Management Services (Contractor) GROUP Categories and Levels Eligibility Criteria. The criteria document can be found on VicRoads website. Note that multiple copies of this page may need to be submitted in order for company to demonstrate that nominated employees meet the minimum experience requirements specified in the Eligibility Criteria. All the relevant projects need to be listed, their description, duration as well as the company that the employee worked for at the time.
NOMINATED EMPLOYEE NAME:
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
Page 6 of 47 Rev. 2
STS1
NOMINATED EMPLOYEE NAME:
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
Page 7 of 47 Rev. 2
STS1
STS1 Personnel & Company Summary (VicRoads Use Only)Summary provided by contractor: Yes No Referees Check Conducted
Yes No Does the experience and qualifications of the employees comply with STS1 level
Yes No Checked by VicRoads OfficerYes No Does the company have the required number of vehicles Yes No
Page 8 of 47 Rev. 2
STS2
APPLYING FOR TRAFFIC SIGNALS MAINTENANCE (STS2) METRO - YES NO (Includes Rural by default) Relevant Work Undertaken
Traffic Signals Yes No Freeway Ramp Metering Yes No Overhead Lane Control Signals Yes No Direct Driven Peripheral Elec. Signage Yes No
Specific Eligibility Criteria Complies Minimum of four permanent full time employees that are holders of an Electrician’s License Such
personnel shall be based at company’s office/depot; (Evidence that the staff are permanent such as payroll summary)
Yes No
Minimum of three years relevant field experience within the last six years within this area of competency; Yes No
Minimum number of four suitable vehicles. Yes No
Comments
PERSONNEL EXPERIENCE SUMMARY
Page 9 of 47 Rev. 2
STS2
Only provide personnel experience relevant to the levels company is applying for. The experience requirements for each level are described in Traffic Management Services (Contractor) GROUP Categories and Levels Eligibility Criteria. The criteria document can be found on VicRoads website. Note that multiple copies of this page may need to be submitted in order for company to demonstrate that nominated employees meet the minimum experience requirements specified in the Eligibility Criteria. All the relevant projects need to be listed, their description, duration as well as the company that the employee worked for at the time.
NOMINATED EMPLOYEE NAME:
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
NOMINATED EMPLOYEE NAME:
Page 10 of 47 Rev. 2
STS2
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
NOMINATED EMPLOYEE NAME:
Page 11 of 47 Rev. 2
STS2
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
NOMINATED EMPLOYEE NAME:
Page 12 of 47 Rev. 2
STS2
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
STS2 Metro - Personnel & Company Summary Review (VicRoads Use Only)
Page 13 of 47 Rev. 2
STS2
Summary provided by contractor: Yes No Referees Check ConductedYes No
Does the experience and qualifications of the employees comply with STS2 level
Yes No Checked by VicRoads OfficerYes No Does the company have the required number of vehicles Yes No
APPLYING FOR TRAFFIC SIGNALS MAINTENANCE (STS2) RURAL - YES NO Relevant work undertaken Traffic Signals Yes No
Page 14 of 47 Rev. 2
STS2
Direct Driven Peripheral Elec. Signage Yes No
Number of Sites Specific Eligibility Criteria Complies
Up to 100 Minimum of one permanent full time employee plus backup that are holders
of an Electrician’s License.(Evidence that the staff are permanent such as payroll summary)
Yes No
Minimum number of two suitable vehicles. Yes No
101-200 Minimum of two permanent full time employees that are holders of an
Electrician’s License.(Evidence that the staff are permanent such as payroll summary)
Yes No
Minimum number of two suitable vehicles. Yes No over 200 Minimum of four permanent full time employees that are holders of an
Electrician’s License.(Evidence that the staff are permanent such as payroll summary)
Yes No
Minimum number of four suitable vehicles. Yes No
Comments
PERSONNEL EXPERIENCE SUMMARYOnly provide personnel experience relevant to the levels company is applying for. The experience requirements for each level are described in Traffic Management Services (Contractor) GROUP Categories and Levels Eligibility Criteria. The criteria document can be found on VicRoads website.
Page 15 of 47 Rev. 2
STS2
Note that multiple copies of this page may need to be submitted in order for company to demonstrate that nominated employees meet the minimum experience requirements specified in the Eligibility Criteria. All the relevant projects need to be listed, their description, duration as well as the company that the employee worked for at the time.
NOMINATED EMPLOYEE NAME:
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
NOMINATED EMPLOYEE NAME:
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
Page 16 of 47 Rev. 2
STS2
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
STS2 Rural - Personnel & Company Summary Review (VicRoads Use Only)
Summary provided by contractor: Yes No Referees Check ConductedYes No
Does the experience and qualifications of the employees comply with STS2 (Rural) level
Yes No Checked by VicRoads OfficerYes No Does the company have the required number of vehicles Yes No
Page 17 of 47 Rev. 2
STS2
Page 18 of 47 Rev. 2
STCE1
APPLYING FOR PUBLIC LIGHTING AND BASIC ELECTRICAL WORKS (STCE1) - YES NO Relevant Work Undertaken Public Lighting, installation and maintenance works Yes No Installation of electrical and communication conduit and pit work Yes No
Specific Eligibility Criteria Complies Minimum of two permanent full time employees that are holders of an Electrician’s License and
based at company’s office/depot. (Evidence that the staff are permanent such as payroll summary)Yes No
Minimum of three years relevant field experience within the last six years within this area of competency.
Yes No
Minimum number of two suitable vehicles. Yes No
Comments
Page 19 of 47 Rev. 2
STCE1
PERSONNEL EXPERIENCE SUMMARYOnly provide personnel experience relevant to the levels company is applying for. The experience requirements for each level are described in Traffic Management Services (Contractor) GROUP Categories and Levels Eligibility Criteria. The criteria document can be found on VicRoads website. Note that multiple copies of this page may need to be submitted in order for company to demonstrate that nominated employees meet the minimum experience requirements specified in the Eligibility Criteria. All the relevant projects need to be listed, their description, duration as well as the company that the employee worked for at the time.
NOMINATED EMPLOYEE NAME:
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
NOMINATED EMPLOYEE NAME:Page 20 of 47 Rev. 2
STCE1
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
Note: Add pages here for additional employees if required.
Page 21 of 47 Rev. 2
STCE1
STCE1 Personnel & Company Summary (VicRoads Use Only)
Summary provided by contractor: Yes No Referees Check ConductedYes No
Does the experience and qualifications of the employees comply with STCE1 level
Yes No Checked by VicRoads OfficerYes No Does the company have the required number of vehicles Yes No
Page 22 of 47 Rev. 2
STCE2
APPLYING FOR OTHER ON-ROAD ELECTRICAL ITS DEVICES (STCE2) - YES NO (also STCE1 by default) Relevant Work Undertaken
Freeway Data Stations Yes No Help Phones Yes No Drive Time Yes No Electronic Signs Yes No Ice Warning Yes No Vehicle Height Yes No Public Lighting Yes No Bluetooth Data Stations Yes No Transmission Equipment Yes No
Specific Eligibility Criteria Complies Minimum of two permanent full time employees that are holders of an Electrician’s License and
based at company’s office/depot. (Evidence that the staff are permanent such as payroll summary) Yes No Minimum of three years relevant field experience within the last six years within this area of
competency. Yes No Minimum number of two suitable vehicles. Yes No
Comments
Page 23 of 47 Rev. 2
STCE2
PERSONNEL EXPERIENCE SUMMARYOnly provide personnel experience relevant to the levels company is applying for. The experience requirements for each level are described in Traffic Management Services (Contractor) GROUP Categories and Levels Eligibility Criteria. The criteria document can be found on VicRoads website. Note that multiple copies of this page may need to be submitted in order for company to demonstrate that nominated employees meet the minimum experience requirements specified in the Eligibility Criteria. All the relevant projects need to be listed, their description, duration as well as the company that the employee worked for at the time.
NOMINATED EMPLOYEE NAME:
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
Page 24 of 47 Rev. 2
STCE2
NOMINATED EMPLOYEE NAME:
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
Note: Add pages here for additional employees if required.
Page 25 of 47 Rev. 2
STCE2
Page 26 of 47 Rev. 2
STCE2 Personnel & Company Summary (VicRoads Use Only)
Summary provided by contractor: Yes No Referees Check ConductedYes No
Does the experience and qualifications of the employees comply with STCE2 level
Yes No Checked by VicRoads OfficerYes No Does the company have the required number of vehicles Yes No
SCTV
APPLYING FOR SPECIALIST ON-ROAD ITS DEVICES (STCE3) - YES NO (does not cover STCE1 & STCE2) Relevant Work Undertaken
Yes No Yes No Yes No
Below is minimum STCE3 Specific Eligibility Criteria, these requirements might change based on the works the company is applying for.
Specific Eligibility Criteria Complies Minimum of two permanent full time employees that are holders of an Electrician’s License and
based at company’s office/depot. (Evidence that the staff are permanent such as payroll summary) Yes No Minimum of three years relevant field experience within the last six years within this area of
competency. Yes No Minimum number of two suitable vehicles. Yes No
For a company to apply for this level, a VicRoads representative needs to identify the works as very specific and that they are not covered by other prequalification levels. List below ITS work type the company wishes to apply for.
Comments
Page 27 of 47 Rev. 2
SCTV
PERSONNEL EXPERIENCE SUMMARYOnly provide personnel experience relevant to the levels company is applying for. The experience requirements for each level are described in Traffic Management Services (Contractor) GROUP Categories and Levels Eligibility Criteria. The criteria document can be found on VicRoads website. Note that multiple copies of this page may need to be submitted in order for company to demonstrate that nominated employees meet the minimum experience requirements specified in the Eligibility Criteria. All the relevant projects need to be listed, their description, duration as well as the company that the employee worked for at the time.
NOMINATED EMPLOYEE NAME:
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
NOMINATED EMPLOYEE NAME:Page 28 of 47 Rev. 2
SCTV
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
Note: Add pages here for additional employees if required.
Page 29 of 47 Rev. 2
SCTV
STCE3 Personnel & Company Summary (VicRoads Use Only)
Summary provided by contractor: Yes No Referees Check ConductedYes No
Does the experience and qualifications of the employees comply with STCE3 level
Yes No Checked by VicRoads OfficerYes No Does the company have the required number of vehicles Yes No
Page 30 of 47 Rev. 2
SCTV
APPLYING FOR COMMUNICATIONS (SCTV) - YES NO Relevant Work Undertaken CCTV Camera Network Systems Yes No CCTV Transmission Equipment Yes No CCTV Distribution & Termination Cabins Yes No
Specific Eligibility Criteria Complies Minimum of two permanent full time employees that are licensed in accordance with ACMA
requirements and based at company’s office/depot. (Evidence that the staff are permanent such as payroll summary)
Yes No
Minimum of one permanent full time employee that is holder of an Electrician’s License and based at company’s office/depot.
Yes No
Minimum of three years’ relevant field experience within the last six years within this area of competency.
Yes No
Minimum number of two suitable vehicles. Yes No
Comments
Page 31 of 47 Rev. 2
SCTV
PERSONNEL EXPERIENCE SUMMARYOnly provide personnel experience relevant to the levels company is applying for. The experience requirements for each level are described in Traffic Management Services (Contractor) GROUP Categories and Levels Eligibility Criteria. The criteria document can be found on VicRoads website. Note that multiple copies of this page may need to be submitted in order for company to demonstrate that nominated employees meet the minimum experience requirements specified in the Eligibility Criteria. All the relevant projects need to be listed, their description, duration as well as the company that the employee worked for at the time.
NOMINATED EMPLOYEE NAME:
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
Page 32 of 47 Rev. 2
SCTV
NOMINATED EMPLOYEE NAME:
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
Note: Add pages here for additional employees if required.
Page 33 of 47 Rev. 2
SCTV
SCTV Personnel & Company Summary (VicRoads Use Only)
Summary provided by contractor Yes No Referees Check ConductedYes No
Does the experience and qualifications of the employees comply with SCTV level
Yes No Checked by VicRoads OfficerYes No Does the company have the facilities and required number of vehicles Yes No
Page 34 of 47 Rev. 2
SVDL
APPLYING FOR VEHICLE DETECTOR (SVDL) METRO - YES NO (Includes Rural by default) Relevant Work Undertaken
Traffic Signals Yes No Freeway Data Stations Yes No Lane Delineation & Markings Yes No
Specific Eligibility Criteria Complies Minimum of two permanent full time employees that have relevant experience in the area of
competency. Such personnel shall be based at company’s office/depot; (Evidence that the staff are permanent such as payroll summary)
Yes No
Minimum of three years relevant field experience within the last six years within this area of competency; Yes No
Minimum number of two suitable vehicles in Metro area Minimum number of one suitable vehicle in Rural area. Yes No
Comments
PERSONNEL EXPERIENCE SUMMARY
Page 35 of 47 Rev. 2
SVDL
Only provide personnel experience relevant to the levels company is applying for. The experience requirements for each level are described in Traffic Management Services (Contractor) GROUP Categories and Levels Eligibility Criteria. The criteria document can be found on VicRoads website. Note that multiple copies of this page may need to be submitted in order for company to demonstrate that nominated employees meet the minimum experience requirements specified in the Eligibility Criteria. All the relevant projects need to be listed, their description, duration as well as the company that the employee worked for at the time.
NOMINATED EMPLOYEE NAME:
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
NOMINATED EMPLOYEE NAME:
Page 36 of 47 Rev. 2
SVDL
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
SVDL Personnel & Company Summary (VicRoads Use Only)
Page 37 of 47 Rev. 2
SVDL
Summary provided by contractor: Yes No Referees Check ConductedYes No
Does the experience and qualifications of the employees comply with SVDL level
Yes No Checked by VicRoads OfficerYes No Does the company have the required number of vehicles Yes No
Page 38 of 47 Rev. 2
SOED
APPLYING FOR SUPPLY OF ON-ROAD ELECTRICAL DEVICES (SOED) - YES NO VicRoads Type Approved Product
Variable Message Signs Yes No Traveller Information Signs Yes No Other Electronic Signs Yes No Environmental Warning Systems Yes No Other Electronic Signage Which is in common usage Yes No
Specific Eligibility Criteria Complies Minimum of one full time employee with Diploma of Electronics or equivalent. (Evidence that the
staff are permanent such as payroll summary)Yes No
History of project completion and delivery Yes No Competency in the manufacture and supply of signs (this is proven by attainment of VicRoads
type approval for a minimum of two current on-road electronic display, data collection or advisory equipment)
Yes No
Comments
PERSONNEL EXPERIENCE SUMMARYPage 39 of 47 Rev. 2
SOED
Only provide personnel experience relevant to the levels company is applying for. The experience requirements for each level are described in Traffic Management Services (Contractor) GROUP Categories and Levels Eligibility Criteria. The criteria document can be found on VicRoads website. Note that multiple copies of this page may need to be submitted in order for company to demonstrate that nominated employees meet the minimum experience requirements specified in the Eligibility Criteria. All the relevant projects need to be listed, their description, duration as well as the company that the employee worked for at the time.
NOMINATED EMPLOYEE NAME:
PROFESSIONAL/TECHNICAL QUALIFICATION:
(ensure that copies of any licences or qualifications are provided as part of the application)
PROJECT HISTORY (EMPLOYEE)COMPANY
NAMENAME OF THE
PROJECTDURATION WORKED (start and completion date)
DETAILED DESCRIPTION OF WORKS
REFEREE CONTACT DETAIL(email and phone number)
SOED Personnel & Company Summary (VicRoads Use Only)
Page 40 of 47 Rev. 2
SOED
Summary provided by contractor: Yes No Referees Check ConductedYes No
Does the experience and qualifications of the employees comply with SOED level
Yes No Checked by VicRoads OfficerYes No
Page 41 of 47 Rev. 2
Plant and Premises
PLANT & PREMISES ASSESSMENT
Existing applicants: - please fill out and sign the declaration for Plant & Premises self-assessment checklist below (Please indicate how your company’s premises meet the criteria):
New applicants: - site inspection will be conducted after reviewing your application on the checklist below.
Item Criteria Description of Facility at Company Premises1. Does the company maintain a secure, suitable size lockable
depot in the works area for the purpose of storing goods and equipment relevant to the works?
2. Does the company maintain a manned office (staff of the company and not a third party) that is serviced during business hours for the purpose of receiving and relaying work instructions?
3. Does the company have a secure storage facility, electronic and manufacturing factory or workshop with the capability to supply on-road electronic devices including test facilities?
4. As nominated by the level, suitable vehicles that are equipped to readily undertake the works associated with the area of competency. (Excludes SOED)
Vehicle should be fitted with a minimum of;Flashing yellow lights, safety cones, first Aid Kit and Fire extinguisher. Evidence in form of picture and registration numbers needs to be provided in the application.
5. Does the company have appropriate design and development Page 42 of 47 Rev. 2
Plant and Premises
capability?
6. Has the company previously supplied on-road electronic devices to VicRoads requirements?
Page 43 of 47 Rev. 2
Company Declaration
Company Name:
Company Representative undertaking assessment
Name (print):
Signature:
Date of assessment:
I declare that the particulars shown herein are true and correct in every detail:
Signed: ……………………………………………………………………………
Name (print): ……………………………………………………………………
Position in Company: ………………………………………………………
Date: ……………………………………………….
Page 44 of 47 Rev. 2
Declaration – to be made by a director or chief executive
VicRoads Use only
Referee Check Details - (VicRoads Use Only)
Summary provided by contractor: Yes No Checked by VicRoads Officer: Yes No Referees Remarks
Referees Name & Date of Works Work Type Comments SatisfactoryYes No Yes No Yes No Yes No Yes No
Standard Eligibility Criteria - (VicRoads Use Only)
The Contractor has demonstrated compliance with:Comment
a. the requirements described for personnel: Yes No b. the requirements described for the company: Yes No
Page 45 of 47 Rev. 2
VicRoads Use only
RECOMMENDATION ( VicRoads Use only )
Company Name:Date:
Application: New Contractor Existing Pre-qualified Contractor
Assessment Rating
Level Applied For Rating CommentsSCTV Yes No STCE Yes No STS1 Yes No STS2 Yes No SVDL Yes No SOED Yes No
STS2(Rural only) Yes No
Ratings TableQualifies Does Not Qualify
Very Good Good Conditional Limited Poor Suspend1 2 3 4 5 6
VicRoads Officer:Date:
Business Area:Section:
Page 46 of 47 Rev. 2
VicRoads Use only
CONDITIONAL PRE-QUALIFICATION - SUMMARY & RECOMMENDATION
ITEM DESCRIPTION RECOMMENDED CONDITION1
2
Page 47 of 47 Rev. 2