Direct Service Provider – API Industrial Services

Direct service Provider application //

A direct Service Provider is an entity or person that directly offers and delivers services to clients or end-users.

Here is a checklist of items you MAY need to complete this online form. The form does not save so make sure you have them available for completion.

Accepted Upload File types: pdf, docx, doc, jpeg, png.

DSPQ FORM optional //

Will the supplier/subcontractor be performing physical work at API’s shop, office or at site under API’S purchase order?

If YES please continue with the form below:

Health and Safety Statistics for the past 3 Years
Health and Safety Contact details
judgements, claims or suits pending or outstanding against your company details
WCB Clearance Letter
COR Certificate

Company Name

Under current management since:

Form completed by (name)

Title

Email Address

Telephone Number

Fax Number

Form of Business

Sole Owner Partnership Corporation

Describe Services Performed

Describe any affiliations with labour organizations

Largest Projects during the last three years

Are there any judgements, claims or suits pending or outstanding against your company?

Yes No

If yes, please attach details.

Please enter this information from the last three years (including subcontractors):

Number of Fatalities:

2023

2022

2021

Number of lost time incidents:

2023

2022

2021

Number of medical aid injuries/restricted work cases:

2023

2022

2021

Do you have a modified work program?

Yes No

Please list your past three year’s total recordable incident rate (TRI Rate) including subcontractors:
i.e Total Number of Recordable Incidents X 200,000 = Total employee hours (Yearly)

2023

2022

2021

Man hours (including those of the subcontractors) worked in the last three years:

Shop/Office 2023

Shop/Office 2022

Shop/Office 2021

Field 2023

Field 2022

Field 2021

Total 2023

Total 2022

Total 2021

Number of medical aid injuries/restricted work cases:

WCB 2023

WCB 2022

WCB 2021

Please attach WCB Clearance Letter

Have you received an Alberta Labour OH&S stop work order, or equivalent, from another province in the last three years?

Yes No

If yes, please explain.

Highest ranking safety professional in your organization?

Name

Title

Email Address

Phone Number

Do you have or provide a full-time ONSITE Health & Safety Representative?

Yes No

Do you have a written Health & Safety Management Program?

Yes No

Does the program address the following key elements:

Accountabilities and responsibilities for managers, supervisors, and employees?

Yes No

Employee participation?

Yes No

Hazard recognition and control?

Yes No

Management, commitment and expectations?

Yes No

Resources for meeting health and safety requirements?

Yes No

Does your company hold a current COR Certificate?

Yes No

Certificate Number

COR Certificate

Do you work personnel trained to perform First Aid and CRP?

Yes No

Is applicable PPE provided for employees?

Yes No

Do you have a program to ensure PPE is inspected and maintained?

Yes No

I certify that this information provided above is true to the best of my knowledge.

Yes

Title

Name

Date

Interested in working with us? //

We are always on the lookout for dedicated, hard-working, and talented individuals to join our team. If that sounds like you, fell free to fill out our online Careers form and submit your resume.

Direct service Provider application //

DSPQ FORM //

DSPQ FORM optional //

Please enter this information from the last three years (including subcontractors):

Number of Fatalities:

Number of lost time incidents:

Number of medical aid injuries/restricted work cases:

Please list your past three year’s total recordable incident rate (TRI Rate) including subcontractors: i.e Total Number of Recordable Incidents X 200,000 = Total employee hours (Yearly)

Man hours (including those of the subcontractors) worked in the last three years:

Number of medical aid injuries/restricted work cases:

Highest ranking safety professional in your organization?

Does the program address the following key elements:

Interested in working with us? //

Please list your past three year’s total recordable incident rate (TRI Rate) including subcontractors:
i.e Total Number of Recordable Incidents X 200,000 = Total employee hours (Yearly)