FF-PRJ-FRM-13 Supplier Qualification Form

SUPPLIER QUALIFICATION FORM
INSTRUCTIONS:
ALL Suppliers must complete ALL Sections for evaluation by Mansa Engineering. Required attachments (***) must be submitted
together with this completed form. Supplier may attach any relevant document as necessary to demonstrate capability.
SECTION 1: ORGANIZATION
Company: Parent Company:

Address:
Telephone: Email: Date:
Product / Service:
☐
Supplier Type: Agent/Broker ☐ Engineering Services ☐ OEM ☐ Other
Completed by: Position/Title:
SECTION 2: EXPERIENCE
Does supplier have Oil & Gas, Mining, Power, Other industrial experience
(Attach project reference list is attached for the past 3 projects/years)*** Yes No N/A
Does supplier have Petroleum Commission Permit? Yes No N/A
If yes, attach Petroleum Commission Permit***

Relevant product brochures or technical reports required for evaluation of
product/service are attached Yes No N/A
Supplier acknowledges that financial documentation including audited
financial reports may be requested at a later date Yes No N/A
Indicate specific industry codes, standards, and specifications to which
supplier complies
SECTION 3: QUALITY
Does supplier have a Quality Manual? Yes No N/A
If yes, attach copy***

Indicate specific certifications to which supplier complies to ISO
certifications such as ISO 9001, ISO 14001, and OHSAS 18001 etc.
Does supplier have a system to assure quality outside normal working

hours when a quality representative is not present Yes No N/A
Is there a quality inspection program/procedure? Yes No N/A
If yes, attach copy***
FF-PRJ-FRM-13
SECTION 4: HEALTH, SAFETY AND ENVIRONMENT (HSE)
Does supplier have an HSE Policy? Yes No N/A

If yes, attach a copy ***
Does supplier have a Drug and Alcohol Policy? Yes No N/A
Does supplier have a documented management system for HSE Yes No N/A
Has supplier had any reportable HSE incident in the last 2 years Yes No N/A
Do supplier activities require appropriate Personal Protective Equipment
(PPE) to be worn Yes No N/A
SECTION 5: ENGINEERING
Does supplier perform all engineering activities in-house Yes No N/A

Indicate percentage of engineering activities performed in-house (typical)
Does supplier perform regular and documented design reviews Yes No N/A
Does supplier have a procedure to ensure usage of relevant documents,
and applicable codes and standards
Yes No N/A
SECTION 6: DOCUMENT CONTROL
Does supplier have a Document Control procedure in place Yes No N/A
Does supplier have a system to ensure distribution and use of revised

documents, and the removal of obsolete documents Yes No N/A
Does supplier have procedure to control maintenance of records Yes No N/A

Does supplier have capability of submitting technical inquiries via an
Electronic Procurement System or Electronic Doc. Management System Yes No N/A
SECTION 7: RESOURCES
Does supplier have the necessary resources to execute a typical Oil & Gas,
Mining, Power, Other Industrial projects? Yes No N/A
Can supplier provide organizational chart reflecting structure and number
of employees in each functional area? Yes No N/A
Please attach organizational chart
Does supplier use CAD (Computer Aided Design) or CAM (Computer

Aided Manufacturing) systems, or similar Yes No N/A
Indicate the type of system/software used
SECTION 8: INSPECTION AND TESTING
Does supplier conduct inspections and tests in accordance with procedures Yes No N/A
Does supplier have procedures to ensure calibration of inspection and test Yes No N/A
Are all supplier test facilities adequately equipped and well maintained to
meet industry standards
Yes No N/A
Does company have a procedure in place to control Non-Conformance and
Corrective Action Yes No N/A
Does your company or its employees possess specialized international
certification for this category (Inspection & Testing)? Yes No N/A
If yes, attach a copy ***
FF-PRJ-FRM-13
SECTION 9: LOCAL CONTENT
Is your Company an Indigenous Ghanaian Company (IGC)? Yes No
Do you have a Joint Venture (JV) in Ghana? Yes No
If yes;
Name of JV? ___________________________________________
Is the JV registered with Petroleum Commission, Ghana? Yes No
If yes, attach Petroleum Commission Permit

Please provide names of the JV partners with registered address and
Company registration number(s) below:
Partner Name Reg. Address Company Reg. #
1.
2.
3.
Add additional
rows if necessary
Supplier acknowledges that ownership structure for the IGC, JV partners and other related documentation
may be requested at a later date if necessary.
Yes No
FF-PRJ-FRM-13
ATTACHMENTS (Tick All That Applies)
☐ Certificate to commence business

☐ Valid Petroleum Commission Permit
☐ Documentation with names of the partners to evidence a joint venture’s existence (in the case of a joint
venture company)
☐ Company brochures
Company Organizational Chart

☐
Specialized International Certification
☐
Quality system description (min. List of contents in Quality Manual)
☐
HSE system description (min. List of contents in HSE Manual
☐
If none of the two above exists; list of existing procedures
☐
Typical HSEQ plan
☐
Copy of certificates (ref. Quality Management System)
☐
Other
☐
DECLARATION
I, the undersigned, hereby certify that to the best of my knowledge the particulars given in this Form are true and correct. I
authorize Mansa Engineering Limited to make direct enquiries and references to the undersigned in this Form to verify
information submitted herein or regarding the competence and general reputation of the firm.
Name (print): Title: Date:
Signature: E-mail:
MANSA ENGINEERING INTERNAL USE ONLY
Decision: Approve Deny
Comments:
Reviewed By: Date:

Title
Approved By: Date:

Title
FF-PRJ-FRM-13

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SUPPLIER QUALIFICATION FORM

Company: Parent Company:

Completed by: Position/Title:

Does supplier have Petroleum Commission Permit? Yes No N/A

If yes, attach Petroleum Commission Permit***

Does supplier have a Quality Manual? Yes No N/A

If yes, attach copy***

Does supplier have a system to assure quality outside normal working

Is there a quality inspection program/procedure? Yes No N/A

If yes, attach copy***

SECTION 4: HEALTH, SAFETY AND ENVIRONMENT (HSE)

Does supplier have an HSE Policy? Yes No N/A

Does supplier perform all engineering activities in-house Yes No N/A

SECTION 6: DOCUMENT CONTROL

Does supplier have a Document Control procedure in place Yes No N/A

Does supplier have a system to ensure distribution and use of revised

Does supplier have procedure to control maintenance of records Yes No N/A

Does supplier use CAD (Computer Aided Design) or CAM (Computer

SECTION 8: INSPECTION AND TESTING

SECTION 9: LOCAL CONTENT

Is your Company an Indigenous Ghanaian Company (IGC)? Yes No

Do you have a Joint Venture (JV) in Ghana? Yes No

Name of JV? ___________________________________________

Is the JV registered with Petroleum Commission, Ghana? Yes No

If yes, attach Petroleum Commission Permit

Partner Name Reg. Address Company Reg. #

ATTACHMENTS (Tick All That Applies)

☐ Certificate to commence business

Company Organizational Chart

Name (print): Title: Date:

MANSA ENGINEERING INTERNAL USE ONLY

Decision: Approve Deny

Reviewed By: Date:

Approved By: Date:

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