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Company Information

Street/Mailing address of office completing this questionnaire

Key Company Sales Contact

Head Office

Type of Company *

Please select one of the following:

Please indicate if you are a business where 51% of the ownership is by one or more of the following groups:

Does your company’s ownership structure include at least 25% ownership by an Aboriginal community or a member of an Aboriginal community?

Which provinces/territories/states/countries, etc. are you licensed to do business in? *

Please select one or more of the following:

Health, Safety and Environment

Do you have valid Workers’ Compensation (WCB) coverage?

Do you have a safety program?

Do you track HSE (Health, Safety and Environment) performance statistics?

Is your company a current subscriber to ISNetworld, Husky’s outsourced partner for supplier prequalification? Refer to www.isnetworld.com for information.

Please select primary category of business *

Please describe any innovative technologies & operational efficiencies that your company will be able to deploy for Husky:

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Please describe the value-added services that your company can provide to Husky:

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