Supplier Assessment Questionnarie（供应商评估问卷）.docx
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1、SUPPLIERAssessment QuestionnarieFACILITY DETAILSCompany Name:Site Name (if different):Parent Company Name (if applicable):Site Street Address:Site City:SiteState/Province/County:Site Postal/Zip Code:Site Country:SITE CONTACT INFORMATIONSite Representative Name (host):Title:Phone Number:Email Address
2、:HSE (Health, Safety, Environmental Protection) Representative Name:Title:HR (Human Resources) Representative Name:Title:Facility Background InformationPlease indicate which is the main activity of the siteFlood 口Volcanic Activity 口Is the facility located in a region that has experienced any of the
3、following natural disasters in the previous 50 years:Earthquake Tsunami Impact Damaging windstorm Hurricane/Typhoon Wildfires 口Tornado 口Primary language:Other languages (spoken by at least 10% of the workforce):If yes, what is the approximate number of workers living in company-provided housing:Desc
4、ribe the type of work currently being, orproposed to be performed at this facility (includeproduct types such as antibiotics, solvents):Please describe the facility HSE (Health Safety& Environment) resources (number of staff ortime spent on HSE):What is the primary language spoken by theIs company s
5、ponsored housing provided to anymajority of the employees at this location?contract or full time employees working at thislocation? Yes 口 No Number of Employees/Workers by Category (Provide data for the entire site. Also, please note that there may be workers/employees who fit into multiple categori
6、es and should be accounted for under each applicable category (i.e., there is overlap between categories)Total employee population onsite (including temporary, part-time and contract workers)Full time employees/workers directly employed by the companyPart-time employees/workers directly employed by
7、the companyIndirect, contract or dispatch employees/workersEmployees/workers under the age of 18Migrant or Foreign WorkersStudent workers (include students, apprentices and interns)Total Site Area (m2):Does your company own the facility?If the facility is not owned by the parent company, are the fol
8、lowing within your operational control?Indicate if the site is in a rural, industrial, residential or mixed commercial settingManufacturing Area (m 2):Yes DNo口If no, who owns the facility?Waste water treatment plant? Yes DNo Utilities? Yes DNo Security? Yes No Management of the roadways? Yes DNo Rur
9、al Industrial Residential 口Mixed commercial setting 口Please attach a local area map with water sources if available.When was this site initially constructed? Please indicate the years of industrial use of the site.No.QuestionAssessment NotesGeneral Health and Safety Management1.1Does your company ha
10、ve a written health and safety policy? Yes DNo N.A.1.2Has your company appointed a main board member with specific health and safety responsibility? If No or NA, explain Yes DNo N.A.Explain:1.3Does your company have a recognized health and safety certification, or have a plan to gain it? (OSHAS or a
11、nother standard).If yes and if you send a copy of the last certificate, it f Yes DNo N.A.1.4Does Your company have a documented risk management system as a part of the local HSE System? Yes DNo N.A.Explain:1.5Does your company have a risk assessment process to identify, prioritize, and mitigate the
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