Factory Compliance and Code of Conduct Questionnaire

I. Background

A. Auditor and Factory Contacts

Audit Date: ______

Factory Name and Address (specify if more than one facility): ______

Factory Telephone: ______

Factory Fax: ______

Factory E Mail: ______

Factory Contact (Name & Title) responsible for questionnaire preparation: ______

Auditor’s Name: ______

Auditor’s Title: ______

Auditor’s Employer: ______

B. Factory Ownership

Name(s) of Factory Owner(s) and General Manager(s): ______

Name of Parent or Holding Company (if any) that owns the factory: ______

Telephone: ______Fax: ______

Name of Factory Export Manager: ______

Factory Bank, Bank Address and Account Manager: ______

Applicable insurance co. and policy nos.: ______
______

If applicable, list all other factories/vendors at this facility: ______

C. Local Authority

Do local laws govern workplace safety and if so, please specify: ______

Does the local government audit or inspect the factory? ______

If so, do the audits or inspections also include worker’s rights and environmental concerns? ______

When was the last time the factory was inspected or audited, who performed it and how often are such audits or inspections performed? ______

Have local or foreign authorities cited or penalized the factory for any reason relating to health, safety or workers rights within the past three years? If yes, please describe? ______

Have the conditions subject to the citation or penalty been corrected? If so, please explain how and provide any supporting documentation: ______

Is the local inspection or audit system, to your knowledge, fair, knowledgeable and correct?______

Are there any legal actions not mentioned above that are currently pending or have been pending within the past three years against this facility, its owner(s) or manager(s)? ______

Is there any evidence that the manager(s) or owner(s) of this factory have violated local laws or regulations? If so, please specify: ______

D. Factory History

When did the factory begin supplying goods to Polaris: ______

Please describe the product(s) and quantities produced for Polaris over the past 12 months: ______

Do you expect production for Polaris will continue over the next year? If so, please list anticipated products and quantities: ______

What percentage of this factory’s space/equipment/workforce is used for Polaris products? ______

List other buyers/labels using this factory or other factories owned by owners of this factory: ______

E. Current Sub-Contracting Arrangements

List the names and addresses of all sub-contractors used by this factory for Polaris and identify the products, components or materials supplied by each subcontractor: ______

F. Community Relations

Does the management of this facility contribute to helping the community, and if so, how? ______

G. Environmental Protection Policies

Does this factory take steps to control air, land or water pollution? If so, please explain: ______

Is this factory in compliance with local environmental laws? ______

Do local government officials inspect the factory for environmental concerns, and if so, are such inspections fair, knowledgeable and correct?______

Are environmentally friendly materials (for example, recycled and non-toxic products) predominantly used? ______

Where does the factory discharge its sewage? (E.g. municipal sewage, septic tank, deep well injection, etc.)______

Are any factory associates exposed to raw sewage?______

If yes, please explain: ______

Does the factory use Azo dyes, formaldehyde, pentachlorophenol or nickel in manufacturing or incorporate components with these substances in its products? ______If so, please specify the product, processes and amount of the specified substance: ______

What other chemicals are stored on-site?______

Are chemicals separated from materials and machines and stored safely, away from sunlight in a cool, dry room?______

Are the containers free of leakage?______

Are the caps tightly in place?______

Is the chemical storage room labeled “no smoking?”______

How does the factory dispose of empty chemical storage containers?______

  1. Workforce Profile

What is the total number of employees at the factory (workers plus office staff):______

Please specify: Workers ______Office Staff ______Management ______

Does the factory employ foreign nationals? ______

If yes, how many, from what countries, and in what capacity? ______

What language is spoken by factory management and supervisory personnel? ______

What language(s) do the factory’s employees speak? ______

What is the age range of the employees? ______

  1. Personnel Policies

Do the factory employees have ID cards? ______

Are the’ ID card hard copies kept on site? ______

Does this facility have written personnel policies and work place rules? ______If so, please enclose a copy.

Are workplace policies and rules posted where they can readily be viewed by the workers? ______

In what language(s) are the personnel policies and workplace rules posted? ______

Are people hired and promoted on the basis of their ability to do the job rather than on the basis of personal characteristics and beliefs? ______

Are workers favored based on race, color, national origin, gender, disability, or other similar factors? ______

Are there any employees or staff at the factory involuntarily? ______If so, please explain: ______

To the best of your knowledge have prisoners ever worked at the factory? ______

  1. Termination of Employment

Does the factory have a personnel manager?______

If yes, what is his or her nationality? ______

Are records kept of dismissed employees? ______

If so, who keeps them and how long are they kept? ______

Are the above records readily accessible and/or easily retrievable for review? ______

Does the factory pay severance upon termination as required by law?______

If yes, explain if it is paid in full or negotiated: ______

What is the factory’s approximate employee turnover rate for the past year? ______

  1. Harassment

Are you aware of sexual harassment or of any reports of sexual harassment at this facility? ______

If so, what action was taken or is currently being taken to correct such incidents? ______

  1. Disciplinary measures

How does the factory discipline a worker in the event such actions are necessary? ______

Are disciplinary measures permitted to include physical force or punishment? ______

Are the workers ever subject to mental or physical force or abuse in connection with their employment? ______If so, is there any physical evidence of such force or abuse? ______

Is there a procedure to review disciplinary measures taken against employees?______

If so, please explain: ______

F. Wages (When applicable, please specify currency)

Are employees paid by the hour and if so, at what rate per hour? ______

Are employees paid by the piece and if so, how is the piece rate calculated? ______

What is the minimum hourly wage required by law? ______

What is the minimum hourly overtime wage required by law? ______

What percentage of the factory’s workforce consists of untrained workers, and what work is performed by untrained workers? ______

Please advise the following: (Specify US $ or Local Currency)

Hourly wage for: Trained employees: ______Untrained employees: ______

Weekly wage for: Trained employees: ______Untrained employees: ______

Lowest hourly wage to: Trained employees: ______Untrained employees: ______

Average wage paid to: Trained employees: ______Untrained employees: ______

Does the factory offer bonus or incentive plans? ______

If yes, describe the plans offered: ______

G. Payroll

Does the factory have a time clock and if so, is it in proper working order? ______

Is the time clock used to calculate employee pay records? ______

Who punches the clock? employees, supervisor or management? ______

How are employees paid? cash, check, other? ______

Are employees paid timely?

Always ______Usually ______Sometimes ______Seldom ______

Are some workers paid more frequently than others, and if so, why? ______

Are you aware of any situation where the factory held an employee’s wages? ______

If so, how often (frequently, sometimes, seldom, never) and why? ______

Do employees take work home, and if so, how often (frequently, sometimes, seldom, never)?

______

How does the factory pay for home work and what records do they keep of these payments? ______

What type of employee pay and work records are kept by the factory? ______

Who keeps employee pay and work records and where are they kept? ______

How long are employee pay and work records kept? ______

H. Hours and Overtime

Maximum number of work hours (excluding overtime) permitted by local law:

Per day? ______Per week? ______Per month? ______

Maximum number of overtime hours permitted by local law :

Per day? ______Per week? ______Per month? ______

Average number of overtime hours:

Per day? ______Per week? ______Per month? ______

At what rate are employees paid for overtime? ______

Are employees ever required to work overtime involuntarily? ______

If overtime is required, are meals or meal allowances provided? ______

If overtime is required, are employees provided with transportation if needed? ______

Is overtime payment in additional to the workers’ wages? ______

In what form and how often is overtime payment made? ______

On what days of the week do employees work? ______

At what times do shifts, mealtimes and worker breaks begin and end on each day worked? ______

When do overtime periods begin and end on each day worked? ______

What is the daily and weekly number of scheduled work hours?

Per day ______Per week ______

What is the average number of overtime hours worked per week? ______

What is the maximum number of hours employees might be asked to work per day and per week? Per day______Per week ______

Are working hours at this facility different from prevailing local practice, and if so, how? ______

______

Who decides which workers will work overtime and how is that decision made? ______

______

Are all employees given equal opportunity to work overtime? ______

If not, please explain: ______

Do employees ever refuse overtime? ______

How often do employees have one day off? ______

If the working week exceeds 60 hours, please explain reasons and frequency: ______

I. Deductions

Please advise whether the following deductions from payments to employees are made, and if so, the amount of the deduction:

Housing: Yes_____No_____Required______Voluntary______

Meals/Food: Yes_____No_____Required______Voluntary______

Medical Services: Yes_____No_____Required______Voluntary______

Uniforms & Clothing: Yes_____No_____Required______Voluntary______

Tools & Equipment:Yes_____No_____Required______Voluntary______

Dental: Yes_____No_____Required______Voluntary______

Transportation: Yes_____No_____Required______Voluntary______

Child Care: Yes_____No_____Required______Voluntary______

Employment Agency Fees: Yes_____No_____Required______Voluntary______

Other (school, etc., please specify)______:

Yes_____No_____Required______Voluntary______

J. Employee Benefits

What benefits are provided for employees?

Vacations: Yes_____No_____Required______Voluntary______

If pay is deducted, how much? ______

Holidays: Yes_____No_____Required______Voluntary______

If pay is deducted, how much? ______

Cash Bonuses: ______

If so, how are they awarded? ______

Sick Leave: ______

If sick leave is provided, is pay deducted and how much? ______

Maternity Leave: ______

If maternity leave is provided, is pay deducted and how much? ______

Does the factory have a cafeteria facility for employees? ______

K. Pregnancy and Maternity

Are maternity benefits are provided by this facility and if so, please specify: ______

Are women required to provide pregnancy test results when applying for a position or during employment at this facility? ______

Are women permitted to return to the same position at the same rate of pay after their maternity leave? ______If not, please explain: ______

L. Production Quotas

Does the factory establish production quotas for its employees? ______If so, are the quotas by individual employee or by groups? ______

If so, who establishes the quotas and what guidelines are used to establish the quotas? ______

M. Collective Bargaining and related issues

How do employees bring work related issues or complaints to management’s attention? ______

To whom are such issues presented? ______

Do workers have the right to associate freely? ______

Do workers have the right to form a union? ______

Is there a union in this facility and if so, please specify: ______

Have attempts been made to unionize this facility and if so, by which group? ______

Have workers ever been penalized for efforts to join a workers’ organization group? ______

Are workers in this facility covered by a collective bargaining agreement? ______

N. Child Labor Policies

What is the minimum age permitted by local law for working in this locale/country? ______

Until what age, if any, are children legally required to attend school in this country? ______

What is the maximum number of hours per week permitted by local law for minors under 15 in this locale/country? ______

What is the youngest age of an employee present in this factory? ______

Are employees younger than 15 permitted to attend school during the day? ______

How many hours a week do employees younger than 15 years old work? ______

What is the youngest age of employees in other facilities under the same owner(s) as this facility? ______

Is documentation required to prove age when hiring workers? If yes, please explain: ______

O. Contract Labor Policies

Are there any contract employees in this factory? ______

If so, please explain where they are from, the name of the entity or agency with which they are under contract, and the contract conditions: ______

How are they recruited? ______

Please provide a copy of the contract with this form.

Can workers leave before their contract expires? ______

Have any workers chosen to leave before their contracts expire? ______

What records are kept about these workers and where? ______

Who pays travel costs between the workers’ home country and the factory? ______

Do these workers receive a training wage? ______

  1. Health and Sanitation

Do workers have access to medically trained personnel at this facility? If yes, please specify (for example, 1 doctor, 1 nurse): ______

Are first aid supplies readily available in the factory and is a qualified person always present who is able to administer first aid? ______

Do the workers generally appear to be in good health? ______

Do employees have access to clean drinking water? ______

Are washroom facilities and toilets functional, sanitary and clean? ______If not, please specify: ______

Number of men’s toilets? ______

Number of women’s toilets? ______

Are bathroom facilities ever locked? ______

Are employees timed while using the bathroom or are bathroom schedules kept? ______

Indicate if the following items are available in the lavatory:

Toilet Paper:_____Soap:_____Towels(Paper or Cloth):_____

Garbage Pail(for women’s use):_____Doors on bathroom stalls:_____

Are the sinks functional and clean, with running water?______

Is the factory well ventilated? ______

Is the factory adequately heated and/or cooled? ______

Is there an offensive odor in the factory? ______

Is the factory clean? ______

Does the factory have a cleaning staff or use a cleaning service? ______

If yes, how often is the factory cleaned by this staff or service? ______

Are there any obvious signs of infestation (i.e., accumulated garbage, foul smells, pests, rodents?) ______

How often are the cutting room floor and sewing floors swept? ______

B. Safety and Theft Prevention

Is the factory adequately lit?______

Is there an adequate number of clearly marked and unblocked exits in the event of an emergency? ______

Are emergency fire fighting equipment and procedures in place?______

What fire protection systems are featured in this facility? (Automatic sprinklers, water flow alarms, sirens, smoke detectors, fire alarms etc.)

______

Are the following items available to the employees:

Eyewear_____Protective Masks______Protective Cutting Gloves_____

Ear Plugs_____Eyewash Stations_____

What has been the nature and frequency of emergencies, accidents and injuries in the past year? ______

What types of records are kept of injuries and accidents? ______

What hazardous, flammable or combustible items are present in the facility? ______

Are the personnel handling such materials properly trained? If so, please advise the method of training:______

Are such materials properly stored? ______

Are workers provided with safety, educational and/or training materials? If so, please attach:______

Where is the water supply from? Public main____Water tank____Fire pump_____Other___

How far is the factory from the nearest fire station? ______

Are fire drills and procedures routinely practiced with employees and staff? ______

Is written fire protection/control information posted in the factory? If so, please describe: ______

Is emergency fire fighting equipment readily accessible? ______

Number of fire extinguishers:______

Total floor space in sq.ft.:______

Ratio of no. of fire extinguishers per sq. ft.:______

Are all fire extinguishers in working condition?______

Are they inspected periodically? If so, how often?______

Have any employees have been trained to use this equipment? ______

How many fire exits are unblocked, unlocked and readily accessible on each floor of this facility? ______

Are exits located at opposite ends of the facility? ______

Are there any exposed electrical cables and wires in the facility? ______

Are there any holes in the floors, walls, ceiling or roof? ______

Are the aisles and walkways maintained clear of obstructions, bundles overhanging wires and similar materials? ______

Are the aisles and walkways marked? ______

Are there exit maps and signs in the facility? ______

Is emergency lighting installed operating on batteries or independent generators not requiring electricity? ______

What type of burglar protection is used in the facility? ______

If a burglar alarm is used, is it connected to a central station? ______

Are windows and doors protected? If so, how? ______

Is the noise level inside the factory at a safe level? ______

How is the noise level monitored? ______

Are the elevator permits valid? ______

Is there easy access to product transportation areas? ______

Are maintenance records kept for all factory equipment? ______

If so, where and for how long? ______

Has the auditor observed any safety hazards during the review? If yes, please explain: ______

C. Facilities Structure

How many buildings constitute the entire facility? ______

What is the approximate size of the floor space for all operations (including staff) in the factory? ______

What year were the buildings built? ______

Please indicate the building construction types:

Roof: Metal______Wood______Masonry______Other______

Floor: Metal______Wood______Masonry______Other______

Walls: Metal______Wood______Masonry______Other______

Staircases: Metal______Wood______Masonry______Other______

How many stories does the facility have? ______

Do any of the buildings have a basement? ______

Do the sites where the buildings are located appear to be safe and clean? ______

Do the exteriors of the building appear structurally sound and well maintained? ______

Is this facility in a flood zone? ______

Has there ever been flooding in the neighborhood around the facility or in the facility itself? ______