Supplier Self-Assessment

Supplier Self-Assessment

Company

Name:

Address:
Homepage:
Business:
Subsidiary of:
Sales tax identification number
DUNS-No.
Company specific data

1. Partner

Department / Name / Phone / Fax / e-mail
President/ Managing Director
Quality Manager
Responsible for Environment
Engineering Director
Commercial Director
Sales Contact at plant
(Working hours)
Sales Manager

1. Number of employees

Production / Set up an Maintenance
Quality / Others
Design
Tool Shop / Total

1. Company´s turnover

3.
The year before last: / Last year: / This year expectation

4.Customer- and industry structure

Number of customers:
Number of main customers (80% turnover)
Which main customers do you supply?
Mention at least the top three with their %-share of total revenue (if necessary just mention the %-share of total revenue without customers name).
Which industries do you supply?
Mention at least the top three with their %-share of total revenue.

5.Production´s programme

Available production processes:
Available materials:
Which approvals can you offer?
Available machines/equipment:
Which process steps are outsourced?

6.Production capacities

Describe your production capacities
(i.e. number of machines)

7.Measuring and testing equipment

Describe your measuring and testing equipment

8.Standard terms

Delivery terms:
Packaging terms:
‚
Payment terms:

9.Logistics

Which logistic systems do you provide?

(For example Kanban, consignment stock, etc.)

10.Certification level of Quality Management System Please mark the appropriate certificate and enclose it:

ISO 9000ff ISO/TS 16949 Other
Further certifications planned? (When, by whom?)
On which regulation are your initial samples performed?
Capability of design a process FMEA?
Which Advance Quality Planning System is utilized?
Does the accuracy of your outgoing material checks allow a cancellation of your customer’s incoming material checks? / Yes No Comment
______
______
______
______
______
11.Corporate Social Responsibility
Does your company admit to internationally accept social and ethical rules (SA 8000, UN Global Compact, ISO 26000, ILO etc.)? / Yes No Comment
______
Are you registered to a supplier portal (like Sedex)? / ______
12.Environmental
Do you have an environmental management system?
- ISO 14001?
- EMAS III (EG 1221/2009)?
Are aspects of environmental protection an integrated part of your product planning?
Is your company able to work with IMDS? If yes, please give your ID.
Does your company follow environmental protection guidelines established in writing?
Do you define environmental protection targets and document the results?
Do you work towards the improvement of the environmental protection with your suppliers and contractors? / Yes No Comment
______
______
______
______
______
______
______
13.Safety management
Do you have an occupational safety and health management system?
- certified to OHSAS 18001?
- Internal system? / Yes No Comment
______
______
14.Energy management system
Do you have an energy management system?
- certified according to ISO 50001?
- Internal system? / Yes No Comment
______
______
15.Further certifications
Do you have further certificates?
Do you plan further certifications?
Do you comply with customer standards?
If so, which?
16.CAD - Data
What are the means you use to send your CAD-Data (except from paper)?
What are the CAD-Software and Data formats you use?
Can you convert 3D Data in 2D?
17.Insurance/ Guarantee
Do you have a product/third-party liability insurance including: / Extended liability insurance for products and third-party damages?
Coverage of cost of recalls?
Amount of the current coverage for: / Damages to persons: ______€ / Year
Damages to property: ______€ / Year
Financial losses: ______€ / Year
Recalls: ______€ / Year
A franchise of: / ______€ for each damage is agreed on.
Are you insured against the US risk: / YesNo
What is the maximum warranty period you can agree on with your clients? / ______Months
If needed, Bürkert can get a bank reference of your company? / YesNo
18.In which area / country are you currently selling?
GermanyWest-EuropeSouth-EuropeEast-Europe
North AmericaSouth AmericaAustralia / New Zealand
Asia ChinaIndiaAfrica
19.Which currencies can you quote/invoice?
20.Do you have company holidays / longer country-specific holidays?

Supplier

Date:Signature:

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