4. Customer- and Industry Structure
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Organisationsvorschrift WN 00 3 50016 Formular: Lieferantenselbstauskunft Geltungsbereich: Beschaffung und Lieferantenentwicklung
Ersteller: M. Kunz 22.07.2007 Bearbeiter: W. Mögerle 05.09.2013 Geprüft: C. Trudel 18.11.2013 Freigabe: D. Martiš 21.01.2014 Index: C ECM 1000208195
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
2. Number of employees Production Set up an Maintenance Quality Others Design Tool Shop Total
027f9199fc261e129f20cb1058b49139.doc Seite 1 von 5 3. Company´s turnover
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:
027f9199fc261e129f20cb1058b49139.doc Seite 2 von 5 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 Yes No Comment
Further certifications planned? (When, by whom?) ______On which regulation are your initial samples per- formed? ______
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 ma- ______terial checks?
11. Corporate Social Responsibility
Does your company admit to internationally accept Yes No Comment social and ethical rules (SA 8000, UN Global Com- pact, ISO 26000, ILO etc.)? ______
Are you registered to a supplier portal (like Sedex)? ______
12. Environmental
Do you have an environmental management Yes No Comment system? - ISO 14001? ______- EMAS III (EG 1221/2009)? ______Are aspects of environmental protection an integ- ______rated 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 envir- onmental protection with your suppliers and contract- ______ors?
13. Safety management
Do you have an occupational safety and health man- Yes No Comment agement system?
- certified to OHSAS 18001? ______- Internal system? ______
027f9199fc261e129f20cb1058b49139.doc Seite 3 von 5 14. Energy management system
Do you have an energy management system? Yes No Comment - certified according to ISO 50001? ______- Internal system? ______
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 Extended liability insurance for products and third-party including: 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: Yes No
What is the maximum warranty period you can agree ______Months on with your clients?
If needed, Bürkert can get a bank reference of your Yes No company?
18. In which area / country are you currently selling?
Germany West-Europe South-Europe East-Europe
North America South America Australia / New Zealand
Asia China India Africa
027f9199fc261e129f20cb1058b49139.doc Seite 4 von 5 19. Which currencies can you quote/invoice?
20. Do you have company holidays / longer country-specific holidays?
Supplier
Date: Signature:
027f9199fc261e129f20cb1058b49139.doc Seite 5 von 5