SUPPLIER QUESTIONNAIRE

 Design of Production Borehole

                        

                           SUPPLIER QUESTIONNAIRE 

ALL Suppliers and SubGAZI BORINGs to complete Sections 1-6 and the declaration.Suppliers providing branded products and services, rental vehicles, and construction projects also complete sections 7 and 8.

1 A) Company Profile
Name of Company
Name of …….? staff member you have contact with; if any. (Name, Department,  Location)
Registered Office address
Ordering Address (if different)
Payment Address (if different)
Telephone Number
Email
Website
Company Registration number  (Please attach a copy of the certificate)
Year established
Please state your position in the supply chain  e.g. Agent, Manufacturer, Service Provider,  Importer, Trader
Please specify the product/service being supplied to…….?
Do your goods or services carry the …….? brand?
Company turnover in trading currency (please attach recent financial statement)
Turnover of the part of the business that would serve ......?
Location of other operational sites (national
and international), their functions and
approximate numbers of employees where

…….? goods or services could be positioned 

1 B) Total Number of Workers
	Men (%)	Women (%)	Total
Permanent Workers
Temporary directly employed workers
Agency indirectly employed workers
Homeworkers/out workers

Management 

Is your company committed to achieving labour, environmental, and business integrity  

Yes

standards in …….?'s Ethical and Environmental PolicyNo

2) Health & Safety
Is there anyone designated as being   responsible for Health and Safety issues in your company?	Yes/ No. Give details

I

3) Management Systems and Policies
Do you have or are you working towards any of the following  ethical/environmental, legal, and technical management  standards (add more fields if necessary)	ISO9001 - Quality
	ISO14001 - Environment
	ISO26000 - Social Responsibility
	SA8000 - Labour standards
	Other
Confirm which policies your company has in place. Please attach  these:	Quality
	Health & Safety
	Environmental Management
	Labour Standards
	Equal Opportunities
	Training & Development
	Other

4) Ethical (Labour) Standards
Do you ensure your company meets worker-related legislation? (e.g. wages, hours, health  & safety) Please share what you have in place to support this.	Yes/No. Give details.

5) Environmental Standards
Do you ensure that your company meets all required local laws/regulations covering the environment? Please share what you have in place to support this.	Yes/No. Give details.
Do you have an environmental policy in place? Please attach		Yes

No

6) Experience & Subcontracting
Please provide details of 3 customers/clients for whom you have completed contracts in the last 3 years and are willing to give a reference. If available, attach reference letters.
	Reference 1	Reference 2	Reference 3
Customer/Organisation
Contact name
Telephone No
Date awarded contract
Contract scope and details
Please detail what experience you have with dealing with International Non-Governmental  Organisations (INGO): If yes, please provide details about the scope of the contract and the  INGO name.
If you supply services to…….?, do you subcontract/outsource services?  If yes, please share the name and contact details of the sub- GAZI BORINGs and the type of service provided.

Please complete Sections 7 and 8 IF providing branded products or services, rental  vehicles or construction projects 

7) Pay & Hours
What is the national minimum wage (per hour)?
What is the lowest hourly pay in your company?
What deductions are taken from worker's wages e.g. pension, tax?
If yes, how much are the charges and what are they for?
What are the normal weekly working hours for employees?
Do workers have at least 1 day off in 7?		Yes
		No
What is the average overtime worked each month
What is the minimum age of the worker your company would hire?
Explain how you ensure workers are not hired  below the minimum age requirement
Were any health and safety risk assessments carried out in the last year?		Yes

No 

8) Worker Management Communications
How do you ensure employees are aware of their rights?	Written Contracts
	Staff notice boards
	Intranet
	Employee Handbook
	Other
What forms of representation are used?	Union
	Employees share ownership
	Elected Health & Safety Committee
	Workers co-operative
	Works Council
	Staff Association
	Other
Do any workers belong to a Trade Union		Yes
		No
If yes, please provide the name/s of the Union/s

Declaration (to be completed by Senior Authorised Manager. Please insert electronic signature or type name): I confirm that all the information given is accurate. For and on behalf of the supplier : 

Name :	Position :
Date: Signature :

For …….? use only - Risk Rated by  

NB There are some industries …….? have run campaigns to highlight the harm they can cause to poor communities.

If your company, or any parent or subsidiary, has any involvement with the production or sales of weapons, pharmaceuticals,  infant formula, or pesticides; or with the Finance industry please tell your …….? contact.

Name :	Position :
Date :	Risks :