环境和健康安全调查问卷.doc

附件一ID CODE:W0148-0014-01-A环境和健康安全调查问卷Environment Health and Safety Questrionnaire 此问卷为呈杰对相关方相关综合信息调查的一部分，目的在于了解贵公司相关环境及职业健康安全信息。以促进双方对环境健康和安全信息的沟通交流，达成更好的企业社会责任，建立良好的企业形象。请给予配合，谢谢! The questionnaire is a part of basic information investigation to ChengJies partners. The major purpose is to understand the system at Deltas partners side regarding environment management and occupational health and safety management, to promote the communication on EHS with each other, to implement the social responsibility, and to build good corporate reputation.1.公司基本信息 General Information: 1.1公司名称 Company Name: 1.2公司地址 Company Address: 1.3电话号码 Telephone Number: 1.4传真号码 Fax Number: 1.5主要联系人姓名及职称Primary Contact Name and Position 姓名Name： 职称 Position： 1.6贵公司总占地面积(平方米) The Total Site Area(sq. meter): m2 1.7贵公司为中达供应的产品或服务的名称The Product or Service provided for Delta 1.8请描述贵公司附近的状况(如是否为居住区、商业区等及其分布位置) Please describe the status /environment nearby the company (such as if its residential area, commercial area and its location) 2.环境管理 Environment Management 2.1贵公司是否有专职的环境管理人员? Is an environment manager assigned in your company? 是Yes，如果“是”, 请提供以下联系数据 If “Yes”, please provide the following information:姓名Name: 电子邮箱地址E-mail: 联系电话 Telephone: 传真号码 Fax: 否 No2.2贵公司是否取得下列环境许可或意见书?Does your company have the operating ermits or consents listed below? 1) 环境影响评价报告 Environmental Impact Assessment 是Yes 否No2) 环保设施竣工验收意见书(三同时) Environmental Protection Acceptance Approval (3 Synchronies) 是Yes 否No2.3大气污染物排放 Air Emissions2.3.1请描述贵公司排放的大气污染物及其排放源？Please describe the air pollutants and the source of release？ 2.3.2 贵公司是否定期进行大气污染物的环境监测？Is there any routine monitoring of air pollution taken in your company? 是Yes 否No如果“是”，请提供如下数据 If “Yes”, please provide the following information.2.3.2.1负责大气污染物监测的机构名称 Name of the dept/institution who monitor 2.3.2.2监测项目及其监测结果 the items and results of monitoring： (1)监测结果如未达到国家排放标准，贵公司是否取得污染物排放许可证？Does your company have the Pollutant Discharge Permits if the monitoring results is not within the national allowable air emission standards 是Yes 否No(2)如果“否”，贵公司是否有计划在近几年内进行大气污染物的监测？ If “No”, is your company planning to monitor the air pollution in the coming years? 是Yes 否No2.3.3贵公司是否进行大气污染物处理净化工程？Is there any air emission control devices been applied to sanitize the air emission sources? 是Yes 否No 如果“是”，请简要描述 If “Yes”, please simply describe 2.4 废水排放 Waste Water Discharge 2.4.1请描述贵公司排放的废水类型(如工业废水、生活废水或其他)？Please describe the type of waste water generated in your company (such as process wastewater, sewage or others) 2.4.2 贵公司是否定期对排放的废水进行监测？Is there any routine monitoring been taken?是Yes 否No2.4.2.1如果“是” 请提供如下数据 If “Yes”, please provide the following information(1)负责废水监测的机构名称 Name of the dept/institution who-monitoring : (2)监测项目及其监测结果 The monitoring items and results: 监测结果如未达到国家排放标准，贵公司是否取得污染物排放许可证？Does your company have Pollutant Discharge Permits if the monitoring results is not within the national allowable wastewater discharge standards？是Yes 否No2.4.2.2如果“否”，贵公司是否有计划在近几年内进行废水的监测？If “No”, is your company planning to undertake waste water monitoring in the coming years?是Yes 否 No2.4.3 贵公司是否进行了污水处理工程Does your company apply the wastewater clean devices? 是Yes 否 No如果“是”，请简要描述 If “Yes”, please simply describe 2.5 噪音污染 Noise Pollution2.5.1 贵公司是否对厂界噪音进行定期监测？ In the facility, is there any routine boundary noise monitoring been carried out? 是Yes 否No2.5.1.1如果“是”，请提供如下数据 If “Yes”, please provide the following information(1)负责噪音监测的机构名称 Name of the dept/institution who-monitoring : (2)监测结果 monitoring results: 监测结果如未达到国家标准，贵公司是否取得污染物排放许可证？Does your company have the Pollutant Discharge Permits if the results is not within the national allowable noise pollution standards 是Yes 否No2.5.1.2如果“否”，贵公司是否有计划在近几年内进行噪音的监测？If “No”, is your company planning to monitor noise in the coming years? 是Yes 否No2.6 固体废弃物管理 Wastes Treatment2.6.1 贵公司是否制定废弃物管理控制作业指导或计划?Does your company have a waste control plan? 是Yes 否 No2.6.2 贵公司是否采取措施来减少废弃物的产生?Does your company take any procedure to minimize waste? 是Yes 否 No2.6.2.1如果“是”，请简要描述 If “Yes”, please simply describe： 2.6.3 贵公司是否产生危险废弃物?Does the company produce the hazardous waste? 是Yes 否 No如果“是”，请简要描述废弃物的种类If “Yes”, please simply describe the type of wastes 2.6.4 废弃物是在公司内处理还是在公司外处理?Is the waste disposed onsite or offsite? 公司内 Onsite 公司外 Offsite2.6.4.1如果是在公司内If “onsite”(1)请简要说明公司内部处理的废弃物种类及处理设备的名称Please simply describe the type of waste been disposed onsite and relevant disposal devices/equipment. (2)废弃物处理设备是否取得相应的运行许可证明? Does the disposal devices have the relevant operating permits? 是Yes 否 No(3)公司是否接受处理来源于公司外的废弃物? Does the company accept and dispose the wastes for other party? 是Yes 否 No2.6.4.2如果是在公司外 If “offsite”(1)请简要说明处理的废弃物的种类及其相应的废弃物处理厂商？Please simply describe the type of wastes and the relevant disposal contractors？ (2)废弃物处理厂商是否取得相应的营运资格? Does the wastes disposalcontractors have relevant permits or certification? 是Yes 否No如果“是”，请提供其复印件。If “Yes”, please provide the copy of the license/certificate.2.7 环境管理体系 Environment Management System2.7.1贵公司是否通过了ISO14000环境管理体系认证？Have the company gotten the ISO14001 certification? 是Yes 否 No2.7.1.1如果“是”，请提供复印件。If “Yes”, please provide the copy.2.7.1.2如果“否”，贵公司是否计划在最近几年取得认证？If “No”, does the company plan to apply for the certification in the coming years? 是Yes 否 No2.7.2贵公司是否制定了由最高管理者确定的环境政策？Does the company have an environmental policy comfirmed by the top management? 是Yes 否 No2.7.2.1如果“是”，请提供复印件 If “Yes”, please provide the copy.2.7.2.2贵公司是否将方针传达到所有为公司工作或代表它工作的人员？如何传达？Is the policy communicated to all persons working for or on behalf of the company? Please simple describe the way to communicate? 2.7.3贵公司是否建立一套体系以跟踪收集并持续更新适合于公司的环保法律法规？Has the company established a system to collect, track and update environmental law and legislations applicable to the facility? 是Yes 否 No如果“是”，请提供更新的频率。 If “Yes”, please provide the updated frequency. 2.7.4环境目标指针和方案 2.7.4.1贵公司是否制定了与贵公司环境方针一致的环境目标和实施方案？Has the company established the environmental improvement objectives, performing plan or program to achieve the environmental policy? 是Yes 否 No如果“是”，请例举三项主要的目前正在实施的环境目标、实施计划或方案。If “Yes”, please describe three significant environmental objectives, performance plans or project in the process of practicing 2.7.4.2贵公司是否制定相应的程序追踪环境目标指针和方案的执行过程，并评估其达成情况，请简要描述。Has the company established a procedure to track the environmental objective and project practicing process? And has the company have a evaluating procedure? Please describe simply. 2.7.5贵公司是否有一套系统使得环保信息及其相关规范及时有效地在公司内部及外部传达？Does the company have a system to make environmental protection information and relevant norm communicate effectively and timely inside and outside the company? Yes No如果“是”，简要描述(请特别说明信息交流的方式及频率)？If “Yes”, please simply describe (especially the method and frequency of communication) 2.7.5.1贵公司是否对其重要环境因素与外界进行信息交流？Does the company communicate externally about its significant environmental aspects? 是Yes 否No 如果“是”，请简要描述交流方式：If “Yes”, Please simply describe the content and communicated method ? 2.7.6贵公司是否向为它或代表它工作的人员提供综合环境知识及环保培训以确保其具备相应的能力？ Does the company provide general environment protection training to the person (s) that working for or on behalf of it, to ensure his/her ability?是Yes 否No2.7.7贵公司是否制定程序追踪相关方的环境活动，并要求其遵守环保法规的要求？Does the company establish programs to track its interested partys environmental action and require them to comply with legal requirements? 是Yes 否 No2.8化学品的操作和储存 Chemical Handling and Storage 2.8.1贵公司是否有包括名称及使用部门的化学品列表？Are there chemical material inventory lists, including material name and used department ? 是Yes 否 No2.8.2贵公司是否使用或储存国家规定的危险化学品？Does the company use or store chemical regulated as hazardous or dangerous materials? 是Yes 否 No2.8.3贵公司是否在政府部门办理危险化学品登记手续？Has the company registered the handling and storage of hazardous chemical? 是Yes 否No如果“是”，请提供附件。 If “Yes”, please provide the copy.2.8.4贵公司是否制定化学品的管制文件或计划？Does the company have a document control or plan for chemical control? 是Yes 否No2.8.5贵公司是否有文件规定须对参与化学品操作和储存的人员进行培训？Does the company have documents to provide especial training employees engaged in chemical handling and storage ? 是Yes 否 No如果“是”，请提供相关证明。 If “Yes”, please provide the copy of the proof.2.8.6贵公司是否有化学品储存仓库？ Is there a chemical storage warehouse in the company? 是Yes 否No如果“是”，此仓库是否具备公安部门颁发的消防设备竣工验收意见书？If “Yes”, does the warehouse have any fire protection device checked & accepted Report? 是Yes 否No 如果“是”，请提供附件。If “Yes”, please provide the copy2.8.7贵公司化学品储存区是否有防溢设施？Are any spill prevention equipment employed in the chemical storage area? 是Yes 否No2.8.8贵公司是否有大容量化学品储存容器？Does the company have bulk storage tanks? 是Yes 否No如果“是”，大容量储存容器的导出泵是否有静电防护设置和保护？If“Yes”, does the vent pumpers for the bulk storage tank have ESD protection? 是Yes 否No 2.9石棉 Asbestos2.9.1贵公司是否使用或持有石棉？Does the company use asbestos or have asbestos in its facilities? 是Yes 否No2.9.2请简要说明使用石棉的地点和使用石棉的类型。Please simply state the location using asbestos and the type of asbestos. 2.10 臭氧耗损物 Ozone Depleting Substances2.10.1贵公司是否使用臭氧耗损物？Is there any ozone depleting substances used in the company? 是Yes 否No如果“是”，请指明使用的臭氧耗损物及其产生源 If “Yes”, please list the ozone depleting substances used in the company and sources. 2.10.2贵公司是否制定了臭氧耗损物的替换计划？Is there any ozone depleting substances replacement program or plan in the company? 是Yes 否No2.11危险物质限制 Restriction of Hazardous Substances2.11.1贵公司是否制定了对危险物质的管理控制作业程序或计划？Does the company have any procedure or plan to control and manage the hazardous substances? 是Yes 否No2.11.2贵公司是否对产品中的禁止物质进行鉴别？ Does the company identify the restricted substances in its products? 是Yes 否No2.12贵公司是否收到过任何形式关于环境活动的投诉、改进要求通告或罚款？ Has the company received any type of complaints, improvement notices or fines relating to environmental activity? 是Yes 否No 如果“是”，请简要描述。If “Yes”, please simply describe. 2.13贵公司是否定期评审其环境管理体系？若是？请提供评审频率。If “Yes”, please simply describe. 3. 职业健康和安全管理 Occupational Health and Safety Management 3.1贵公司是否有专职的职业健康和安全管理人员？Is there an occupational health and safety manager appointed in the company? 是Yes 否No如果“是”，请提供以下联系数据。 If “Yes”, please provide the following information:姓名Name: 电子邮箱地址 E-mail: 联系电话 Telephone: 传真号码 Fax: 3.2 贵公司是否取得消防设施竣工验收意见书？ Does the company have Fire Provention Checked & Accepted report? 是Yes否No如果“是”，请提供附件。 If “Yes”, please provide the copy.3.3贵公司是否设置员工食堂？Does the company provide the cafeteria for employees? 是Yes 否No如果“是”，食堂是否取得卫生许可证 ？If “Yes”, does the cafeteria have any hygienic permit? 是Yes 否No如果“否”，请简要说明未取得的理由。If “No”, please simply describe the reason . 3.4 工伤事故 Industrial Accident3.4.1贵公司是否制定程序对工伤事故进行报告和管理？ Does the company have a procedure to report and manage the industry injury? 是Yes 否No如果“是”，请简要描述。If “Yes”, please simply describe. 3.4.2最近三年内，贵公司是否发生过重伤或死亡的重大工伤事故？ Is there any serious injury or casualty accident happened in the company during the last 3 years? 是Yes 否No如果“是”，请提供最近三年内贵公司发生的严重工伤事故数，并标示出重伤或死亡的事故所占比率。If “Yes”, please provide the amount and mark the percentage of serious injury and casualty. 3.4.3贵公司是否按规定为员工交纳工伤社会保险费？ Does the company pay the Social Occupational Injury Insurance as regulation? 是Yes 否No如果“是”，请提供相关文件。 If “Yes”, please provide relevant documentation. 3.5职业病 Occupational Disease 3.5.1贵公司是否有职业病防治计划和实施方案？ Does the company have the plan and the implementation for the occupational disease prevention?是Yes 否No 如果“是”，请加以陈述 If “Yes”, please describe: 3.5.2贵公司是否发生过职业病危害事故？Is there any occupational disease happened in the company?如果“是”，请简要描述。If “Yes”, please simply describe. 3.5.3贵公司是否为雇员建立职业健康监护档案？ Does the company establish the occupational health archives? 是Yes 否No如果“是”，请详细说明档案包括内容及保存时间。If “Yes”, please provide the detail and retained time of the archive: 3.6紧急预案 Emergency Plans3.6.1贵公司是否制定程序确定潜在的事故或紧急情况，并做出响应？Does the company establish procedures to identify potential emergency situation and potential accidents, and make responses? 是Yes 否No3.6.2贵公司是否定期进行紧急应变演习？ Are emergency preparation and responses drill held periodically? 是Yes 否No如果“是”，请提供最近一次演习的时间及参加演习人数占全厂员工总数的比率。If “Yes”, please provide the time of the last drill and percentage of the employee participating in the drill. 3.6.3贵公司是否安装紧急报警系统？ Does the company set the alarm system for emergency situation? 是Yes 否No如果“是”，贵公司是否定期对系统进行测试？ If “Yes”, does the company test the system regularly? 是Yes 否No3.6.4贵公司是否设置消防储备用水水池？ Does the company have reservoir for fire fighting? 是Yes 否No3.6.5贵公司是否提供应急照明设施？ Does the company have emergency lighting devices? 是Yes 否No3.6.6贵公司是否对雇员进行紧急救援的培训？Do employees receive the training on emergency situation? 是Yes 否No如果“是”，请提供培训类型。If“Yes”, Please provide the type of training. 3.7职业健康和安全管理 Occupational Health and Safety Management 3.7.1贵公司是否通过了OHSAS18001职业健康和安全管理体系认证？Has the company gotten the OHSAS18001 certification? 是Yes 否No3.7.1.1如果“否”，贵公司是否计划在最近几年取得认证？ If “No”, Does the company plan apply for the certification in recent year? 是Yes 否No3.7.1.2如果”是”，请提供证件的复印件。 If “Yes”, Please provide the copy.3.7.2贵公司是否制定了高层领导签署的职业健康和安全政策？ Does the company have an Occupational Health and Safety policy signed by the top managemer? 是Yes 否No3.7.3贵公司是否建立一套体系以跟踪收集并持续更新适合于公司的职业健康和安全法律法规？ Does the company establish a system to collect, track and update the occupational health and safety law and legislation applicable to the company? 是Yes 否No如果“是”，请提供更新的时间频率。 If “Yes”, please provide the updated frequency. 3.7.4贵公司是否制定了为达成贵公司的职业健康和安全政策而制定的环境目标, 实施计划或方案？ Does the