Corporate Responsibility Questionaire - Siemens · Web viewCorporate Responsibility Self Assessment...

Corporate Responsibility Self Assessment v 3.0

© Siemens 2012, All Rights reserved.

Munich, July 2012

Dear Partners,

Sustainability is a strategic and managerial approach integrating our economic, environmental and social performance in order to create and protect tangible and intangible value in an ethical way.

For us, Sustainability in the Supply Chain means using excellent and innovative suppliers to generate long-term added value - and acting with clear economical, ecological and social responsibility. We can achieve this only by working even more closely with our suppliers and integrating our sustainability principles into all relevant business processes.Siemens expects all suppliers to demonstrate their commitment towards the standards and principles stated in the Code of Conduct for Siemens Suppliers (www.siemens.com/scm/code-of-conduct).

We are convinced that shared rules and agreements in our business partnership can lead to ecological, social and economic improvements for society. Therefore' in accordance with our "Corporate Responsibility in the supply chain", we would appreciate your co-operation in undertaking the following self-assessment (Corporate Responsibility Self-Assessment).

Meeting the set minimum Corporate Responsibility requirements is very important in the selection of new suppliers. Every supplier must conform to the minimum requirements of the Code of Conduct for Siemens Suppliers. If the self-assessment shows a strong indication of a potential risk regarding Corporate Responsibility issues and this result is confirmed during an inspection, this can lead to an intensive development program or the termination of the partnership. This assessment is in both our interests.

If you have any questions regarding the completion of this questionnaire, please do not hesitate to contact your responsible purchase manager or send an email to: [email protected]

Yours faithfullySiemens

V3.0 Copyright © Siemens AG 2012. All rights reserved

mailto:[email protected]

http://www.siemens.com/scm/code-of-conduct

General Information Company information

0.01 Name and legal form of your company 0.04 City

0.02 Street 0.05 Country

0.03 ZIP code 0.06 D-U-N-S® Number (if available)

Who is the contact person within your company for the topic of sustainability / corporate responsibility / corporate social responsibility? 0.07 Name of responsible contact 0.09 E-mail address

0.08 Telephone number 0.10 Organization / Function

0.11 Does your company have a program in place to manage adherence with your own and/or customers’ sustainability requirements?

Yes No

0.12 Has your company undergone a sustainability audit during recent years? (If “No”, please continue with question 0.17)

Yes No

0.13 Who performed the audit/assessment?

An independent audit firm (e.g. SGS, Intertek, BV, TÜV) Other customer auditors Other

0.14 If “Other”, please specify :

0.15 Audit / Assessment completion date :


0.16 What was the scope of the audit?

Sustainability programs: EICC, BSCI, WCA

Auditor program by another customer on the topic of sustainability

Other

If “Other”, please specify :

0.17 Please select the option below that best describes your company.

Exclusively operating in administration, management, services, marketing, sales consulting

Manufacturing and processing industry (e.g. chemical engineering, heavy engineering, mechanical engineering, logistics (with and without hazardous substances), electrical engineering, etc.)

0.18 How many people does your company employ?

0.19 In which country is your headquarters located?

0.20 In which country is/ are your main production / service site(s)? (List all that apply)

We, as supplier, undertake to ensure that all companies affiliated to us and maintaining a supply relationship with Siemens AG or one of its affiliated companies fulfill the obligations assumed by us in this module, too.

Yes No


1. Compliance with legislation and prohibition of corruption and bribery

1.1 Is a member of your company's executive management (e.g. director) nominated with responsibility for combating corruption, bribery, and antitrust violations?

Yes No

1.2 Has your company been involved in legal proceedings regarding corruption, bribery, or antitrust during the past 5 years?

Yes No

1.3 Do you have an implemented company-wide Compliance program or procedures? (minimum requirements: Compliance communication and training for relevant employees, process specifying how compliance cases of bribery or corruption and antitrust should be internally handled)

Yes No


2. Respect for the basic human rights of employees

2.1 Do you have internal regulations aligned with local legislation that govern the maximum number of working hours for your employees?

Yes No

Please state the maximum number of working hours per week:

2.2 Do you have rules that govern the maximum number of consecutive working days for your employees?

Yes No

Please state the maximum number of consecutive working days:

If “No”, please specify :

2.3 Do you contravene ILO (International Labor Organization) conventions by imposing monetary or other relevant sanctions on employees? www.ilo.org

Yes No

2.4 Do you keep records of your employees' working hours (including overtime) and wage payments in order to ensure compliance with ILO (International Labor Organization) standards and local legislation? (The stricter regulation applies)

Yes No or only partially

If "No or only partially", please specify:


http://www.ilo.org/

2.5 How often are salaries paid to employees at your company / facility?

Monthly / more than once per month Every two months or less

2.6 Does your company provide an opportunity for your employees to give feedback & complaints to management?

Yes No

2.7 Is your company's pay equal to or above the legally regulated minimum wage? (If there is no legally regulated minimum wage, do you provide fair remuneration?)

Yes No


3. Prohibition of child labor

3.1 Does your company have a guideline regulating the minimum age for employment that is aligned with the minimum requirements of local legislation and the ILO (International Labor Organization) convention? (The stricter regulation applies)

Yes No

Please specify minimum age:

3.2 Do you check and verify the age stated by your employees during the hiring process, including when hiring through recruitment agents, headhunters, etc?

Yes No or only partially

3.3 Do you keep copies of legal proof of age documentation on file for all employees? (Only required if you answered "Yes" to 3.2)

Yes No


4. Health and safety of employees

Further information on the Code of Conduct for Siemens Suppliers, Occupational Health and Safety Section, as of 2008

https://w9.siemens.com/cms/supply-chain-management/en/supplier-at-siemens/basic-information/environment/management/Pages/management.aspx

4.1 Is your company / facility certified to OHSAS 18001? (If "Yes", please continue to section 5)

Yes No

4.2 Does your company have a health and safety policy that is adequate for your business, which is communicated in the local language?

Yes No

4.3 Have you conducted risk assessments to identify risks relating to health and safety in your business?

Yes No

4.4 Does your company conduct occupational health and safety training for all relevant employees, and also keep training records? (e.g. in the safe operation of machines)

Yes NoThere are no processes within our operations that necessitate training on occupational health and safety

4.5 Does your company enforce the use of personal protective equipment? (e.g. safety goggles, safety shoes, ear protection, protective gloves, etc.)

Yes NoThere are no processes within our operations that necessitate the wearing of personal protective equipment

4.6 Does your company have a process for providing first aid to injured employees?

Yes No




5. Environmental protection

5.1 Does your company / facility have a certified environmental management system? (If you do not select "No", please continue to section 6)

ISO 14001 EMAS No

5.2 Do you have an environmental management system that complies with Siemens minimum requirements? https://w9.siemens.com/cms/supply-chain-management/en/supplier-at-siemens/basic-information/environment/management/Pages/management.aspx

Yes No

5.3 Is there a management position within your company with nominated responsibility for implementing local environmental legislation?

Yes No




6. Supply chain responsibility

6.1 Do you use reasonable efforts to promote compliance with the Code of Conduct for Siemens Suppliers or your own equivalent code among your suppliers? (e.g. in commercial contracts, terms and conditions of purchase, etc.)

Yes No

6.2 Is your sourcing decision influenced by compliance with the Code of Conduct for Siemens suppliers or your own equivalent code?

Yes No

6.3 Do you take corrective action if you identify a breach of the Code of Conduct for Siemens Suppliers or your own equivalent code by a supplier?

Yes No

Date: Place:

Signature: _____________________ Company seal:

This document must be signed by an authorized representative of the company and returned to Siemens.


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