Doc .code: A32-1 Version date: 14/11/2012 Version number: 3. Page 1 out of 5.
Date: ______. Application Form- ISO 14001 Environmental Management System.
Doc .code: A32-1 Version date: 14/11/2012 Version number: 3
Page 1 out of 5
Date: ____________ Application Form- ISO 14001 Environmental Management System Dear organization's representative,
Please fill in this application form accurately and in detail and attach any relevant information regarding the organization's activities, such as: business registration certificate. It is very important to fill in information regarding organization's key processes and employees' numbers and roles as detailed in the questionnaire. Please note, the details we receive are the basis for an audit program and certification cycle pricing. 1. Details: Company name Company registration number: Mail address: Location and address: Please also detail address for mail if different from operation site
Telephone: Fax:
Fax number:
Another telephone:
Internet
Company Mail:
Website:
Is the organization a DOD supplier? Audit Language
Yes / no / in application process - DOD supplier Number______________________
Names of company managers
Owners:
CEO:
Does the company work at shifts? If so, how many employees every shift?
Total Number of employees:
Management
English/Hebrew/combination of both, other
Marketing and customer relation Operations:
sales
Environment
Partners
Administration:
Design and development:
Emergency team:
production
Engineering and project management:
Contact Person's details
Name and role: Email:
Scope of activity to be certified:
* Specify the organization's operations including products and / or primary and secondary services
Additional sites/branches: Is the organization a subsidiary of another company: Audit days planning
Customer support
Telephone number: Cell phone:
*specify location, activity and number of employees in every site-including construction sites - for different scopes in different sites please detail scope per site.
Specify days when auditing is impossible-why?
Does the company work on Fridays?
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Page 2 out of 5 How did you get to us? Are you using consultancy services?
Existing Customer Reference, clients name____________________ Internet____________________ Other body ______________________
No
Yes , if so please provide the following details:
Consultant name_______________ Phone: ______________ Consultancy company:_________________________ Is the organization certified for one of the international standards?
No
Yes, If so, which standard? _____ by which certification body? __________
What is the reason for transferring? ___________________________________________ *Please attach a copy of a valid certificate and the last audit report.
Please specify any exclusions applicable
2. Description of processes, activities, products/services: Description Please provide detailed description of the activities and processes performed in the organization. Please address in details any design and development activity.
Please describe if there is any use of Out sourcing, sub-contractors and the extend activities performed Please describe the type of organization's customers: governmental offices, small businesses, DOD etc.
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3. Are the auditors required to maintain any safety measure during the audit? _____________________________________________________________________________________ _____________________________________________________________________________________
4. Please state if there are classified documents/sites/ processes which the auditor shall be denied access to: _____________________________________________________________________________________ _____________________________________________________________________________________
5. Multiple site information. Address
Number of
Number
Common
Specific/unique
Specific applicable
Specific
personnel
of shifts
processes
processes/proced
environmental laws
environmental
/procedures
ures
and regulations
aspects, hazards effects,
Head Office Site 1 Site 2 Site 3
5. Security Clearance Does the organization limit access of foreign citizens to the premises?
No
Yes, please describe:
_____________________________________________________________________________________ _____________________________________________________________________________________ ________________________________________________________________ Does the organization have a mandatory confidentiality agreement and/or security clearance process? No
Yes, please describe:
_____________________________________________________________________________________ _____________________________________________________________________________________ ________________________________________________________________ *Please provide NDA form that the auditors are required to sign, including the organization's profile. Please note, in case the organization has a security clearance process, RONET needs to be notified immediately and prior to the audit. 6. Certification scope
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Page 4 out of 5 Single Site
Multiple sites, please provide the number of sites: __________
Do the secondary sites support the primary site?
No
Yes, please describe:
_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 7. Environmental information Hazardous material used: Liquefying Metals Acids Bases Other: ________________________________ Please detail all the environmental aspects identified by the organization: Air Emissions
Hazardous waste production
Management of hazardous materials
Wastewater
Groundwater springs
Wastewater handled on-site
Wastewater intended for purification
Use of energy
Precipitation
Investigation/correction
Use of water
Asbestos
Lead
Odors
Solid waste production
Ground contamination
Ground contamination
Noise
Recycling
Conservation of national resources
Storage tanks below ground
Pesticide/ Herbicides
Toxic chemicals
Storage tanks above ground
Radon
Report any environmental damage caused by the organization (attach supporting documents)
Other: ________________
8. Applicable regulations, standards, environmental requirements, health and safety requirements.
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State of Israel laws and regulations: ______________________________________
o
Municipal Regulations: ________________________________________________
o
Government regulations: _______________________________________________
o
Fire arrangements site File: _____________________________________________
Last Environmental Review – conducted by: Name: Company: Date:
Environmental Risk analysis – conducted by: Name: Company: Date:
9. Are you interested in receiving marketing and business information from RONET. Yes/No _____________________________
________________________________
________________
Organization representative's name
Organization representative's signature
Organization's stamp
Thank you for your cooperation.
