环境和健康安全调查问卷
Environment ﹑Health and Safety Questrionnaire
此问卷为台达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 Delta’s partners. The major purpose is to understand the system at Delta’s 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 it’s 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 No
2.2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No
2) 环保设施竣工验收意见书(三同时) Environmental Protection Acceptance Approval (3 Synchronies) ■是Yes 否No
2.3大气污染物排放 Air Emissions
2.3.1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？
苯、甲苯、二甲苯、乙醇、异丙醇
印刷、腹膜、上光过程排放
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：
达标排放
(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No
2.3.3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、生活废水或其它)？Please describe the type of waste water generated in your company (such as process wastewater, sewage or others) 工业废水
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No
2.4.2.1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:
达标排放
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No
2.4.2.2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 No
2.4.3 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 有污水处理设备
2.5 噪音污染 Noise Pollution
2.5.1 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No
2.5.1.1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: 达标
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No
2.5.1.2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No
2.6 固体废弃物管理 Wastes Treatment
2.6.1 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 No
2.6.2 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 No
2.6.2.1如果“是”，请简要描述 If “Yes”, please simply describe：
节约能源 削减计划
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 纸、油墨（罐）、显影液、洗版水、抹布、胶水
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 Offsite
2.6.4.1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 No
2.6.4.2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？
废纸等—富泰纸业 废PS版等—红叶公司 废油墨（罐）等—园区各顺
(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 System
2.7.1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 No
2.7.1.1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 No
2.7.2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 No
2.7.2.1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?
教育训练、员工手册
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.
每季度
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.
重大环境因素目标标的及方案追踪记录
管理评审
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)
教育训练 资料共享 及时
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 ? 电话 mail 传真等
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No
2.7.7 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 party’s environmental action and require them to comply with legal requirements? ■是Yes 否 No
2.8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清单？Are there chemical material inventory lists, including material name and used department ? ■是Yes 否 No
2.8.2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 No
2.8.3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No
2.8.5 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.
教育训练
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 copy
2.8.7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No
2.8.8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 Asbestos
2.9.1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No
2.9.2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 Substances
2.10.1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No
2.11危险物质限制 Restriction of Hazardous Substances
2.11.1 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No
2.11.2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No
2.12 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. 两次/年
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 Accident
3.4.1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? 是Yes ■否No
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 Plans
3.6.1 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No
3.6.2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. 2009/11/25 100%
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No
3.6.4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No
3.6.5贵公司是否提供应急照明设施？ Does the company have emergency lighting devices? ■是Yes 否No
3.6.6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.
内训 2010/5/18老师来厂培训
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No
3.7.1.1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No
3.7.1.2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No
3.7.3 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 company establish the improvement objectives and performance plan to meet the occupational health and safety policy?
是Yes ■否No
如果“是”，请列举三项主要的目前正在实施的职业健康和安 全目标、计划或方案。If “Yes”, please describe three significant on-going health and safety objectives, performance plans.
3.7.5 贵公司是否有一套系统使得职业健康或安全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 occupational health or safety information and relevant norm communicate effectively and timely inside and outside the company? 是Yes ■否No
如果“是”，请简要描述(请特别说明信息交流的方式及频率)？If “Yes”, please simply describe (especially the way and frequency of communication)
3.7.6雇员是否有参加岗前和岗位OHS培训？Do employees receive pre-employment and on-job OHS training? 是Yes ■否No
如果“是”，请提供相关的记录。 If “Yes”, please provide relevant records .
3.7.7贵公司是否鼓励员工参与职业健康安全管理体系的实施管理？Does the company encourage employees to participate in OHS performance and management?
如果“是”，请简要描述。 If “Yes”, please simply describe the method.
3.7.8 贵公司是否制定程序追踪相关方的职业健康和工业安全活动, 并要求其遵守法规的要求？ Does the company have a procedure to track the interested party’s OHS, Industrial safety action and require them to comply with legal requirements? 是Yes ■否No
3.8贵公司 是否因违反OHS法规收到过任何形式的投诉、改进要求通告或罚款？Has the company received any complaints; improvement requirement notices or fines relating to disobey with OHS legal requirements? 是Yes ■否No
如果“是”，请简要描述。 If “Yes”, please simply describe.
3.9车间空气质量 Air Quality Onsite
3.9.1贵公司工艺流程中是否有毒有害气体或粉尘产生？ Are poisonous, pernicious gas or powder generated during the production processes? ■是Yes 否No
3.9.2如果“是”，贵公司是否定期对所在车间空气进行职业健康卫生监测？If “Yes”, does the company monitor air onsite regularly? 是Yes ■否No
如果“是”，请提供负责监测的机构名称及监测结果。If “Yes”, please provide the name of the dept/institution who monitoring air onsite and results.
3.10贵公司是否对工作现场的温度进行监控？ Does the company monitor the temperature of work field? ■是Yes 否No
如果“是”，请提供最近一次的监测时间及监测结果。 If “Yes”, please provide the time and results of last monitor. 温湿度管控表
3.11贵公司作业场所是否有足够的照明？ Have the work field gotten adequately light?
■是Yes 否No
3.12贵公司是否配置了劳动防护用具？ Does the company employee the Personal Protective Equipment for employee?
如果“是”，请提供其岗位名称及其所配备的劳动防护用具。If “Yes”, please list the type of the Personal Protective equipment and the using station.
手套 口罩 眼罩
3.13贵公司是否有储备饮用水水池？ Does the company have the reservoir for drinking water? 是Yes ■否No
如果“是”，贵公司是否定期进行消毒清洗？ If “Yes”,Is it been disinfected and cleaned regularly?
3.14贵公司是否定期对饮用水质进行检测？Does the company have drinking water tested regularly? 是Yes ■否No
如果“是”，请提供最近一次的检测报告。 If “Yes”, Please provide the tested report for recent time.
3.15贵公司特殊岗位作业人员是否接受了岗前的培训？ Are all employees engaged in especial operation received the training before working? ■是Yes 否No
3.16 贵公司是否有特种设备？(如电梯、叉车、天车、压力容器、锅炉等) Does the company have particular equipment (e.g. Lift, forklift, air carrier, pressure container, boiler, natural gas station, etc.)? ■是Yes 否No
如果“是”，贵公司有何种特种设备？是否依法律法规进行年检？ 操作特种设备人员是否持有相关证件？及是否有进行年审？If “yes”, what kind of particular equipments does the company have? Is there annual check per the law and regulations? Does the operators have relevant certificates? And are the certificates checked annually?
电梯、叉车
年检
3.17贵公司是否有防雷系统？ Does the company have thunder-proof system?
是Yes 否No
如果“是”，是否依法律法规进行年检？ If “yes”, is the thunder-proof system being checked annually per the law and regulations?
3.18贵公司是否有高压供电及低压配电房？Does the company have rooms of high-voltage electricity supply and low-voltage reassignment?
是Yes 否No
如果“是”，高压供电系统是否进行测试？If “yes”, is the high-voltage electricity supply system being tested?
3.19贵公司是否有订定特种作业岗位及人员名单？Does the company have a clear definition of particular positions and the name list of the worker?
■是Yes 否No
如 果“是”，特种作业人员是否进行体检? 特种作业人员是否发放劳保用品？ If “yes”, do the worker have a medical inspection? Do the worker have labor protection supplies?
3.20贵公司是否有紧急广播系统？ Does the company have emergency broadcasting system? ■是Yes 否No
如果“是”，紧急广播系统是否定期进行测试？ If “yes”, is the emergency broadcasting system tested periodically?
是
3.21贵公司是否对车间进行噪音监测？ Does the company have the noise in the workshop monitored? ■是Yes 否No
如果“是”，请填写下列数据。If “yes”, please finish the questionnaire hereinafter.
3.21.1请提供负责监测的机构名称及监测结果。Please provide the name of the monitoring institution in charge and the monitoring result.
自测
3.21.2监测结果是否超标？Does the result go beyond the standard?
是Yes ■否No
如果“是”，请提供相应的防范措施。If “yes”, please suggest how to prevent?
3.22贵公司厂房及宿舍消防通道是否畅通？ Is the fire fighting channel smooth in the workshops and the dormitories in the company? ■是Yes 否No
如果“否”，请提供相应的改善措施。If “no”, please suggest ways to improve.
如果“否”，请提供相应的改善措施。If “no”, please suggest ways to improve