supplier self-evaluation questionnaire Please complete this questionnaire and return to sender by fax or e-mail. SCHOMBURG GmbH & Co.KG Purchase Aquafinstraße 2-8 32760 Detmold Tel.: 05231-953-00 / Fax: 05231-953-123 E-Mail: lieferanten@schomburg.de
1. company data 1.1 contact details company name: street: zip code:
city:
federal state: country: telephone: e-mail: homepage:
1.2 general data headquarters: (Please list!)
group affiliation: (Please list!)
subsidiary: (Please list!)
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12.07.2017 / supplier self-evaluation questinnaire / purchase
1.2 general data location germany: (Please list!)
location europe: (Please list!)
substitute: (Please list!)
year of foundation: number of employees: VAT No:
1.3 contact person Board of Management name: Mr/ Ms telephone:
fax:
mail: sales management name: Mr/ Ms telephone:
mail: contact person sales // product range: name: Mr/ Ms telephone:
mail:
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1.3 contact person contact person sales // product range: name: Mr/ Ms telephone:
mail: research & development name: Mr/ Ms telephone:
mail: plant management name: Mr/ Ms telephone:
mail: production management name: Mr/ Ms telephone:
mail: quality management name: Mr/ Ms telephone:
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1.3 contact person claim processing name: Mr/ Ms telephone:
mail: logistics department name: Mr/ Ms telephone:
mail: purchase depatment name: Mr/ Ms telephone:
2. financial 2.1 financial data bank account: financial institute: account number: bank code: IBAN: SWIFT-BIC:
2.2 Development of turnover in last 3 years: year
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turnover
2. financial 2.3 Does existing a product liability insurance? yes/ amount:
€
no
3. production- and delivery program 3.1 Has your company an own research and development department? yes
3.2 Which of the following products are in your portfolio? armin hardener
preservative
accelerator
corrosion inhibitor
polymer emulsion
redispersible powder
defoamer
conductivity
epoxy resins
solvent
coloured quartz
dispersing agents
fibers
oil/ fet/ wax
fillers
pigments/ colouring
retarder
polyole
isocyanates
reactive diluent
office equipment
shrinkage convensation
packaging
thickener
communication
hydrophobic agent
tools & other working materials
cement/ lime/ gypsum
personal protection equipment others: (e.g. raw- & working materials, advertising, promotion article)
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3.3 Your products quality to our portfolio: waterproofing an restoration tile/ natural stone/ screed installation road and track construction concrete restoration hydraulic structures surface protection systems concrete technology
3.4 Which products do you feel competitive with?
3.5 Which are your customer references?
4. management 4.1 quality management 4.1.1 Does your company accept audits made by customers? yes
4.1.2 Would you agree to signing a secrecy agreement with us? yes
4.1.3 Is a corporate quality management agreement of interest for you? yes
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4.1 quality management 4.1.4 Has your company a certified quality management? yes / which?
If you answer is yes, please enclose the certificate!
4.1.5 If you answer is no, do you plan a certification? yes
4.1.6 Which certification do you want to realise in the future?
appointed date:
4.1.7 Is there any quality guide, where processes of system and operating procedures are described? yes
4.1.8 Are incoming goods subject to an immediate control? yes
4.1.9 Is a valid control plan available for each product? yes
4.1.10 Are measuring and inspection equipment subject to regular tests in accordance fixed intervals? yes
4.1.11 Are machines and equipment subject to preventive maintenance measures? yes
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4.1 quality management 4.1.12 Are damaged parts especially marked and stored separately to avoid confusions? yes
4.2 industrial safety and environmental management 4.2.1 Has your company industrial safety system? yes / which?
4.2.2 If you answer is no, do you plan to launch an industrial safety system? yes
4.2.3 Which industrial safety system do you plan to launch?
4.2.4 Has your company an enviromental system? yes / which?
4.2.5 If you answer is no, do you plan to launch an enviromental system? yes
4.2.6 Which enviromental system do you plan to launch?
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5. delivery & logistics 5.1 How quickly con you react to changes in orders and quantities? within one day
within 2-3 days
within one working week
after one working week
5.2 Are you using returnable packages or other environmently friendly packages when you supply your customers with goods? yes
If you need any further information, please let us know. You are our contact person, if we have any further queries regarding your company data:
tel.-no.:
Please inform us in case your contact details change.
date
signature
Thank you for your efforts!
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