supplier self-evaluation questionnaire_3217.pdf
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<h1>supplier self-evaluation questionnaire_3217.pdf</h1> <p>supplier self-evaluation questionnaire <br />Please complete this questionnaire and return to sender by fax or e-mail. <br />SCHOMBURG GmbH & Co.KG <br />Purchase <br />Aquafinstraße 2-8 <br />32760 Detmold <br />Tel.: 05231-953-00 / Fax: 05231-953-123 <br />E-Mail: lieferanten@schomburg.de</p> <p>1. company data <br />1.1 contact details <br />company name: <br />street: <br />zip code:</p> <p>city:</p> <p>federal state: <br />country: <br />telephone: <br />e-mail: <br />homepage:</p> <p>1.2 general data <br />headquarters: <br />(Please list!)</p> <p>group affiliation: <br />(Please list!)</p> <p>subsidiary: <br />(Please list!)</p> <p>Page 1 of 9</p> <p>12.07.2017 / supplier self-evaluation questinnaire / purchase</p> <p>1.2 general data <br />location germany: <br />(Please list!)</p> <p>location europe: <br />(Please list!)</p> <p>substitute: <br />(Please list!)</p> <p>year of foundation: <br />number of employees: <br />VAT No:</p> <p>1.3 contact person <br />Board of Management <br />name: Mr/ Ms <br />telephone:</p> <p>fax:</p> <p>mail: <br />sales management <br />name: Mr/ Ms <br />telephone:</p> <p>fax:</p> <p>mail: <br />contact person sales // product range: <br />name: Mr/ Ms <br />telephone:</p> <p>fax:</p> <p>mail:</p> <p>Page 2 of 9</p> <p>12.07.2017 / supplier self-evaluation questinnaire / purchase</p> <p>1.3 contact person <br />contact person sales // product range: <br />name: Mr/ Ms <br />telephone:</p> <p>fax:</p> <p>mail: <br />contact person sales // product range: <br />name: Mr/ Ms <br />telephone:</p> <p>fax:</p> <p>mail: <br />research & development <br />name: Mr/ Ms <br />telephone:</p> <p>fax:</p> <p>mail: <br />plant management <br />name: Mr/ Ms <br />telephone:</p> <p>fax:</p> <p>mail: <br />production management <br />name: Mr/ Ms <br />telephone:</p> <p>fax:</p> <p>mail: <br />quality management <br />name: Mr/ Ms <br />telephone:</p> <p>fax:</p> <p>mail:</p> <p>Page 3 of 9</p> <p>12.07.2017 / supplier self-evaluation questinnaire / purchase</p> <p>1.3 contact person <br />claim processing <br />name: Mr/ Ms <br />telephone:</p> <p>fax:</p> <p>mail: <br />logistics department <br />name: Mr/ Ms <br />telephone:</p> <p>fax:</p> <p>mail: <br />purchase depatment <br />name: Mr/ Ms <br />telephone:</p> <p>fax:</p> <p>mail:</p> <p>2. financial <br />2.1 financial data <br />bank account: <br />financial institute: <br />account number: <br />bank code: <br />IBAN: <br />SWIFT-BIC:</p> <p>2.2 Development of turnover in last 3 years: <br />year</p> <p>Page 4 of 9</p> <p>turnover</p> <p>12.07.2017 / supplier self-evaluation questinnaire / purchase</p> <p>2. financial <br />2.3 Does existing a product liability insurance? <br />yes/ amount:</p> <p>€</p> <p>no</p> <p>3. production- and delivery program <br />3.1 Has your company an own research and development department? <br />yes</p> <p>no</p> <p>3.2 Which of the following products are in your portfolio? <br />armin hardener</p> <p>preservative</p> <p>accelerator</p> <p>corrosion inhibitor</p> <p>polymer emulsion</p> <p>redispersible powder</p> <p>defoamer</p> <p>conductivity</p> <p>epoxy resins</p> <p>solvent</p> <p>coloured quartz</p> <p>dispersing agents</p> <p>fibers</p> <p>oil/ fet/ wax</p> <p>fillers</p> <p>pigments/ colouring</p> <p>retarder</p> <p>polyole</p> <p>isocyanates</p> <p>reactive diluent</p> <p>office equipment</p> <p>shrinkage convensation</p> <p>packaging</p> <p>thickener</p> <p>communication</p> <p>hydrophobic agent</p> <p>tools & other working materials</p> <p>cement/ lime/ gypsum</p> <p>personal protection equipment <br />others: (e.g. raw- & working materials, advertising, promotion article)</p> <p>Page 5 of 9</p> <p>12.07.2017 / supplier self-evaluation questinnaire / purchase</p> <p>3.3 Your products quality to our portfolio: <br />waterproofing an restoration <br />tile/ natural stone/ screed installation <br />road and track construction <br />concrete restoration <br />hydraulic structures <br />surface protection systems <br />concrete technology</p> <p>3.4 Which products do you feel competitive with?</p> <p>3.5 Which are your customer references?</p> <p>4. management <br />4.1 quality management <br />4.1.1 Does your company accept audits made by customers? <br />yes</p> <p>no</p> <p>4.1.2 Would you agree to signing a secrecy agreement with us? <br />yes</p> <p>no</p> <p>4.1.3 Is a corporate quality management agreement of interest for you? <br />yes</p> <p>Page 6 of 9</p> <p>no</p> <p>12.07.2017 / supplier self-evaluation questinnaire / purchase</p> <p>4.1 quality management <br />4.1.4 Has your company a certified quality management? <br />yes / which?</p> <p>no</p> <p>If you answer is yes, please enclose the certificate!</p> <p>4.1.5 If you answer is no, do you plan a certification? <br />yes</p> <p>no</p> <p>4.1.6 Which certification do you want to realise in the future?</p> <p>appointed date:</p> <p>4.1.7 Is there any quality guide, where processes of system and operating <br />procedures are described? <br />yes</p> <p>no</p> <p>4.1.8 Are incoming goods subject to an immediate control? <br />yes</p> <p>no</p> <p>4.1.9 Is a valid control plan available for each product? <br />yes</p> <p>no</p> <p>4.1.10 Are measuring and inspection equipment subject to regular tests in <br />accordance fixed intervals? <br />yes</p> <p>no</p> <p>4.1.11 Are machines and equipment subject to preventive maintenance measures? <br />yes</p> <p>Page 7 of 9</p> <p>no</p> <p>12.07.2017 / supplier self-evaluation questinnaire / purchase</p> <p>4.1 quality management <br />4.1.12 Are damaged parts especially marked and stored separately to avoid <br />confusions? <br />yes</p> <p>no</p> <p>4.2 industrial safety and environmental management <br />4.2.1 Has your company industrial safety system? <br />yes / which?</p> <p>no</p> <p>If you answer is yes, please enclose the certificate!</p> <p>4.2.2 If you answer is no, do you plan to launch an industrial safety system? <br />yes</p> <p>no</p> <p>4.2.3 Which industrial safety system do you plan to launch?</p> <p>appointed date:</p> <p>4.2.4 Has your company an enviromental system? <br />yes / which?</p> <p>no</p> <p>If you answer is yes, please enclose the certificate!</p> <p>4.2.5 If you answer is no, do you plan to launch an enviromental system? <br />yes</p> <p>no</p> <p>4.2.6 Which enviromental system do you plan to launch?</p> <p>appointed date:</p> <p>Page 8 of 9</p> <p>12.07.2017 / supplier self-evaluation questinnaire / purchase</p> <p>5. delivery & logistics <br />5.1 How quickly con you react to changes in orders and quantities? <br />within one day</p> <p>within 2-3 days</p> <p>within one working week</p> <p>after one working week</p> <p>5.2 Are you using returnable packages or other environmently friendly <br />packages when you supply your customers with goods? <br />yes</p> <p>no</p> <p>If you need any further information, please let us know. <br />You are our contact person, if we have any further queries regarding your company data:</p> <p>tel.-no.:</p> <p>Please inform us in case your contact details change.</p> <p>date</p> <p>signature</p> <p>Thank you for your efforts!</p> <p>Page 9 of 9</p> <p>12.07.2017 / supplier self-evaluation questinnaire / purchase</p>
