Friday, 14 September 2012

UL DQS Inc. Sustainability Registration Program

RP-1S Preliminary Information

The information requested is essential for UL DQS to understand your organization and determine the resources required for Sustainability Programs (SP), which includes: ISO14001, Environmental Management System (EMS), Occupational Health and Safety Management System (OHSMS), BS OHSAS 18001 (OHSAS), Responsible Care or combined Environmental Health and Safety (EHS) Registration Program. Please give as much detail as possible. If a question does not apply, please indicate with “N/A.” If you have questions about this form, or any other aspect of UL DQS Inc. Registration Programs, call us at 1-800-2UL-4ISO (1-800-285-4476).

1.1. Name and Location of the Facility to be Registered

If you seek UL DQS' services for more than one facility, please complete a separate form for each facility.

1.1	Company Name:
1.2	Facility address (please do not include P.O. boxes):
1.3	Facility mailing address (if different from 1.2. above):
1.4	Name of EHS Representative:	Alternate EHS Representative:
1.5	EHS Representative Position:	Alternate EHS Representative Position:
1.6	Telephone numbers:
1.7	Fax numbers:
1.8	Cell or mobile numbers:
1.9	Email addresses:

2.2. Subscriber Information

The subscriber is the organization responsible for UL DQS invoices for the SP / EHS services.

(If information is the same as above, check this box and go to section 3).

2.1	Subscriber Company name:
2.2	Subscriber address:
2.3	Name of subscriber’s representative:
2.4	Company Position:
2.5	Telephone number:
2.6	Fax number:
2.7	Please indicate to whom and where UL DQS invoices should be sent (if different from above):

3.3. Information Concerning Your Firm

3.1	To which standard(s) / specification are you seeking registration? ISO 14001 OHSMS BS OHSAS 18001 RC 14001 RCMS Other
3.2	Is your facility Registered to ISO 9001 or similar Standards? Yes No If yes, to which standards (TL 9000, ISO/TS 16949, etc.):
3.3	Is UL DQS your Registrar? Yes No
3.4	Please provide details of any other approvals granted by certifying bodies.
3.5	Are you using a Consulting Agency? Yes No If yes, list the Agency.

4.4. Facility Information

4.1	Total number of employees at the facility:
4.2	Total number of temporary or contract employees working on site on a regular basis:
4.3	Current number of shifts:

5.5. Category Information

5.1	Please list the product lines and / or services that are provided under your facility's EHS and the SIC Codes, NAICS Codes, EA Codes or NACE Codes
5.2	Please check which of the following are the primary activities of the site (check all that apply but limit to the major functions of the site): Manufacturing Design / R&D Warehousing, Transport and/or Distribution Center Assembly Energy Generation and Distribution Corporate Headquarters or Administrative Headquarters Service or Repair location Other Please specify Please list your primary manufacturing or service processes:
5.3	Please indicate the proposed scope of activity for which facility registration is sought.
5.4	Does any work take place on customer premises, for which your organization is responsible? Yes No If yes, please provide details.

6.6. Environmental Health and Safety Management System Information

6.1	Does the facility have a documented SP / EHS? Yes No If so, how long has it been in operation? If not, please note when the documentation and implementation of the EHS will begin and be completed.
6.2	Are there any SP / EHS functions that are performed at off site facilities / locations other than the one represented by this RP-1SUS form? (i.e. warehouses, design centers, satellite manufacturing sites, administrative offices etc.)? Yes No If yes, complete the following: Company Name: Address: Function:
6.4	List any processes / services to be included in the scope of registration that are outsourced.
6.5	Are EHS functions performed at the "corporate" or "division" level? Yes No If so, what?
6.6	Please list all SP / EHS controls and applicable SP / EHS regulations (e.g. air emission control, waste water treatment, hazardous waste, forklifts, HazComm, etc.):
6.7	Please identify key manufacturing / service processes and technologies:
6.8	Please list all remediation projects:
6.9	Please specify all laboratories and their functions within the facility that are involved in environmental health and safety control activities?

7.7. Health and Safety Requirements

7.1	Does the facility have safety requirements regarding clothing and/or protective equipment? Yes No If protective equipment is required, is it provided at the facility (Steel toe shoes, safety glasses, side shields, hearing protection, respirators, clean room suits, etc.)? Yes No
7.2	Are contact lenses, beards, dresses, open toed shoes, etc. allowed or appropriate? Yes No
7.3	Does the facility have any other special safety requirements? Yes No If yes, please list:

8. Responsible Care

8.1	Does the facility have a documented RC14001 or RCMS? Yes No If so, how long has it been in operation? If not, please note when the documentation and implementation of the EHS will begin and be completed.
8.2	Are there any RC 14001 / RCMS functions that are performed at off site facilities / locations other than the one represented by this RP-1S form? (i.e. warehouses, design centers, satellite manufacturing sites, administrative offices etc.)? Yes No If yes, complete the following: Company Name: Address: Function:
8.3	List any processes / services to be included in the scope of registration that are outsourced.
8.4	Are RC functions performed at the "corporate" or "division" level? Yes No If so, what?
8.5	Please list all RC controls and applicable RC regulations (e.g. ACC, air emission control, waste water treatment, hazardous waste, forklifts, HazComm, security, etc.):
8.6	Please identify key manufacturing / service processes and technologies:
8.7	Does the facility require a Chemical-terrorism Vulnerability Information (CVI) Authorized User Certificate for auditor review of emergency and security plans? Yes No
8.8	Please specify all laboratories and their functions within the facility that are involved in environmental health, safety, security and responsible care control activities?
8.9	Does the facility have any other special safety or security requirements? Yes No If yes, please list:

9. UL DQS' SP Services

9.1	Will a translator(s) be necessary in order for UL DQS to provide any of the following services? Yes No If so, please indicate for which language(s):
Please identify the UL DQS EHS service(s) your company is interested in:
Please note that either a Pre-assessment Meeting (Section 9.2) or a Preliminary Evaluation (Section 9.3) is required to fulfill the Stage 1 registration requirements.
9.2	Pre-Assessment Meeting (optional service). The purpose is to enhance your company's understanding of your EMS / OHS management system and explain the mechanics of our registration program. We can also help your company assess its needs regarding the scope of registration, selection of facilities to be registered, organizational structure and proposed schedules. Is your company interested in this service? Yes No If yes, please list a preferred date:
9.3	Preliminary Evaluation (optional service). A preliminary evaluation (also an optional service) is a limited investigation of a facility's management system to ISO 14001, OHSMS or BS OHSAS. After the evaluation, UL DQS documents the investigation's findings, but will not draw conclusions regarding the eligibility of the facility for registration to the applicable standard(s). However, you can use the information obtained during a preliminary evaluation to streamline the registration assessment processes. Is your company interested in this service? Yes No If yes, please list a preferred date:
9.4	Registration Assessment The registration assessment is conducted in two stages – Stage 1 is a Readiness Review and Stage 2 is the Registration Audit. Stage 1 is normally conducted on-site and can be combined with the Preliminary Audit. As the Stage 1 will assess your level of conformity and readiness for certification, it is to be conducted after you have implemented your internal audit and management review systems. A separate Stage 1 report will be generated noting any concerns and a recommendation for whether the Stage 2 can be performed as scheduled or needs to be postponed. Stage 2 is required to determine the compliance of an EHS to the requirements of ISO14001, OHSMS, BS OHSAS 18001, RCMS or RC 14001. When the facility’s EHS meets these requirements, a Certificate of Registration will be granted.
9.5	Continuous Assessments. In order to maintain your Registration, ongoing annual or semi-annual Continuous Assessments are required, including a Triennial Reassessment once every third year after Registration.
9.6	Please indicate which Accreditation Body (AB) marks you would like on the Certificate (if any): Standard UL DQS Certificate (No Accreditations indicated) ANAB* A fee applies for each mark. UL DQS must be accredited by that body for the defined scope. *Required for RC 14001 and RCMS

10. Additional Information

Please provide any additional information that you feel may be helpful as we prepare and conduct the auditing or sustainability program activities you have requested.

10.1

11. Submission

Please note the individual or group completing this information on behalf of the facility seeking registration. Thank you for your cooperation in completing this form.

Date:

Name:

Position: