Supplier Environmental Impact Assessment Form

Supplier Information

Supplier Name Contact Person Contact Email Location / Address Assessment Date

Environmental Management

Does your organization have an environmental policy? Yes No Environmental certifications (if any) Describe your environmental management system

Resource Usage

Waste Management

Types of waste generated Waste disposal methods Recycling or waste minimization programs Yes No

Emissions

Types of emissions (air, water, etc.) Emission control measures in place

Compliance

Is your organization compliant with local environmental regulations? Yes No Any environmental violations in the past 5 years? Yes No

Additional Information

Additional comments or documentation