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
Type of Energy Used
Total Annual Energy Used (kWh)
Water Usage (liters/year)
Raw Materials Used
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