SUPPLIER SELF-ASSESSMENT QUESTIONNAIRE (SAQ):

BUILDING THE FOUNDATION FOR SUSTAINABLE SUPPLY CHAINS

How to Use This Supplier Self-Assessment Questionnaire (SAQ)

Supplier Guidance
Increasingly companies are realizing in order to effectively manage their sustainability impacts, which comprise
economic as well as environmental, social, and governance (ESG) impacts, they must ensure their suppliers are doing
the same. As such, more and more companies are engaging suppliers on these issues, encouraging integration of
ESG sustainability into core decision-making and implementation of leading practices for improving supply chain
sustainability performance.

This has led to a proliferation of initiatives aimed at assessing and improving supply chain sustainability performance,
some of which you as a supplier may have experienced. Our research has demonstrated that the majority of these
initiatives focus exclusively on one aspect of sustainability or another, which leads to suppliers having to complete a
myriad of self-assessment questionnaires (SAQs).

Our intent with this questionnaire is to offer a harmonized approach, allowing one SAQ to demonstrate the important
steps you as a supplier are taking to effectively identify and manage ESG risks and opportunities.

Self-assessments are a valuable tool in any supply chain sustainability program. They can help you evaluate, manage,
and communicate your ESG policies, practices, and performance. In addition, addressing the issues highlighted in
this SAQ can help you identify efficiencies, realize cost savings and productivity benefits, and set the stage for
product innovation.

The SAQ asks you to collect information on the following topics:

I. General Company Information

◆ Facility Information ◆ Workforce Profile ◆ Employment Relationship

II. Environment
◆  anagement Systems
M ◆ Air Emissions ◆ Pollution Prevention
and Training
◆ Water Management ◆ Other Raw Materials
◆  reenhouse Gas Emissions
G
◆ Waste Management ◆ Transportation
and Energy Usage
◆ Packaging

III. Social
◆ Workplace Management ◆ Discrimination ◆ Compensation
◆ Health & Safety ◆ F reedom of Association ◆ Hours of Work
& Collective Bargaining
◆ Forced Labor
◆ Harassment & Abuse
◆  hild Labor
C
& Young Workers

IV. Governance
◆ Accountability ◆ Supplier Management ◆ Disclosure
◆ Grievance and Remediation ◆ Stakeholder Engagement

Supplier Self-Assessment Questionnaire (SAQ): Building the Foundation for Sustainable Supply Chains 3
Two areas critical to developing and demonstrating effective management of sustainability issues are stakeholder
engagement and comprehensive disclosure of sustainability performance and impacts. While companies, investors,
and other stakeholders are increasingly seeking supplier disclosure of sustainability policies, practices, and performance,
along with stakeholder engagement, for many suppliers such public disclosure remains in its nascent stage. This
presents a leadership opportunity for any supplier currently engaging with stakeholders in its community—including
community groups, NGOs, and government—or publicly disclosing ESG data. The governance section of the SAQ
allows those suppliers currently engaging in these areas to demonstrate their efforts, while providing others with key
indicators for future reporting.

To complete this questionnaire, you may wish to develop a self-assessment strategy in order to consider how best to
gather the data you need. We recommend assigning responsibility to a senior manager within the company or to a
human resources or corporate responsibility director.

It is also helpful to consult a variety of resources, including company policies, certificates, wage slips, and records.
Speaking with relevant colleagues, for example health and safety officers and human resource managers, is also
important to gaining a clear picture of the realities at your facility. Workers in your facility are a valuable resource,
and it may be impossible to get accurate information without their input. Interviewing workers will be particularly
important if your facility employs migrant workers either directly or through a broker.

Suppliers are encouraged to respond candidly and completely to the questionnaire, establishing a true baseline
of ESG practices and management from which future performance improvements and impact can be tracked, measured,
and communicated. Answers can be entered directly into the questionnaire and additional documentation attached,
as needed.

The SAQ is not a means to an end, but rather the first step in the development of a constructive dialogue between you
and your customers—one that provides an opportunity to build and strengthen relationships with both current and
potential business partners.

Supplier Self-Assessment Questionnaire (SAQ): Building the Foundation for Sustainable Supply Chains 4
I. General Information

I.A. Facility Information

I.A.1

Name of Facility

Address of Facility

I.A.2

Contact Name

Title

I.A.3

Date of Self-Assessment

I.A.4 Name, City & Country of Facility Owners or Parent/Holding Company:

Detail:

I.A.5 List the names and addresses of all sub-contractors. Describe the tasks and processes
they perform for the facility. Attach additional documentation, as needed.

Detail: Detail: Detail:

I.A.6 List the names and addresses of all labor brokers used to source labor (foreign or
domestic) at this facility (if applicable). Attach additional documentation, as needed.

Detail: Detail: Detail:

I.B. Workforce Profile

I.B.1 Total number of employees at the facility: Number:

I.B.2 Percentage of employees that are male/female. M (%): F (%):

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I. General information (continued)

I.B.3 Percentage of employees that are foreign/migrant workers. %:

I.B.4 Number of temporary contract workers employed by the facility. Number:

I.C. Employment Relationship

I.C.1 Contract workers are under contract to: Employer (#): Broker (#): Other (#):

I.C.2 If contract workers are migrant workers, which countries of origin are represented?
Attach additional documentation, as needed.

Detail:

I.C.3 Does the facility have procedures to ensure contract workers are not required to pay Yes No
an excessive recruitment fee or lodge a deposit with their labor broker?

I.C.4 Does the facility have procedures to ensure freedom of movement of contract Yes No
workers is not unreasonably restricted?

I.C.5 Does the facility have a system in place to ensure that contract labor providers Yes No
adhere to all relevant labor laws?

I.C.6 Are all employees provided a written employment agreement with the facility in a Yes No
language that they understand?

I.C.7 Does the facility maintain a personnel file on every employee? Yes No

II. Environment

II.A. Management Systems and Training

II.A.1 Does the facility have a management system in place, or is it developing one, to Yes No
assess environmental risks associated with production?

II.A.2 Is the facility management system in compliance with applicable environmental laws Yes No
and regulations?

II.A.3 Does the facility have up-to-date ISO 14001, RC 14001, or EMAS certification? Yes No
Please list relevant certifications:

6
II. Environment (continued)

II.A.4 Does the facility hold the necessary license(s) or permit(s) for and has the facility received any fines,
prosecution, or warnings by regulators in relation to (select all that apply):
License(s) or Permit(s): Fines, prosecution, or warnings by regulators:
Air emissions Air emissions
Storage or use of hazardous substances Storage or use of hazardous substances
Wastewater management  reventing soil & groundwater
P
contamination
Waste issues
Wastewater management
Waste issues

II.A.5 Are environmental policies, practices, and expectations communicated to all Yes No
employees and suppliers in local or appropriate languages?

II.A.6 Are employees trained on relevant environmental matters, including Yes No

(select all that apply):

Air emissions Wastewater management

 anagement & use of hazardous
M  aste management,
W
substances including hazardous waste
 reventing soil & groundwater
P Water use
contamination

II.A.7 Does the facility have established environmental targets and objectives to improve Yes No
environmental performance?

If yes, what are the targets and objectives?

II.A.8 Does the facility review its environmental performance annually? Yes No

II.B. Greenhouse Gas (GHG) Emissions and Energy Usage

II.B.1 Does the facility monitor and track energy consumption and conduct Yes No
on-site energy audits?

II.B.2 Does the facility have a system in place to reduce the environmental impact of Yes No
energy use and greenhouse gases?

II.B.3 Does the facility have a program and/or procedures to reduce the use of energy? Yes No

II.B.4 Does the facility have goals and targets to reduce GHG emissions? Yes No
If yes, what are the targets?

What is the total annual GHG emissions in the most recent year measured Tons CO2e:
(enter in total metric tons CO2e)?

7
II. Environment (continued)

II.B.5 Does the facility have set goals and targets in relation to increased energy efficiency? Yes No
If yes, what are the targets?

II.B.6 Does the facility report GHG emissions and climate change strategy to the Carbon Yes No
Disclosure Project (CDP) or publicly disclose an equivalent amount and type of
information on an annual basis?

II.C. Air Emissions

II.C.1 Does the facility regularly test air emissions (i.e. NOx, SOx, mercury, hazardous Yes No
air pollutants)?

II.C.2 Does the facility have a system in place to manage air emissions? Yes No

II.C.3 Does the facility have set targets in relation to reducing air emissions? Yes No
If yes, what are the targets?

II.C.4 Does the facility have pollution prevention devices on chimneys, vents, and extraction Yes No
systems?

II.D. Water Management

II.D.1 Does the facility have a system in place to manage and monitor water withdrawals Yes No
and consumption?

II.D.2 Does the facility have a program and/or procedures to reduce water use or Yes No
reuse/recycle water?

II.D.3 Does the facility have set targets to reduce water consumption? Yes No
If yes, what are the targets?

II.D.4 Does the facility have a system in place to address wastewater generation Yes No
and management?

II.D.5 Does the facility treat wastewater prior to off-site discharge? Yes No
If yes, what is the standard?

8
II. Environment (continued)

II.D.6 Does the facility identify the sources of its water (e.g. aquifers, municipal water Yes No
sourced from local water body, harvested rainwater, etc.)?

Does the company assess external supply and quality risks related to these Yes No
water sources?

II.E. Waste Management

II.E.1 Does the facility have a program and/or procedures to reduce or eliminate pollution Yes No
and waste in its operations?

II.E.2 Does the facility have a recycling program to reduce or eliminate pollution and waste Yes No
in its operations?

II.E.3 Does the facility have a program and/or procedures to manage and dispose of Yes No
hazardous waste (if applicable), wastewater, solid waste, and airborne emissions?

II.E.4 Does the facility have set targets to reduce the volume of waste generated? Yes No
If yes, what are the targets?

II.E.5 Does the facility maintain records of off-site transfer, treatment, and disposal Yes No
of waste?

II.E.6 If the facility uses external waste contractors, does it conduct regular audits Yes No
of those contractors?

Do contractors have relevant certifications? Yes No

Have contractors received any compliance violations within the past 3 years? Yes No

II.F. Packaging
II.F.1 Does the facility have goals and targets to reduce, reuse, and recycle the amount of Yes No
packaging used for its products?

If yes, what are the targets?

II.F.2 Does the facility incorporate packaging reduction, reuse, and recycling in its Yes No
purchasing practices?

II.G. Pollution Prevention

II.G.1 Does the facility consider Design for Environment (DfE) in its development Yes No
of products?

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II. Environment (continued)

II.G.2 Does the facility use life cycle assessment (LCA) as part of determining chemical Yes No
selection for product inputs?

Does the facility use chemical hazard assessment and/or comparative chemical hazard Yes No
assessment as part of determining chemical selection for product inputs?

II.G.3 Does the facility assess whether substances stored, used, or handled on-site are Yes No
prohibited by national or international laws or protocols?

II.G.4 Does the facility have a system in place to address pollution prevention and Yes No
management of hazardous and potentially hazardous substances?

II.G.5 Does the facility maintain up-to-date material safety data sheets (MSDS) for all Yes No
hazardous substances used on-site?

II.G.6 Does the facility set targets in relation to eliminating or reducing hazardous Yes No
substances on-site?

If yes, what are the targets?

II.G.7 Does the facility conduct tests to identify impact on soil and groundwater from Yes No
facility operations?

II.H. Other Raw Materials

II.H.1 Does the facility keep inventory of all chemical substances used, stored, processed, Yes No
and manufactured?

II.H.2 Does the facility have a program and/or procedures to reduce the use of resources Yes No
(other than water), and promote sustainable natural resource practices?

II.H.3 Does the facility have a policy statement and/or management system that addresses Yes No
conflict minerals?

II.H.4 Does the company engage with the government, commercial contacts, or civil society Yes No
groups regarding conflict minerals and/or rare earth materials?

If yes, with whom and how?

II.I. Transportation
II.I.1 Does the facility have in place targets and programs to reduce overall sustainability Yes No
impacts by managing transportation logistics (e.g. prioritizing low impact
transportation modes)?

If yes, what are the targets and programs?

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III. Social

III.A. Workplace Management

III.A.1 Does the facility have a written corporate responsibility policy or statement of Yes No
commitment that defines its approach to labor, health, and safety standards?

III.A.2 Does the facility have policies that prohibit forced labor and child labor? Yes No

III.A.3 Does the facility have written personnel policies that cover (select all that apply):

Benefits and deductions Overtime wage rates

Discipline and termination Regular hours
Grievance procedures Vacation and leave
Harassment and abuse Wages
Overtime hours

Does the policy cover all workers, including migrant workers? Yes No

III.A.4 Does the facility have a management system in place, or is it developing one, Yes No
to assess labor, health, and safety risks?

III.A.5 Is the facility performance management system in compliance with applicable social Yes No
laws and regulations?

III.A.6 Does the facility have up-to-date SA8000, ETI, or other recognized certification? Yes No
Please list relevant certifications:

III.A.7 Does the facility have a system in place for employee appraisal that covers Yes No
regular workers and probationary employees/trainees?

III.A.8 Are formal and written policies and procedures for disciplining and terminating Yes No
employees standardized throughout the facility?

III.A.9 Does the facility strictly prohibit physical punishment of employees as a Yes No
disciplinary measure?

III.A.10 Are labor, health, and safety policies, practices, and expectations communicated to all Yes No
employees and suppliers in local or appropriate languages?

What communication vehicles are used? (Select all that apply)

Bulletin board posting Formal training

Electronic mail Manager meeting
Employee handbook/literature Website

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III. Social (continued)

III.B. Health & Safety

III.B.1. Facility
III.B.1.a To which laws and regulations governing environment, health, and safety does the
facility adhere?

Detail:

III.B.1.b Does the facility have up-to-date OHSAS 18001, ANSI Z10, CSA Z1000, BSI 8800, Yes No
or OSHA VPP certification?

Please list relevant certifications:

III.B.1.c Does the facility have procedures in place to ensure appropriate machinery is well- Yes No
maintained and equipped with necessary safety devices?

III.B.1.d Does the facility have written procedures for the safe storage, use, and disposal of Yes No
each hazardous material used in production (if applicable), in language(s) workers
understand?

III.B.1.e Does the facility have procedures in place to ensure appropriate Personal Protection Yes No
Equipment (PPE) is provided to employees?

If yes, provide a list of Personal Protection Equipment (PPE) distributed and the
number of employees using it:

Detail:

III.B.1.f How often are noise levels and air quality in the facility regularly monitored? Times per year:

III.B.1.g Does the facility have a written emergency response plan and fire evacuation Yes No
procedure?

III.B.1.h Has the emergency response plan and fire evacuation procedure been Yes No
communicated to all parties that could be affected by the emergency in local
or appropriate languages?

III.B.1.i How often does the facility conduct emergency drills? Times per year:

12
III. Social (continued)

III.B.1.j Are all emergency exits unobstructed and unlocked from the inside at all times Yes No
during working hours?

III.B.1.k Does the facility have procedures in place to ensure employees are not denied Yes No
permission or delayed from leaving the facility under reasonable circumstances
(e.g. in the event on an emergency or personal urgency)?

III.B.2. Facility Emergency Management

III.B.2.a Does the facility have well-stocked, unlocked first aid stations at every Yes No
production site?

III.B.2.b Are all employees trained on relevant health and safety matters, including
(select all that apply):

Emergency management Machine safeguarding

Hazardous materials handling Occupational health and safety
Living conditions Personal protection equipment

III.B.2.c Has the facility operated without serious injury and/or fatality over the past year? Yes No

Over the past three years? Yes No

III.B.3. Dormitory (if applicable)

III.B.3.a Are all emergency exits unlocked from the inside and unobstructed? Yes No

III.B.3.b Are dormitory living conditions clean, secure, and adequately cooled, heated, Yes No
lighted and ventilated?

III.B.3.c Are dormitory accommodations in separate building(s) from production areas? Yes No

III.B.3.d Are toilet facilities clean, ventilated, equipped with running water, accessible, Yes No
and lighted at night?

III.B.3.e Do all employees who reside in dormitories have access to running water, safe Yes No
drinking water, sanitary cooking facilities, and adequately private showers?

III.B.3.f Do all dormitories have fire alarms and extinguishers that are regularly tested? Yes No

III.B.3.g Do all employees who reside in facility dormitories have means of securing Yes No
personal documents themselves?

III.C. Forced Labor

III.C.1 Does the facility does employ prison labor? Yes No

III.C.2 Are any of the workers under bond, debt, or other obligation to the facility or to Yes No
labor brokers?

III.C.3 Are workers free to resign from their employment at any time without penalty, Yes No
giving reasonable notice?

13
III. Social (continued)

III.C.4 Are workers free to leave the facility and related dormitories during non-working Yes No
hours and at the end of their shift?

III.C.5 Does the facility (or labor broker) withhold worker ID cards or passports? Yes No

III.C.6 Are workers required to deposit money prior to or during employment? Yes No

III.D. Child Labor & Young Workers

III.D.1 Does the facility employ child labor (workers younger than 14 or 15)? Yes No

III.D.2 Are young workers (above the legal minimum age, but under the age of 18) Yes No
requiring protective restrictions employed in accordance with the law?

III.D.3 Do any young workers perform night work, hazardous jobs, or are they exposed to Yes No
risks from chemicals, machinery, tools or excessive cold, heat, or noise?

III.D.4 Does the factory have effective procedures for verifying workers’ ages? Yes No

III.E. Discrimination
III.E.1 Does the facility have written personnel policies in place for its hiring, salary, Yes No
benefits, termination, and/or retirement practices to prevent discrimination on the
basis of (select all that apply):

Age Medical history Religion

Disability Nationality Sexual orientation
Gender Political opinion Social or ethnic origin
 ender identity
G Pregnancy status Union affiliation
and/or expression
Race Veteran status
Marital status

III.E.2 Does the facility have procedures in place to ensure employees receive equal pay for Yes No
equal work, regardless of those factors listed in question III.E.1?

III.E.3 Are female applicants asked about their pregnancy status when applying for a job? Yes No

III.E.4 Are employees permitted to perform religious obligations without restriction? Yes No

III.F. Freedom of Association & Collective Bargaining

III.F.1 Are there any laws or regulations in the facility’s country/region of operation Yes No
concerning workers’ freedom to join or form trade unions or workers’ organizations
of their own choosing and to collectively bargain?

III.F.2 Are workers free to join or form trade unions or workers’ organizations of their own Yes No
choosing and collectively bargain, if permitted by law?

III.F.3 Does the facility recognize trade unions or other independent workers’ organizations Yes No
representing employees in the workplace (if applicable)?

14
III. Social (continued)

III.F.4 Which of the following types of labor organizations are present and active in the
facility? (Select all that apply)

Dormitory committee Independent trade union

Government union Worker’s committee
Health & safety committee Other

III.F.5 Are employees in the facility able to participate democratically in the selection of Yes No
representatives for labor organizations (if applicable)?

III.G. Harassment & Abuse

III.G.1 Does the facility have a formal, written policy that clearly states a commitment to Yes No
prevent harassment and abuse in the workplace?

III.G.2 Does the facility have procedures in place to ensure the workplace is free of physical Yes No
abuse, corporal punishment, physical contact with the intent to injure or intimidate,
and disciplinary measures that cause physical discomfort?

III.G.3 Does the facility have procedures in place to ensure the workplace is free of Yes No
sexual harassment?

III.G.4 Does the facility have procedures in place to ensure the workplace is free of Yes No
verbal abuse and/or harassment?

III.G.5 Does the facility have procedures in place to document and confidentially report Yes No
events, complaints, cases, and management responses and action related to
harassment and abuse?

III.H. Compensation
III.H.1 Does the facility have procedures in place to ensure all workers are paid at least the Yes No
legal minimum wage for standard working hours?

III.H.2 Does the facility have procedures in place to ensure all workers are paid the legal Yes No
overtime rate?

III.H.3 Does the facility have procedures in place to ensure all workers are provided all the Yes No
benefits to which they are entitled upon hire?

III.H.4 Does the facility have procedures in place to ensure all workers are provided the Yes No
holidays and leave to which they are legally entitled?

III.H.5 Does the facility have procedures in place to ensure no unauthorized or illegal Yes No
deductions are taken from employee wages?

III.H.6 Does the facility have procedures in place to ensure payroll documents indicate all Yes No
hours worked?

III.H.7 Are all workers provided with a written explanation, in local or appropriate Yes No
languages, of pay and any deductions taken?

15
III. Social (continued)

III.I. Hours of Work

III.I.1 Which laws regulating working hours apply to this facility?
Detail:

III.I.2 Which laws regulating overtime hours are applicable to this facility?
Detail:

III.I.3 Does the facility have procedures in place to ensure all workers are given at least Yes No
one day off in seven?

III.I.4 Does the facility have procedures in place to ensure all overtime performed at the Yes No
facility is voluntary?

IV. Governance

IV.A. Accountability
IV.A.1 Does the facility have a management representative assigned responsibility for Yes No
assuring compliance with environmental laws, regulations, and codes?

List the name(s) and title(s):

IV.A.2 Does the facility have a management representative assigned responsibility for Yes No
assuring compliance with labor, health, and safety laws, regulations, and codes?
List the name(s) and title(s).

List the name(s) and title(s):

IV.A.3 Has the facility conducted audits of its environmental management system(s) in the Yes No
past year?

In the past three years? Yes No

IV.A.4 Has the facility conducted audits of its labor, health, and safety laws management Yes No
system(s) in the past year?

In the past three years? Yes No

16
IV.A.5 Are corrective actions identified by the environmental, labor, health, and safety Yes No
audits tracked to closure?

IV.A.6 Does the corrective action process include root cause analysis and preventative Yes No
mechanism implementation?

IV.A.7 Does the facility have a process in place to evaluate and update environmental, Yes No
social, and governance policies and systems on an on-going basis?

IV.B. Grievance and Remediation

IV.B.1 Does the facility have effective grievance procedures in place to allow employees Yes No
to bring environmental and/or work-related violations and/or concerns to
management’s attention in an anonymous manner without fear of retribution?

IV.B.2 Does the facility have procedures in place to investigate reports of environmental Yes No
and/or work-related violations and/or concerns?

IV.B.3 In the past year, how many complaints have been received and investigated? Received: Resolved:
How many have been resolved?

IV.C. Supplier Management (if applicable)

IV.C.1 What procedures does the facility have in place to ensure that suppliers, including
labor brokers, operate in compliance with all applicable environmental and labor
laws and regulations?

Detail:

IV.C.2 What procedures does the facility have in place to assess and manage identified risks
relating to the labor practices of suppliers, including labor brokers?

Detail:

IV.C.3 What procedures does the facility have in place to evaluate and select suppliers
based on their ability to meet ESG standards?

Detail:

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IV. GOVERNANCE (continued)

IV.D. Stakeholder Engagement

IV.D.1 Does the facility regularly engage stakeholders on its sustainability strategies, Yes No
disclosure, and performance, including community groups, employees, NGOs,
and government?

If yes, who and how often?

IV.D.2 What procedures does the facility have in place to incorporate stakeholder input into
its business and operational strategies?

Detail:

IV.D.3 Does the facility publicly disclose results of its stakeholder engagement? Yes No
If yes, please provide a link to the disclosure:

IV.E. Disclosure
IV.E.1 Does the facility publicly disclose its ESG policies, programs, and performance either Yes No
online or in a sustainability report?

If yes, please provide a link to the disclosure:

IV.E.2 Does the facility require its suppliers to publicly disclose key ESG information, Yes No
including policies, programs, and performance?

If yes, please provide a link to the disclosure:

IV.E.3 Does the facility factor supplier’s performance on key ESG indicators into its Yes No
purchasing decisions?

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IV. GOVERNANCE (continued)

V. Additional Information

V.A.1 Provide a list of all attached documents:

Attached document names: Attached document names:

V.A.2 Additional comments, if needed:

Detail:

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