Guidelines for Completing the RoHS Compliance Form GENERAL OVERVIEW This document is used to collect, verify and track supplier substance-level part information in support of Plantronics' Environmental Compliance Program. Plantronics follows the Joint Industry Guide (JIG) for determining the maximum concentration levels of hazardous substances listed in the Plantronics Material Declaration Form (Tab 4). This JIG closely resembles RoHS for the substances listed, with the exception of Cadmium (75 ppm vs. 100 ppm for RoHS). Reference the following source for JIG substance thresholds: http://leadfree.ipc.org/lf_5-0.htm INSTRUCTIONS STEP 1 - Complete the Part Survey Form (tab 2) for all Plantronics Part Numbers listed. If you need more than one row to enter all appropriate information (for example exceptions), then make sure to enter the Plantronics Parts Number in the first cell of each row pertaining to that Part. STEP 2 - Click on the button "Create MDF sheets" to create a Material Declaration Form for each compliant Plantronics part number listed in the Part Survey Form. If the part is not compliant, use the Part Survey Form to add information about compliance plans and dates. Note that we only require you to fill an MDF if the part is believed to be compliant, therefore only MDF for compliant parts are created. Please do not change the tabs names for the created MDFs, as the names are critical to import the data into our system. Note: A material analysis Test Report, from a Plantronics approved test facility, must be submitted with each completed Material Declaration Form. The Test Report should reference each part number and the material description for which the test was performed. A list of Plantronics approved test facilities can be found at: http://www.plantronics.com/north_america/en_us/conformity/index.jhtml For concentration levels that are below the detection limit of the test method, include the detectable threshold level. If testing for a substance in a particular material is not required (for example PBB or PBDE in Metals and Ceramics), then enter zero. If a material exceeds the maximum limits and an exemption is allowed by RoHS, the supplier must identify the exemption. See the Annex of the RoHS Directive for exemptions: http://www.dti.gov.uk/sustainability/weee/index.htm#consultation_on_goverrment_implementation STEP 3 - Print the Certificate of Environmental Compliance (tab 3) and have it signed (not typed) by the employee responsible for RoHS Compliance. Scan the signed page(s) and return it along with the RoHS Compliance Form Excel file. Note that the Certificate is prefilled with the compliant parts from the Part Survey Form. STEP 4 - Return the RoHS Compliance Form to Plantronics when completed. The completed file must be saved in Excel format, only (not PDF), with the exception of the Certificate of Environmental Compliance form which may be sent in PDF format. When returning the file, please do not change the file name. Updates to the file will be requested from suppliers as needed until all parts listed in the Part Survey Form are compliant and all information is provided in the MDF(s). Revision E (02/08/2005)
DESCRIPTIONS AND CLARIFICATIONS PART: A part is any item or assembly that a supplier sells to Plantronics or Plantronics manufactures for sale. REPORTING: For each part number sold to Plantronics, hazardous substance concentrations must be individually listed for all materials comprising the part. Concentration levels are to be measured as a percentage of the total mass of the material (gm/kg) and is to be reported in PPM. (Formula = mass of hazardous substance / mass material x 1,000,000). For concentration levels that are below the detection limit of the test method, include the detectable threshold limit of the test (e.g., "< 5 ppm" instead of "none detectable"). Example: A semi-conductor package is made up of several materials and/or substances which can be separated by mechanical means. These include but are not limited to the plastic molding material, lead frame, solder alloy used to attach the chip, gold bonding wires, etc. MATERIALS VS. SUBSTANCES: Materials are used to construct parts. A material is made up of one or more substances; for example alloy is a material, which in turn is made up of a number of defined substances. Materials are defined as "uniform in composition throughout" (i.e., cannot be separated further into other materials by mechanical actions such as unscrewing, cutting, crushing, grinding, and abrasive processes). For example: solder alloys, ceramics, glass, metals, paper, board, resins, coatings, etc. Substances are chemical elements and their compounds. For example, lead (chemical element), lead oxide (compound), polyvinyl chloride (compound). Registry numbers (RN) of the Chemical Abstracts System of the American Chemical Society ('CAS' numbers) are attributed to all chemical elements and most of their compounds. Please reference the following source for CAS numbers: http://leadfree.ipc.org/lf_5-0.htm Example of Homogenous Materials: Surface-mount IC chip structure Silicon chip Bond wire (Au) Lead-frame (Cu) Lead-frame plating (Cr) Solder bump (Sn-Pb) Die attach adhesive (silver epoxy or high lead solder) Plastic encapsulation Adapted from Paul Goodman, ERA Revision E (02/08/2005)
SUPPLIER INFORMATION Part Survey Form Date: 7-Dec-2004 Contact Name: Thomas Chen Supplier Name: International Components Telephone #: 86-755-682-7301 Supplier code: 5002A Email: tchen@international.com Address: 440 Industry Road, SheKou Industry Zone, ShenZhen, China PLANTRONICS MANUFACTURER COMPLIANCE STATUS Y / N / UNDER INVESTIGATION (Does not contain substances in excess of RoHS Maximum Concentration Levels as referenced in the Material Declaration Form (MDF) or qualifies for exemption under the RoHS Directive) EXEMPTIONS (list those that may apply) CITE ROHS SECTION PLANNED COMPLIANCE DATE (for noncompliant parts) DD / MMM / YYYY COMMENTS 12345-99 TN-89552 Yes 55555-55 TN-50562-XX Yes RoHS Directive 2002/95/EC, SCHEDULE 3 regulation 4 (2), item 5 lead in glass of resistor Page #1 Revision E (02/08/2005)
Certificate of RoHS Environmental Compliance I certify that I am authorized to declare this Material Declaration Form (MDF) on behalf of my company and that the information contained herein is true and accurate to the best of my knowledge and belief. I further certify that any changes to the process or materials which could potentially exceed the RoHS restricted substances concentration levels requires retesting and a re-submission of the MDF to Plantronics. CERTIFIED BY: Type name here Authorized Company Representative This must be actual signature, scanned in, not typed Signature Title Phone Division Type email here E-mail Part Number(s) Referenced 12345-99 55555-55 Part Number(s) Referenced Page #2 Revision E (02/08/2005)
Material Declaration Form Required 30 Days from Receipt Entry Date: 7-Dec-2004 Contact Name: Thomas Chen Supplier Name: International Components Telephone #: Supplier Code: 5002A E-mail: tchen@international.com Address: 440 Industry Road, SheKou Industry Zone, ShenZhen, China SUPPLIER INFORMATION 86-755-682-7301 HAZARDOUS SUBSTANCE MAXIMUM CONCENTRATION LEVELS (PPM) Y / N / TBD Y / N Y / N PLANTRONICS MANUFACTURER PART NAME TOTAL MASS (g) 12345-99 TN-89552 Transformer, Audio 8.512 MATERIAL DESCRIPTION LEAD (Pb) [1000 ppm] [300 ppm - PVC Cables only] Mercury (Hg) [1000 ppm] CADMIUM (Cd) [75 ppm] HEXAVALENT CHRONIUM (Cr VI) [1000 ppm] BIPHENYLE (PBB) [1000 ppm] DIPHENYLE ETHER (PBDE) [1000 ppm] MEETS JOINT INDUSTRY GUIDE (for substances listed) TEST REPORT PROVIDED? 3.2 Bobin <5 <5 <5 <5 <5 <5 Yes No Yes 1.15 Nickel Lamination 120 <5 10 <5 0 0 Yes No Yes 2.7 Copper Wire <5 <5 <5 <5 0 0 Yes No Yes 0.34 Tape <5 <5 <5 <5 <5 <5 Yes No Yes 0.002 Varnish <5 <5 <5 <5 <5 <5 Yes No Yes 1.12 Steel Chip 50 <5 28 <5 0 0 Yes No Yes EXEMPTIONS APPLY? Materials are used to construct parts and may be comprised of one or more substances. Materials are defined as "uniform in composition throughout" (i.e., cannot be separated further into other materials and substances by mechanical actions such as unscrewing, cutting, crushing, grinding, and abrasive processes). (Examples include solder alloys, plastics, ceramics, glass, metals, paper, board, resins, coatings, etc.). No cells may be left blank. All cells must have values For concentration levels that are below the detection limit of the test method, please include the detectable threshold limit of the test (e.g., "< 5 ppm" instead of "none detectable") Ensure that the Test Report references the part number for which is it. Include all applicable materials for a given Plantronics Part Number (one for each row). Add additional rows as needed. If testing for a substance in a particular material is not required (for example PBB or PBDE in Metals and Ceramics), then enter zero Page #3 Revision E (02/08/2005)
Material Declaration Form Required 30 Days from Receipt Entry Date: 7-Dec-2004 Contact Name: Thomas Chen Supplier Name: International Components Telephone #: Supplier Code: 5002A E-mail: tchen@international.com Address: 440 Industry Road, SheKou Industry Zone, ShenZhen, China SUPPLIER INFORMATION 86-755-682-7301 HAZARDOUS SUBSTANCE MAXIMUM CONCENTRATION LEVELS (PPM) Y / N / TBD Y / N Y / N PLANTRONICS MANUFACTURER PART NAME TOTAL MASS (g) 55555-55 TN-50562-XX Resistor 3 MATERIAL DESCRIPTION LEAD (Pb) [1000 ppm] [300 ppm - PVC Cables only] Mercury (Hg) [1000 ppm] CADMIUM (Cd) [75 ppm] HEXAVALENT CHRONIUM (Cr VI) [1000 ppm] BIPHENYLE (PBB) [1000 ppm] DIPHENYLE ETHER (PBDE) [1000 ppm] MEETS JOINT INDUSTRY GUIDE (for substances listed) TEST REPORT PROVIDED? 2 Ceramic 1700 <5 <5 <5 <5 <5 Yes Yes Yes 0.25 Terminations 52 <5 10 <5 <5 <5 Yes No Yes 0.75 Copper Wire <5 <5 <5 <5 0 0 Yes No Yes EXEMPTIONS APPLY? Materials are used to construct parts and may be comprised of one or more substances. Materials are defined as "uniform in composition throughout" (i.e., cannot be separated further into other materials and substances by mechanical actions such as unscrewing, cutting, crushing, grinding, and abrasive processes). (Examples include solder alloys, plastics, ceramics, glass, metals, paper, board, resins, coatings, etc.). No cells may be left blank. All cells must have values For concentration levels that are below the detection limit of the test method, please include the detectable threshold limit of the test (e.g., "< 5 ppm" instead of "none detectable") Ensure that the Test Report references the part number for which is it. Include all applicable materials for a given Plantronics Part Number (one for each row). Add additional rows as needed. If testing for a substance in a particular material is not required (for example PBB or PBDE in Metals and Ceramics), then enter zero Page #4 Revision E (02/08/2005)