ENVIRONMENTAL MANAGEMENT SYSTEMS QUOTE REQUEST FORM Please provide the following information to enable us to confirm the costs of registration. To which standard are you requiring registration? (please tick) SO 14001:2004 ISO:14001:2015 EMAS BS 8555 (Acorn Scheme) 1) Organisation details: Company name: Company number: Main site address: Postcode: Tel: Fax: Web site: Contact name: Job title: E-mail: Tel: Mobile: 2) Details of head office and branches/agencies: Address and postcode: No. of 1 2 3 4 Total no. of shifts Number of staff in shift employees Head office: Branch 1: Branch 2: Branch 3: Branch 4: Branch 5: (Please continue on separate sheets as necessary) Total no. of employees *: *Where part time workers or contracted workers are employees, please provide full time equivalent, (e.g. 10 persons x 4 hrs / normal working hours) 1
3) How long has your management system been in place? 4) What activities are to be covered by your certification (scope)? 5) Are you? a. A new NQA client Yes No b. A transferring client Yes No If a transferring client, please provide details of previous registration(s): Note: Copies of current certificates of registration and previous audit reports will need to be supplied. c. Extending your scope? Yes No If yes, please provide details of the new scope: d. Have you previously been registered with NQA? Yes No 6) Do you provide installation or other client site works? Yes No 7) Do you have outsourced activities? Yes No Please provide details of outsourced activities: 8) Do you have a target assessment date? 9) Organisational and process complexity: Does the organisation have a simple structure with vertical lines of management communication and few decision makers? Yes No Is the management system highly complex with numerous specific processes? (e.g. a manufacturer where each process is critical to the end product may have many procedures and references to legislative and regulatory documentation) Yes No Are there a large number of the employees completing a similar simple task(s)? (e.g. manned guarding, commercial cleaning, similar assembly lines) Yes No Is the organisation highly regulated by external agencies? (typical industry sectors would be food preparation, aerospace, automotive, electricity generation & gas/oil production etc) Yes No Do stakeholders have specific expectations of the organisation? (e.g. security, health/safety inspections, dangerous waste processing etc) Yes No Does the organisation work within/operate areas having strict security controls? (e.g. chemical plants, oil/gas refineries, electricity generating stations etc) Yes No Are the organisation s operations managed as part of or influenced by a larger organisation s management system? (e.g. controlled by parent company or heavily influenced by local/central government etc) Yes No Are there any other factors which affect the complexity of the organisation s management and processes? Yes No If you have answered yes to any of the above questions please provide details below: 2
10) Combined and integrated management systems: Do you require the auditing of your environmental management system to form part of a combined audit with other management system standards? Yes No If yes, are your management systems fully integrated? Yes No Please complete the following (11-17) for each site (duplicate these pages as necessary). Site name: 11) Permits to operate: Are your operations subject to an authorisation/permit/licence/registration from a regulatory body? (e.g. environmental permit, hazardous waste producer registration, abstraction licences, registered waste or water discharge exemptions etc) Yes No If yes, please provide details (including permit/licence/registration numbers): 12) Discharges to water/sewer: Do you produce any industrial effluent (other than domestic sewage and surface water)? Frequently Occasionally Never 13) Waste: Do you produce hazardous/special/clinical waste? Frequently Occasionally Never 14) Noise and nuisance: Have you had complaints with respect to noise or other nuisances (smoke, dust, fumes, odours or other escapes) from your premises? Frequently Occasionally Never 15) Radioactive and dangerous substances: Do you keep, use, accumulate or dispose of radioactive substances? Yes No Does your business handle, produce, use or store dangerous substances in large quantities and could therefore be subjected to COMAH (Control of Major Accident Hazards)? (dangerous substances include toxic, oxidising, explosive, flammable etc) Yes No If you have answered yes to any of the above questions, please provide details below: 3
16) Incidents/Prosecutions: Have you had any environmental incidents leading to high clean-up costs or a breach of legislation (including prosecution)? Yes No 17) Site sensitivity: Are there any surface waters (rivers, lakes, streams etc) or boreholes within or adjacent to the site boundaries? Yes No Is your site overlying groundwater of significance (e.g. major/minor aquifer)? Yes No Do you have listed buildings (Grade I, Grade II*, Grade II) or archeological sites (tumuli, burial mounds etc.) on site? Yes No Are you within or adjacent to any designated nature conservation sites? (e.g. SSSI Site of Special Scientific Interest, National Park, Special Areas of Conservation) Yes No Are there any other conservation issues at the site? Yes No Is there evidence to suggest land contamination requiring clean up is present at the site? Yes No If you have answered yes to any of the above questions please provide details below: 18) Consultant use: Will you be using a consultant to help you implement/manage the Environmental Management System? Yes No (If yes, please complete their details below). Consultant name: Address: E-mail: Tel: Fax: 19) Completed by: Date: Company: Name: 4
20) Where did you hear about NQA? By recommendation from consultant By recommendation from another company From an editorial From an advert Via NQA s web site www.nqa.com You are an existing NQA client From an exhibition Via a search engine: e.g. Google Other (please specify) Please provide further details below: If you have any problems completing this questionnaire please call 08000 522424 or email sales@nqa.com Click here to send via email Or print and send to: NQA Sales, Warwick House, Houghton Hall Park, Houghton Regis, Dunstable, Bedfordshire LU5 5ZX, UK Data Protection Act 1998 This information is collected, processed and stored to adhere with the UK Data Protection Act 1998. Information will be held and used by NQA and may from time to time be used to send you marketing information relating to products or services we feel you may be interested in. Please confirm that you would be happy to receive this information: By Fax: E-mail: Telephone: Please tick here if you would prefer not to receive marketing information from NQA. Please tick here if you would prefer not to receive marketing information from carefully selected third parties. Contact us NQA, Warwick House, Houghton Hall Park, Houghton Regis, Dunstable, Bedfordshire LU5 5ZX, UK T: 08000 522424 E: sales@nqa.com www.nqa.com/ems QF/EMS/02/FEB15 5