环境和健康安全调查问卷精选文档

环境和健康安全调查问卷精选文档TTMS system office room 【TTMS16H-TTMS2A-TTMS8Q8-附件一ID CODE:W0A环境和健康安全调查问卷Environment ﹑Health and Safety Questrionnaire此问卷为呈杰对相关方相关综合信息调查的一部分，目的在于了解贵公司相关环境及职业健康安全信息。

以促进双方对环境健康和安全信息的沟通交流，达成更好的企业社会责任，建立良好的企业形象。

请给予配合，谢谢!The questionnaire is a part of basic information investigation to ChengJie’s partners. Themajor purpose is to understand the system at Delta’s partners’ s ide regarding environment management and occupational health and safety management, to promote the communicationon EHS with each other, to implement the social responsibility, and to build good corporate reputation.1.公司基本信息 General Information:公司名称 Company Name: 公司地址 Company Address: 电话号码 Telephone Number: 传真号码 Fax Number: 主要联系人姓名及职称Primary Contact Name and Position姓名Nam e：职称 Positio n：贵公司总占地面积(平方米) The Total Site Area(sq. meter): m2贵公司为中达供应的产品或服务的名称The Product or Service provided for Delta请描述贵公司附近的状况(如是否为居住区、商业区等及其分布位置) Please describethe status /environment nearby the c ompany (such as if it’s residential area, commercialarea and its location)2.环境管理 Environment Management贵公司是否有专职的环境管理人员? Is an environment manager assigned in yourcompany?是Yes，如果“是”, 请提供以下联系数据If “Yes”, please provide the followinginformation:姓名Name:电子邮箱地址E-mail:联系电话 Telephone: 传真号码 Fax: 否 No贵公司是否取得下列环境许可或意见书?Does your company have the operating ermitsor consents listed below?1) 环境影响评价报告 Environmental Impact Assessment 是Yes 否No2) 环保设施竣工验收意见书(三同时) Environmental Protection Acceptance Approval(3 Synchronies) 是Yes 否No大气污染物排放 Air Emissions请描述贵公司排放的大气污染物及其排放源？Please describe the air pollutants and the source of releas e？贵公司是否定期进行大气污染物的环境监测？Is there any routine monitoring of air pollution taken in your company?是Yes 否No如果“是”，请提供如下数据If “Yes”, please provide the following information.负责大气污染物监测的机构名称 Name of the dept/institution who monitor监测项目及其监测结果 the items and results of monitorin g：(1)监测结果如未达到国家排放标准，贵公司是否取得污染物排放许可证？Does your company have the Pollutant Discharge Permits if the monitoringresults is not within the national allowable air emission standards 是Yes否No(2)如果“否”，贵公司是否有计划在近几年内进行大气污染物的监测？If“No”, is your company planning to monitor the air pollution in the coming years?是Yes 否No贵公司是否进行大气污染物处理净化工程？Is there any air emission control devices been applied to sanitize the air emission sources?是Yes 否No 如果“是”，请简要描述If “Yes”, please simply describe废水排放 Waste Water Discharge请描述贵公司排放的废水类型(如工业废水、生活废水或其他)？Please describe the type of waste water generated in your company (such as process wastewater, sewage or others)贵公司是否定期对排放的废水进行监测？Is there any routine monitoring been taken?是Yes 否No如果“是” 请提供如下数据If “Yes”, please provide the following information(1)负责废水监测的机构名称 Name of the dept/institution who-monitoring :(2)监测项目及其监测结果 The monitoring items and results:监测结果如未达到国家排放标准，贵公司是否取得污染物排放许可证？Does your company have Pollutant Discharge Permits if the monitoringresults is not within the national allowable wastewater discharge standard s？是Yes 否No如果“否”，贵公司是否有计划在近几年内进行废水的监测？If “No”, is your company planning to undertake waste water monitoring in the coming years?是Yes 否 No贵公司是否进行了污水处理工程Does your company apply the wastewater clean devices? 是Yes 否 No如果“是”，请简要描述If “Yes”, please simply describe噪音污染 Noise Pollution贵公司是否对厂界噪音进行定期监测？ In the facility, is there any routine boundary noise monitoring been carried out? 是Yes 否No如果“是”，请提供如下数据If “Yes”, please provide the following information(1)负责噪音监测的机构名称 Name of the dept/institution who-monitoring :(2)监测结果 monitoring results:监测结果如未达到国家标准，贵公司是否取得污染物排放许可证？Doesyour company have the Pollutant Discharge Permits if the results is not withinthe national allowable noise pollution standards 是Yes 否No 如果“否”，贵公司是否有计划在近几年内进行噪音的监测？If “No”, is your company planning to monitor noise in the coming years? 是Yes 否No固体废弃物管理 Wastes Treatment贵公司是否制定废弃物管理控制作业指导或计划?Does your company have a waste control plan? 是Yes 否 No贵公司是否采取措施来减少废弃物的产生?Does your company take any procedure to minimize waste? 是Yes 否 No如果“是”，请简要描述If “Yes”, please simply describ e：贵公司是否产生危险废弃物?Does the company produce the hazardous waste?是Yes 否 No如果“是”，请简要描述废弃物的种类If “Yes”, please simply describe the type of wastes废弃物是在公司内处理还是在公司外处理?Is the waste disposed onsite or offsite?公司内 Onsite 公司外 Offsite如果是在公司内If “onsite”(1)请简要说明公司内部处理的废弃物种类及处理设备的名称Please simplydescribe the type of waste been disposed onsite and relevant disposal devices/equipment.(2)废弃物处理设备是否取得相应的运行许可证明? Does the disposal deviceshave the relevant operating permits? 是Yes 否 No(3)公司是否接受处理来源于公司外的废弃物? Does the company accept anddispose the wastes for other party? 是Yes 否 No如果是在公司外If “offsite”(1)请简要说明处理的废弃物的种类及其相应的废弃物处理厂商？Please simplydescribe the type of wastes and the relevant disposal contractor s？(2)废弃物处理厂商是否取得相应的营运资格? Does the wastesdisposalcontractors have relevant permits or certification? 是Yes 否No如果“是”，请提供其复印件。