Form 2240501Ver.

Supplier's Check Sheet for the Evaluation of Environmental Conservation
Supplier code

Company name

Effective date

Location

Authorized by:

Head officeBusinesscategory *1. Manufacturer 2. Trading company
3. Other

Evaluation
conducted by:
Telephone no.

* If either "2. Trading company" or "3. Other" applies, only provide answers for paragraphs (1), (2) and (3), together with
Items 1-6 of Paragraph (4). Also if the answer to any of the items in Paragraph (1) is "Yes," then omit Items 1-6 ofParagraph (4).

(1) Items concerning ISO14001 certification granted by external auditors
ISO14001
obtainedcertification

alreadyYES/NO

Date acquired

Certifying organization

ISO14001 certification scheduled
to be obtained within 1 year

YES/NO

Date acquired

Certifying organization

Certification no.

(2) Items concerning Eco-Action 21 certification[If the answer to either item in Paragraph (1) is "Yes," then omit this paragraph]
Certification already obtained
Certification scheduled
obtained within 1 year

tobeYES/NO

Date acquired

Certifying organization

YES/NO

Date acquired

Certifying organization

Certification no.

(3) Items concerning Green Procurement activities
No12

Evaluation items
Has understood the content of the Carrier Japan Green Procurement guidelines
Has complied with the matters requested under the Carrier Japan Green Procurement
guidelines

YES2020NO00Grades(4) Items concerning environmental conservation activities[If the answer to either item in Paragraph (1) is "Yes," then omit Items 1-23]
No12

Environmental
policy345678

Schedule/organization

910111213

Environmental
aspect/system

Evaluation items
Has a corporate philosophy on environmental conservation.
Has an environmental policy that clearly specifies the basic
direction of environmental conservation measures.
Has established an environmental policy and has pledged to makecontinuous improvements and to prevent pollution.
Has pledged in an environmental policy to strictly observe
environment-related laws and regulations.
Has put an environmental policy in writing, familiarized all theemployees with the policy, and has made the policy available tothe public.
Regularly reviews the environmental policy.
Has environment-related objectives/goals, and has documented them.
Has established an action plan clarifying responsibilities, means,and schedule for achieving the objectives/goals.
Has established the organization, manager, roles, and authority forachieving the objectives/goals.
Has evaluated/controlled environmental impact of air pollution
and is striving for improvement.
Has evaluated/controlled environmental impact of water pollution
and is striving for improvement.
Has evaluated/controlled environmental impacts on waste and is
striving for improvement.
Has evaluated/controlled environmental impacts on resource
consumption and is striving for improvement.

YES
55NO
00

50

50

5055500050

5050

50

50

Grades14151617181920
21
22

Education/information disclosure232425

Biodiversity
Quality management
system for chemicals
containedinproducts26

Has evaluated/controlled environmental impacts on energy
consumption and is striving for improvement.
Has evaluated/controlled environmental impact due to offensive
odors, noise, and vibration, and is striving for improvement.
Is actively engaged in improving delivery packing, isreusing/recycling packages, and making the means oftransportation used more efficient.
Has a product assessment system.
Has a system for handling emergencies.
Has corrective and preventive measures to handle non-conformities.
Has an internal environmental audit system.
Implements environment-related education/training.
Separately implements appropriate education/training for
employees engaged in work which may have a significant impact
on the environment, and manages the participation by such
employees in such education/training.
Publishes information on its environmental conservation activities.

50505055555500000050Is engaged in biodiversity conservation. (*)
Based on environmental laws, as well as on customer requests,etc. (stating a deadline for the complete abolition of the use ofcertain chemicals, etc.), has documented goals for managing useprohibited substances/controlled substances, as well as plans forthe complete abolition of the use of such chemicals, for reducing
the quantity thereof used or for employing substitute chemicals.
Activities in this connection are being promoted.
Has built/operated a system for gathering/disseminating/controlling/providing instructions regarding and otherwise
handling information.

550050(*) Agrees with the purport of the Basic Act on Biodiversity (Act No. 58 of June 6, 2008) and is striving to improve theenvironmental impact of energy consumption, etc.
(5) Ranking○ Business category: "1. Manufacturer”(a) If the answer to either Paragraph (1) orParagraph (2) is "Yes"(b) Paragraph (3), Items 1-2(c) Paragraph (4), Items 1-23 *(d) Paragraph (4), Items 24-26

115* Not to be counted if(a) applies

Total

RankSA
B

Score
170
155-169
100-154

CD50-990-49

RankSAB

Score
7055-69
40-54

CD

20-39
0-19

○ Business category: "2. Trading company" or "3. Others"(a) If the answer to either Paragraph (1) orParagraph (2) is "Yes"(b) Paragraph (3), Items 1-2(c) Paragraph (4), Items 1-6 *Total

30* Not to be counted if(a) applies···········································································································································* This is the end of the evaluation. Thank you for filling in the check sheet. It would be greatly appreciated if you
would take time to respond to the questionnaire below.
-If you have obtained or plan to obtain an EMS (environmental management system) certification other thanabove Paragraphs (1) and (2), please answer the following.

Already obtained certification

YES/NO

Date acquired

Name of EMS

Certifying institution

Scheduled to obtain certification
within 1 year

YES/NO

Date acquired

Name of EMS

Certifying institution

Certification no.