Survey Form for Supply Chain - PDF

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Survey Form for Supply Chain - PDF Powered By Docstoc
					                                                                         SUPPLIER DETAILS AND DECLARATION: By signing (or submitting electronically) I declare all information provided is true and correct.
                                                                             Company Name                                                                         Phone
                                                                           Authorised Officer                                                                        Fax
             FIRST SUPPLY / SPECIAL ORDERS                                            Position                                                                    E-Mail
     TIMBER & WOOD PRODUCT SURVEY FORM                                                   Signed                                                                     Date

            Please complete one form for each product group supply chain. If a product group comes from multiple supply chains, complete one form for each supply chain.

                                                        Chipboard                 Component Product                   Decking                          Doors                           Dressed Timber
                                   Product Group
                                       Select One       Firewood                  Garden Furniture                    Joinery                          Laminate Flooring               Manufactured Whole Timber

                                                        MDF                       Mouldings                           Plywood                          Sawn Timber                     Solid Timber Flooring
                   Product Description
   Provide a short description of product
         Product’s Timber Composition
                            Select one                  Component                 Whole-Wood

                                                                                                                                     Please provide common or botanical name of timber species.
                                                                                                                                     General terms such as ‘hardwood’ will not be accepted.

                 Country of Forest Source

                                                                                                                                     If a Plantation, Plantation             November 1994 or before
                                   Type of Forest       Native                 Private                       Plantation              Conversion Date (Select one):           after November 1994

                          Risk Category                                                                                              NOTE: VH products will not be accepted; H and M risk products will be required to be Certified
         Use the Risk Matrix to select one              VH           H               M                  L                 VL         Sustainable by 2012 and 2013 respectively.

            Estimated Sales to Bunnings
                       $ Value (Ex. GST)            $                                                                                NOTE: include ONLY the
            Estimated Sales to Bunnings                                                                                              part of the product that is timber
                                      3                                                                                         3
                                     m                                                                                         m

                        Type of Certification           Government Permit/Approval                3 Party Certification             Other; Please specify:

     Government Department Name or
         rd                                                                                                                               Issued To
        3 Party Cert. Scheme Name:

                           Document Number                                                                                               Expiry Date

                Does this product meet                                                                                                   Action Plan for H risk product completed.
                                                        Yes           No             If NO, complete an ACTION PLAN
           documentation benchmarks?                                                                                                     Action Plan for M risk product completed.

FirstSupplySurvey_FINAL_20101116                                                                                                                                                                               Page 9 of 20

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