COMPLIANCE SELF - ASSESSMENT

Supplier Company Profile Factory Company Profile

Company Name: Company Name:

Address: Address:

City: City:
State/Province: State/Province:
Postal Code: Postal Code:
VAT/TAX No. VAT/TAX No.
Country: Bangladesh Country: Bangladesh
Phone Number: Phone Number:
Fax Number: Fax Number:
Compliance Contact: Mr. Compliance Contact: Mr.
Title: Title:
Email: Email:
2nd Contact: Mr. 2nd Contact: Mr.
Title: Title: Manager Compliance
Email: Email:
Supplier is only an office/agent ✘ YES NO Factory is owned by supplier? YES NO

Supplier has also manufacturing capability ✘ YES NO

Factory Details (this area needs to be completed by production factory )

Factory size (m²): Nr.of buildings:
Product Category Factory in-house capabilities
Garments Sections Building Nr. Floor Nr.
Knits (Top) Warehousing 1
Knits (Bottom) Cutting 1
Woven (Top) Embroidery 1
Woven (Bottom) Screen-printing 2
Denim (Top) Garment Knitting 2
Denim (Bottom) Sewing/Stitching 1
Sweaters Finishing/Pressing
Other Laundry
Garment Dyeing
Accessories Denim washing
Shoes Scraping
Socks, Scarves etc. Laser unit
Other Spray unit
Packing
Non-textile Access. Packaging 1
Jewelry Trimming 1
Belts Ticketing
Bags Treatment Plant Shed GF
Other Other

Trim Accessories

Use one form per new facilityPlease ensure that all information is complete and legible
Button, Rivet etc.
Hangtags etc.
Other
(please explain)

Use one form per new facilityPlease ensure that all information is complete and legible
 Questionnaire-1
Workers
Total number of Workers
Section Male Female Shift-1 Shift-2 Shift-3 Shift-4
1. Staff Working Hours :
2. Sewing Working Hours :
3. Cutting Working Hours :
4. Finishing Working Hours :
5. Cleaner Working Hours :
6. Security Working Hours :
7. Dyeing Working Hours :
8. Accessories Working Hours :
9. Knitting Working Hours :
10. Printing, Embroidery, Electrical, 175,44,177, 5679,53,0,1 Working Hours :

A. Does the factory use workers paid piece rate? YES ✘ NO If yes, How many workers do you have? :
B. Does the factory use homeworkers? YES ✘ NO If yes, How many workers do you have? :
C. Does the factory use temporary workers? YES ✘ NO If yes, How many workers do you have? :
D. Does the factory employ migrant workers? YES ✘ NO If yes, How many workers do you have? :

Facility
1. Does the factory provide a current operating license? ✘ YES NO N/A
2. Does the factory maintain employee contracts for all workers? ✘ YES NO N/A
3. What is the youngest age of any employee at the factory? (Birth date)
4. What is the minimum wage paid at the factory? As per local law - BDT 5300
5. Are all the employees registered to social security institution (MoL)? (%) YES ✘ NO N/A
6. When did the factory make last payment for employee benefits and governmental taxes? 5 Jun,2018 and July,2018
7. Does the factory maintain documentation for employment authorization? ✘ YES NO N/A
8. Does the factory provide attendance and payroll records for all employees? ✘ YES NO N/A
9. After how many hours in a week does the factory pay overtime to its employees? Monthly paid
10. What is the overtime premiums paid at the factory? As per local law - (Basic/104* performed OT hour)
11. Are employees required to take any medical tests prior to hire? YES ✘ NO N/A
11.1. If YES, please list all tests required.
12. Are women required to take any tests prior to hire? YES NO ✘ N/A
12.1. If YES, please list all tests required.
13. Does the factory allow employees the right to organize? YES NO ✘ N/A
13.1. Is there any unions present in the facility? Please list the name of the union We have elected perticipation committee.
14. Is any part of the production process operated outside of the factory? YES ✘ NO N/A
14.1. If YES, please explain where and what operation. Embroidery, Wash & Print
15. Does the factory have at least two emergency exits on each floor on opposite sides? ✘ YES NO N/A
16. Does the factory have fire alarms installed on each floor? ✘ YES NO N/A
17. Does the factory have a written evacuation plan and train all employees on that? ✘ YES NO N/A
18. When did the factory conduct the last evacuation/fire drill? 8th July, 2015
19. Does the factory have person/people trained in first aid employed at the factory? ✘ YES NO N/A
20. Does the factory provide personal protective equipment to employees where necessary? ✘ YES NO N/A
21. If applicable, does the factory hire certified Health&Safety Officer and Doctor/Nurse? ✘ YES NO N/A
22. If applicable, does the factory have current inspection certificate for building safety? ✘ YES NO N/A
23. If applicable, does the factory have current inspection reports for boilers, compressors etc.? ✘ YES NO N/A
24. If applicable, does the factory have current wastewater discharge permit? ✘ YES NO ✘ N/A
25. Does the factory have dormitories for the employees? ✘ YES NO ✘ N/A
Compliance/Audit Certification (social/ethical/health&safety/building safety etc.) date of start date of expire Certification Body
1.
2.
3.

Use one form per new facilityPlease ensure that all information is complete and legible
4.
5.

Use one form per new facilityPlease ensure that all information is complete and legible