Supplier questionnaire on human rights

We are committed to ensuring respect for human rights in our own activities and throughout our
supply chains. We expect the same commitment from our suppliers. The aim of this self-assessment is
to gain an initial understanding of the extent to which our suppliers are already aware of-, and/or
engaging with, risks for adverse human rights impacts.
 We are looking for honest answers! Whatever your responses to the questions below, they will not
affect our decision to engage you as a (potential) supplier.
 That said, a failure to respond to this questionnaire could negatively affect our overall assessment
of you as a (potential) supplier.
 Attention for human rights and sustainability in business is growing internationally. We are
convinced that your engagement in this process could also benefit you as a company.
 Confidentiality is key. We guarantee that none of the information provided will be shared outside
our organization.

General company information

Contact person: Click or tap here to enter text.
Company name and headquarters:
Click or tap here to enter text.
Other locations:
Click or tap here to enter text.
Staff headcount (worldwide):
>1000
250-1000
<250 (medium-sized enterprise)
<50 (small enterprise)
<10 (micro enterprise)
Number of years in operation: Click or tap here to enter text.
Main activities:
Click or tap here to enter text.
Key goods/services that you produce/provide:
Click or tap here to enter text.
Are you mostly active in local, regional, or international markets?
Click or tap here to enter text.
Who are your key clients (general descriptions, for instance: large pharmaceutical
companies, retail, local governments, individual consumers)?
Click or tap here to enter text.
What activities do you outsource or subcontract to others?
Click or tap here to enter text.

Workforce
Average age (approx.): Click or tap here to enter text.
Ratio permanent/contract workers (approx.): Click or tap here to enter text.
Presence of trade unions or other types of worker associations: Click or tap here to enter text.
Existing knowledge
What key goods/services do you buy from other companies?
Click or tap here to enter text.
What raw materials are used in your products? Would you be able to tell where these raw
materials come from?
Click or tap here to enter text.
Would you be able to identify the suppliers of your suppliers?
Click or tap here to enter text.
Are you aware of risks for human rights violations within your sector? Please specify.
Click or tap here to enter text.
Have you ever discussed issues related to working conditions or human rights with (one of)
your suppliers?

Risk monitoring
Have you ever been subjected to a social audit? Who carried out this audit? Were any
important violations detected?
Click or tap here to enter text.
Have you ever been subjected to social inspections?
Click or tap here to enter text.
Do you regularly receive questions from other clients in relation to human rights or working
conditions? What are these questions about?
Click or tap here to enter text.
Do you have proper systems in place for ensuring good working conditions (for instance:
health and safety, working hours)?
Click or tap here to enter text.

Policies and processes

Do you have official policies related to worker rights or human rights (for instance: human
rights policy, (supplier) code of conduct, conflict minerals policy)?
Click or tap here to enter text.
Do you have any labels or certificates related to sustainability?
Click or tap here to enter text.
Do you take-, or participate in-, initiatives with the aim of addressing sustainability
challenges in your supply chains?
Click or tap here to enter text.
Do you publicly report about human rights, or about sustainability issues more broadly?
Click or tap here to enter text.