環境和健康安全調查問卷

環境和健康安全調查問卷
Environment ､Health and Safety Questrionnaire

此問卷為台達對相關方相關綜合資訊調查的一部分，目的在於瞭解貴公司相關環境及職業健康安全資訊。以促進雙方對環境健康和安全資訊的溝通交流，達成更好的企業社會責任，建立良好的企業形象。請給予配合，謝謝!
The questionnaire is a part of basic information investigation to Delta’s partners. The major purpose is to understand the system at Delta’s partners’ side regarding environment management and occupational health and safety management, to promote the communication on EHS with each other, to implement the social responsibility, and to build good corporate reputation.

1.公司基本資訊General Information:
1.1公司名稱Company Name:
1.2公司地址Company Address:
1.3電話號碼Telephone Number:
1.4傳真號碼Fax Number:
1.5主要聯繫人姓名及職稱Primary Contact Name and Position
姓名Name：職稱Position：
1.6貴公司總占地面積(平方米) The Total Site Area(sq. meter): m2
1.7貴公司為中達供應的產品或服務的名稱The Product or Service provided for Delta


1.8請描述貴公司附近的狀況(如是否為居住區、商業區等及其分佈位置) Please describe the status /environment nearby the company (such as if it’s residential area, commercial area and its location)



2.環境管理Environment Management
2.1貴公司是否有專職的環境管理人員? Is an environment manager assigned in your company?
■是Yes，如果“是”, 請提供以下聯繫資料If “Yes”, please provide the following information:
姓名Name:
電子郵箱位址E-mail:
聯繫電話Telephone:傳真號碼Fax:否No
2.2貴公司是否取得下列環境許可或意見書?Does your company have the operating ermits or consents listed below?
1) 環境影響評價報告Environmental Impact Assessment ■是Yes 否No
2) 環保設施竣工驗收意見書(三同時) Environmental Protection Acceptance Approval (3 Synchronies) ■是Yes 否No
2.3大氣污染物排放Air Emissions
2.3.1請描述貴公司排放的大氣污染物及其排放源？Please describe the air pollutants and the source of release？
苯、甲苯、二甲苯、乙醇、異丙醇
印刷、腹膜、上光過程排放
2.3.2 貴公司是否定期進行大氣污染物的環境監測？Is there any routine monitoring of air pollution taken in your company?
■是Yes 否No
如果“是”，請提供如下資料If “Yes”, please provide the following information.
2.3.2.1負責大氣污染物監測的機構名稱Name of the dept/institution who monitor

2.3.2.2監測專案及其監測結果the items and results of monitoring：
達標排放
(1)監測結果如未達到國家排放標準，貴公司是否取得污染物排放許可證？Does your company have the Pollutant Discharge Permits if the monitoring results is not within the national allowable air emission standards 是Yes 否No
(2)如果“否”，貴公司是否有計劃在近幾年內進行大氣污染物的監測？If “No”, is your company planning to monitor the air pollution in the coming years?
是Yes 否No
2.3.3貴公司是否進行大氣污染物處理淨化工程？Is there any air emission control devices been applied to sanitize the air emission sources?
是Yes ■否No 如果“是”，請簡要描述If “Yes”, please simply describe

2.4 廢水排放Waste Water Discharge
2.4.1請描述貴公司排放的廢水類型(如工業廢水、生活廢水或其他)？Please describe the type of waste water generated in your company (such as process wastewater, sewage or others) 工業廢水
2.4.2 貴公司是否定期對排放的廢水進行監測？Is there any routine monitoring been taken?
■是Yes 否No
2.4.2.1如果“是” 請提供如下資料If “Yes”, please provide the following information
(1)負責廢水監測的機構名稱Name of the dept/institution who-monitoring :

(2)監測專案及其監測結果The monitoring items and results:
達標排放
監測結果如未達到國家排放標準，貴公司是否取得污染物排放許可證？Does your company have Pollutant Discharge Permits if the monitoring results is not within the national allowable wastewater discharge standards？
是Yes 否No
2.4.2.2如果“否”，貴公司是否有計劃在近幾年內進行廢水的監測？If “No”, is your company planning to undertake waste water monitoring in the coming years?
是Yes 否No
2.4.3 貴公司是否進行了汙水處理工程Does your company apply the wastewater clean devices?■是Yes 否No
如果“是”，請簡要描述If “Yes”, please simply describe 有汙水處理設備

2.5 噪音污染Noise Pollution
2.5.1 貴公司是否對廠界噪音進行定期監測？In the facility, is there any routine boundary noise monitoring been carried out?■是Yes 否No
2.5.1.1如果“是”，請提供如下資料If “Yes”, please provide the following information
(1)負責噪音監測的機構名稱Name of the dept/institution who-monitoring :

(2)監測結果monitoring results:達標
監測結果如未達到國家標準，貴公司是否取得污染物排放許可證？Does your company have the Pollutant Discharge Permits if the results is not within the national allowable noise pollution standards 是Yes 否No
2.5.1.2如果“否”，貴公司是否有計劃在近幾年內進行噪音的監測？If “No”, is your company planning to monitor noise in the coming years?是Yes 否No
2.6 固體廢棄物管理Wastes Treatment
2.6.1 貴公司是否制定廢棄物管理控制作業指導或計畫?Does your company have a waste control plan? ■是Yes 否No
2.6.2 貴公司是否採取措施來減少廢棄物的產生?Does your company take any procedure to minimize waste? ■是Yes 否No
2.6.2.1如果“是”，請簡要描述If “Yes”, please simply describe：
節約能源削減計畫
2.6.3 貴公司是否產生危險廢棄物?Does the company produce the hazardous waste?
■是Yes 否No
如果“是”，請簡要描述廢棄物的種類If “Yes”, please simply describe the type of wastes 紙、油墨（罐）、顯影液、洗版水、抹布、膠水

2.6.4 廢棄物是在公司內處理還是在公司外處理?Is the waste disposed onsite or offsite? 公司內Onsite ■公司外Offsite
2.6.4.1如果是在公司內If “onsite”
(1)請簡要說明公司內部處理的廢棄物種類及處理設備的名稱Please simply describe the type of waste been disposed onsite and relevant disposal devices/equipment.
(2)廢棄物處理設備是否取得相應的運行許可證明? Does the disposal devices have the relevant operating permits? 是Yes 否No
(3)公司是否接受處理來源於公司外的廢棄物? Does the company accept and dispose the wastes for other party? 是Yes 否No
2.6.4.2如果是在公司外If “offsite”
(1)請簡要說明處理的廢棄物的種類及其相應的廢棄物處理廠商？Please simply describe the type of wastes and the relevant disposal contractors？
廢紙等—富泰紙業廢PS版等—紅葉公司廢油墨（罐）等—園區各順
(2)廢棄物處理廠商是否取得相應的營運資格? Does the wastes disposalcontractors have relevant permits or certification? ■是Yes 否No
如果“是”，請提供其影本。If “Yes”, please provide the copy of the license/certificate.
2.7 環境管理體系Environment Management System
2.7.1貴公司是否通過了ISO14000環境管理體系認證？Have the company gotten the ISO14001 certification?■是Yes 否No
2.7.1.1如果“是”，請提供影本。If “Yes”, please provide the copy.
2.7.1.2如果“否”，貴公司是否計畫在最近幾年取得認證？If “No”, does the company plan to apply for the certification in the coming years?是Yes 否No
2.7.2貴公司是否制定了由最高管理者確定的環境政策？Does the company have an environmental policy comfirmed by the top management?
■是Yes 否No
2.7.2.1如果“是”，請提供影本If “Yes”, please provide the copy.
2.7.2.2貴公司是否將方針傳達到所有為公司工作或代表它工作的人員？如何傳達？Is the policy communicated to all persons working for or on behalf of the company? Please simple describe the way to communicate?
教育訓練、員工手冊

2.7.3貴公司是否建立一套體系以跟蹤收集並持續更新適合於公司的環保法律法規？Has the company established a system to collect, track and update environmental law and legislations applicable to the facility?■是Yes 否No
如果“是”，請提供更新的頻率。If “Yes”, please provide the updated frequency.
每季度
2.7.4環境目標指標和方案
2.7.4.1貴公司是否制定了與貴公司環境方針一致的環境目標和實施方案？Has the company established the environmental improvement objectives, performing plan or program to achieve the environmental policy?■是Yes 否No
如果“是”，請例舉三項主要的目前正在實施的環境目標、實施計畫或方案。If “Yes”, please describe three significant environmental objectives, performance plans or project in the process of practicing



2.7.4.2貴公司是否制定相應的程式追蹤環境目標指標和方案的執行過程，並評估其達成情況，請簡要描述。Has the company established a procedure to track the environmental objective and project practicing process? And has the company have a evaluating procedure? Please describe simply.
重大環境因素目標標的及方案追蹤記錄
管理評審

2.7.5貴公司是否有一套系統使得環保資訊及其相關規範及時有效地在公司內部及外部傳達？Does the company have a system to make environmental protection information and relevant norm communicate effectively and timely inside and outside the company?■Yes No
如果“是”，簡要描述(請特別說明資訊交流的方式及頻率)？If “Yes”, please simply describe (especially the method and frequency of communication)
教育訓練資料共用及時
2.7.5.1貴公司是否對其重要環境因素與外界進行資訊交流？Does the company communicate externally about its significant environmental aspects?
■是Yes 否No
如果“是”，請簡要描述交流方式：If “Yes”, Please simply describe the content and communicated method ?電話mail 傳真等

2.7.6貴公司是否向為它或代表它工作的人員提供綜合環境知識及環保培訓以確保其具備相應的能力？Does the company provide general environment protection training to the person (s) that working for or on behalf of it, to ensure his/her ability?
■是Yes 否No
2.7.7貴公司是否制定程式追蹤相關方的環境活動，並要求其遵守環保法規的要求？Does the company establish programs to track its interested party’s environmental action and require them to comply with legal requirements?■是Yes 否No
2.8化學品的操作和儲存Chemical Handling and Storage
2.8.1貴公司是否有包括名稱及使用部門的化學品清單？Are there chemical material inventory lists, including material name and used department ?■是Yes 否No
2.8.2貴公司是否使用或儲存國家規定的危險化學品？Does the company use or store chemical regulated as hazardous or dangerous materials?是Yes ■否No
2.8.3貴公司是否在政府部門辦理危險化學品登記手續？Has the company registered the handling and storage of hazardous chemical?是Yes ■否No
如果“是”，請提供附件。If “Yes”, please provide the copy.
2.8.4貴公司是否制定化學品的管制檔或計畫？Does the company have a document control or plan for chemical control?■是Yes 否No
2.8.5貴公司是否有檔規定須對參與化學品操作和儲存的人員進行培訓？Does the company have documents to provide especial training employees engaged in chemical handling and storage ?■是Yes 否No
如果“是”，請提供相關證明。If “Yes”, please provide the copy of the proof.
教育訓練
2.8.6貴公司是否有化學品儲存倉庫？Is there a chemical storage warehouse in the company?■是Yes 否No
如果“是”，此倉庫是否具備公安部門頒發的消防設備竣工驗收意見書？If “Yes”, does the warehouse have any fire protection device checked & accepted Report?
是Yes 否No
如果“是”，請提供附件。If “Yes”, please provide the copy
2.8.7貴公司化學品儲存區是否有防溢設施？Are any spill prevention equipment employed in the chemical storage area? ■是Yes □否No
2.8.8貴公司是否有大容量化學品儲存容器？Does the company have bulk storage tanks? 是Yes ■否No
如果“是”，大容量儲存容器的導出泵是否有靜電防護設置和保護？If“Yes”, does the vent pumpers for the bulk storage tank have ESD protection?
是Yes 否No
2.9石棉Asbestos
2.9.1貴公司是否使用或持有石棉？Does the company use asbestos or have asbestos in its facilities?是Yes ■否No
2.9.2請簡要說明使用石棉的地點和使用石棉的類型。Please simply state the location using asbestos and the type of asbestos.

2.10 臭氧耗損物Ozone Depleting Substances
2.10.1貴公司是否使用臭氧耗損物？Is there any ozone depleting substances used in the company?是Yes ■否No
如果“是”，請指明使用的臭氧耗損物及其產生源If “Yes”, please list the ozone depleting substances used in the company and sources.

2.10.2貴公司是否制定了臭氧耗損物的替換計畫？Is there any ozone depleting substances replacement program or plan in the company?是Yes ■否No
2.11危險物質限制Restriction of Hazardous Substances
2.11.1貴公司是否制定了對危險物質的管理控制作業程式或計畫？Does the company have any procedure or plan to control and manage the hazardous substances?是Yes 否No
2.11.2貴公司是否對產品中的禁止物質進行鑒別？Does the company identify the restricted substances in its products?是Yes 否No
2.12貴公司是否收到過任何形式關於環境活動的投訴、改進要求通告或罰款？Has the company received any type of complaints, improvement notices or fines relating to environmental activity?是Yes ■否No
如果“是”，請簡要描述。If “Yes”, please simply describe.

2.13貴公司是否定期評審其環境管理體系？若是？請提供評審頻率。If “Yes”, please simply describe.兩次/年
3. 職業健康和安全管理Occupational Health and Safety Management
3.1貴公司是否有專職的職業健康和安全管理人員？Is there an occupational health and safety manager appointed in the company?是Yes ■否No
如果“是”，請提供以下聯繫資料。If “Yes”, please provide the following information:
姓名Name:
電子郵箱位址E-mail:
聯繫電話Telephone:傳真號碼Fax:
3.2 貴公司是否取得消防設施竣工驗收意見書？Does the company have Fire Provention Checked & Accepted report?■是Yes 否No
如果“是”，請提供附件。If “Yes”, please provide the copy.
3.3貴公司是否設置員工食堂？Does the company provide the cafeteria for employees?■是Yes 否No
如果“是”，食堂是否取得衛生許可證？If “Yes”, does the cafeteria have any hygienic permit?■是Yes 否No
如果“否”，請簡要說明未取得的理由。If “No”, please simply describe the reason .

3.4 工傷事故Industrial Accident
3.4.1貴公司是否制定程式對工傷事故進行報告和管理？Does the company have a procedure to report and manage the industry injury?是Yes ■否No
如果“是”，請簡要描述。If “Yes”, please simply describe.

3.4.2最近三年內，貴公司是否發生過重傷或死亡的重大工傷事故？Is there any serious injury or casualty accident happened in the company during the last 3 years?
是Yes ■否No
如果“是”，請提供最近三年內貴公司發生的嚴重工傷事故數，並標示出重傷或死亡的事故所占比率。If “Yes”, please provide the amount and mark the percentage of serious injury and casualty.

3.4.3貴公司是否按規定為員工交納工傷社會保險費？Does the company pay the Social Occupational Injury Insurance as regulation?■是Yes 否No
如果“是”，請提供相關檔。If “Yes”, please provide relevant documentation.
3.5職業病Occupational Disease
3.5.1貴公司是否有職業病防治計畫和實施方案？Does the company have the plan and the implementation for the occupational disease prevention?
是Yes ■否No
如果“是”，請加以陳述If “Yes”, please describe:

3.5.2貴公司是否發生過職業病危害事故？Is there any occupational disease happened in the company? 是Yes ■否No
如果“是”，請簡要描述。If “Yes”, please simply describe.


3.5.3貴公司是否為雇員建立職業健康監護檔案？Does the company establish the occupational health archives?是Yes ■否No
如果“是”，請詳細說明檔案包括內容及保存時間。If “Yes”, please provide the detail and retained time of the archive:

3.6緊急預案Emergency Plans
3.6.1貴公司是否制定程式確定潛在的事故或緊急情況，並做出回應？Does the company establish procedures to identify potential emergency situation and potential accidents, and make responses?■是Yes 否No
3.6.2貴公司是否定期進行緊急應變演習？Are emergency preparation and responses drill held periodically?■是Yes 否No
如果“是”，請提供最近一次演習的時間及參加演習人數占全廠員工總數的比率。If “Yes”, please provide the time of the last drill and percentage of the employee participating in the drill. 2009/11/25 100%

3.6.3貴公司是否安裝緊急報警系統？Does the company set the alarm system for emergency situation?■是Yes 否No
如果“是”，貴公司是否定期對系統進行測試？If “Yes”, does the company test the system regularly?是Yes 否No
3.6.4貴公司是否設置消防儲備用水水池？Does the company have reservoir for fire fighting?是Yes 否No
3.6.5貴公司是否提供應急照明設施？Does the company have emergency lighting devices?■是Yes 否No
3.6.6貴公司是否對雇員進行緊急救援的培訓？Do employees receive the training on emergency situation?■是Yes 否No
如果“是”，請提供培訓類型。If“Yes”, Please provide the type of training.
內訓2010/5/18老師來廠培訓
3.7職業健康和安全管理Occupational Health and Safety Management
3.7.1貴公司是否通過了OHSAS18001職業健康和安全管理體系認證？Has the company gotten the OHSAS18001 certification?是Yes ■否No
3.7.1.1如果“否”，貴公司是否計畫在最近幾年取得認證？If “No”, Does the company plan apply for the certification in recent year?是Yes 否No
3.7.1.2如果”是”，請提供證件的影本。If “Yes”, Please provide the copy.
3.7.2貴公司是否制定了高層領導簽署的職業健康和安全政策？Does the company have an Occupational Health and Safety policy signed by the top managemer?
是Yes ■否No
3.7.3貴公司是否建立一套體系以跟蹤收集並持續更新適合於公司的職業健康和安全法律法規？Does the company establish a system to collect, track and update the occupational health and safety law and legislation applicable to the company?
是Yes ■否No
如果“是”，請提供更新的時間頻率。If “Yes”, please provide the updated frequency.

3.7.4貴公司是否制定了為達成貴公司的職業健康和安全政策而制定的環境目標, 實施計畫或方案？Does the company establish the improvement objectives and performance plan to meet the occupational health and safety policy?
是Yes ■否No
如果“是”，請列舉三項主要的目前正在實施的職業健康和安全目標、計畫或方案。If “Yes”, please describe three significant on-going health and safety objectives, performance plans.



3.7.5貴公司是否有一套系統使得職業健康或安全資訊及其相關規範及時有效地在公司內部及外部傳達？Does the company have a system to make occupational health or safety information and relevant norm communicate effectively and timely inside and outside the company?是Yes ■否No
如果“是”，請簡要描述(請特別說明資訊交流的方式及頻率)？If “Yes”, please simply describe (especially the way and frequency of communication)

3.7.6雇員是否有參加崗前和崗位OHS培訓？Do employees receive pre-employment and on-job OHS training?是Yes ■否No
如果“是”，請提供相關的記錄。If “Yes”, please provide relevant records .

3.7.7貴公司是否鼓勵員工參與職業健康安全管理體系的實施管理？Does the company encourage employees to participate in OHS performance and management?
如果“是”，請簡要描述。If “Yes”, please simply describe the method.

3.7.8貴公司是否制定程式追蹤相關方的職業健康和工業安全活動, 並要求其遵守法規的要求？Does the company have a procedure to track the interested party’s OHS, Industrial safety action and require them to comply with legal requirements?是Yes ■否No
3.8貴公司是否因違反OHS法規收到過任何形式的投訴、改進要求通告或罰款？Has the company received any complaints; improvement requirement notices or fines relating to disobey with OHS legal requirements? 是Yes ■否No
如果“是”，請簡要描述。If “Yes”, please simply describe.

3.9車間空氣品質Air Quality Onsite
3.9.1貴公司工藝流程中是否有毒有害氣體或粉塵產生？Are poisonous, pernicious gas or powder generated during the production processes?■是Yes 否No
3.9.2如果“是”，貴公司是否定期對所在車間空氣進行職業健康衛生監測？If “Yes”, does the company monitor air onsite regularly?是Yes ■否No
如果“是”，請提供負責監測的機構名稱及監測結果。If “Yes”, please provide the name of the dept/institution who monitoring air onsite and results.

3.10貴公司是否對工作現場的溫度進行監控？Does the company monitor the temperature of work field?■是Yes 否No
如果“是”，請提供最近一次的監測時間及監測結果。If “Yes”, please provide the time and results of last monitor. 溫濕度管控表

3.11貴公司作業場所是否有足夠的照明？Have the work field gotten adequately light?
■是Yes 否No
3.12貴公司是否配置了勞動防護用具？Does the company employee the Personal Protective Equipment for employee?
如果“是”，請提供其崗位名稱及其所配備的勞動防護用具。If “Yes”, please list the type of the Personal Protective equipment and the using station.
手套口罩眼罩

3.13貴公司是否有儲備飲用水水池？Does the company have the reservoir for drinking water?是Yes ■否No
如果“是”，貴公司是否定期進行消毒清洗？If “Yes”,Is it been disinfected and cleaned regularly?
3.14貴公司是否定期對飲用水質進行檢測？Does the company have drinking water tested regularly?是Yes ■否No
如果“是”，請提供最近一次的檢測報告。If “Yes”, Please provide the tested report for recent time.
3.15貴公司特殊崗位作業人員是否接受了崗前的培訓？Are all employees engaged in especial operation received the training before working?■是Yes 否No
3.16貴公司是否有特種設備？(如電梯、叉車、天車、壓力容器、鍋爐等) Does the company have particular equipment (e.g. Lift, forklift, air carrier, pressure container, boiler, natural gas station, etc.)? ■是Yes 否No
如果“是”，貴公司有何種特種設備？是否依法律法規進行年檢？操作特種設備人員是否持有相關證件？及是否有進行年審？If “yes”, what kind of particular equipments does the company have? Is there annual check per the law and regulations? Does the operators have relevant certificates? And are the certificates checked annually?
電梯、叉車
年檢

3.17貴公司是否有防雷系統？Does the company have thunder-proof system?
是Yes 否No
如果“是”，是否依法律法規進行年檢？If “yes”, is the thunder-proof system being checked annually per the law and regulations?

3.18貴公司是否有高壓供電及低壓配電房？Does the company have rooms of high-voltage electricity supply and low-voltage reassignment?
是Yes 否No
如果“是”，高壓供電系統是否進行測試？If “yes”, is the high-voltage electricity supply system being tested?

3.19貴公司是否有訂定特種作業崗位及人員名單？Does the company have a clear definition of particular positions and the name list of the worker?
■是Yes 否No
如果“是”，特種作業人員是否進行體檢? 特種作業人員是否發放勞保用品？If “yes”, do the worker have a medical inspection? Do the worker have labor protection supplies?


3.20貴公司是否有緊急廣播系統？Does the company have emergency broadcasting system?■是Yes 否No
如果“是”，緊急廣播系統是否定期進行測試？If “yes”, is the emergency broadcasting system tested periodically?
是
3.21貴公司是否對車間進行噪音監測？Does the company have the noise in the workshop monitored?■是Yes 否No
如果“是”，請填寫下列資料。If “yes”, please finish the questionnaire hereinafter.
3.21.1請提供負責監測的機構名稱及監測結果。Please provide the name of the monitoring institution in charge and the monitoring result.
自測
3.21.2監測結果是否超標？Does the result go beyond the standard?
是Yes ■否No
如果“是”，請提供相應的防範措施。If “yes”, please suggest how to prevent?

3.22貴公司廠房及宿舍消防通道是否暢通？Is the fire fighting channel smooth in the workshops and the dormitories in the company?■是Yes 否No
如果“否”，請提供相應的改善措施。If “no”, please suggest ways to improve.

3.23貴公司廠房及宿舍消防設備(滅火器、應急燈、逃生圖等)數量是否足夠？Does the company have sufficient fire fighting equipments (e.g. fire extinguisher, emergency light, flee-for-life map) in the workshops and the dormitories? ■是Yes 否No
如果“否”，請提供相應的改善措施。If “no”, please suggest ways to improve.