trung tm chng nhn ph hp tiu chun - Quacert

trung tm chng nhn ph hp tiu chun - Quacert

8 ng Hong Quc Vit, Qun Cu Giy, H Ni

Tel: (04) 7561025 ; (04) 7565483Fax: (04) 7563188

E-mail: Quacert@netnam.org.vnWebSite: http: //www.quacert.gov.vn

Chng trnh chng nhn h thng qun l mi trng

environmental management system certification scheme

ng k chng nhn

Application for certification

tn doanh nghip:

Tn ting Vit / In Vietnamese:

Organisation's Name

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Tn ting Anh / In English:

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a ch, in thoi, fax,..............................................................................................................Address, telephone, fax,..............................................................................................................

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Dnh cho QUACERT / For QUACERT onlyM s/ Client File No.:SIC code:Ngi xem xt:/ Reviewer:

1. thng tin chung / General information

i din doanh nghip

Organisation's RepresentativeH tn / Full Name: ..........................................................................................

Chc v / Position: ............................................................................................

Tel: ....................................................Fax.................................................................................

ngi lin h

Contact Person

H tn / Full Name: ..........................................................................................

Chc v / Position: ............................................................................................

Tel: ...................................................Fax.................................................................................

E-mail: ...............................................................................................................

Ngy thnh lP

Foundation Date...........................................................................................................................

Loi hnh doanh nghip

Type of Business Venture

( Quc doanh / State Owned

( C phn / Joint Stock

( Hp danh / Partnership

( Nc ngoi / Foreigner Owned ( T nhn / Private

( Lin doanh / Joint Venture

( Trch nhim HH / Limited

( Thnh phn khc / Others

Th trng chnh

Main Markets

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Tng s cn b nhn vin

No. of Employees

Trong h thng qun l mi trng / in EMS: (bao gm nhng ngi phi p dng cc quy trnh, hng dn,.. ca h thng qun l mi trng):.... Trc tip sn xut l / in shop floor : ..........................................................

Nu SX theo ca, s NV trong tng ca l: - Ca 1/Shift No.1:......................

(in shift(s), if applicable) - Ca 2/Shift No.2: .....................

- Ca 3/Shift No.3: .....................

Note: Nu chng nhn m rng, ch ghi s nhn vin thuc khu vc m rng/ If Extension, please specify No. of employees under extension area

2. Thng tin chng nhn / certification information

loi hnh chng nhn Certification Type

Chng nhn ln u/ Initial Audit:

( Chng nhn m rng/ Extension Audit:

( Chng nhn li/ Renewal:

(

doanh nghip c p dng h thng qun l no khc ( V d: ISO 9000...)?/ Is any other mangement system applied in the organization ( e.g., ISO 9000....)? ( C / Yes

( Khng / NoNu c, xin nu chi tit tiu chun, t chc chng nhn/ If so, please notify standard applied, certification body: ............................................................................................................................ ...........................................................................................................................

lnh vc ng k chng nhn

Scope of Certification

Ting Vit / in Vietnamese: .................................................................................

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Ting Anh / in English: .......................................................................................

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Xin hy lit k mt s nguyn vt liu chnh u vo/ Please list out some main input materials

Ti nguyn, nhin liuHo cht, cht c hiNguyn vt liuLoi khc

Chng loiS lngChng loiS lngChng loiS lngChng loiS lng

Xin hy lit k mt s cht thi chnh thuc hot ng ng k chng nhn / Please list out some main wastes under the certification activities....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

xin vui lng ghi r cc kha cnh mi trng c ngha ca doanH nghip (c th ghi vo ph lc nh km) / Please specify the significant environmental aspects of the organisation? (Attachment may be used) ............................................................................................................................ ................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ ......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

xin vui lng ghi r cc vn bn php quy v cc tiu chun vit nam v mi trng m doanh nghip ang p dng / Please specify the environmental regulations and standards of Vietnam being applied in the organisation?

............................................................................................................................ .................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................. ....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Doanh nghip c Quyt nh ph chun bo co nh gi tc ng mi trng?/ Do the organisation have approval for Environmental Impact Assessment Report ?

( C / Yes ( Khng / No

Nu c, xin nu chi tit ngy c ph duyt v c quan thm nh / If so, please notify the date and governmental body to do it:..........................................................................................................................................................................................................................

nu c trn 1 a im thuc lnh vc ng k chng nhn, ngh ghi r tn, a ch v sn phm/ dch v ca tng a im (c th ghi vo ph lc nh km)/ Please specify the relevant names, addresses and products/services of each site to be audited (Attachment may be used)..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

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s lng cc ti liu ca h thng qun l mi trng thuc hot ng ng k chng nhn

Please specify number of documents of EMS to be certified S tay qun l mi trng / Environmental Manual:................... Th tc hay Quy trnh / Procedure(s): .........................................

Hng dn / Instruction(s): ..........................................................

Cc loi ti liu khc / Others: .....................................................

Thi gian ngh nh gi

Time proposal for nh gi s b, nu c / Pre-assessment, if required: .......................

nh gi chnh thc / Initial assessment: ..................................

3. Cc Thng tin khc / Other information

xin vui lng cho bit t chc no t vn cho doanh nghip, nu c / Please inform who is your consultancy, if any..............................................................................................................

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xin vui lng cho bit cc yu cu khc, nu c / Please specify other requests, if you have any

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Chng ti xin cam oan cc thng tin trong n l ng. We certify that the statements made by us in this form are true and correct to the best of our knowledge.

Chng ti hiu r v cam kt tun th cc yu cu trong bn "Quy nh v iu kin chng nhn h thng" ca Tng cc Tiu chun o lng Cht lng v QUACERT / We have understood and committed to follow all requirements in " Terms and Conditions of System Certification" specified by STAMEQ and QUACERT.

Ngy / Date Thng / Month Nm / Year

i din c thm quyn / authorised representative (K tn v ng du / Sign and Stamp)

QF 14-06 Rev.: 1.6.2002

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