Your contact information
 

Company name *

Last name *

First name

E-mail address *

Phone number *

 

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• economics

EC.1 has your business been profitable over the last 5 years?
yes no

EC.2 will it be profitable this year?
yes no

EC.3 what are the foresights for the coming years?


EC.4 what percentage of your profit do you invest innovation and R&D?


EC.5 are you insured for calamities?
yes no

EC.6 have your key selling products been the same over the last 5 years?
yes no

EC.7 how well are your doing compared to your competitors?
better
comparable
worse
I do not know

EC.8 do you perform better than the market average?
yes no

EC.9 have you recently launched new products?
yes no

EC.10 do you invest in greening your business?
yes no

EC.11 do you switch suppliers regularly?
yes no

EC.12 What is your main financial concern?

You have reached the end of the economics part
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• socials

SO.1 What kind of (partial) employee benefits do you have?
health care
pension
paid holidays
life insurance
profit share
day care

Please add what is missing


SO.2 are you involved in community programs?
yes no

SO.3 what percentage of your profit is invested in education and development?


SO.4 are your employees a good reflection of society?
age
gender
race

Please specify your answer


SO.5 How many people do you employ?


SO.5 how many people have left the company last year?


SO.6 what is the main reason for people leaving the company?


SO.7 are employees involved in decision making?
yes no

SO.8 are employees involved in strategy?
yes no

SO.9 how are employees managed and are achievements monitored?
by objectives
by tasks
by accomplishments
by hours
other

Please specify your answer


SO.10 do you ask you clients for their feedback?
yes no

SO.11 What is your main social concern?


You have reached the end of the socials part
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• environment

E1. Do you ask your suppliers for their environmental performance?
Never
Sometimes
In specific cases
Always

Please specify your answer


E2. Do you monitor your energy consumption?
Never
Sometimes
In specific cases
Always

E3. What responsibility do you take for the end-of-life of your  product or service?


E4. What percentage of secondary resources do you use?


E5. How much waste do you produce per unit of product
Please answer in terms of ...tons per 1000 tons of product

of which
0%
0-10%
10-25%
>25%

is chemical waste

E6. What is the main source of energy you us?


E7. Do you use green energy?
yes no

If yes, what kind

If yes, to what extend? 


E8. Are you (ISO) certified?
yes no

Please specify the type(s) of certification


E9. Do you have permits for emissions?
yes no

If yes, for which type of emissions?


E10. What is your main environmental concern?

You have reached the end of the environment part
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Would you recommend this scan to other companies?
 Yes No

Please specify your answer

 

Please add any comments or questions you have




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