Masco Industries Ltd.

SUPPLIER EVALUATION FORM

Section – A
COMPANY DATA
To be completed by the Purchasing /Marketing Department
Vendor’s Name : Epyllion Limited
Address : Kutubpur,Kanchpur,Sonargaon,Narayangonj
Contact # : Mail: [email protected] Cell :01730725942
Contact Person : Mr. Ahsan
Product/Services :Twill Tape,Drawstring,Hanger loop,Herring tape,shoulder tape etc.

Section – B
QUALITY SYSTEM
Information to be provided by the supplier

1. Are you registered to ISO 9000? Yes No √

If so, please supply photocopy of your certificate.
If the answer to (1) is “No”, please answer question 2-6 inclusive.

2. Do you have Quality Management/Quality Assurance System? Yes √ No

3. Do you perform inspection and testing at:

A. Incoming stage? Yes √ No
B. In process stage? Yes √ No
C. Final stage? Yes √ No

4. How do you control Non-Conforming products?

Nonconforming Product do not pass and not come to market/ delivery after identifying the root
cause then corrective action taken.

5. How do you rate the skills and training of your personnel?

Low Medium √ High

6. Do you have a customer complaint System? Yes √ No

7. Who are your major customers?
Mascotex Ltd, Masco Cottons Ltd., Masco Industries Ltd. ACS Textiles Ltd etc.
__________________________________________________________________________
__________________________________________________________________________

8. Information provided by: _______________________ Position: ______________________

 Section – C
SOCIAL ACCOUNTABILITY
Information to be provided by the Supplier/Auditor

CHILD LABOUR
1. Is any one under 14 yrs. of age in your factory? Yes □/ No □
√
FORCED LABOUR
1. Is prison or forced labour used in your factory? Yes □/ No □
√
DISCIPLINARY PRACTICES
1. Are workers punished physically or mentally? Yes □/ No □
√
COMPENSATION
1. Are workers paid at least the legal minimum wage? Yes □
√ / No □
2. Do you deduct wages as disciplinary action against workers? Yes □/ No □
√
WORKING HOURS
1. Do you comply with applicable laws for maximum working hours? Yes √□/ No □
2. Do you allow you workers one day off for every seven day period? Yes □
√ / No □
3. Do you ensure that the overtime (more than 48 hrs./week) does not Yes □
√ / No □
exceed 12 hrs./week?
4. Is there any punch card system that employees punch by themselves? □/ No □
Yes √
5. Do the pay stubs shown the number the hours worked and rate of pay per hour? Yes □
√ / No □
HEALTH & SAFETY
1. Are adequate first aid kits available in the factory Yes □
√ / No □
2. Is there a registered doctor or nurse available to administer first aid Yes □/ No □
√
3. Does the factory provide enough personal protective equipment? Yes □
√ / No □
4. Do factory staff have unrestricted access to clean drinking water? Yes □
√ / No □
5. Are toilets functional, clean and accessible at all times? □/ No □
Yes √
6. Number of workers per toilet: Man: Women:
7. Is the work area adequately ventilated? Yes √□/ No □
8. Is the lighting in the work area adequate? Yes □
√ / No □
9. Is the work place clean? Yes √□/ No □
10. Are adequate fire-fighting equipment & procedures in place? Yes √□/ No □
11. Are there adequate number of exists in the event of an emergency? Yes □
√ / No □
12. Are emergency exists clearly marked, unblocked & unobstructed? □/ No □
Yes √
13. Are all electrical cables wires & fuse boxes in good condition & clearly marked? Yes □
√ / No □
14. Are the aisles & walkways clearly marked, free of obstructions and accessible? □/ No □
Yes √
15. Is battery operated emergency lighting installed & regularly maintained? Yes □
√ / No □
16. Are all chemicals/hazardous materials properly handles & stored? Yes □
√ / No □
 Section – C
SOCIAL ACCOUNTABILITY
Information to be provided by the Supplier/Auditor

No Precarious Employment
1.Does provide employment contract to the worker? Yes √□/ No □
Ethical Business Behavior
1. Does the facility falsifying information related to its activities, structure Yes □/ No □
√
Performance?

2. Does Facility any act of misrepresentation of its supply chain? Yes □/ N □

√
FREEDOM OF ASSOCIATION
1. Do you allow formation of trade unions in your company? Yes √/ No □
2. If trade unions are restricted under law, do you provide parallel means
of collection bargaining and free association for your employees? Yes √/ No □

DISCRIMINATION
1. Does the company have any discrimination policy for hiring,
compensation, training, promotion, termination or retirement based on
race, caste, nationality, religion, disability, gender, sexual orientation,
union membership or political affiliation? Yes√ / No

MANAGEMENT SYSTEM
1. Does your company have documented policy for social accountability? Yes √ / No □
2. Does your company carry out social audits? And do you review the
effectiveness of social accountability system in your company? Yes √ / No □

3. Do you evaluate your suppliers based social accountability issues? Yes √ / No □

And do you maintain records of such evaluation?

Note : If answer to any of the above question is “No” please give details regarding the corrective
actions you plan to take to address the related issue(s) in the section give below: (You can use
attachments if required).

DECLARATION

This is to confirm that the above information is correct and can be verified by a third party by visiting
our company (informed or uninformed) at any time.

Information provided by:___________________________________ Date:______________

Name & Designation/Stamp
 Section – D
PERFORMANCE
To be completed by the Purchasing/Marketing Department

1. For how long has the supplier been providing goods/services to the company?
______________________________________________________________________________
2. Has the vendor regularly met his commitment to the company with respect to:-
 Quality Requirements? Yes
 On time delivery? Yes
 After sales services? Yes
Yes √ No
3. Is the supplier prompt in reply to enquiries?
4. Does the vendor enjoy a good market reputation? Yes √ No

Section – E
ON-SITE SURVEY
To be completed by the Auditor/Representative

1. Does the supplier follow set procedures for performing work? Yes √ No
2. Are machines sufficient/adequate to procedure required Yes √ No
quality Product?
3. Are storage areas/conditions adequate to safeguard Yes √ No
the Product against deterioration?
4. Are the management and workers committed to quality? Yes √ No
5. Does the supplier follow written specification/standard? Yes √ No

Visit conducted by:____________________________ Date: 20/01/17

Section – F
DECISION
To be completed by Management Representative/Marketing

√ Approved Not Approved

Remarks : Approved for next one year

Approved by : ___________________________________________________

Next Review : 20/01/18