Supplier self disclosure	Document name
B&R Industrial Automation GmbH

Master data

Company:	Telephone:
Street:	Fax:
Post code, town:	Internet:
Country:	Email:
Legal form of organization:	Commercial reg. no:
Year founded:	Dun & Bradstreet no.:
Owner:	Company type:
Group affiliation:	Function in the group:
What sets your company apart from other market players?
Arrangement as B&R supplier desired? If "yes", Annex 1 should be fully filled out	Yes No

Person in charge of:	Name	Email	Function in the company
Company management
Sales
Development & construction
Production
Purchasing & logistics
Technical support
Quality management
Finances

Production sites (name / place)	Production procedure	Product groups
Is separate tool manufacturing available?	Yes No
Is it possible to manufacture custom products?	Yes No

Production sites (name / place)	Investments in the current year	Investments next year

Do you have customers in the area of automation technology?	Yes No
References in automation technology
Other references:

Revenue and employees

Revenue in the past 4 years
Year
Revenue + currency
R&D expenditure in % of revenue

Sales region	Asia	USA	Europe	Other countries
%
Customer structure	Automotive	Industry	Communication	Entertainment	Computers	Others
%
Product groups
%

Employee development in the past 4 years
Year
Employee number

Number of employees	Area
Company management
Sales
Development & construction
Design
Production
Purchasing & logistics
Technical support
Quality management & assurance
Total

Quality

Quality management system

Is a certified quality management system present?	yes no
If so, according to which standard(s)?
If not, are there plans to certify such a system? If so, by when?	yes no
Are company areas exempt from the existing QM system? If so, which ones?	yes no
Are audits by B&R possible?	yes no
If so, are individual areas exempt from this? If so, which ones?	yes no
Is there willingness to enter into a quality assurance agreement?	yes no

Securing the quality of purchased parts

Which of these methods are used to ensure the quality of purchased parts or raw materials?
Random sample inspection upon delivery	First article inspection
Works test certificate	Quality assurance agreements
Audits at the supplier	Quality objective agreements
Other

Inspections during production

Are complete plans for ensuring production quality available?	yes no
What level of inspection is applied?

Final inspection

Are complete plans for ensuring production quality available?	yes no
What level of inspection is applied?

Sampling

Are initial sample inspection reports provided?	yes no

Inspection of faulty material

Are testing/analysis options available for examining delivered products in fault event for their cause?	yes no
If so, what possibilities are there? Please provide additional information about whether this is carried out internally or through external service providers.

Corrective and preventative measures

Which methods are used for problem solving?
How are faults and claims analyzed and what measures are taken to prevent any reoccurrence?
Is there a continual improvement process?	yes no

Claim process

Description of the organizational procedure of claim processing
Internal goal for the duration of claim processing	Calendar days
Is an 8D report provided on request for a claim?	yes no
How is the traceability of your products / services ensured?

Quality performance

Product group	Delivery quality [ppm]	Warranty quota [ppm]	Typical faults

Development & construction

Is there a documented change management process?	yes no
How and when are customers informed about product changes / cancellations?
Is there a documented requirements management process?	yes no

Production

Is there in-house production where all products are manufactured?	yes no
Does "brand-label" production exist?	yes no
If not, is there different type? (short description)
Are there production procedures that are performed by external companies? If so, which ones?	yes no

Purchasing & logistics

Is there willingness to enter into a framework supply contract and logistics agreements?	yes no
Is there willingness to enter into a non-disclosure agreement?	yes no
What types of logistics solutions (e.g. forecast, safety stock, consignment, etc.) can be offered?
Which ERP/PPS system is being used?
Is it possible to use Electronic Data Exchange (EDI)? If so, which documents?	yes no
Is there willingness to participate in Evaluated Receipts Settlement (ERS)?	yes no
To what degree are customers informed of delivery delays?
Is there an early-warning system in the event of a delivery delay? If so, please provide a description.	yes no
How would you guarantee deliveries to B&R in the case of emergency (e.g. loss of preliminary deliveries, machines and/or loss of personnel)?
How are cost reduction potentialities determined / communicated?
Is there the possibility to carry out brand-labeling for OEM customers?

Product liability insurance

Is there an extended product liability insurance?	yes no
If so, the total sum that is covered by the expanded product liability insurance
- bodily injury	/ year
- pure financial loss	/ year
- property damage	/ year
Is there worldwide coverage?	yes no

Health, security and protection of people and the environment

Is there a certified environment management system available? If so, according to which standard(s)?	yes no
Is a certified health and safety management system available? If so, according to which standard(s)?	yes no
Does the company acknowledge a corporate code of social responsibility (code of conduct)? If so, which one?	yes no
Is there willingness to agree on a code of conduct with B&R?	yes no
Is there a guideline available on DRC conflict-free purchasing? DRC = Democratic Republic of the Congo. Please consult the standards of the Dodd Frank Act: A provision of the U.S. "Dodd-Frank Act"* states that we as a company must provide documentation to ensure that sourced products do not contain "conflict minerals". "Conflict minerals" are minerals (tantalum, tin, gold, tungsten) that are mined in the Democratic Republic of the Congo or in a neighboring country under the control of armed groups whose sale is used to finance the ongoing conflict in this region.	yes no
Is there corresponding information made available in accordance with Guideline IPC-1755 Conflict Minerals Data Exchange Standard (in the form of a CFSI Conflict Minerals Reporting Template)? If so, on what level (company level, product level, user defined)?	yes no

Regulations, guidelines, standards

Do the products fall into the range of application defined in the currently valid REACH regulation? If so, are these items or substances?	yes no items substances
Are there processes for complying with the requirements of the REACH regulation available?	yes no
Do the products fall into the application range of the currently valid RoHS directive?	yes no
If not, will a confirmation be made available to comply with the substance prohibitions in accordance with the RoHS directive?	yes no
Is information provided about the used exceptions of substance restrictions made in accordance with Annex III of the RoHS directive?	yes no
Is there willingness to declare substances in a manner that goes beyond the requirements defined in the REACH regulation and RoHS guideline?	yes no

Attached documents

Please provide a copy of the following documents:
Company profile	Organization chart
Company report	ISO 9001 certificate
Linecard	ISO / TS 16949 certificate
OHSAS 18001 certificate	ISO 14001 certificate
Quality policies	Environmental policies
Code of conduct	RoHS and REACH explanation
Annex 1 for supplier facilities
Remarks:

,
..........................................................
Signature ,
Name and title in block letters

Annex 1 master data for supplier facilities

Biller data

Full company name
Street / house number
Post code / location
Optional P.O. box
Optional post code / location for P.O. box
Country
Telephone + extension
Fax – extension
Contact person + EMAIL address
WEBSITE
Value added tax identification numbers (VAT ID) + countries
Optional account book no. / commercial registry no.
Optional RMA process for returned goods present If so, contact person + EMAIL address	Yes No

If different from order address data

Full company name
Street / house number
Post code / location
Optional P.O. box
Optional post code / location for P.O. box
Country
Telephone + extension
Fax – extension
Contact person + EMAIL address
WEBSITE
Value added tax identification numbers (VAT ID) + countries
Optional account book no. / commercial registry no.

If different from supplying company data

Full company name
Street / house number
Post code / location
Optional P.O. box
Optional post code / location for P.O. box
Country
Telephone + extension
Fax – extension
Contact person + EMAIL address
WEBSITE
Value added tax identification numbers (VAT ID) + countries
Optional account book no. / commercial registry no.

Payment transactions

Currency 1 (e.g. EUR, USD, etc.)
Name and address of the account-operating financial institution
IBAN no.
BIC / SWIFT CODE
Optional account number
Optional bank code
Currency 2 (e.g. EUR, USD, etc.)
Name and address of the account-operating financial institution
IBAN no.
BIC / SWIFT CODE
Name and address of the account-operating financial institution
Optional account number
Optional bank code