Supplier Pre-Assessment Survey (Supplier Copy)

Supplier Information (completed by supplier)

John Deere Assessment Information (completed by John Deere)

Supplier Name

John Deere Team Lead

Street Address
City/State/Zip Code

Unit / Location

Country

E-mail

Primary EHS Contact

Position Title

John Deere Team Member

Phone Number
E-mail

Unit / Location

Secondary EHS Contact

Position Title
Phone Number

E-mail

E-mail
John Deere Team Member

Property Owned, Leased, Rented (list site/facility owner)

Facility Ownership: Private, Incorporated, Subsidiary (list parent
company)

Unit / Location

Size of Facility / Percent Developed

Length of Time in Business

E-mail

Number of Employees / Hours of Operation

Plating

Painting

Heat Treat

Shot Blast

Phosphate

Pickling

Paint Stripping/Coating Removal

Fabrication

Grinding

Assembly

Chromate Conversion

(Complete section if you provide any of the following services)

Type of Facility, Process or Service Direct to John Deere (Tier 1) Rework

John Deere Team Member

Unit / Location

Other (please list):

E-mail

Other (please list):

If you provide painting/coating services on John Deere owned

parts, materials, or components, please list the name of the paint Please List:
material supplier/s. *Includes primer, topcoat, liquid, powder, ecoat.

Date of Assessment

Please List:

If painting/coating services are outsourced, please list the name of Please List:
the paint material supplier/s (tier 1 to supplier).
Primary John Deere Units Using Supplier
List all other John Deere work outsourced

COMPLETE SECTION IF YOU PROVIDE ANY TREATMENT, STORAGE, DISPOSAL OF WASTE OR RECYCLING SERVICES FOR JOHN DEERE LISTED BELOW:
Hazardous (RCRA/Local Hazardous)
Type of Waste Accepted:

Industrial/ Special Waste (or Equivalent)

Municipal-like Waste (or Equivalent)
Industrial Waste Landfill
Municipal Solid Waste Landfill Only
Battery Processor
Fuel Blender
Tire Processor
Sorbent Recycler

Type of Facility:

Computer/ Electronics Demanufactuer

Glass Processor
PCB/ Mercury Processor
Wood/Paper/ Cardboard Recycler
Plastic Recycler
Flourescent Tube Processor
Drum/ Tote Reclaimer
Industrial Wastewaster Treatment
Name

Registrations, Permits, Certifications, or Government Approvals

(List applicable registrations, permits, certifications, or government
approvals (includes EHS, Fire Protection, EIS - Environmental
Impact Statement)

Expiration Date

Signature - Team Lead

Environmental Certification (ISO 14001)?
Health & Safety Certification (ISO 18001, SA 8000)?

John Deere Supplier Environmental Assessment

x
Interview Questions

Is supplier aware of the "John Deere Restricted Materials List for

Suppliers", and knows where to access the list?

Does supplier have procedures to verify (by inspection and testing)

that no products are manufactured or supplied to John Deere
containing substances in excess of the amounts listed on the "John
Deere Restricted Material List for Suppliers"?

Has the supplier communicated to their suppliers their requirement to

conform to the "John Deere Restricted Materials List for Suppliers"?

Is supplier in compliance with the "John Deere Restricted Material

List for Suppliers" and any other applicable laws restricting
substances in products, components, or materials manufactured or
supplied to John Deere?

Scoring Criteria

Yes/No

Floor
Verificatio
n

Interview

Restricted Materials Compliance (Not applicable for TSDF - Treatment, Storage, Disposal Facilities)
Example Supporting Evidence / Notes

Interview Questions

Not applicable (N/A) *Enter

"X" into cell if N/A

What is supplier share of direct business with John Deere (% of

business as Tier 1 direct supplier)?

Less then 10%

10%-30%

Greater than 30%

Who are other customers?

Fortune 500 companies, large

businesses, government entities

Municipalities or other small

privately owned businesses

Small privately owned businesses

What type of insurance does the supplier have for the business?

General and environmental liability

insurance

General liability insurance only

No insurance

Does the company have environmental reserves (closure and postclosure financial assurance requirements)?

Adequate closure and post-closure funds

Minimal closure and post-closure

funds

No closure or post-closure funds

What is the financial condition of the business?

Positive net income and large parent

company

Negative net income and large

parent company

Small privately owned company

What are the approximate annual net sales of the business?

Greater than $15 Million

Between $5-$15 Million

Less than $5 Million

Average Section Score - Business and Financial:

Score (1,3,5)

0.0

Floor
Verification

Scoring Criteria
B

Interview

Business and Financial

Example Supporting Evidence / Notes

Interview Questions

Not applicable (N/A) *Enter

"X" into cell if N/A

What is the former history of this property?

Previous site owner(s) identified & no

evidence of contamination. Site
previously undeveloped or used for
agriculture

Previous site owner(s) identified &

contamination remediated

Previous site owner(s) identified & site

contamination still present

Has there ever been any onsite waste disposal on this property?

No historic onsite waste disposal

No known historic onsite waste

disposal

Potential for historic onsite waste disposal

What are the surrounding properties of this facility?

Residential housing or other

No residential housing or other sensitive
Residential housing or other sensitive land
sensitive land use areas (e.g.
land use areas (e.g. wetlands, natural
use areas (e.g. wetlands, natural
wetlands, natural preserves) within 1
preserves) within 3 miles of facility
preserves) adjacent to facility
mile of facility

Are there subleasors performing work on the property?

No subleasors on property

Minimal subleasors on property

Has the facility received any governmental violations for

environmental compliance?

No violations ever
received/administrative/paperwork
violations greater than 5 years ago

Administrative/paperwork violations Significant violations received during the

during the past 5 years
past 5 years

Has the facility received a consent decree (agreed judgment),

enforcement or corrective actions from a government entity for
environmental compliance reasons?

No consent decree, agreed judgment or

Consent decree(s) issued / agreed
corrective action ever received/consent Consent decree(s) / agreed
judgment / corrective action required, but
decree(s) / corrective action received and judgment / corrective action ongoing
facility has not started correction process
resolved

Has the facility received any type of significant enforcement actions

by an agency/authority, or citizen actions or complaints?

No significant agency enforcement or

citizen actions or complaints

Average Section Score - Site History / Environmental Performance:

Score (1,3,5)

Multiple subleasors on property

Enforcement and/or citizen actions Current enforcement by an agency or

or complaints in the past (> 3 years) citizen action or complaint (< 3 years)

0.0

Interview

Scoring Criteria
C

Floor
Verification

Site History / Environmental Performance

Example Supporting Evidence / Notes

Interview Questions

Not applicable (N/A) *Enter

"X" into cell if N/A

Does the facility have underground tanks on site?

Underground tanks present, no evidence Underground tanks present, no

of leakage, leak detection mechanism in evidence of leakage, no leak
place
detection in place

Leaking underground tanks present

Does the facility have aboveground tanks?

Aboveground tanks present, no

Aboveground tanks present, no evidence
evidence of leakage, no regular
of leakage, regular integrity assessments
integrity testing

Leaking aboveground tanks present

Does the facility have on-site: Landfill, Land Treatment, Land

Disposal, Impoundments, Ponds, Pits, Piles?

Double-lined units at site

Single-lined units at site

Unlined units at site

Does the facility have Incinerators?

Gas-fired incinerator present with

continuous emission monitors

Gas-fired incinerator present without

Liquid-waste fired incinerator present
continuous emission monitors

Does the facility have a waste/residue acceptance plan/procedure?

Waste/residue acceptance plan and

sampling procedures in place

Waste/residue acceptance plan in

place

What is the final disposition of any wastes/residues?

Wastes are disposed of on-site in double

Wastes are disposed of off-site at a
Wastes are disposed of off-site at
lined units and the facility has all proper
vendor that has not been
JD approved waste disposal vendor
authorizations
reviewed/approved by JD

Average Section Score - Site Operations

Score (1,3,5)

No waste/residue acceptance plan

0.0

Interview

Scoring Criteria
D

Floor
Verification

Site Operations (Completed for TSDF - Treatment, Storage, Disposal Facilities)

Example Supporting Evidence / Notes

Interview Questions

Not applicable (N/A) *Enter

"X" into cell if N/A

Does the facility have resources onsite to manage environmental

compliance?

Designated person(s) with greater than

50% time devoted to environmental
activities

Designated person(s) with 20% Facility has no designated environmental

50% time devoted to environmental staff, or utilizes a 3rd party consultant for
management activities
environmental management activities

Does the facility have an Environmental Management System in

place to manage environmental aspects and compliance?

Formal management systems (e.g.

policies and procedures, ISO 14001) in
place

Informal management systems (e.g.

Few to no management systems (e.g.
policies and procedures); in process
policies and procedures) in place
of developing formal systems

Does the facility understand environmental roles and responsibilities,

and environmental impacts relating to the operations?

Environmental roles and responsibilities

clearly defined and communicated,
environmental impacts are known

Environmental roles and

responsibilities informal but
generally understood, some
understanding of environmental
impacts

Environmental roles and responsibilities

are not defined or communicated, facility
is not aware of environmental impacts
from operations

Does the facility provide environmental awareness, or health and

safety training?

Employee training is well implemented

and employees are aware of
environmental risks

Some informal environmental

training provided, employees have
basic awareness

No environmental training is provided,

employees are not aware of
environmental risks

Does the facility use or rely on subcontractors for work?

Use of subcontractors is minimal

and/or for low risk jobs.
Use of subcontractors is none to minimal Management of subcontractors is
informal; work performance is
periodically monitored

Has the facility obtained applicable permits, licenses, registrations

and government approvals?

Applicable permits obtained and/or

exemptions and other supporting
documentation on file

Does facility have environmental sustainability program, or recycling

imitative in place (pollution prevention and resource reduction)?

Facility has implemented formal recycling

Informal recycling or resource
imitative, or program to reduce waste,
reduction program in place
energy and water consumption

Average Section Score - Facility Management and Organization

Score (1,3,5)

Use of subcontractors is extensive, and

they are performing moderate to high-risk
jobs. Management of subcontractors is
informal or does not regularly occur; work
performance is not regularly monitored

Not all applicable permits obtained; Few to no permits obtained; minimal

permit applications in process
understanding of requirements

No sustainability imitative, recycling or

resource reduction programs in place

0.0

Interview

Scoring Criteria
E

Floor
Verification

Facility Management and Organization

Example Supporting Evidence / Notes

Interview Questions

Not applicable (N/A) *Enter

"X" into cell if N/A

Does the facility have sources of air emissions from operations and
manufacturing, and is the facility aware of the sources?

Most to all air emission sources known

and identified

Minimal understanding of facility air

Some air emissions sources known
emission requirements / air emissions
and identified
sources not identified

Does the facility have pollution control equipment in place?

Equipment in place, maintained and in

good working condition

Some equipment in place, or in

process of installing equipment

Do facility operations require government permits, licenses,

registrations, or environmental impact statements?

Applicable permits/licenses/registrations Not all applicable

obtained, and/or exemptions and other
permits/licenses/registrations
supporting documentation are on file
obtained; applications in process

Few to no permits/licenses/registrations in
place; minimal understanding of
requirements

Does the facility keep, or required to keep an inventory, record or

monitoring analysis of air emission/atmospheric emission sources
exhausted from their operations?

Informal tracking of air emissions

Air emissions inventory or records are
inventory or records exists, and
tracked and in place. Facility is aware of
facility generally aware of emission
emission sources.
sources

No air emission inventory or records are

tracked or managed, and facility is not
aware of emission sources

Does the facility have procedures in place to monitor and manage air
emissions/atmospheric emission measuring requirements?

Formal procedures in place to monitor

compliance with applicable standards

Average Section Score - Air Quality and Pollution Control:

Informal procedures in place, or

being developed to monitor
compliance with applicable
standards

Score (1,3,5)

No equipment in place, or inadequate

equipment, bad working condition

No procedures in place or being

developed to monitor compliance with
applicable standards

0.0

Interview

Scoring Criteria
E

Floor
Verification

Air Quality and Pollution Control

Example Supporting Evidence / Notes

Interview Questions

Not applicable (N/A) *Enter

"X" into cell if N/A

Does the facility have sources of industrial wastewater from its

processes or operations?

All water/wastewater discharge sources

known and identified

Most water/wastewater discharge

sources known and identified

Minimal understanding of facility

water/wastewater requirements, discharge
sources not identified

Does the facility monitor and/or discharge any industrial wastewater

from its operations?

No offsite discharge of wastewater

Wastewater is monitored and

discharged to an offsite regulated
treatment facility

Wastewater is monitored and discharged

to a stream, river, lake before or after pretreatment

Is the facility required to characterize the industrial wastewater of its

operations (physical and chemical characteristics, wastewater
analysis reports, records)?

Wastewater is characterized and

monitored. Facility is aware of sources.

Informal / incomplete
characterization of wastewater
exists, and facility generally aware
of sources

Wastewater is not characterized, and

facility is not aware of sources

Do facility operations require government permits, licenses,

registrations, or environmental impact statements?

Applicable permits/licenses/registrations Not all applicable

obtained, and/or exemptions and other
permits/licenses/registrations
supporting documentation are on file
obtained; applications in process

Does facility understand wastewater treatment requirements for its

operations to ensure legal requirements are met?

Knowledge of wastewater requirements

and regulations understood

Knowledge of wastewater
requirements and regulations
generally known

Does supplier have storm water management or protection measures

in place (if applicable)?

No industrial sources of potential storm

water contamination are stored outside
(drums, containers, oils, chemicals, or
construction activity)

Storm water protection requirements Storm water protection requirements

applicable; Facility plan in place and applicable; Facility does not have required
implemented
permit, certificate or license in place

Is groundwater monitoring conducted on property (if required or

applicable)?

Groundwater is monitored, legal

requirements are met, or not applicable
or required

Groundwater is monitored,
corrective action in place to meet
legal requirements

Average Section Score - Water/Wastewater and Pollution Control:

Score (1,3,5)

Few to no permits/licenses/registrations in
place; minimal understanding of
requirements

Limited knowledge of wastewater

requirements

Groundwater is not being monitored, legal

requirements are not being met

0.0

Interview

Scoring Criteria
F

Floor
Verification

Water/Wastewater and Pollution Control

Example Supporting Evidence / Notes

Interview Questions

Not applicable (N/A) *Enter

"X" into cell if N/A

What are the types and volumes of chemicals used at the facility?

Some hazardous chemicals used, Variety of toxic and hazardous chemicals

Few chemicals used and small amounts
generates moderate amounts of
used, large volumes of hazardous waste
of waste generated (< 100 kg of
waste (between 100 and 1000 kg of generated (> 1000 kg of hazardous
hazardous waste / month)
hazardous waste / month)
waste / month)

Is storage of waste managed in a way to prevent onsite

contamination or releases to the environment?

Minimal or no waste stored onsite,

containment in place to prevent
accidental spills

Moderate amounts of waste stored

onsite, some precautions in place to Large amounts of waste being stored
prevent accidental releases or
onsite, potential exposures to accidental
contamination (spill kits, storage,
releases or contamination exist
containment)

Does the facility characterize and identify the waste onsite (list types
of chemical and solid wastes, can determine if wastes hazardous or
non-hazardous) ?

All waste is identified and characterized

as hazardous or non-hazardous

Some sources of waste identified or Facility has no method to determine if

characterized
waste is hazardous or non-hazardous

Does the facility dispose of waste onsite?

No onsite waste disposal of any type;

facility uses a disposal company to
remove the waste for disposal

Minimal onsite waste disposal,

mostly limited to nonhazardous
waste

Onsite waste disposal occurs (permit or

no permit)

Wastes are segregated; facility can

identify where waste is generated from;
Some waste recycled

Some waste streams are

segregated; some ability to identify
where waste generated from

Facility does not segregate waste; waste

products are mixed together; No ability to
identify where waste generated from

Does the facility segregate the waste generated onsite?

Does the facility conduct audits or reviews of their offsite waste

disposal vendors/suppliers (treatment, storage, disposal)?

Average Section Score - Solid and Hazardous Waste Management:

Audits/reviews are conducted on vendors

Informal reviews or meetings are
who treat, store and dispose of waste;
conducted on vendors who treat,
regular onsite inspections or reviews are
store and dispose of waste
conducted

Score (1,3,5)

No audits/reviews are conducted on

vendors who treat, store and dispose of
waste

0.0

Interview

Scoring Criteria
G

Floor
Verification

Solid and Hazardous Waste Management

Example Supporting Evidence / Notes

Interview Questions

Not applicable (N/A) *Enter

"X" into cell if N/A

Moderate quantities of oil and/or

hazardous chemicals stored
above/below ground

Does facility store chemicals or hazardous waste onsite?

Small quantities of oil and/or hazardous

chemicals stored above/below ground

Does facility have underground storage tanks onsite?

No underground tanks at site, or

Underground tanks present, no
underground tanks present; no evidence evidence of leakage, no leak
of leakage, leak detection and testing
detection or testing mechanism in
mechanism in place
place

What is the condition of containers and drums storing chemicals or

waste?

No leaks; condition of containers or

No leaks; condition of containers is Containers or drums are leaking, tipped
drums is good; labels visible with ability to fair; not all containers or drums have over and in poor condition; no labeling in
identify material
labels
place on containers or drums

Does facility have appropriate secondary containment?

Secondary containment for aboveground Some secondary containment in

containers in place
place

No secondary containment for

aboveground containers

Does facility have security measures in place on property?

Secure facility (e.g. fencing, lighting,

cameras, security guards)

No security measures in place (e.g. no

fencing, accessible storage tanks)

Does the facility have emergency response or spill equipment in

place?

Sufficient spill containment / control / PPE

equipment available (fire extinguishers, Some spill containment / control /
spill kits); emergency exits are visible and PPE equipment available
not blocked

Is facility required to have Spill Prevention Control and

Countermeasures plan (oil pollution prevention)?

Requirements not applicable

What is facility spill history (releases to environment)?

None, or very few spills or releases to the Facility has some history of spills or Facility has large number of spills or
environment
releases to the environment
releases to the environment

Does facility have emergency response plan in place?

Emergency response plan in place (fire,

weather, explosion, spills, etc.); periodic
drills with employees conducted

Average Section Score - Spill Control and Emergency Planning:

Some security measures in place,

but still have potential exposures

Requirements applicable; spill

prevention plan implemented

Emergency response plan (fire,

weather, explosion, spills, etc.) in
place, no regular drills conducted
with employees

Score (1,3,5)

Large quantities of oil and/or hazardous

chemicals stored above/below ground

Underground tanks present, evidence of

leakage, no testing mechanism in place
to detect leaks or tank integrity

Inadequate or no spill containment /

control / PPE equipment; emergency exits
are locked, blocked and not accessible for
emergency exit

Requirements applicable; no spill

prevention plan addressed or
implemented

Facility does not have documented

emergency response plan (fire, weather,
explosion, spills, etc.)

0.0

Interview

Scoring Criteria
H

Floor
Verification

Spill Control and Emergency Planning

Example Supporting Evidence / Notes