omron green procurement standards

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Omron Green Procurement Standards Aiming to become a responsible and environmentally friendly corporate citizen Ver. 4.1, March 2014 OMRON CORPORATION

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Page 1: Omron Green Procurement Standards

Omron Green Procurement Standards

Aiming to become a responsible and environmentally friendly corporate citizen

Ver. 4.1, March 2014 OMRON CORPORATION

Page 2: Omron Green Procurement Standards

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Table of Contents

Foreword ...............P2

Chapter 1 Omron’s Environmental Activities

1. Purchasing Policies ...............P3

2. CSR Action Guideline ...............P4

Chapter 2 Omron’s Green Procurement Activities

1. Objectives ...............P5

2. Scope ...............P5

3. Requirements ...............P6

Chapter 3 Procedure for Qualification of “Green Supplier”

1. Process of Qualification ...............P8

2. Operation Flow ...............P9

Chapter 4 Guide to Entry

1. Application for qualification of Green Supplier ...............P10

Chapter 5 Terms of Definitions ...............P12

Chapter 6 Revision History ...............P13

Attachment 1: Environmental Control Surveillance Sheet ...............P14

Attachment 2: Self-audit sheet of Chemical Management System for supplier..P15

Attachment 3: Certificate of Non-inclusion for Regulated Substances....P19

Attachment 4: Declaration of Phase-out of Regulated Substances...........P20

Attachment 5: Green Procurement (Former JGPSSI) Survey Response Tools..P21

Attachment 6: JAMP Information Transmission Sheet (AIS) ...............P22

Attachment 7: JAMP Information Transmission Sheet (MSDSplus).......P23

Attachment 8: Application for Qualification of Green Supplier (New/Renew) ..P24

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Foreword

Omron Group (hereinafter referred to as “Omron”) recognizes that the global

environmental issues are the greatest challenge common to human beings. Standing on the

firm belief, we established “Group Environmental Policies” in 1996 and “Green Omron 21”

as an environmentally conscious management prospect in 2002, and have worked on the

promotion activities of environmentally conscious management. We promoted this activity

furthermore as “Green Omron 2020”, and have been working on the contribution to the

sustainable recycling-based society. In this activity, we have been promoting Green

Procurement with the aim of realization of “Eco-products” which means to provide

environmentally-warranted products to the customers.

In Omron’s Green Procurement, we have positioned “Ecology (reduction of

environmental burden)” and “Compliance (compliance with laws and regulations/social

norms)” as important policies for the supply chain, and have actively been working on them.

Green Procurement is unable to promote without support from suppliers. We will greatly

appreciate the continued understanding and cooperation from our suppliers in the future.

March 2014

Senior General Manager

Global Manufacturing Innovation Headquarters

OMRON Corporation

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Chapter 1 Omron’s Environmental Activities

1. Purchasing Policies Omron has a corporate motto, “At work for a better life, a better world for all,” and a corporate

principle that is based on the belief that “Working for the benefit of society”. These thoughts reflect

our hope of contributing to the development of society and reduction of environmental burden,

through the corporate activities and provision of products that satisfy our customers.

In line with our spirit, we state the purchasing policies as follows. We greatly appreciate the

continued support from suppliers in order for us to create the products that are trusted even more

strongly by our customers, and to fulfill our Corporate Social Responsibilities (CSR) in carrying out

all business activities.

Basic Policies <OPEN>: Our procurement is based on an “open” policy and the principles of free

competition. We are willing to provide any supplier, regardless of nationality, company size,

previous business relationship or lack thereof, and any other status with an

opportunity to join us based on the principles of free competition. Positive and

excellent suggestions and presentations are welcome.

<FAIR>: We place importance on partnership based on fairness and equality. In procuring component materials and services, we will select suppliers in a fair

manner by not only taking into consideration product quality, price, delivery period,

environmental conservation, technologies and healthy business management, but also

by adding such items as compliance with laws, ordinances, and social standards.

<GLOBAL>: We seek good international partners. From an international perspective, we will procure outstanding materials, parts and

services from sources all over the world, in the optimal regions.

Key Policies <ECOLOGY>: We carry out purchasing and procurement activities that contribute

to reducing adverse impact on the global environment. We will actively use materials and parts that do not contain hazardous chemical

substances, and promote “green” procurement that contributes to reducing any

adverse impact on the environment.

<COMPLIANCE>: We strictly comply with laws, ordinances, and social standards by maintaining a high level of morality. Based on Omron Group’s CSR Action Guidelines (refer to next page), we will

strictly observe laws, ordinances and social standards related to purchasing and

procurement activities, and build partnerships with our suppliers. Moreover,

we will appropriately manage and protect supplier’s confidential and personal

information which we had obtained through our purchasing and procurement

activities.

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2. CSR Action Guideline We do our best to conduct corporate activities that remain true to the Omron principles, according

to the sense of value and the policy established in the “Management Principles,” “Management

Commitments” and “Guiding Principles for Action” for all employees to share and follow. The

“Management commitments” stipulate in the “Awareness and Practices of Corporate Citizenship”

that we contribute to the economic and cultural growth of local society as a member of the

international society and make all-out efforts to protect and preserve resources and the environment.

In order to realize management for corporate social responsibility shown in the Management

Commitments, we established the CSR Action Guideline in November 2006 to specifically show

what we should do for that purpose. The basic policies for the environment stated in the Policy are

“environmentally conscious business activities” and “environmental conservation activities.”

In line with these basic policies, we endeavor to create products and technology kind to the

environment as we conduct business activities, thereby trying to simultaneously fulfill the two

objectives of “ecology” and “economy”. Every employee and director at Omron is also determined

to respect environmental conservation in our daily activities outside work as part of our efforts to

help solve social issues related to the environment.

CSR Practice Guidelines Environmental Activities

1. Environmental Activities Throughout our operations with respect to research and development, production, sales, administration and after-sales service, we will undertake environmental activities such as energy and natural resource conservation, reducing waste, discontinuing or reducing use of hazardous materials, reclaiming unused products and recycling.

2. Compliance with Environmental Regulations We must properly understand and comply with all applicable environmental laws, national and local regulations, and other governmental requirements and agreements for preserving the environment and protecting it against industrial pollutants.

3. Compliance with International Standards We will establish an environmental management system to achieve conformance with international standards. We will maintain relevant environmental standard certifications.

4. Environmental Learning We will actively acquire and seek to master knowledge regarding the preservation of the environment in order to apply that knowledge toward reducing the environmental impact of our business activities.

Environmental Conservation Activities

1 Voluntary Environmental Conservation We will strive to lessen the environmental impact of our private activities and participate in community programs for environmental conservation.

2 Active Participation in the Company’s Environmental Activities We will actively participate in environmental conservation activities organized and carried out by the company or its departments as part of our social contributions.

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Chapter 2 Omron’s Green Procurement Activities

1. Objectives We purchase the raw materials, parts, subsidiary materials, packing and packaging materials,

semi-finished and finished products, etc. (hereinafter referred to as “parts and materials”) to

manufacture products from many suppliers.

In recent years the laws and regulations for control of chemical substances have been tightened

both in Japan and abroad from the viewpoint of environmental pollution and consumer protection.

As a result, the number of customer requirements regarding provision of “products with a warranty

of regulated chemical substance control” has increased. To meet such needs, we have added the

“Control of chemical substances in products” to the selection conditions of supplier in addition to

“Quality, Delivery and Cost” and “Environmentally conscious business operation”. We will certify

the suppliers satisfying these standards as “Green Supplier”. We would like to ask our suppliers to

understand “Omron’s Green Procurement Standards (ver. 4.1)” and comply with the requirements

specified therein.

2. Scope

2.1 Suppliers covered by these standards These standards apply to the primary suppliers supplying the parts and materials (refer to

paragraph 2.2 “Parts and materials covered by these standards”) for our products (including the

products of Omron’s group companies). The primary supplier includes the supplier to whom the

assembly of products or intermediate products is outsourced.

In addition, the primary suppliers are required to inform their subcontractors with the

requirements of “Omron Green Procurement Standards” and “Investigation Manual for

Regulated Chemical Substances (latest version)” so as to build a chain of information

communication for control of chemical substances in products. Please note that these standards

may apply to the secondary suppliers as needed.

2.2 Parts and materials covered by these standards These standards apply to Omron products, and parts and materials composing the products, etc.

(1) The scope of products is described as follows:

1) Products that Omron designs/manufactures and sells;

2) Products that Omron commissions a third party to design/manufacture or buys from

other companies to sell under the name of Omron;

3) The products that Omron is commissioned the design/manufacture by a third party (the

parts and materials specified by the third party are excluded);

However, in such case that Omron sells other companies’ products under contrast, those

products that Omron has no responsibility for the design/manufacture are excluded from

the scope of these standards.

(2) Specific examples are described as follows:

1) Parts and materials (electronic parts, machined parts, raw materials, packing and

packaging materials, etc.);

2) Assembled parts including functional units/modules, board assembly;

3) Constituent materials such as subsidiary materials (solder materials, adhesives, inks,

grease, tapes, etc.);

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4) Instruction manuals;

5) Maintenance supplies and accessories (optical disk, SD Memory Card, cables, etc.);

The followings are excluded from the scope;

・ Parts and materials including other companies’ products used in the systems

(PCs and servers), which Omron has no responsibility regarding the

design/manufacture;

・ Packing and packaging materials that are used by suppliers for delivery, but are

not delivered to customers as constituting materials of the products,

・ Packing and packaging materials and boxes that are returned to Omron.

3. Requirements

We would like to request our suppliers of that the environmentally conscious business activities

are performed and the regulated chemical substances in delivery parts and materials comply with

laws and regulations and are managed certainly.

(1) Environmentally conscious business activities are conducted (Establishment of EMS): refer

to paragraph 3.1

(2) Chemical substances in delivery parts and materials (manufactured by suppliers) are

controllable and the information is able to be provided

1) Management System: refer to paragraph 3.2.1

2) Management Criteria: refer to paragraph 3.2.2

3) Information provision: refer to paragraph 3.2.3

We qualify the suppliers meeting the requirements above as “Green Supplier”.

3.1 Environmentally conscious business activities (Establishment of EMS) The suppliers are required to establish an Environmental Management System (EMS) in

consideration of the reduction of environmental burden, when conducting business activities.

* Establishment of Environmental Management System (either of 2 items below should be

satisfied)

(1) The EMS has acquired ISO 14001 certified by a third party, or EMAS certificate;

(2) Or, the EMS has acquired “Environmental Management Certification System” which is

recognized by Omron as equivalent to ISO 14001.

Examples: Eco-Action 21, etc

3.2 Control and information provision of chemical substances in delivery parts and materials from suppliers (Establishment of CMS)

3.2.1 Management System

In order to ensure the non-inclusion of those Banned substances/Intended uses and/or Non-use

substances/Intended uses specified in the latest “Investigation Manual for Regulated Chemical

Substances”, provided separately by Omron, the suppliers are required to establish the

management system of chemical substances based on “Guideline for the Management of

Chemical Substances in Products (after the ver. 2.0)” which is jointly issued from JAMP*1 and

JGPSSI*2. We will verify the management system of chemical substances at primary suppliers

by Chemical Management System (CMS*3) audit.

* Please refer to “Chapter 5 Definitions of terms”. *1 JAMP: Definitions of Terms, 5

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*2 JGPSSI: Definitions of Terms, 3 *3 CMS: Definitions of Terms, 2

(1) Purpose of CMS Audit

Our CMS auditors verify that the management system of regulated chemical substances at

suppliers meet acceptable level of Omron.

(2) Procedure for CMS Audit

1) Written confirmation

Please submit the “Environmental Control Surveillance Sheet (Attachment 1)” and

“Self-audit sheet of Chemical Management System for Supplier (Attachment 2)”,

provided separately by Omron.

2) On-site Investigation by Omron Auditors

After conducting written audit, our auditors will conduct the on-site investigation.

However, we may complete the evaluation process by written confirmation.

3.2.2 Management Criteria

“Investigation Manual for Regulated Chemical Substances” provided separately by Omron

defines control substances/intended uses and the management classification (Rank). The

suppliers are required to establish management system in which Banned Substances (A

rank) and Non-use Substances (A1 rank) defined in the latest “Investigation Manual for

Regulated Chemical Substances” are regarded as management criteria at suppliers.

* We may ask suppliers to correspond differently from above, depending on their business

and/or industry.

3.2.3 Information Provision

Please provide the following information.

(1) The content amount of chemical substance by using the format designated by Omron*

(2) Certificate of Non-inclusion for Regulated Substances (Attachment 3) or Declaration of

Phase-out of Regulated Substances (Attachment 4) designated by Omron

* The formats (standards) designated by Omron are shown as follows. Please correspond

to each format according to instructions from department in charge, at Omron.

・ JGPSSI (JIG/Omron’s “Investigation Manual for the Regulated Chemical

Substances”, Attachment 5)

・ JAMP-AIS (Attachment 6)/MSDSplus (Attachment 7)

・ JAMA/IMDS (GADSL)

・ Others: formats designated by Omron

3.3 Banning of ozone layer depleting substances in manufacturing processes Use of ozone layer depleting substances (as listed in the “Investigation Manual for Regulated

Chemical Substances”), which are conventionally used in the production process (such as

cleansing) of parts and materials, shall be banned.

* We may ask suppliers to correspond differently from above, depending on their business

and/or industry.

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Chapter 3 Procedure for Qualification of “Green Suppliers

1. Process of qualification

1.1 Confirmation of the requirements Suppliers are required to confirm that the requirements described in paragraph 3, Chapter 2 are satisfied.

1.2 Application Please apply with “Application for Qualification of Green Supplier (Attachment 8)” to the person in charge at Omron. Please refer to Chapter 4 for the entry method of “Application for Qualification of Green Supplier”. - Necessary Documents - (1) Application for Qualification of Green Supplier (2) Certificate of EMS issued by a third-party certification (examination) organization (copy of

the certificate) (3) Control substances list of the supplier

“Substance name”, “Management level*”, “Regulated value”, and “Intended use” should be stated.

* Management level means the level of management for chemical substances as “Banned” or “Grasp of contained amount/ratio”.

(4) Environmental Control Surveillance Sheet (Attachment 1) * If the supplier checked the box for the question I “Chemical Substances Management

System” to inform the self-declaration of conformance, the following documents will be required to be submitted.

1) A copy of the Self-Declaration of Conformance regarding management system of chemical substances in products

2) “Guidelines for the management of chemical substances in products ANNEX : LIST OF ACTION ITEMS AND CHECK SHEET”

(5) Self-audit sheet of Chemical Management System for supplier (Attachment 2)

1.3 Qualification by Omron (1) We will certify the supplier based on the information submitted as paragraph 1.2 Application,

Chapter 3 and the on-site investigation carried out by Omron’s auditors. In this connection, the supplier may be asked to present further information as needed.

(2) The results of qualification will be informed to the applicant supplier from the contact section-in-charge.

1.4 Renewal and cancellation of qualification We will confirm the status of qualified suppliers regarding the following 2 items. If the supplier has satisfied the qualification criteria, we will renew the qualification. If not, we have to cancel the qualification as a general rule. (1) Environmentally conscious business activities (Establishment of EMS)

If the third party certification for EMS is renewed, please send the copy of the certificate to Omron contact section-in-charge.

(2) Control of chemical substances in parts and materials (Establishment of CMS) We will confirm the actual control achievement of chemical substances in delivery parts and materials. As necessary, our contact section-in-charge will conduct CMS audit (written confirmation and/or on-site investigation).

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2. Operation Flow The procedure for qualification of suppliers shall be as shown in the following flow.

Items Omron Supplier

Public

announcement/Distribution (see below)

Receipt of results

Entry of the application, etc.

Notification of results, and registration on database

Accepted

・ Omron Green Procurement Standards

・ Investigation Manual for Regulated Chemical substances

・ (Manual for JAMP-AIS, MSDSplus)

・ Environmental Control Surveillance Sheet

・ Self-audit sheet of Chemical Management System for Supplier

・ Others

Qualification as Green Supplier

Evaluation as to whether the

application is accepted or

rejected

Confirmation of requirements 1) Establishment and maintenance

of EMS <Confirmation method> Confirming the acquisition status of EMS certificate by a third party

2) Reduction/Investigation and control activities of chemical substances in parts and materials

<Confirmation method> CMS audit ・ Written confirmation ・ On-site investigation by

Omron’s auditors

1) Application for Qualification of Green Supplier

2) Certificate for EMS by a third party certification organization (copy)

3) List of control substances 4) Environmental Control

Surveillance Sheet 5) Self-audit Sheet of Chemical

Management System for Supplier

Acceptance and update management

1) Establishment and maintenance of EMS

2) Reduction/investigation and control activities of chemical substances in pars and materials

Rejected

Submission of information

Judgment for qualification

Supplier’s “Environmentally conscious” and “Control of chemical substances in products” activities

Proposal and acceptance of requirements

Confirmation for qualification

Qualification of Green Supplier

Notice of qualification results

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Chapter 4 Guide to Entry

1. Application for Qualification of Green Supplier (New/Renewal)

1.1 Information of supplier (1) Date of Application

Please enter the date of application (YYYY/MM/DD)

Example: April 1, 2014 2014/04/01

(2) Company Name, and Name of the President

Please enter the company name and name of the president of supplier.

(3) Supplier Code No.

Please enter the code used for the transaction with Omron (e.g. 02XXXXXX, 66PXXXXX).

It is unnecessary for new applicant.

(4) Name of the person responsible for the application, Position/Department, TEL No., E-mail

Address

Please enter the information on the responsible person who is in a position to respond to our

inquiries raised during the examination of qualification of Green Supplier.

1.2 Check Items Please circle either of the answers in check cells in order to confirm compliance with the

qualification requirements.

(1) Establishment of Environmental Management System

1) If the third party certification for EMS has been acquired, please attach the copy of the

certificate issued from certification organization.

2) Please enter the detail of the certificate.

・ Documents title (eg. Certification, Registration No. etc)

-Name of the certification system: ISO 14001, EMAS, etc.

-Registration No.: Alpha-numeral (one-byte character)

・ Confirmed Date

-Date of Acquisition: YYYY/MM/DD (one-byte character)

・ Confirmed by (Certification body)

-Auditing organization: JQA, JACO, BVC, etc.

* Precaution

The scope of a third party certification shall be entered per company.

In the case that the supplier is a trading company and has not obtained the

certificate, it is not deemed to have obtained the certificate even if the

manufacturer supplying the parts and materials has obtained the third party

certification.

(2) Control of Contained Chemical Substances (Establishment of CMS)

1) Management System

Please enter whether you have established chemical substance management system

based on JAMP/JGPSSI “Guideline for the Management of Chemical Substances in

Products (after the ver. 2.0)” or not.

Please fill out the suitable date for on-site investigation by our auditors.

2) Management Criteria

Please enter whether the management criteria at your company compliant with that of

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Omron’s.

Please enter the version of “investigation Manual for Regulated Substances” that you

have received from Omron.

3) Information Provision

a. Please circle “Yes” or “No” on the available formats (standards) to report the content

of chemical substances in products delivered to Omron.

・ JGPSSI (JIG/Omron’s “Investigation Manual for Regulated Chemical

Substances”)

・ JAMP-AIS/MSDSplus

・ IMDS/JAMA (GADSL)

・ Others: formats designated by Omron

b. Please circle “Yes” or “No” for whether the supplier can submit “Certificate of

Non-inclusion for Regulated Substances” designated in “Investigation Manual for

Regulated Chemical Substances”.

* If the supplier is unable to submit the documents stated in a. and b. above, please

circle “Yes” or “No” for whether the substances and/or intended uses regulated by

EU RoHS are controlled.

(3) Banning of ozone layer depleting substances in manufacturing processes

Please enter the usage status of ozone layer depleting substances in manufacturing processes

of parts and materials (e.g. cleansing).

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Chapter 5 Definitions of Terms

1. EMAS EMAS stands for Eco-Management and Audit Scheme and is a set of EU regulations on environmental management and audit systems applied in the EU.

2. CMS (Chemical substances Management System in Products) CMS stands for Chemical Substances Management System in Products. This is to conduct appropriate control of chemical substances in products through various stages such as raw material procurement, production and shipment, in compliance with the international enhancement of regulations for use of chemical substances. (that is, the systematical activities such as investigation, analysis, evaluation, correction, and prevention in detail). We define and manage the chemical substances based on “Guideline for the Management of Chemical Substances in Products (second edition)” jointly issued from JAMP and JGPSSI. “CMS Audit” is to verify this management system.

3. JGPSSI JGPSSI stands for Japan Green Procurement Survey Standardization Initiative. This organization was established in January 2001 by corporations of the electric and electronic equipment industries in Japan. This organization has operated with the aim of reducing the workload of part and material surveys and improving the quality of responses, by standardizing the list of surveyed substances and the survey response format. JGPSSI expansively disbanded in May 2012 and transferred the main activities to IEC/TC111/VT62474 Japanese mirror committee.

4. IMDS IMDS stands for International Material Data System. This is a system to collect information on materials for automobiles and on the chemical substances contained therein.

5. JAMP JAMP stands for Joint Article Management Promotion-consortium. This is a inter-industrial organization intended to establish and promote a clearly defined and operable mechanism that ensures appropriate management of chemical substances contained in articles (defined herein to mean parts, materials and molded items) and smoothly disclose and transmit such information through the supply chain. JAMP proposes information transmission sheets for chemical substances contained in parts and materials (MSDSplus and AIS).

6. JIG JIG stands for Joint Industry Guide. This is a guideline designed to commonalize the control substances related to Green Procurement which was jointly issued from JGPSSI, EIA, and EICTA. Standards for the reporting and selection of substances stated in JIG were carried over into IEC62474. IEC62474 is a database of “Procedure for declaration of chemical substances in products” and “The list of declarable substances”, operated by IEC/TC111.

7. JAMA JAMA stands for Japan Automobile Manufactures Association. The standardized data sheet of JAMA/JAPIA is a component survey data sheet which was standardized consensually among JAMA and JAPIA (standing for Japan Auto Parts Industries Association).

8. GADSL GADSL stands for Global Automotive Declarable Substance List. This is a list of substances to exchange the information of substances of concern created by consensus decision of the group formed by automobile-related manufacturers in various countries.

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Chapter 6 Revision History

Green Procurement Standards is subject to change according to the future trend of legal control

and social movement.

Version Date of revision Major Points of Revision

Ver. A May 2001 Original (established)

Ver. 2.0 May 2004 Amendment of requirement for qualification, documents to be submitted, etc.

Ver. 2.01 July 2004 Responsible Managing Officer has Changed.

Ver. 2.02 October 2005 P9 (Note): The statement that “Investigation Manual for the Regulated Chemical Substances” can be seen on Omron’s environmental web site is deleted due to discontinuation of posting.

Ver. 2.03 February 2006 P.11: -Version No. of the “Investigation Manual for the Regulated Chemical Substances” described in the “Certificate of Non-inclusion for Regulated Substances” is changed to 1.1. -“Omron’s Prohibited Substances” are changed to 64 substance groups. P.13 to 15: “Survey Form for Regulated Chemical Substances, Sheets 1 through 3” is changed. (Manual version 1.1)

Ver. 2.1 December 2008 Omron’s environmental activities were updated. The list of third-party certification organizations was updated. Descriptions were completely reviewed. Attachments were updated.

Ver. 3.0 April 2011 Qualification requirements: Survey sheets 1 to 3 replaced by JGPSSI survey format Qualification requirements: Use of IMDS permitted for automobile parts and materials specified Requirement: Prohibition of ozone depleting substances in production processes added Requirement: Transmission of information with JAMP (AIS, MSDSplus) added Certification systems or organizations that satisfy the qualification requirements added

Ver. 4.0 September 2013 Update of the contents of “Foreword” Chapter 1: Addition of the purchasing policies Chapter 2: Addition of requirements As requirements for suppliers, establishment of chemical substance management system based on the “Guideline for the Management of Chemical Substances in Products” was added. Chapter 3 and 4 Certification process and fill-in items were changed in response to implementation of confirmation for establishment status of chemical substance management system.

Ver. 4.1 March 2014 Review of the expression of the descriptions

Omron Green Procurement Standard Version 4.1

Issued in May 2001 Revised in March 2014 Issued by Omron Corporation Global Manufacturing Innovation Headquarters

Purchasing Process Innovation Center Quality Innovation Center Environment Innovation Center

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Attachment 1 Environmental Control Surveillance Sheet

TO : Omron Corporation

(Include Omron Group Companies)Approver Superior Surveyor

Environmental Control Surveillance Sheet

Department

Title

Name

Contact Information E-mail TEL No.Note : Please submit again if any changes.

Please answer the question No.1-4.

It is not declared.

Management System/Standard Name

QMS (ISO9001, etc.)EMS (ISO14001, etc.)IECQC080000

Yes/No

Omron Control No.

ICP (Inductively-Coupled Plasma optical emission spectrometry) analysis capabilityNo potential at every manufacturing sites It is performed at a part of manufacturing sites

In the case that banned substances are used, please report the name, the reason, and the mixing prevention measure.

In the case that banned substances are used, please report the subject plant (manufacturer).

* This survey sheet is Omron's green procurement work use only. Please submit it with your agreement.

4. Other Confirmation Items

Not confirmed yet

No.3 Certification audit for QMS and EMS    Please fill out the certification performances. Copy of certification reports are attached with this sheet.

*1 : Self-Declaration means that Chemical Substances Management System conforms to "Guidelines for the Management ofChemical Substances in Products" published by JAMP (Joint Article Management Promotion-consortium) and JGPSSI (JapanGreen Procurement Survey Standardization Initiative).Please refer to the following URL for "Self-Declaration of Conformance".

Mixed production ofBanned Substances

XRF (X-Ray Fluorescence spectrometer) analysis capability

Self-Declaration (*1) of Conformance Regarding Systems for Managing Chemical Substances in Products has already declared.

  Please submit the following documents:

No.2 Certification audit for Chemical Substances Management System. Please fill out the certification performances within last three years, if adapted to the customers requirements (Please attach a copy of thecertificate if you have).

1. Copy of "Self-Declaration of Conformance Regarding System for Managing Chemical Substances in Products";

Self Audit Date : YYYY/MM/DD

2. and, Guidelines for the Management of Chemical Substances in Products Action Item List & Check Sheet.

3. Please fill out the attached "Self-audit sheet of Chemical Management System for supplier"

Certification Company Name Certification Number Invalid Date

*2 : If you have not acquired them yet, the scheduled dates and plans are also applicable.

Signature or Stamp (supplier)

Supplier Contact (General Manager)

Omron Group Associated Site Name

Audited Site Address

№ GQP-12030C

Submission Date : YYYY/MM/DD

No.1 Chemical Substances Management System Please check the applicable box

SurveyRepresentative

Products

Supplier Name

Certified Date Certification No.Certification Company Name

Certified Date *2

http://www.jamp-info.com/dl

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Attachment 2 Self-audit sheet of Chemical Management System for Supplier

 

NO Questions Self-audit result Evidence/document name/others

(1)

Do you identify chemical substances subject to the managementof chemical substances in products and their management criteria(prohibitions, restrictions, content control, etc.)?

Enter the names of relevant records

(2)

Are the latest legislation, industry criteria, and customerrequirements studied and reflected on your management criteria?

Enter the names of relevant records

(3)

Are the management criteria conveyed to related departments? Enter the names of relevant records

(4)

Are there documents that set forth procedures for conducting (1)to (3) above ?

Enter document names, document numbers,item names, and revision numbers.

(1)

Are organizations, products, constituent materials, plants &processes, business, etc. clarified as the scope of management ofchemical substances in products?

(2)

Is the scope of management of chemical substances in productsextensive enough to satisfy customer requirements?

(1)

Do you verify that parts, materials, and subsidiary materialsconstituting each designed product satisfy management criteria ofchemical substances?

Enter the names of relevant records

(2)

Do you request suppliers, as necessary, to comply withmanagement criteria by means of drawings, specifications, etc.?

Enter the names of relevant records

(3)

Are there documents that set forth procedures for conducting (1)to (2) above?

Enter document names, document numbers,item names, and revision numbers.

Self-audit sheet of Chemical Management System for supplier

Self-audit Questions

Enter document names, document numbers,item names, and revision numbers for (1)and (2) questions.

2.2Definition of Scope ofManagement

1. Documents describing the scope of management of chemical substancesin products[Viewpoint of verification](1)Are organizations, products, constituent materials, plants & processes,business, etc. clarified as the scope of management of chemical substancesin products?*It is acceptable to clarify out of the application scope.

(2)Is the scope of application extensive enough to satisfy customerrequirements?*The scope of application should include manufacturing plants, processes,suppliers, and sub-contractors.

Action items

2.1Definition ofManagement Criteria

3.Documents describing the checking of compliance with managementcriteria in the design and development phase[Viewpoint of verification](3)Are there documents that set forth procedures for conducting (1) to (2)above?

3.1Design anddevelopment

Verification evidence and viewpoints

1. Management criteria that specify substances subject to the managementof chemical substances in products (list of in-house controlsubstances/substances managed as per customer requirements)[Viewpoint of verification](1) Are chemical substances subject to management in products and theirmanagement criteria (prohibitions, restrictions, content control, etc.)clarified?

2.Records of reflecting the latest legislation, industry criteria, andcustomer requirements on company's management criteria (e.g., revisionhistory)[Viewpoint of verification](2)Are the latest legislation, industry criteria, and customer requirementsstudied and reflected on company's management criteria?*The latest status need not be reflected on the criteria when the substancein products is judged to have no inclusion based on scientific grounds.

3. Records of communicating (1) aboveExamples: records of circulating the management criteria, publication onthe intranet[Viewpoint of verification](3)Are the management criteria conveyed to related corporate units?

4. Documents describing the establishment of criteria for the managementof chemical substances in products[Viewpoint of verification](4)Are there documents that set forth procedures for conducting (1) to (3)above?

1.Records of verification performed during design to ensure that parts,materials, and subsidiary materials constituting each product satisfymanagement criteria[Viewpoint of verification](1)Does the company verify that parts, materials, and subsidiary materialsconstituting each product satisfy management criteria?

2.Records (drawings, specifications, etc.) of requests made to suppliers tocomply with management criteria[Viewpoint of verification](2)Does the company request suppliers to comply with managementcriteria, as necessary by means of drawings, specifications, etc.?

How to fill in

1.Please select Yes or No or N/A from a pull-down menu.

2.Please refer to "Verification evidence and viewpoints "for all answers.

3,In the case of answer ; Yes, please show evidences (e.g. record names, document names, document number, revision number etc. )

4.In the case of answer; No, please show action plan and schedule.

5. Please answer the action item No. 3.1Design and development, if the supplier decide to use constituent material.

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(1)

Do you examine information on chemical substances in purchasedparts and materials?

(2)

Do you examine all chemical substances without omissions withinthe scope of management of chemical substances in products?

(3)

Does examinations include inclusion/no inclusion of substances,contained amount and concentration, use, etc.?

(4)

Do you make sure that all the information in (3) above isrecorded without omissions?

(5)

Is each part/material checked for conformity with managementcriteria?

Enter the names of relevant records

(6)

Is each OMRON product checked for conformity withmanagement criteria?

Enter the names of relevant records

(7)

Do you count the data on chemical substances by each units forOMRON product?

Enter the names of relevant records

(8)

Are there documents that set forth procedures for conducting (1)to (7) above?

Enter document names, document numbers,item names, and revision numbers.

(1)

Do you require suppliers to perform the "management ofchemical substances in products"?

Enter the names of relevant records

(2)

Do you evaluate new suppliers?

(3) When continuing business relationship, do you update evaluationperiodically?

(4) Are suppliers evaluated in light of (1) above?

(5)

Do you take any action for suppliers not evaluated yet orsuppliers whose evaluation content and results have problems?

(6)

Do you check that your primary suppliers evaluate secondarysuppliers from which they purchase parts/materials?

(7)

Are there documents that set forth procedures for conducting (1)to (6) above?

Enter document names, document numbers,item names, and revision numbers.

4. Records of checking if each product complies with the criteria (list ofevaluation results by product)[Viewpoint of verification](6)Is each product checked for conformity with criteria management ?

5. Records of counting result on chemical substances in products[Viewpoint of verification](7)Do you count the data on chemical substances by each products units?

6. Documents describing the procedure for acquiring and verifyinginformation on chemical substances in products[Viewpoint of verification](8)Are there documents that set forth procedures for conducting (1) to (7)above?

3.2.1Verification andAcquisition ofChemical Substancesin ProductsInformation

3.2.2Verification ofSupplierManagement Status

Enter the names of relevant records for (1)and (2) questions.

Enter the names of relevant records for (2)and (6) questions.

(4)Does the company make sure that all the information in (3) is recordedwithout omissions? *When inadequacy is found, resubmission should be requested.

3.Records of checking if each part/material complies with managementcriteria (examination result list)[Viewpoint of verification](5)Is each part/material checked for conformity with managementcriteria? *When a part/material does not comply with management criteria,action shall be taken such as "not to purchase"

1.Records of requests made to suppliers (e.g., records of handing out greenprocurement standards and supplier evaluation sheets)[Viewpoint of verification](1) Are suppliers required to perform the "management of chemicalsubstances in products"? *The “management of chemical substances in products” refers to asystem for applying the appropriate management of chemical substancesin products in each stage of purchasing, manufacture, and sales. Example:“Guidelines for the Management of Chemical Substances in Products”issued by JGPSSI and JAMP *When some suppliers are exempted from the requirement, the reasonand action to be taken for them should be clarified.

1.Records of examination objects and results (list of examination objectsand results)[Viewpoint of verification](1)Does the company examine information on chemical substances inpurchased parts and materials? *Check if actions are taken for parts and materials not examined yet.

(2)Is examination conducted without omissions within the scope ofmanagement of chemical substances in products? *If exception from examination are made, the reason must be confirmed. *Both subsidiary and auxiliary materials should be subject to examine.

2.Records of examinations on individual parts and materialsExamples: JGP file, AIS, each company's original examination form,MSDSplus, composition list, certification of nonuse, etc.[Viewpoint of verification](3)Is examination conducted without omissions within the scope ofmanagement of chemical substances in products?

3.Documents describing supplier evaluation procedure[Viewpoint of verification](7)Are there documents that set forth procedures for conducting (1) to (6)above?

2.Records of supplier evaluation (list of evaluation results, individualevaluation records)[Viewpoint of verification](2)Are new suppliers evaluated?

(3) Is evaluation updated periodically in the case of continuingtransactions?(4)Are suppliers evaluated in light of (1) above?

(5) Is action taken for suppliers not evaluated yet or suppliers whoseevaluation content and results have problems? *When suppliers need improvement, they must receive guidance andinstructions for making improvement.

(6)Does the company check that their primary suppliers evaluatesecondary suppliers from which they purchase parts/materials?

Enter the names of examination forms anddescribe the examination method for (3) and(4) questions.※When different examination forms andmethods are used for different types ofpurchased parts/materials, list them by typeof purchased part/material.

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(1)

At the time of acceptance, do you verify compatibility with yourmanagement criteria according to the risks of purchased goodsand keep records of the verification?

Enter the names of relevant records

(2)

Are there documents that set forth procedures for conducting (1)above?

Enter document names, document numbers,item names, and revision numbers.

(1)

Do some processes within the scope of management use parts ormaterials containing prohibited substances?※Select "N/A" with following questions from (2) to (9) if theanswer is "N/A".

When the reply is YES, enter the name,process, and use of the concerned materialthat contains a prohibited substance(s).

(2)

Is proper stock management performed for parts & materialscontaining prohibited substances (including subsidiary materialsand packaging materials) to prevent incorrect use, admixture,mixing, and contamination?

Describe the specific management method toprevent incorrect use, admixture, mixing,and contamination.

(3)

Is proper management of production process performed for parts& materials containing prohibited substances used (including thevicinity and stock at production lines) to prevent incorrect use,admixture, mixing, and contamination?

Describe the specific management method toprevent incorrect use, admixture, mixing,and contamination.

(4)

Is proper management performed for parts & materialscontaining prohibited substances in the "rework process" toprevent incorrect use, admixture, mixing, and contamination?

Describe the specific management method toprevent incorrect use, admixture, mixing,and contamination.

(5)

Is proper management performed for "production facilities andjigs/tools" that come into contact with parts & materialscontaining prohibited substances, to prevent incorrect use,admixture, mixing, and contamination?

Describe the specific management method toprevent incorrect use, admixture, mixing,and contamination.

(6)

Is proper management performed for parts & materialscontaining prohibited substances in "product storage space inshipping warehouses" to prevent incorrect use, admixture,mixing, and contamination?

Describe the specific management method toprevent incorrect use, admixture, mixing,and contamination.

(7)

Is proper management performed in "long-term goods-in-processstorage space" to prevent incorrect use, admixture, mixing, andcontamination of parts & materials containing prohibitedsubstances and unchecked parts & materials?

Describe the specific management method toprevent incorrect use, admixture, mixing,and contamination.

(8)

In processes other than (2) to (7) above, is proper managementperformed if there is a possibility of the incorrect use, admixture,mixing, and contamination of parts & materials containingprohibited substances?

Describe the specific management method toprevent incorrect use, admixture, mixing,and contamination.

(9)

Are there documents that stipulates procedures for performingmanagement activities ② to ⑧ described above?

Enter document names, document numbers,item names, and revision numbers.

(4)Is proper management performed with parts & materials containingprohibited substances in the "rework process" to prevent incorrect use,admixture, mixing, and contamination?

(5)Is proper management performed with "production facilities andjigs/tools" that come into contact with parts & materials containingprohibited substances, to prevent incorrect use, admixture, mixing, andcontamination?

1.Records of acceptance verification[Viewpoint of verification](1) At the time of acceptance, does the company verify compatibility withits management criteria, according to the risks of purchased goods? Arerecords of the verification kept?*Acceptance verification should include sub-contractors.*It is acceptable that the company establishes a system to order only parts& materials that meet its management criteria and check order Nos.,model names, etc. at the time of incoming.

(8)In processes other than (2) to (7) above, is proper managementperformed if there is a possibility of the incorrect use, admixture, mixing,and contamination of parts & materials containing prohibited substances?*The management method for preventing incorrect use and admixture in(2) to (7) is adequate when fool-proof operations are established

2. Records that enable verification of the management status of theconcerned processes (information given to the left)[Viewpoint of verification](2)Is proper stock management performed for parts & materialscontaining prohibited substances (including subsidiary materials andpackaging materials) to prevent incorrect use, admixture, mixing, andcontamination?

3.3AcceptanceVerification

3.4.1Preventing IncorrectUse, Admixture, andContamination

1.Records that enable verification of the concerned prohibited substancename, process, and use (information given to the left question, Column G.)[Viewpoint of verification](1) Do some processes within the scope of management use parts/materialscontaining prohibited substances?

2.Documents describing the method of acceptance verification Example:receiving inspection procedure[Viewpoint of verification](2)Are there documents that set forth procedures for conducting (1)above?

(6)Is proper management performed with parts & materials containingprohibited substances in "product storage space in shipping warehouses"to prevent incorrect use, admixture, mixing, and contamination?

(7)Is proper management performed in "long-term goods-in-processstorage space" to prevent incorrect use, admixture, mixing, andcontamination of parts & materials containing prohibited substances andunchecked parts & materials?

3.Records describing management procedures to prevent incorrect use andcontamination in the concerned processes (work standards, etc.)[Viewpoint of verification](9) Are procedures for implementing (2) to (8) above determined?

(3)Is proper management of production performed for parts & materialscontaining prohibited substances (including the vicinity and stock atproduction lines) to prevent incorrect use, admixture, mixing, andcontamination?*Cleaning processes (e.g., sponge for cleaning soldering irons) in thevicinity should be subject to the management. --*Processes for other businesses should also be subject to the management.

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(1)

Do the following two conditions apply?・Manufacturing processes that use substances/preparationsinclude a process where changes occur in constituents andconcentrations.・Neglecting to manage this process may cause residues orcreation of controlled chemical substances in excess ofmanagement criteria.

※Select "N/A" with following questions (2) and (3) if the answer is "N/A".

When the reply is YES, describe theconcerned process, materials in use, anddetails of reaction.

(2)

Are management requirements and details for the concernedprocess defined clearly?

Describe the specific management method ofreaction processes.

(3)

Are there documents that set forth procedures for conducting (2)above?

Enter document names, document numbers,item names, and revision numbers.

(1)

When making changes inside the company with possible effectson chemical substances in products, do you check compliancewith management criteria in advance?

Enter the names of relevant records.

(2)

(2)When suppliers/sub-contractors are going to make changeswith possible effects on chemical substances in products, do youverify in advance their compliance with your managementcriteria?

Enter the names of relevant records.

(3)

When changes having possible effects on chemical substances inproducts are to be made inside the company or by suppliers/sub-contractors, do you notify customers of these changes in advance?

Enter the names of relevant records.

(4)

Are there documents that set forth procedures for conducting (1)to (3) above?

Enter document names, document numbers,item names, and revision numbers.

(1)

Are there rules for taking emergency measures against non-conformity?

(2)

Are there rules for identifying the cause and implementing theappropriate countermeasures?

(3)

Are there rules for spreading the appropriate countermeasurehorizontally throughout the company to prevent recurrence?

(4)

Are there rules for taking preventive measures against non-conformity?

№ Evaluation items # of item YES NO N/A

2.1 Definition of Management Criteria 4 0 0 02.2 Definition of Scope of Management 2 0 0 03.1 Design and Development 3 0 0 0

3.2.1Verification and Acquisition of Chemical Substances inProducts Information

8 0 0 0

3.2.2 Verification of Supplier Management Status 7 0 0 0

3.3 Acceptance Verification 2 0 0 0

3.4.1 Preventing Incorrect Use, Admixture, and Contamination 9 0 0 0

3.4.2 Appropriate Management of Chemical Reaction Processes 3 0 0 03.7 Change Control 4 0 0 03.8 Non-conformity Response 4 0 0 0

46 0 0 0№ GQP-12031

2.Records that enable verification of the management status of theconcerned process (records of analysis results, etc.)Verification method: process photographs, on-site inspection[Viewpoint of verification](2)Are management items and details for the concerned process definedclearly?

3.Records of notifying customers of changes with possible effects onchemical substances in products (process change applications submitted tocustomers)[Viewpoint of verification](3)When elemental changes with possible effects on chemical substances inproducts are to be made inside the company or by suppliers/sub-contractors, does the company notify customers of these changes in

1.Records that enable verification of the concerned process, materials inuse, and details of reaction (information given to the left)[Viewpoint of verification](1)Do the following two conditions apply?・Manufacturing processes that use substances/preparations include aprocess where changes occur in constituents and concentrations.・Neglecting to manage this process may cause residues or creation ofcontrolled chemical substances in excess of management criteria.*Answer the following questions when the above applies.≪Examples of reaction≫ ・Polymerization (PVC: chemical reaction by vinyl chloride) ・Electroless nickel plating process (lead: concentration variations in theplating solution) ・Ink paints (lead, cadmium, etc.: concentration variations due to theevaporation of solutions, etc.) ・Sealants (DBT, DOT: curing reaction of 2-component-type sealant) ・Adhesives (tributyltin oxide: management of impurity when dibutyltinis used)

3.8Non-conformityResponse

3.7Change Control

2.Records of checking compatibility with company management criteriawhen suppliers make changes with possible effects on chemical substancesin products (process change applications submitted by suppliers)[Viewpoint of verification](2)Does the company verify compliance with its management criteriabefore suppliers/sub-contractors make elemental changes with possibleeffects on chemical substances in products?*Suppliers (including secondary and tertiary suppliers) should be notifiedof the change control procedure.

Result

3.4.2AppropriateManagement ofChemical ReactionProcesses

4.Documents describing change control[Viewpoint of verification](4)Are there set forth procedures for conducting (1) to (3) above? *Changes with possible effects on chemical substances in products:"changes and additions in suppliers", "changes in purchased items", and"changes in processes". Changes not affecting quality should also besubject to the change control. *Flow of communication with suppliers, sub-contractors, and customersmust be clarified.

total

Enter document names, document numbers,item names, and revision numbers for (1) to(4) questions.

3. Documents describing the management method of the concerned process[Viewpoint of verification](3)Are there documents that set forth procedures for conducting (2)above?

1.Records of checking compatibility with management criteria regardingin-house changes with possible effects on chemical substances in products(records of verification at the time of engineering changes)[Viewpoint of verification](1)Does the company verify compliance with management criteria beforemaking in-house elemental changes with possible effects on chemicalsubstances in products?

1.Documents describing measures to be taken against non-conformity[Viewpoint of verification](1)Are there rules for taking emergency measures against non-conformity? ≪Examples of emergency measures≫   ・Identification of the scope of influence (identification of the affectedlot, equipment involved, etc.)   ・Containment (halting production, halting shipping, isolation)   ・Communication within the company (communication to relateddivisions, persons responsible for management of chemical substances inproducts, managers), communication to customers(2)Are there rules for identifying the cause and implementing theappropriate measures?

(3)Are there rules for implementing horizontal deployment to preventrecurrence?

(4)Are there rules for taking preventive measures against non-conformity?

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Attachment 3 <Reference>

- Certificate of Non-inclusion for Regulated Substances -

To: Omron Corporation

Date:

Company name:

Signature:

Telephone:

1. Subject chemical substances

Banned substances (A rank): ×× substance groups

Non-use substances (A1 rank): × substance group

* It is confirmed that these are not the intended uses of A and A1 ranks.

*

2. Target products, parts or materials

* Please affix a separate sheet of paper if there is not enough space on this form.

We hereby certify that the chemical substances cited below are not contained in our products,parts or materials that are supplied to Omron Corporation (including its subsidiary and affiliatedcompanies) by us (including our subsidiary and affiliated companies):

Certificate of Non-inclusion for Regulated Substances

Product Number Article Name

The following chemical substances listed in Attachment 1 "List of the Regulated ChemicalSubstances" in the Investigation Manual for Regulated Chemical Substances, Version ×.× ofOmron Corporation:

Remarks

3

7

12

456

89

101112

However, it is premised that Omron Corporation will not use Nickel and PhthalatesGroup 1 and 2 for any intended uses of A and A1 ranks.

15

1314

When you use this format, be sure to use the version and file format of the format shown in the Investigation Manual for the Regulated Chemical Substances separately provided by Omron.

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Attachment 4 <Reference>

- Declaration of Phase-out of Regulated Substances -

To: Omron Corporation

Date:

Company name:

Signature:

Telephone:

1. Subject Substances

*

*

2. Target products, parts or materials

* Please affix a separate sheet of paper if there is not enough space on this form.

Deadline forNon-use

(MM/YYYY)

JGPSSI useclassification

code

Remarks

We hereby pledge that we (including our subsidiary and affiliated companies) have verified thatthe prohibited substances (A rank) cited below are not contained in the following products,parts or materials delivered to Omron Corporation (including its subsidiaries and affiliates) andare committed to attaining the goal for phasing out the following non-use substances (A1 rank),

2

Declaration of Phase-out of Regulated Substances

Product Number

The following chemical substances listed in Attachment 1 "List of the Regulated ChemicalSubstances" in the Investigation Manual for Regulated Chemical Substances, Version ×.×of Omron Corporation:

Article Name

Non-use substances (A1 rank): × substance group

However, it is premised that Omron Corporation will not use Nickel andPhthalates Group 1 and 2 for any intended uses of A and A1 ranks.

Prohibited substances (A rank): ×× substance groups

1

34567

98

13

101112

1415

It is confirmed that these are not the intended uses of A and A1 ranks.

When you use this format, be sure to use the version and file format of the format shown in the Investigation Manual for the Regulated Chemical Substances separately provided by Omron.

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Attachment 5 <Reference> Green Procurement (Former JGPSSI) Survey Response Tools

When you use this format, be sure to use the version and file format of the format shown in JAMP AIS and the MSDSplus Preparation Manual separately provided by Omron.

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Attachment 6 <Reference> JAMP Information Transmission Sheet (AIS)

When you use this format, be sure to use the version and file format of the format shown in JAMP AIS and the MSDSplus Preparation Manual separately provided by Omron.

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Attachment 7 JAMP Information Transmission Sheet (MSDSplus)

When you use this format, be sure to use the version and file format of the format shown in JAMP AIS and the MSDSplus Preparation Manual separately provided by Omron.

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Attachment 8 Application for Qualification of Green Supplier (New/Renewal)

To. Omron Corporation

Application for Qualification of Green Supplier (New/Renewal)

Now that we meet the requirements in Omron Corporation's Green Procurement Standards (Ver. 4.1), we hereby apply for "Qualification of Green Supplier" as follows:

Check Items

1. Establishment of Environment Management System(EMS)

Confirmed Date

2. Control of Contained Chemical Substances (Establishment of CMS)

Yes NoIn the process of

establishment

Please fill out the suitable date for on-site investigation by Omron's auditors.

Yes No N/A

Yes No

Yes No

<selectable more than one> Yes No

Yes No

Yes No

* Yes No

3. Banning of ozone layer depleting substances in manufacturing processes

No Yes

■ Necessary Documents to be Attached

 

<For Omron's Use Only>

Received by Approved by Received by Approved by

[Establishment of Environment Management System]

[Other Particular Notes]

Attach Omron CMS audit result    □

Haven't you used ozone layer depleting substances in manufacturing processes ofparts and materials (e.g. cleansing)?

□ Environment document of EMS certification or document of environmental management confirmation    □ List of control substances

□ Environmental Control Surveillance Sheet (including the relevant documents required as attachment)

Name of the person responsible for theapplicationPosition/DepartmentTEL No. (one-byte characters)E-mail Address (one-byte characters)

1) Is the management criteria at your company compliant with that of Omron's?

2) What is the version of "Investigation Manual for Regulated Substances" that youhave received from Omron?

(3) Information Provision

Date of Application (YYYY/MM/DD)

Company NameSupplier Code No. (one-byte characters)Name of the President

□ "Self-audit sheet of Chemical Management System for supplier"; OR (1) a copy of "Self-Declaration of Conformance" regarding themanagement system of chemical substances in products and (2) JAMP/JGPSSI Guideline, Attachment 1: List of Action Items & Check

  □ Conformed [Name of the standard:            /Information provision format:             ]

1) Can you report the content of chemical substances in products which are delivered to Omron?

Reporting formats(standards)

(Note 1) Please circle the appropriate answer in the check column.(Note 2) In the case of suppliers to whom the assembly of products or intermediate products is outsourced and the parts, materials or subsidiary materials used in those productsare not procured by the suppliers at all, please circle "N/A" regarding paragraph 2(2).

(2) Can you submit the "Certificate of Non-inclusion" designated by Omron?

In case that you are unable to submit the documents stated in 1) and 2) above, areyou able to control the Substances and/or Intended uses regulated by EU RoHS?

JGPSSI (JIG/Omron "Investigation Manual for RegulatedChemical Substances")

  □ Conformed (copy of certificate attached)  □ Conformed (document of environmental management confirmation attached)  □ Not conformed

(1) Confirmation of Environment Management System (please attach documents, eg. certification)Confirmed by (Certification body)Documents title (eg. Certification, Registration No. etc)

Others: format designated by Omron

JAMP-AIS/MSDSplus

(2) Management Criteria

1) Have you established chemical substance management system based on JAMP/JGPSSI"Guideline for the Management of Chemical Substances in Products (after the ver. 2.0)"?

On or after . .

Check

IMDS/JAMA (GADSL)

(1) Management System

  Ver. _______________________________

□ Not conformed  □ Not applicable (no self-procurement product)

Application Receiving Department Certification Department

Confirmation of conformance (confirmation by the application receiving department)

[Control of Contained Chemical Substances (Establishment of CMS)]