Date Issued:
Name of Licensee/Vendor: Licensee/Vendor #:
Region:
Name of Factory: Factory #:
Physical Address:
Mailing Address:
Telephone #: Fax #:
Name of Contact:
Facility Name:
Physical Address:
Mailing Address:
Telephone #: Fax #:
(Please review information above, make changes on form if necessary.)
FACTORY:
Ownership Type of Factory:
Joint Venture _____ Partnership _____ Corporation _____ Privately Owned _____
Foreign Investment _____ Other ________________________________________
Name of Broker/Agent (if applicable):
Mailing Address:
Telephone #: Fax #:
FACILITY (Note: Complete a questionnaire for each facility location)
Ownership Type of Facility:
Joint Venture _____ Partnership _____ Corporation _____ Privately Owned _____
Foreign Investment _____ Other _____________________________________________
Year Facility Established:
Name of Plant Manager:
Telephone #: Fax #:
Articles Produced:
Total Employees at this Facility: Contract: Local:
If contract workers employed, length of contract:
Street Address of Dormitories (if applicable):
SUBCONTRACTING FACILITIES OR SISTER COMPANIES
Name(s)__________________________________________________________________________
Location(s)________________________________________________________________________
Operations performed_______________________________________________________________
NUMBER OF MACHINES – Specify the following:
Number of Estimated
Employees on Monthly
Machine Type Number Machine Production
Cutting Machines _______ _______ _________
Cutting Tables _______ _______ _________
Knitting Machines _______ _______ _________
Sewing Machines _______ _______ _________
Making Machines _______ _______ _________
Looping Machines _______ _______ _________
Processing Machines:
Permapressing machines _______ _______ _________
Dying machines _______ _______ _________
Stone washing machines _______ _______ _________
Other _______ _______ _________
Weaving Machines _______ _______ _________
Yarn making Machines _______ _______ _________
COMPLETED BY:
Name: Title:
Signature: Date:
1. Are all employees voluntarily working in this facility? Yes No
a. What procedures ensure/monitor that all employees are working voluntarily?
2. Are there any workers in this facility that are prisoners, have been assigned by the military, or any other branch of government? Yes No
3. Do employees have freedom of movement that is not unnecessarily impeded? Yes No
a. If no, explain:
4. Are employees free to leave when their work shift ends? Yes No
a. If no, explain:
5. Are guards posted only for normal security reasons? Yes No
a. If so, what are their basic duties?
6. Are doors and gates on the factory premises locked only for normal business security purposes? Yes No
a. If no, explain:
7. What is the age of the youngest worker in this facility?
a. What is the minimum age allowed by law? ________________________________________
b. Do you have a minimum age policy different from local law? Yes No
If yes, explain:
c. Do workers execute a statement that they are at or above the minimum age? Yes No
If yes, is the statement filed in the employees’ personnel files?
8. Are there any work experience or apprentice programs for school age children? Yes No
a. If yes, explain:
9. Are there restrictions for workers under 18? Yes No
a. If yes, explain:
10. What proof of age documents are obtained from prospective employees?
11. What procedures does this facility have in place to verify the authenticity of age documentation?
12. How are employees recruited (i.e., newspaper advertisement, agent, contract)?
13. How does management handle misconduct or poor performance on the part of an employee?
a. Does this management of misconduct or poor performance include fines? Yes No
If yes, explain factory policy. Include examples:
14. Do you restrict employment by age, race, ethnic group, religion, gender, sexual orientation, political affiliation, and/or national origin? Yes No
a. If yes, explain:
15. What is the lowest wage paid by this facility for trained (i.e., production) employees?
For untrained (i.e., janitors, trainees) employees?
16. How are employees paid? Cash Check Auto Pay Other
17. How is the pay rate calculated? Per Hour Piece Rate Per Day Other
a. If other, explain:
18. If employees are paid on a piece rate basis, what system does the facility use in order to track the number of pieces worked on each day by individual employees?
19. Is work time documented by a time card? Yes No
a. If no, explain system:
20. How often are employees paid? Hourly Weekly Monthly Other
21. Does the factory provide all employees a pay record or stub which details the current period’s wage calculation? Yes No
a. If no, explain:
22. Are there any deductions from employees’ wages? Yes No
a. What charges are deducted from your employees’ pay?
b. How is this documented?
23. Does any employee owe the factory money? Yes No
a. If yes, explain:
24. What allowances and benefits are provided to employees in this facility? Please circle the following that apply: Housing, meals, transportation, and other allowances; health care; child care; sick leave; emergency leave; pregnancy and menstrual leave; vacation; religious and holiday leave; and contributions for social security, life, health, worker’s compensation and other insurance coverage.
If food is provide, how many meals/day? _____ Free Subsidized ; Other benefits __________
a. What benefits are required to be given to factory workers per local law? :
25. Are benefits and/or allowances included in calculating the minimum wage? Yes No
a. If yes, explain:
26. Are there any incentive plans offered (e.g., bonuses)? Yes No
a. If yes, explain:
27. Are workers paid any special wages, e.g., for probation or training? Yes No
a. If yes, explain:
28. What is the facility policy on maximum consecutive days of work?
a. How often in a 3 month period is that maximum exceeded? __________________________
29. What are the standard operating hours of this facility? From _________a.m. to _____ p.m.
30. How many work shifts do you run in your facility?
a. How many hours per work shift?
31. Do you pay for overtime? Yes No
a. What is the minimum wage for overtime in the local law? ____________________________
32. How are overtime wages calculated (e.g., weekdays 1.5x; holiday 2x, etc.)?
33. What is the average number of overtime hours worked per worker each week?
34. What is the maximum number of work hours per day at regular pay?
35. What is the maximum number of hours employees are asked to work in a given week? ________
36. Does the factory obtain waivers from governing authorities in the event that the number of planned work hours for a given week exceed the maximum as per
local and national law? Yes No
a. If no, explain:
37. Do employees have time each day for a meal? Yes No
38. Do employees have time each day for breaks? Yes No
a. If yes, how many and what is the duration of each break?
39. Do employees take work home? Yes No
a. If yes, how are wages for this work determined?
b. What type of work? __________________________________________________________
40. Are first aid supplies available in this facility? Yes No
41. Are there any medically trained personnel on site? Yes No
42. Are safety education/training programs offered (i.e., first aid, etc.)? Yes No
a. If so, what?
43. Do you have fire extinguishers and/or sprinkler systems in this facility? Yes No
44. Do you train all workers on the basic use of fire extinguishers? Yes No
45. Do you perform fire safety drills? Yes No
a. If yes, do you keep records of these drills with all pertinent details as to the results of the drills? Yes No
46. Are fire escapes available for buildings more than one story high? Yes No
47. Do you have emergency evacuation plans, in the native language(s) of the employees and posted in view of factory workers? Yes No
48. Is personal protective equipment available at no cost to the employee? Yes No
49. Do employees have unrestricted access to drinkable water? Yes No
50. How many functional toilets does this facility have? Male _____ Female_____
51. Do you have a ventilation and lighting system? Yes No
52. Do you use any materials that generate toxic or hazardous fumes or waste? Yes No
53. Have any employees become ill due to working with products? Yes No
54. Is there a supervisor on the floor for each work shift? Yes No
a. How many supervisors per work shift?
55. Do you allow your employees to associate? Yes No
56. What efforts does the company make in regards to the environment (i.e., wastewater management, air purification, hazardous material disposal)?
57. Do you provide dormitory or other residential facilities for workers? Yes No
a. If yes: facility controlled rental units other
If dormitories are provided, please answer questions 58 through 74.
58. Number of buildings: ____________ Number of employees that reside in dormitories: ________
59. Average number of employees in a sleeping room:
60. Approximate space (in square meters) per employee in sleeping room: ____
61. Are sleeping quarters segregated by gender? Yes No
62. Are employees provided their own individual mats or sleeping space? Yes No
63. Are directions for evacuation in the case of fire or other emergencies posted in all
sleeping quarters in the native language? Yes No
64. Does this facility have fire extinguishers in all sleeping quarters? Yes No
65. Are fire drills conducted? Yes No
66. Are fire escapes available for buildings more than one-story high? Yes No
67. Are combustible materials stored in the dormitories or buildings connected
to the dormitories? Yes No
68. Number of toilets for employees: Male __________ Female __________
69. Are kitchen or laundry facilities provided? Yes No
70. Do employees pay for the following? (Pay in cash, or payroll deductions)
a. If yes, how much?
Sleeping quarters:
Meals:
Transportation:
Uniforms:
Damaged equipment:
Others (please list):
71. Is dormitory access controlled? Yes No
a. If yes, explain:
72. Are there any curfews on employees? Yes No
a. If yes, explain:
73. Are employees free to come and go as they please? Yes No
a. If no, explain:
74. Do employees have unrestricted access to drinkable water? Yes No
75. Does the factory conduct verifications of production? Yes No
a. If no, explain:
76. What is the actual garment/unit output on a monthly basis? __________
77. Does the factory engage in multi-country processing? Yes No
78. Does the factory have copies of the outward processing arrangements in which it is involved? Yes No
a. If no, explain:
79. Does the factory maintain accurate records of all transactions with sub-contractors? Yes No
a. If no, explain:
80. Do the finished products correspond to the purchase orders? Yes No
a. If no, explain:
81. Can the trail of production be traced via paper from initial order to final export? Yes No
a. If no, explain:
82. Has the factory been visited by a U.S. official? Yes No
a. If yes, what was the outcome of the visit?
___________________________________________________________________________
83. Has the factory been visited by a national official (of that country?) Yes No
84. If yes, what was the outcome of the visit? Yes No
85. Does the factory own quota? Yes No
86. Does the factory buy quota from other factories? Yes No
87. Does the factory have quota for the categories it is capable of producing? Yes No
88. Has a statement of policy regarding a drug free environment been developed? Yes No
89. Has the factory familiarized itself with the characteristics of each type of drug? Yes No
90. Do you out-source or subcontract any of your production? Yes No
91. Do you out-source to individuals, families, or collective work groups? Yes No
a. What articles/components are produced by these workers?
___________________________________________________________________________
b. How are these workers paid?
___________________________________________________________________________
92. Please complete the following for all subcontractors or subcontract sites for the Company’s products: (please attach additional sheets, if necessary).
Subcontractor #1
Name:
Address:
Products:
Subcontractor #2
Name:
Address:
Products:
