Environmental Audit Questionnaire

Privileged and Confidential

This pre-audit questionnaire is intended to elicit background information from the operating
facility pertaining to its EH&S management activities. This background information will assist
the audit team in planning and conducting facility audits. Accurate and timely completion is
requested. Please return the completed questionnaire (e-mail preferred) to the following
individual at least one (1) week prior to the scheduled audit.
Name:
Address:
Phone: Cel: E-mail :
Please call if you have questions or wish to discuss your response. Please attach additional
information as necessary to explain further any of the responses given below.

GENERAL INFORMATION
Date Questionnaire Completed

Facility Division

Address

Facility Phone Number

EHS Site Manager

Phone Email

Plant Manager

Phone Email

Person Completing This Questionnaire

Size of Facility Age of Facility

Manufacturing/Processing Area (ft2 or m2)

Is the property owned or leased?

Total Personnel Production Personnel

Facility Operating Schedule:

Hours/Day Shifts/Day Days/Week

Did the site have any agency inspections for EHS in the last two years? (If so, describe)
There was inspection by the STPS, civil protection and firefighters in security matters, and by
PROFEPA and PAOT in environmental matters

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 Environmental Audit Questionnaire
Privileged and Confidential

Did the site receive any notices of violation from an agency, fines or community
complaints in the last two years? (If so, describe)

No

FACILITY DESCRIPTION
Site Activities (check those that apply)
Manufacturing
R&D Lab
Quality Control Lab
Warehouse/Distribution
Sales Office
Other (please describe)
Recicling of industrial waste

Does the facility have any of the following operations/equipment? (Check all that apply)
Molding/vacuum forming
Foaming
Welding (solvent, sonic, traditional)
Painting (with or without drying oven)
Laser scoring
Flame treatment
Cleaning line/ops (including parts washer)
Adhesives
Heat treating
Leather cladding
Plastic extrusion
Die casting
Thermal riveting
Airbag testing
Metal stamping
Dust collector/bag house(s)
Incinerator(s)/thermal oxidizer(s)
Powered industrial trucks (forklifts)
Compressed gas cylinders storage
Flammable/Combustible Liquids Storage

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 Environmental Audit Questionnaire
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Check One1

Other Facility Operations Y N DK

a. Are there any off-site locations (e.g., warehouses,

processing plants) which fall under the direct control of
plant management?

b. Does the site have any on-site contractor operations?

Please describe the energy utilities used by the site, i.e., electrical service, natural gas
pipelines, oil pipelines, etc.
The energy used are electric power, LP gas and diesel fuel

Please describe the property zoning of the plant site and surrounding area.

Agro-industrial zone with an area of 8718.84 m2

If the plant is located in a water protection area or other environmentally sensitive area, please
describe.
N/A

Are there any schools, day care centers, nursing homes, prisons, churches
or hospitals within 1.0 mile / 1.5 km of your facility?

Is the distance to the nearest residential structure from the facility fence line:

Less than 0.5 mile / 0.8 km?

0.5 to 1.0 mile / 1.5 km?

Greater than 1.0 mile / 1.5 km?

If you know, please describe the use of the site prior to your occupancy.

Please provide any additional information about the facility, its history, or its operations that the
auditors should know about.

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Note that the following abbreviations will be used throughout this document:
Y– Yes
N– No
DK – Don’t Know
NA – Not Applicable
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 Environmental Audit Questionnaire
Privileged and Confidential

Facility Environmental Management System

Please give the names, titles and other areas of responsibility of the designated EHS
Coordinator(s) at the facility.

To whom do they report (name and title)?

Name: Title:

What percentage of their time is actually spent on EHS related activities? %

Y N DK
Is there an existing or pending enforcement action against the facility?

Does the facility conduct an annual self-assessment?

Were any EHS Audits conducted internally or by third parties?

Does the site have any major project activities planned? If yes, briefly
describe the project?

Air Emissions
Y N DK NA
Has the site conducted an air emissions inventory within the past two years?

Have emissions inventories included fugitive emissions?

Does the site have any of the following types of air emissions sources?

a. Plating

b. Backup Generator

c. Storage Tanks

d. Painting

e. Boilers/Air Make up Units

f. Other Point Sources (describe)

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Y N DK NA
Other Fugitive Sources (describe )

Does the facility have an air registration or permit?

If yes, what sources are covered by these permits?

Is the facility subject to national, state, or local standards for air emissions?

Does the facility conduct fence line monitoring of any air emissions?

Have facility emissions resulted in complaints from the general public?

Are chlorofluorocarbons (CFC's) used onsite?

Wastewater & Stormwater Discharges

Y N DK NA
Does the facility generate any wastewate?

a. Non-contact cooling water

b. Process wastewater

c. Wastewater treatment plant effluent

d. Sanitary wastewater

e. Manufacturing/storage area, parking area, or roadway

non-precipitation-related runoff, washwaters, or rinsewaters
containing detergents, and other cleansers

f. Undeveloped area non-precipitation-related and non-irrigation-related

runoff

g. Other (describe)

Does the facility discharge any of the generated wastewater into a waterway
(e.g., river, stream, brook, lake, etc.)?

a. If so, what is the name of the waterway?

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 Environmental Audit Questionnaire
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Y N DK NA
Does the facility discharge into a municipal wastewater treatment plant?

Does the facility have a wastewater discharge permit?

Does the facility treat wastewater onsite before discharge? If yes, briefly
describe the process(es) used.

Does the facility have a septic system?

Does the facility have a stormwater permit?

Drinking Water
What is the source of your drinking water, e.g., municipal, on-site wells, bottled water, etc.?

Ground Water
Y N DK NA
Has the facility evaluated ground water quality?

Does the facility monitor ground water?

Are there any abatement, remediation and/or soil or ground water treatment
operations underway?

Material Management
Y N DK NA
Does the facility have any underground storage tanks?

If yes, approximately how many?

Does the facility have any aboveground storage tanks?

If yes, approximately how many?

Does the facility produce and or transport hazardous/ dangerous goods or

wastes?

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 Environmental Audit Questionnaire
Privileged and Confidential

PCBs
Are any of the following equipment used or stored at the facility? Y N DK NA

a. Transformers

b. Capacitors/ Rectifiers

c. Lighting Ballasts

d. Heat transfer fluid

Is there a utility-owned transformer on the site?

Pesticides
Y N DK NA
Does the facility use any pesticides, herbicides or biocides onsite?

Do contractors apply the pesticides? (If applied by contractors, have available

a list of those contractors.)

Solid Waste
Y N DK NA
Does the facility generate any waste material classified as hazardous waste?

Indicate estimated annual volume of hazardous/ special waste generated.

Does the facility have permits for hazardous or special waste, including
Treatment, Storage, or Disposal?
Does the facility

a. Store, treat, or dispose of hazardous wastes onsite?

b. Generate, treat, or store medical or infectious wastes onsite?

c. Treat, store, or dispose non-hazardous industrial wastes onsite?

d. Treat, store, or dispose domestic type commercial waste onsite?

Are asbestos containing materials located onsite?

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 Environmental Audit Questionnaire
Privileged and Confidential

Oil Spill and Petroleum Prevention

Y N DK NA
Does the facility store oil in volumes greater than 500 gallons/ 2000 liters?

Other Country/Region/State-Specific Programs or Regulations that the Auditors Should

Know About?

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 Environmental Audit Questionnaire
Privileged and Confidential

INFORMATION COLLECTION CHECKLIST

The Facility EHS Coordinator should make the following information available during the audit.

Management Systems Available Not Available Not Appl.

 Organization chart

 Inspection and follow-up records

 Environmental training records

 Incident response plan

 Previous audit reports

Air Emissions Available Not Available Not Appl.

 Copies of all current air permits

 Air monitoring data for the past 24 months

 Air emissions inventory

 Air emissions reports submitted to regulatory agencies

 Copies of any violation notices received in the past three years

 Copies of any federal/national, state/provincial and/or local

emissions standards

 CFC equipment maintenance records

 Air pollution abatement equipment maintenance records

Water, Wastewater, Stormwater, Groundwater Available Not Available Not Appl.

 Copies of all national/provincial or municipal wastewater

discharge permits

 Copies of any federal/national, state/provincial and/or local

discharge standards

 Copies of discharge monitoring data/reports for flow and permit

parameters

 Copy of site’s water balance

 Copy of the site’s wastewater discharge inventory

 Copy of the site’s water supply profile

 Wastewater sewer drawings

 Wastewater treatment plant maintenance records and drawings

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 Environmental Audit Questionnaire
Privileged and Confidential

 Stormwater sewer drawings

 Copies of violation notices received in the past three years

 Well construction diagrams for on-site water supply or

groundwater monitoring wells

 Water quality analyses from water supply or groundwater

monitoring wells for the past 12 months

Material Management Available Not Available Not Appl.

 Tank inventory

 Containerized hazardous material inventory

 Monthly material loss calculations for materials stored in tanks

 Listing of all oil containing equipment with the amount of oil

indicated as well

 Tank and containment inspection records

 Tank integrity and tightness test records

 Drum management plan

 Pesticide inventory

Solid Waste Available Not Available Not Appl.

 Waste arisings inventory

 Waste transaction documentation (manifests, receipts, invoices)

 Copies of any federal/national, state/provincial and/or local waste

regulations

 Waste permits or registrations

 Any waste-related reports to regulatory authorities

 Copies of violation notices received in the past three years

 Inspection records

 Inventory of asbestos-containing materials

 PCB-containing equipment inventory

 PCB test results from analysis on electrical equipment

 Radioactive material inventory

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