SUPPLIER DETAILS AND DECLARATION: By signing (or submitting electronically) I declare all information provided is true and correct. Company Name
Phone
Authorised Officer
Email
Position
2013 TIMBER & WOOD PRODUCT SURVEY FORM
Signed
Date
Please complete one form for each product group supply chain. If a product group comes from multiple supply chains, complete one form for each supply chain. Product Group (Select one)
Chipboard Firewood Mouldings
Component Product Garden Furniture Plywood
Decking Joinery Sawn Timber
Doors Laminate Flooring Solid Timber Flooring
Product Description (Provide a short description)
Product’s Timber Composition (Select one)
Native
If a Plantation, Plantation Conversion Date (Select one)
Plantation
November 1994 or before
Whole-Wood
after November 1994
Not 100% from
100% from
100% from
100% from
100% from
100% Re-used
Other,
recycled/waste
pruning
harvest waste
mill waste
factory waste
Post-Consumer
Please Specify:
Risk Category (Use Risk Matrix to select one)
VH
Estimated Sales to Bunnings AUD$ Value (Ex. GST)
$
Type of Certification (Select one)
Component
State/Region/ Province of Harvest
Country of Harvest
Is your product 100% from recycled/waste materials?
Flat-Pack Furniture MDF
Please provide botanical name or common name of timber species. General terms such as ‘hardwood’ will not be accepted.
Species Name
Type of Forest (Select one)
Dressed Timber Manufactured Whole Timber
HH
H
M
L VL
NOTE: VH products will not be accepted; HH products are required to forward a copy of certification to
[email protected]; H risk products are required to be Certified Responsibly Sourced. M risk products will be required to be Certified Responsibly Sourced by end 2013. L products required to commit to transitioning to Certified Responsibly Sourced by end 2015. Complete item below.
Estimated Sales to Bunnings in cubic metres (m3)
3rd Party Certification
______________________________________
Government Permit/Approval
m3
NOTE: include ONLY the part of the product that is timber
Other, Please Specify:
rd
3 Party Cert. Scheme or Government Department Name
Issued To
Document Number
Expiry Date
Is your product marked with a 3rd party certification logo? L risk product commitment (Select one if L risk product) Does this product meet documentation benchmarks?
Yes
No
This product is already Certified Responsibly Sourced.
We commit to transitioning towards 3rd party Certified Responsibly Sourced by end 2015.
Yes
No
If NO, complete an ACTION PLAN
Action Plan for HH/H risk product completed.
Action Plan for M risk product completed.
