Application



ApplicationFor each applicable section please provide all information requested and mark the section as completed or not applicable.General (For all applications)GENERAL INFORMATIONBusiness name FORMTEXT ?????SIC or NAICS code FORMTEXT ?????General business description FORMTEXT ?????PRIMARY CONTACT INFORMATIONName FORMTEXT ?????Title FORMTEXT ?????Telephone FORMTEXT ?????Email FORMTEXT ?????Mailing address FORMTEXT ?????SCOPE INFORMATIONScope of the certification/verification(e.g. products, activities, services) FORMTEXT ?????CURRENT CERTIFICATIONSCERTIFICATION BODYISO 9001 FORMTEXT ?????ISO 14001 FORMTEXT ?????OHSAS 18001 FORMTEXT ?????ISO 45001 FORMTEXT ?????ISO 50001 FORMTEXT ?????SEP FORMTEXT ?????Verified GHG inventory FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ?????MANAGEMENT SYSTEM INTEGRATIONPlease describe any integration across management systems. FORMTEXT ?????Please provide the mailing address and a general site description of all facilities that are part of the entity seeking certification/verification.SITESUB-SCOPE FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Attach additional pages as required.SITE REQUIREMENTSPlease describe the site requirements for safety necessary for site access. FORMTEXT ?????Please describe the site requirements for security necessary for site access. FORMTEXT ?????Please describe any site confidentiality requirements. FORMTEXT ?????ISO 14001SITE NAMEKEY PROCESSESFULL TIME PERSONNELPART TIME PERSONNEL FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Attach additional pages as required.RISK INFORMATIONPlease identify the key aspects associated with processes. FORMTEXT ?????Please identify the main hazardous materials used in the processes. FORMTEXT ?????GENERAL INFORMATIONPlease provide a general description of the human and technical resources available for environmental management. FORMTEXT ?????Please provide a general description of the functions and relationship in a larger organization, if any. FORMTEXT ?????OUTSOURCINGAre there any outsourced processes that may affect conformity requirements? If so, please explain. FORMTEXT ?????USE OF CONSULTANTSWere any consultants used to develop or implement the environmental management system? If so, please describe to what degree. FORMTEXT ?????RELEVANT LEGAL REQUIREMENTSPlease provide a brief description of relevant legal obligations. FORMTEXT ?????3.0ISO 45001SITE NAMEKEY PROCESSESFULL TIME PERSONNELPART TIME PERSONNEL FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Attach additional pages as required.OFF-SITE ACTIVITIESAre any services provided at another organization’s premises? If so, does the OH&SMS cover these activities? FORMTEXT ?????RISK INFORMATIONPlease identify the key hazards and OH&S risks associated with processes. FORMTEXT ?????Please identify the main hazardous materials used in the processes. FORMTEXT ?????GENERAL INFORMATIONPlease provide a general description of the human and technical resources available for occupational health and safety management. FORMTEXT ?????Please provide a general description of the functions and relationship in a larger organization, if any. FORMTEXT ?????OUTSOURCINGAre there any outsourced processes that may affect conformity requirements? If so, please explain. FORMTEXT ?????USE OF CONSULTANTSWere any consultants used to develop or implement the occupational health and safety management system? If so, please describe to what degree. FORMTEXT ?????RELEVANT LEGAL REQUIREMENTSPlease provide a brief description of relevant legal obligations. FORMTEXT ?????4.0ISO 50001SITE NAMEANNUAL ENERGY CONSUMPTIONSOURCESSEUsEFFECTIVE PERSONNEL FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Attach additional pages as required.GENERAL INFORMATIONPlease provide a general description of the human and technical resources available for energy management. FORMTEXT ?????Please provide a general description of the functions and relationship in a larger organization, if any. FORMTEXT ?????OUTSOURCINGAre there any outsourced processes that may affect conformity requirements? If so, please explain. FORMTEXT ?????USE OF CONSULTANTSWere any consultants used to develop or implement the energy management system? If so, please describe to what degree. FORMTEXT ?????RELEBANT LEGAL REQUIREMENTSPlease provide a brief description of relevant legal obligations. FORMTEXT ?????5.0Superior Energy Performance (SEP)ENERGY SOURCE ID / NAMESOURCE CONSUMPTION (MMBtu) AND DESCRIPTION FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Attach additional pages as required.PROCESS ID / NAMEPROCESS DESCRIPTION FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Attach additional pages as required.LEVEL OF IMPROVEMENTWhat level of improvement is expected? (SEnPI) FORMTEXT ?????What is the achievement period? FORMTEXT ?????ENERGY IMPROVEMENT METHODSPlease provide an overview of the method(s) for demonstrating energy performance improvement to be verified. FORMTEXT ?????MODEL APPROVALDid the method used for the SEP Measurement and Verification Protocol require pre-approval? If so, has this approval been provided? FORMTEXT ?????6.0GHG VerificationAPPLICABLE GHG PROGRAM(S)What programs do you participate in that require this verification? FORMTEXT ?????MONITORING DESCRIPTIONPlease provide a description of the measurement & monitoring processes and the process that deliver the information and data in the GHG assertion. FORMTEXT ?????REPORTING BOUNDARYState / Province (please specify) FORMTEXT ?????North America FORMTEXT ?????Global FORMTEXT ?????REPORTING PERIODYears to be verified FORMTEXT ?????7.0Client ApprovalThis is not a contract for services and does not imply any obligation on the part of the applicant or AWM. FORMTEXT ????? FORMTEXT ?????Approval signatureDate FORMTEXT ?????Title8.0AWM Review and ApprovalPROGRAMAPPLICABLE SECTORISO 14001 FORMTEXT ?????ISO 45001 FORMTEXT ?????ISO 50001 + SEP FORMTEXT ?????GHG FORMTEXT ?????APPLICATION REVIEWDECISIONIs the information provided sufficient for the conduct of the audit and/or verification? FORMTEXT ?????Have the requirements for certification and/or verification been clearly defined and documented and provided to the applicant? FORMTEXT ?????Have any known differences in understanding between AWM and the applicant been resolved? FORMTEXT ?????Does AWM have the competence and ability to perform the certification and/or verification activity? FORMTEXT ?????Has the scope of certification and/or verification sought, the location(s) of the applicant, time required to conduct the audit and/or verification, and any other points influencing the certification and/or verification activity been adequately defined? FORMTEXT ?????Has AWM identified and analyzed potential conflict of interest situations from certification and/or verification activities, including potential conflicts arising from any relationships, evaluated finances and sources of income to demonstrate that commercial, financial or other factors do not compromise impartiality? FORMTEXT ?????ADDITIONAL NOTES FORMTEXT ?????APPLICATION DECISIONBased on the information in this application, shall this certification activity be undertaken? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Approval signatureDate FORMTEXT ?????Title ................
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