Green Achiever - Registration Form

For your Free Environmental Health Check Report

Stay on the right side of the ever changing legislation!
In Strict Confidence and with no obligation.
Please complete the boxes below answering as many question as you can.
The more information, the more meaningful the report. Our report will be sent to you in electronic format.
A link will be supplied to download a Green Achiever Logo for your website..

First Name  
Last Name    
Company Name    
Your E-Mail
Your Website address :  http://      

General information about your company...

Please use the checkboxes below to select the business sectors
you normally participate in...
(multiple selections ARE allowed)


Recycling & Waste Management
Your Specific Type of Business
...Or if none suitable, please specify here »
Your main Business Activity Search Keywords
*This Field will be used in our 'company search' feature and will help interested visitors find YOUR
listing details and contact you with any enquiries.
- Simply enter some terms relating to the nature of your business, your services and what you do.
(Just seperate each term or phrase with a space)

characters remaining
Number of Employees
Annual Turnover
Do you have an Environmental Policy? No   Yes
Do you have an Environmental Management System (e.g. ISO14001)? No   Yes
Do you operate a Services Department? No   Yes
Do you know your Carbon Footprint? No   Yes
Would you know like to know your business Carbon Footprint? No   Yes
Do you know about Carbon Offsetting? No   Yes
Would you like to learn more about
Carbon Offsetting?
No   Yes

Section 1 - Manufacturing & Construction
If these questions do not apply  please go to section 2.
Do you carry out Paint Spraying? No   Yes
Do you make Electrical or Electronic Goods? No   Yes
Do your products carry the CROSSED OUT 'wheelie bin' logo? No   Yes
Do you specify the packaging of the products manufactured? No   Yes

Section 2 - Oils Policy
Is machine maintenance oil used or stored on site? No   Yes
Do you store more than 200 litres (45 gals.) on site? No   Yes
Do you have a 'spillage plan' in operation? No   Yes

Section 3 - Drains - Do you know where your drains go?

(multiple selections ARE allowed)

Foul Water Sewer No   Yes
Foul water via an interceptor on site No   Yes
Soak Away No   Yes
Septic Tank No   Yes

Section 4 - Chemical Handling
Do you carry any notifiable Chemicals on Site? No   Yes
Do you import or manufacture chemicals? No   Yes
Do you use volumes of individual chemicals in excess of 1 tonne per year? No   Yes

Section 5 - Waste Management - Do you dispose of any of the following?
Card? No   Yes
Plastic? No   Yes
Wood (Pallets?) No   Yes
Electrical or electronic? No   Yes
Paint Cans or Containers? No   Yes
Oil? No   Yes
Oil Rags? No   Yes
Food and Canteen Waste? No   Yes
Chemicals? No   Yes
Batteries? No   Yes
Fluorescent Light Bulbs? No   Yes
Drugs / Pharmaceutical Products? No   Yes
Used Swabs / Dressings? No   Yes
Used Syringes / Needles? No   Yes
Human or Animal Tissue? No   Yes
Blood or Body Fluids? No   Yes
Other General? No   Yes
Do you recycle any waste? No   Yes
Do you take back old and redundant products from customers? No   Yes
What products do you recycle (If any)?

Section 6 - Packaging
Do you buy packaging for packing (e.g. plastic bags, shrink wrap, cartons)? No   Yes

ection 7 - Energy - Which forms of energy do you use?
Electricity? No   Yes
Gas? No   Yes
Oil? No   Yes
Energy generated on site? No   Yes
Do you use any renewable energy? No   Yes
Do you monitor your consumption? No   Yes

Section 8 - Transport
Do you have your own fleet? No   Yes
Do you have company cars? No   Yes
Do you use Biofuels? No   Yes
Do you carry out your own maintenance? No   Yes
Do you use third party logistics? No   Yes
Do you operate a Bike 2 Work Scheme? No   Yes

Section 9 - Other general questions
Have you been asked for your Environmental Policy? No   Yes
Do you ask your suppliers for their Environmental Policy? No   Yes
Do you source supplies locally? No   Yes
Do you import products? No   Yes
Do you advertise your Green Credentials? No   Yes
Do you feel any pressure to become a 'Greener' Company? No   Yes
How did you hear of the Green Achiever Scheme?

I heard about your scheme from...
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