Responsible Distribution Customer Policy Survey

Responsible Distribution Canada
Responsible Distribution®

As a condition of membership, the member companies of Responsible Distribution Canada are committed to Responsible Distribution® [1]. Responsible Distribution® governs member company actions as they relate to all aspects of the distribution of chemicals, chemical products, ingredients, and chemical services.

Customer Policy

As a member company of Responsible Distribution Canada (RDC), we are committed to the Responsible Distribution® management program.

This means we will work with our customers to ensure the safe supply, handling, distribution, use, and disposal of chemicals, ingredients, and chemical products. The goal is to distribute chemicals, chemical products, ingredients, and services in a manner that protects people and the environment

We request that you review your current practices and identify opportunities to reduce risks associated with the supply of chemicals, ingredients, and chemical products to you.

As your supplier, we recommend that you consult and follow up with us regarding any actions or assistance required. We pledge our support in helping you better understand our expectations of you as a valued customer.

Step 1 of 15

This assessment is a guide to assist in the implementation of the Customer Policy for the responsible management of chemicals and ingredients. Responsible Distribution Canada assumes no liability for the completeness or accuracy of this information.
Customer Information
Company Name*
Date*
YYYY dash MM dash DD
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Completed By:*
Title:*

Assessment Return
(Where do you want us to send the completed assessment to?)
Name
Title:*
Email
Would you like the assessment returned to the same address?*
- Yes
- No
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Fax

Pre-Qualification
Not everyone needs to fill out the full assessment. If you do not ship HAZMAT or you are a member of a recognized chemical association and/or security association, you do not have to fill out the full assessment.
Is your organization a chemical handler of Hazardous Materials? (A chemical handler is any entity that manufactures, distributes, ships or receives Hazardous Materials) ?*
- Yes
- No
Are you a member of any of the following associations/organizations?*
- Responsible Distribution Canada (RDC)
- National Association of Chemical Distributors (NACD)
- Custom Trade Partnership Against Terrorism (C-TPAT)
- Chemistry Industry Association of Canada (CIAC)
- Society of Chemical Manufacturers and Affiliates (SOCMA)
- American Chemical Society (ACS)
- NONE OF THESE

Action Required
1. Have you identified any additional Responsible Distribution® assessment requirements?*
- YES
- NO
2. Have you identified follow-up actions you will address as a result of the self-assessment?*
- YES
- NO
Action Item
Assigned To
Target Date
MM slash DD slash YYYY
Action Item 2
Assigned To 2
Target Date 2
MM slash DD slash YYYY
Action Item 3
Assigned To 3
Target Date 3
MM slash DD slash YYYY
Additional Action Items
Max. file size: 4 MB.
If you have more than 3 action items please upload an additional spreadsheet. (max file size 4MB)
These action items will be reviewed to ensure they are completed as scheduled by:
Reviewer Name
Scheduled Review Date
MM slash DD slash YYYY

Your Assessment is complete
Please sign and submit the form.
Signature of Commitment*

[1]Responsible Distribution® is an industry-wide program designed to further improve the performance of the Canadian chemical distribution industry in the fields of health, safety, the environment, and in all communication interfaces with its public. It is a registered trademark of Responsible Distribution Canada (RDC).

Customer Policy – RDC, Revised February 2016

Responsible Distribution Customer Policy Survey

Responsible Distribution Canada
Responsible Distribution®

Customer Policy

Step 1 of 15

Customer Information

Assessment Return

Pre-Qualification

Assessment

Health & Safety

B. Receiving, Storage, Use & Shipping

C. Environment

D. Security

E. Emergency Response

Action Required

Your Assessment is complete

Responsible Distribution Canada Responsible Distribution®

Customer Policy

Step 1 of 15

Customer Information

Assessment Return

Pre-Qualification

Assessment

Health & Safety

B. Receiving, Storage, Use & Shipping

C. Environment

D. Security

E. Emergency Response

Action Required

Your Assessment is complete

Responsible Distribution Canada
Responsible Distribution®