Application for ISO 14001 Registration
Performance Review Institute Registrar
Application for ISO 14001 Registration
Parent Company Name (if applicable): / Click here to enter text. /Company Name: / Click here to enter text. /
Address: / Click here to enter text. / Phone Number: / Click here to enter text. /
City: / Click here to enter text. / State: / Click here to enter text. / Fax Number: / Click here to enter text. /
Zip Code: / Click here to enter text. / Country: / Choose an item. / Legal Status: / Choose an item. /
Total number of employees: / Click here to enter text. / Square footage of facility: / Click here to enter text. /
Primary Industry: / Choose an item. / If other, please list: / Click here to enter text. /
Environmental Contact: / Click here to enter text. / Title: / Click here to enter text. / E-mail: / Click here to enter text. /
Do you have more than one location that requires registration? / ☐Yes / ☐No / Total number of locations: / Click here to enter text. /
(If yes, please request and complete REG-FRM-3a EMS [Additional FacilitiesApplication] for each individual location)
Facility / Property: / Choose an item. / Surrounding: / Choose an item. /
Environmental Sensitivity of Surroundings: / Click here to enter text. /
☐ Yes / ☐ No / On-Site Pre-Treatment (Sanitary Water)
☐ Yes / ☐ No / On-Site Pre-Treatment (Process Water)
Permitting Agencies (Please list): / Click here to enter text. /
Description of Environmental Scope (Check applicable items, list associated permits and which facilities they apply to):
☐ / Emission to Air / ☐ / Hazardous Waste
Click here to enter text. / Click here to enter text. /
☐ / Biohazardous Waste / ☐ / Industrial Water Effluent Treatment
Click here to enter text. / Click here to enter text. /
☐ / Bulk Chemical Storage / ☐ / Noise Pollution
Click here to enter text. / Click here to enter text. /
☐ / Drinking Water Effluent Treatment / ☐ / Pesticides / Herbicides
Click here to enter text. / Click here to enter text. /
☐ / Emergency Preparedness / ☐ / Radiation / Radioactivity
Click here to enter text. / Click here to enter text. /
☐ / Energy Use / ☐ / Sanitary Effluent
Click here to enter text. / Click here to enter text. /
☐ / Groundwater / ☐ / Solid Waste
Click here to enter text. / Click here to enter text. /
Do you process either of the following?
- Surface and other chemically based treatment processes for metal fabricated products, excluding primary production?
☐ Yes / ☐ No
- Surface and other chemically based treatment for general mechanical engineering?
☐ Yes / ☐ No
Please provide the following information:
☐ Yes / ☐ No / Do you work multiple shifts?
If yes, list shift hours: / 1st / Click here to enter text. / 2nd / Click here to enter text. / 3rd / Click here to enter text. /
☐ Yes / ☐ No / Do you have a non-English speaking workforce? (All audit documents must be provided in English)
If yes, what language? / Click here to enter text. /
☐ Yes / ☐ No / Is there an English speaking technical expert available for each auditor?
☐ Yes / ☐ No / Are you regulated by such organizations as the FDA, FAA, etc.?
If yes, please list the organizations: / Click here to enter text. /
☐ Yes / ☐ No / Do you have documented list of anticipated environmental aspects/impacts? (Please submit along with this completed application) / These items must be completed prior to a Stage 2 audit being performed
☐ Yes / ☐ No / Is there a corporate EMS manual?
☐ Yes / ☐ No / Has your EMS been in place at least 6 months?
☐ Yes / ☐ No / Has at least one cycle of internal auditing been completed?
☐ Yes / ☐ No / Has at least one cycle of management review been completed covering the requirements of ISO 14001?
☐ Yes / ☐ No / Are any processes within the EMS outsourced?
If yes, what processes? / Click here to enter text. /
☐ Yes / ☐ No / Are you now using, or have you ever used management system consultancy?
If yes, who was the consultant? / Click here to enter text. /
Brief description of your product / process: / Click here to enter text.
Scope of Registration (as it will appear on your certification): / Click here to enter text.
What is your IAF / NACE code? / Choose from dropdown.
(Choose one selection, by clicking the arrow, which best describes your company)
If yes, who will be the responsible party to be contacted for direction regarding ITAR / EAR issues?
Name and Title: / Click here to enter text. / Phone: / Click here to enter text. / E-mail: / Click here to enter text. /
Please choose one option below: (NOTE: If you are applying for a transfer of registration, this section is not needed)
☐ / Option 1: / Include a pre-assessment. Stage One Document Review will occur on-site either 30 days prior to the pre-assessment or the day before the pre-assessment
☐ / Option 2: / No pre-assessment. Stage One Document Review to occur on-site 30-60 days or more prior to the Stage Two Assessment audit.
What time-frame do you desire registration? / Month: / Choose an item. / Year: / Click here to enter text. /
Reason(s) for seeking transfer:
(N/A if new registration) / Click here to enter text. /
Signature: / Title: / Date:
Note – If submitting the application electronically, no signature required
For PRI Registrar office use only: If this is a TRANSFER AUDIT, verification has been made by staff to assure that this client holds a certificate to the above standards
By Whom? / Click here to enter text. / Via what method? / Click here to enter text. / Date: / Click here to enter text. /
Applicant agrees to comply with the requirements for certification/registration and to supply
any information needed for its evaluation should it chose the Performance Review Institute Registrar as its Registrar
When completed, please e-mail to .
REG-FRM 3 EMS 5-FEB-16Performance Review Institute Registrar • 161 Thorn Hill Road, Warrendale, PA 15086 USA1 Website: • Email: • Phone: (724)772-1616 • Fax: (724)772-4080