Supplier Evaluation Form
Any documentation provided within this form will be treated as confidential within Mirus. It will only be used for the purpose of evaluation process and not shared with any parties outside of our business
Name
*
First Name
Last Name
Job Title
*
E-mail
*
Company
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Type of Company
*
PLC
Ltd
Partnership
Sole Trader
Type of Supplier
*
Business Systems and Support Supplier
Hardware and Ancillary Supplier
Both
Company Registration Number
*
VAT Registration Number
*
Bank Name
*
Bank Account Number
*
Sort Code
*
Key Contacts
We must have at least 1 general contact and 1 finance contact
General
This will be someone we can contact on a daily basis with general queries
Name
*
First Name
Last Name
Job Title
*
Phone Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
Name
First Name
Last Name
Job Title
Phone Number
-
Area Code
Phone Number
E-mail
example@example.com
Finance
This will be someone we can contact regarding accounts specific queries
Name
*
First Name
Last Name
Job Title
*
Phone Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
Name
First Name
Last Name
Job Title
Phone Number
-
Area Code
Phone Number
E-mail
example@example.com
Quality Requirements
Do you hold any of the following Accreditations?
ISO 27001
*
Yes
No
ISO 22301
*
Yes
No
ISO 14001
*
Yes
No
OHSAS 18001 or ISO 45001
*
Yes
No
If you have answered yes to any of the above, please upload a copy of your Certificate here;
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Information Security
Do you have a documented Information Security Policy?
*
Yes
No
If yes, please upload a copy of the Policy here;
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Do you have and enforce a Password Policy?
*
Yes
No
Do you use antivirus and malware protection?
*
Yes
No
Do you use a Patching Policy to keep all your machines up to date?
*
Yes
No
Do you use network firewalls?
*
Yes
No
If you will be supplying third party remote support accessing our network, are the connectivity tools you use encrypted?
*
Yes
No
Do you carry out independent penetration testing?
*
Yes
No
Do your Employees sign a confidentiality agreement or a non disclosure agreement?
*
Yes
No
As an organisation do you consider yourself to be GDPR compliant?
*
Yes
No
If you hold our data is it held outside of the EU?
*
Yes
No
Business Continuity
Do you have a documented Business Continuity Policy?
*
Yes
No
If yes, please upload a copy of the Policy here;
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If supplying a cloud/outsourced business system (on your infrastructure or an outsourced infrastructure), how do you ensure continuity of service if an issue occurs?
Environmental Management
Do you have an Environmental Policy?
*
Yes
No
If yes, please upload a copy of the Policy here;
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Have you established your environmental aspects and impacts?
*
Yes
No
Do you have a carbon management plan or a plan of how you will control or reduce your environmental impacts?
*
Yes
No
Health and Safety
Do you have a documented Health & Safety Policy?
*
Yes
No
If yes, please upload a copy of the Policy here;
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Have you established your Health & Safety risks relevant to the supplies you are going to provide to Mirus and do you have controls in place to mitigate these?
*
Yes
No
If yes, please provide details below;
Other
Do you comply with the requirements of the Modern Slavery Act 2015?
*
Yes
No
Declaration
By signing below you are confirming that the information you have provided on this form and in any supporting documentation is accurate at the time it was provided and that any products or services provided by your organisation to Mirus fully comply with statute law and associated guidance, health and safety guidelines, relevant standards and codes of practice.
Signature
Date
*
-
Month
-
Day
Year
Date
Submit
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