Product declaration
This Product Declaration is an annex of the Supplier Declaration. In case you have signed the
Supplier Declaration not longer than 2 years ago, it is not needed to sign it again.
In order to deliver sustainable products to our customers, we need to be sure our raw materials
are positively defined according Cradle to Cradle®. Therefore we need information from our
suppliers.
Next to Cradle to Cradle®, we also want to produce EPD’s where we need reliable LCA
information, which is compliant with EN15804.
Please provide us with that information by completing and signing this document (incl. initials on
every page) and the possible attachments for each product Desso purchases from your
company.
When we have received the completed forms, the information will be send to our assessor
(currently EPEA) to assess the product with a view to two of the subjects for Cradle to Cradle®
certification: Material Health and Material Reutilization.
The cooperation between Desso and the assessor aims at the development of Cradle to Cradle®
products for technical or biological cycles for differentiation on the market place. The
establishment of the quality of the product of Cradle to Cradle® requires positive definition of its
composition and its production process and therefore information including and exceeding
information contained typically in MSDS and Technical Data Sheets.
The sequence of interaction between the assessor and the supplier will be typically:
Step 1:
Step 2:
Step 3:
Step 4:
Transfer of information on the function and the composition of the product and its
production process by the supplier or of alternatives regarded as environmentally
superior for the same function: CAS-Number, percentage in the formulation,
eventual specification of the production process.
Feedback of assessor on the capability to assess the product.
Feedback of the supplier to answer possible additional questions from the
assessor
Statement by the assessor on the ABC-X-categorisation
The toxicological and ecotoxicological assessment will include the impact of the product on:



the organisms likely to be exposed to the chemicals in current scenarios of material flows
and in the perspective of material flow. Toxicity for mammals, aquatic organisms, higher
soil organisms and micro-organisms.
the succession of generations (mutagenicity, impact on fertility and reproduction)
food chain (bioaccumulation)
Confidential data can be delivered on the basis of a secrecy agreement with Desso or with the
assessor.
Product Declaration (v1.2)
Printed copies are not controlled
The reference of the latest version is available on the purchase order
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Material Input and Process Information Collection Form
PLEASE COMPLETE ONE FORM FOR EACH MATERIAL INPUT
GENERAL MATERIAL INPUT INFORMATION
Background on the material for reference and communication
1) MATERIAL / PART / COMPONENT NAME
2) FUNCTION
3) COMPANY NAME
4) COMPANY CONTACT NAME
NAME:
TITLE:
5) COMPANY CONTACT INFO
ADDRESS:
CITY:
STATE/PROVINCE:
COUNTRY:
POSTAL CODE:
TELEPHONE:
FAX:
EMAIL:
ADDRESS PRODUCTION LOCATION:
CITY:
STATE/PROVINCE:
COUNTRY:
POSTAL CODE:
6) MEANS OF TRANSPORTATION TO DESSO
Load factor products to Desso:
%
7) MSDS AVAILABILITY (according to EG 1907/2006) + TECHNICAL DATA SHEET
AVAILABLE (ATTACHED)
Product Declaration (v1.2)
Printed copies are not controlled
The reference of the latest version is available on the purchase order
NOT AVAILABLE (LIST REASON)
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INGREDIENT AND COMPONENT DETAIL
Specific information about the material input
8) INGREDIENT / COMPONENT / CHEMICAL DETAIL
INGREDIENTS (INCL. ADDITIVES AND
PIGMENTS, RESIDUAL MONOMERS)
CAS No1 / C.I.2 /
EC No3
Composition completely listed (including
all additives, pigments, etc.)
M% in
product
% PostIndustrial4
recycled
content
% PostConsumer4
recycled
content
PRODUCTION
LOCATION
(address)
MEANS OF
TRANSPORTATION
LOAD FACTOR
SVHC or C2C Banned
List SUBSTANCE?5
YES / NO
Composition not completely listed. 1) Please list reason:
2) SVHC or C2C Banned List substances5 incorporated (Yes/No)?
1
CAS registry number „Chemical Abstract Service“ are unique numerical identifiers for chemical compounds, polymers, biological sequences, mixtures and alloys.
Colorants (dyes and pigments) are listed according to Colour Index Generic Names and Colour Index Constitution Numbers
3 EC-No "European Commission number" is the seven-digit code that is assigned to chemical substances that are commercially available within the European Union.
4 Material can be derived from an internal of external process, but must not be recycled within the same process where it is derived from; ‘recycling’ comprises some additional effort, like an additional cleaning step or mechanical grinding step or any other
processing; (definition according ISO 14021).
2
5
http://echa.europa.eu/candidate-list-table and http://c2ccertified.org/images/uploads/C2CCertified_Banned_Lists_V3_121113.pdf
Product Declaration (v1.2)
Printed copies are not controlled
The reference of the latest version is available on the purchase order
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9) LCA
EPD (according to ISO 140256) attached: YES / NO
If no EPD is available, is there an internal (not verified) LCA for your product available: YES / NO
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
If yes: are you willing to share the results with us? YES / NO (If yes, please attach.)
If no: are you willing to co-operate with Desso or any other trustee to build a life cycle
inventory or a life cycle impact assessment for your product? YES / NO
Who within your company can be contacted for LCA issues and further proceedings concerning LCA?
Please provide contact details:
Name:
Telephone number:
Mail address:
10) (ECO) -TOXICOLOGICAL DATA
If any toxicological or ecotoxicological
information available (exceeding the
information in the MSDS), please list or attach
ORGANOHALOGEN CONTENT
no information
available
no organohalogen content
Yes, as follows:
no information available
METAL CONTENTOLOGICAL
no metal content
Yes, as follows:
no information available
11) RESOURCES USED AND WASTE GENERATED
TOTAL COMPANY
PRODUCT RELATED PER KG
Used electricity (GJ)
Green electricity (%)
Self-produced electricity (%)
Used gas (GJ)
Green gas (%)
Self-produced gas (%)
Water consumption (m3) + type:
drink / surface / ground / total
/
/
/
/
/
/
Waste generated (ton) +
categorisation (f.i. glass, wood,
metal)
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An EPD is an external document that publishes the results of an LCA study conform ISO14041/44; The information is validated by an EPD
program holder; LCA calculations are made according to rules that are agreed in an open stakeholder dialog, the so called “Product
Categorization Rules”.
Product Declaration (v1.2)
Printed copies are not controlled
The reference of the latest version is available on the purchase order
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"As an authorized representative of the company, I verify that all responses provided are
correct, based upon our currently available data. I am aware of the fact that random analysis
will be possible"
Date, Place
Name and Signature
Product Declaration (v1.2)
Printed copies are not controlled
The reference of the latest version is available on the purchase order
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