New Rising Steward Application

All information provided in the application is considered public information. If there are confidentiality issues, please contact an ESI team member at 1-877-623-6748 or esi@ncdenr.gov

General Information

Please provide the general information about the facility as indicated on this page. Please note, you may not apply at the Rising Steward level with a single application for multiple sites. Each site must apply individually.

Organization Name

Previous Name

(If name has changed within past 2 years)

NAICS Code

Products or Services Provided by your Organization

Number of Employees

Site/Facility Address

Street Address

City

Zip Code

County

Facility's Main Phone Number

Check box below if your mailing address is different than listed above

Primary Contact for your ESI Membership

Contact Name

Contact Title

Contact Email

Contact Phone Number

Secondary Contact

Secondary Name

Secondary Title

Secondary Email

Secondary Phone

Site/Facility Management

Manager Name

Manager Title

Manager Email

Manager Phone

Number of Paid Environmental Staff

Facility or Corporate Website

Permit Information

Please list any environmental permits and regulatory requirements, including permit numbers and/or ID numbers (i.e. hazardous waste identification numbers, etc). A pull-down menu is provided for most state permits. For those local, federal or state permits not listed, or if you need extra lines, use the Additional Permits text box

Permit 1

Permit/ID Number 1

Permit 2

Permit/ID Number 2

Permit 3

Permit/ID Number 3

Additional Permits

EMS Information

Please tell us about the facility's environmental management system and its maturity.

A mature EMS is a requirement of the Rising Steward Level.

Check box if this site is certified to ISO 14001

Has the site completed implementation of an EMS but not become 3rd party certified?

Yes

Is the site planning to get certified to ISO 14001?

Yes

Has the site been deemed functionally equivalent by ESI staff?

If the site is not going for certification and has not yet been deemed functionally equivalent, ESI Staff will schedule an assessment of the EMS prior to the site visit verifying the rest of the application.

Yes

EMS Maturity

Number of Internal EMS audits performed on system since implementation:

Number of 2nd party EMS Audits since implementation:

If applicable, including FE audit by ESI staff, customer audits, corporate audits, etc.

Number of 3rd party (external) EMS audits performed on system since implementation:

Number of management review meetings that address all the requirements defined by ISO 14001 since implementation:

Titles of management in regular attendance at management review meetings:

Describe examples of your mature EMS

(Focus on areas other than goals, which will be discussed in another section. For example, improvement in awareness and competence, communications, auditing, corrective & preventive actions, diversity of involvement from management to workers, etc)

Noncompliance

Have you had a regulatory noncompliance in the last 5 years?

Yes

Current Goals

Tell us about your current measurable environmental goals. Space for 5 goals is provided, but it is not required or expected that your organization will have that many goals. A minimum of 2 measurable goals is required for the Rising Steward Level.

Use SMART goals whenever possible:

S - Specific

M - Measurable

A - Attainable

R - Relevant

T - Time-Bound

Goal 1

(Objective - include numerical target associated with units as well as baseline and timeframe)