Cradle to Cradle Certified Assessment Summary Form

Applicant Company:	[Company]
Product:	[Product]
Submission Date:	[Date Submitted]

Form last revised: March 2022

Cradle to Cradle Products Innovation Institute

CONFIDENTIAL AND PROPRIETARY—For use only by [Applicant Company], [Assessment Body(ies)], and the Cradle to Cradle Products Innovation Institute.

Assessor Attestation

I hereby certify under penalty of law, that to the best of my knowledge and belief:

All information provided in this assessment, on behalf of the company identified below, is complete and accurate.

Except as may be otherwise indicated, this assessment fully conforms with the requirements of ISO 17065, the Cradle to Cradle Certified Product Standard (‘Standard’), and the Cradle to Cradle Certified Products Program (‘Program’) documents. The assessment procedures of the standard and program documents were followed without deviation and the application of such procedures did not indicate any conditions of non-compliance with the requirements of ISO/IEC 17021-1 and 17065, the Standard, or Program documents.

This assessment was conducted in conformance with all requirements of the Program, as well as the impartiality requirements of ISO/IEC 17021-1 and 17065. There were no conflicts of interest present between the individuals that conducted the assessment and the certification client or their material suppliers.

BY SUBMITTING A SIGNED COPY OF THIS ASSESSOR ATTESATION AND ASSESSMENT YOU HEREBY AGREE TO THE TERMS, CONDITIONS AND PROVISIONS REPRESENTED IN THIS ASSESSOR ATTESTATION. YOU ACKNOWLEDGE THAT YOU HAVE READ AND UNDERSTOOD THIS ASSESSMENT AND ALL EXHIBITS AND SCHEDULES HERETO, ALL PROGRAM POLICIES AND GUIDELINES, INCLUDING THE STANDARD AND ASSESSMENT METHODOLOGIES, AND TRADEMARK USAGE POLICY APPLICABLE TO THE ASSESSMENT, AND THAT YOU HAVE BEEN PROVIDED THE OPPORTUNITY TO MAINTAIN A RECORD OF THIS ASSESSOR ATTESTATION.

By:

Assessor Signature:_____________________________

Date:	[Date of signature]
Assessor name:	[Name of individual signing]
On behalf of Assessment Body:	[Name of assessment body]

Instructions

Purpose

This document is the form for submitting assessment summaries of products applying for Cradle to Cradle certification according to Version 3.1 of the Cradle to Cradle Certified Product Standard (‘the standard’). The intention is that an accurately completed form contains all of the information required for third-party review by the Cradle to Cradle Products Innovation Institute (C2CPII) for the purposes of awarding certification.

Assessor Attestation

On the second page, please insert your digital signature (as an image) in the place provided. No submission will be accepted without the assessor’s signature included. Alternatively, you may convert the completed document to PDF and add your signature in Adobe or similar software.

General Guidance

This form contains general instructions for providing information to support a certification decision. Please refer to the standard for detailed guidance on required methods, documentation, and the definitions of certification criteria.

Instructions are provided in italics throughout the application. Follow the instructions and complete the form using the checkboxes, drop-down menus, and text boxes provided. Please also note that placeholder text on the title page (‘Applicant Company’ and ‘Assessment Body(ies)’) needs to be replaced with the appropriate, applicable information prior to submission.

Recertification

This form is also to be used for recertification applications. For recertification, the application must demonstrate the fulfillment of each individual requirement and also progress that occurred with respect to the previous certification of this product or product group. Using text highlighting, clearly indicate which sections of the ASF have been updated since the last assessment for certification.

Updates on all optimization strategies must be provided (sections 5.9, 6.3, 7.3, 8.8/8.10, and 9.3). Specific progress must be shown on the Material Optimization Strategy (section 6.3) for products that have not yet obtained the Gold or Platinum level in the Material Health category and in at least one of the other categories otherwise. If any problems were identified during the local- and business-specific water issues characterization or the streamlined self-audit, progress must also be shown in those areas at recertification. Note that documentation and numbers on energy use, water audits, emissions, purchased RECs, and offsets need to be updated for every recertification, including applications submitted for Platinum products.

Documentation Guidelines

Where required, supporting documentation that needs to be submitted to demonstrate fulfillment of a given requirement is called out in the corresponding prompt in bold with an underline, and a document icon (example: Submission Authorization form signed by the applicant is attached). Supporting documents may be submitted as separate attachments alongside the completed assessment summary form. If required documentation is attached separately, enter the filename in the fields provided. If any separate files are submitted that do not correspond with the information types for which filename fields have been provided, please indicate the purpose of these files and filenames in the assessor notes sections or other relevant locations. Follow a systematic naming format. The suggested format is the following: ‘Section code’_’Document type’_’Company name’_’Product name’_’year’.pdf. Here is an example: ‘MH_BOM_AcmeCo_iAnvil_2021.pdf’. See the table below for a list of section codes.

Section Name	Section Number	Section Code
General/Administrative	Section 1 & 2	GA
Material Health	Section 5	MH
Material Reutilization	Section 6	MR
Renewable Energy & Carbon Management	Section 7	RECM
Water Stewardship	Section 8	WS
Social Fairness	Section 9	SF
Recommendations for Product Optimization	Section 10	RPO

Assessor Notes

At the beginning of each section is a text field with the placeholder text ‘Assessor Notes’. These fields may be used by the Assessor to make notes during the assessment process. For example, this field can be used to leave reminders regarding missing items or fields that still need to be filled in. Typically, such notes should be removed prior to submitting the completed assessment to C2CPII. However, in the rare cases in which additional information needs to be provided to the auditor that does not fit into any of the other fields, these fields may also be used for this purpose. In such cases, please include a clear explanation of why the additional information is needed for the auditor.

Application Submission

After all required information has been included in this assessment form:

Thoroughly review the form to ensure it does not contain inaccurate information, typos, omissions, or remaining replaceable text.

In order to update the Table of Contents and conduct a final Spellcheck:

For Mac Users: you may unlock the document using the Tools menu, and selecting “Protect Document” or by using the keyboard shortcut “Command” + “\”

For PC Users: Go to the Review tab in MS Word, then click on Restrict Editing tab on left of screen and uncheck editing restriction.

Update the table of contents to reflect current page numbers (right click on TOC and select ‘update field’).

Run document Spellcheck

Convert the filled-out form to a PDF file. Note: Non-PDF versions of the ASF will not be accepted.

Name the file following this convention: AS_’Product name’_’Date submitted (YYMMDD)’.pdf.

Submit the completed form and all supporting documentation (total file size not to exceed 25 MB) in a single email to certification@c2ccertified.org, with applicant company and product name in the subject line.

Other forms that may be required:

Assessment Report Submission Authorization Form Material Health Certificate Form Externally Managed Component Form VOC Emissions Testing Form Bill of Materials Template Supplier Banned List Declaration Form Energy Data Worksheet Energy Data Guidance	Water Stewardship Form Water Audit Worksheet Social Fairness Streamlined Self Audit Form Innovative Social Project Form

Table of Contents

1	Version Control & Overview	1

2	Contacts	3

2.1	Lead Assessment Body	3

2.2	Material Health Assessment Body	3

2.3	Applicant	4

2.4	Certification Scorecard	4

3	Product Information	5

3.1	Products Covered in this Application	5

3.2	Product Registry Information: Description and Image	7

3.3	Product Category(ies) or Classification	7

3.4	Packaging	7

3.5	Certified Product Private Label Verification	8

4	Manufacturing Site(s)	10

4.1	Site Visit(s)	10

4.2	Final Manufacturing Stage of Product	10

4.3	Final Manufacturing Stage Facilities	11

5	Material Health	12

5.1	Overview	12

5.2	Product Metabolism (Basic)	13

5.3	Banned List Compliance (Basic)	13

5.4	ABC-X Assessment Results (Bronze)	17

5.5	Hazard and Risk Assessment Considerations (Bronze)	21

5.6	Determining Absence of CMR Substances (Silver)	24

5.7	Volatile Organic Compound (VOC) Emissions Testing (Gold)	26

5.8	Process Chemicals Assessed and not x-Assessed (Platinum)	26

5.9	Material Optimization Strategy (Bronze)	26

6	Material Reutilization	28

6.1	Overview	28

6.2	Material Reutilization Score (Bronze)	28

6.3	Nutrient Management Strategy and Nutrient Cycling (Gold, Platinum)	30

7	Renewable Energy and Carbon Management	32

7.1	Overview	32

7.2	Final Manufacturing Stage Electricity & On-Site Emissions (Basic)	33

7.3	Renewable Energy and Carbon Management Strategy (Bronze)	34

7.4	Addressing Electricity & GHG Emissions (Silver/Gold/Platinum)	35

7.5	Embodied Emissions (Platinum)	39

8	Water Stewardship	40

8.1	Overview	40

8.2	Statement on violations of water discharge permits within the past two years (Basic):	41

8.3	Qualitative description of effluent management (Basic):	41

8.4	Local and industry-specific water issues relating to this product (Basic):	41

8.5	Strategy for addressing water issues identified (Basic):	42

8.6	Results of water audit (Bronze):	42

8.7	Results of effluent chemicals characterization and assessment (Silver for manufacturers with product-relevant wastewater):	42

8.8	Optimization plan for product-relevant chemicals in effluent (Silver for manufacturers with product-relevant wastewater):	43

8.9	Local and business-specific water issues identified among tier 1 suppliers (Silver for manufacturers without product-relevant wastewater):	44

8.10	Strategy for addressing supply chain water issues (Silver for manufacturers without product-relevant wastewater):	44

8.11	Effluent Optimization (Gold for manufacturers with product-relevant wastewater):	45

8.12	Water Stewardship Optimization Progress (Gold for manufacturers without product-relevant wastewater)	45

8.13	Drinking Water Quality (Platinum)	45

9	Social Fairness	47

9.1	Overview	47

9.2	Streamlined Self-Audit (Basic)	48

9.3	Full self-audit (Bronze)	49

9.4	Material-specific or issue-specific audit (Silver/Gold/Platinum)	50

9.5	Supply chain social issues investigation and impact strategy (Silver/Gold/Platinum)	50

9.6	Innovative Social Project (Silver/Gold/Platinum)	51

9.7	Two Silver Achievements Completed (Gold)	51

9.8	Facility-Level Audit by Third Party (Platinum)	52

10	Recommendations for Product Optimization (Optional)	53

10.1	Material Health	53

10.2	Material Reutilization	53

10.3	Renewable Energy and Carbon Management	53

10.4	Water Stewardship	53

10.5	Social Fairness	53

11	Assessment Documentation Overview	54

11.1	Documentation Overview Tables	56

Version Control & Overview

[assessor notes]
Instructions: Provide the application version history for this certification in the table below. Begin by filling in the original date of submission for this application for certification/recertification. If additional versions of this ASF are submitted after the initial submission during the review process, add an entry to the table for each version, noting the reason for the additional submission. Required for Interim Assessment Reviews (IAR): Using text highlighting, clearly mark and describe the specific changes requiring an updated ASF submission in the Reason for Submission column below (e.g., certificate correction, merging or splitting of certificates). Please provide sufficient detail and indicate what sections of the ASF have been updated. Required for recertifications: Provide a high-level summary of the major changes that occurred since the last certification and list the relevant sections where these major changes were made. If more efficient to highlight these changes throughout the report, this would be acceptable as an alternative. [...]
Version Number	Date Submitted	Reason for Submission
1	[...]	[...]
2
3
4
5
Instructions: Provide an overview of this application by filling out the table below. Additional information regarding what to enter in each row is provided below:
Purpose of Application
Version of Standard used
If one or more categories were assessed to V4.0, please indicate which:
Material Health Certificate desired? (Indicate Yes or No) MHCs requested concurrently with a full certification application are free of charge	[...]
Recommended certification level
Assessment start date This is the date on which the final Bill of Materials was received by the Assessment Body.	[...]
Certification start date The default is for new certifications and interim assessments to be issued and appear on the public registry immediately upon approval. If the applicant wants to hold certification issuance and publication until a later time, indicate this here and enter the desired issuance date (Note: the date may be no more than six months after the assessment package submission date).	Issuance date: [...]
Note: Any additional information not covered elsewhere in the application, but necessary for understanding the nature of the application, may also be included in paragraph form in the space below (e.g., if the application is needed to support the addition, exclusion, or re-grouping of products with respect to the previous certification or if the application is submitted at an irregular time for the purpose of a mid-certification period level change). If the purpose of the application is stated as 'other,’ this should be explained in a separate paragraph here.
[...]

Contacts

[assessor notes]

Lead Assessment Body

Instructions: Provide the contact information for all individuals involved in this assessment and application preparation by replacing the placeholder text with the indicated information. The project manager of the lead assessment body, the materials assessment lead of the materials assessment body, and the company contact will be the ones receiving audit communications. Ensure that the applicant’s address is the current billing address, because it will be used for invoicing.
Company:	[company name]
Project Manager [required]:	[name], [title], [email], [phone number]
Final Assessment Sign-off [required]:	[name], [title], [email]
Other Individuals Involved in Assessment:	[name], [title], [company name (if different from above)]
Required: An individual other than the individual doing the majority of the assessment work has reviewed this assessment summary. Final assessment sign-off was by an individual trained/accredited by C2CPII (and named in the table above).

Material Health Assessment Body

Instructions: Complete this section only if the Material Health assessment was conducted by a company other than the lead assessment body indicated in section 2.1. Otherwise, write: “Same as Lead Assessment Body.”
Company:	[company name]
Material Health Assessment Lead:	[name], [title], [email]
Other Individuals Involved in Assessment:	[name], [title]

Required for new and recertifications: The Material Health Assessor Attestation Form has been completed and signed by the Cradle to Cradle Certified Material Health assessor that conducted the material health assessment for this product/product group. The filename is: [...].

Applicant

Instructions: Provide the contact information for the applicant company and all relevant company contacts. This needs to include the person to whom the Certification Agreement for this certification should be sent. If multiple contacts are provided, indicate to whom the agreement should be directed. The ‘accounts payable contact’ is the person at the applicant organization to whom C2CPII should send invoices for certification-related fees.
Company Name:	[company name]
Billing Address:	[company billing address]
Primary Contact:	[name], [title], [email], [phone number]
Accounts Payable Contact (If different):	[name], [title], [email], [phone number]
Additional Contacts:	[name], [title], [email], [phone number]
Required for new and recertifications: The Submission Authorization Form signed by the applicant is attached. The filename is: [...]. Note: An updated Submission Authorization Form is required for recertification.

Certification Scorecard

Instructions: Select the recommended achievement level for each of the five categories. Set the overall certification level to the lowest among the levels achieved in the individual categories.

Category	Level
Material Health
Material Reutilization
Renewable Energy and Carbon Management
Water Stewardship
Social Fairness
Overall Certification Level

This product is being recommended for certification at the lowest level achieved across the five categories of certification, as summarized above. At the conclusion of the certification cycle, this product may be recertified, based on progress on stated objectives for replacing X-assessed components and any demonstrated progress on the criteria for material reutilization, renewable energy, water stewardship and social fairness. For more information on the certification process and criteria, please visit www.c2ccertified.org.

Product Information

[assessor notes]

Products Covered in this Application

Product or Product Group Name

Instructions: In the space below, provide the name of the product or product group submitted for certification. This product or product group name will appear on the certificate and the product registry.

Product or Product Group Name (for certificate and registry): [...]

Product Description for Assessment Use Only

Instructions: In the space below, provide a clear, but brief description of what the product or product group is, its function, and the different variations that are included in the group, if applicable (e.g. color, size, shape, material variations). This description is not for publication on the product registry. Rather, this is for C2CPII’s internal use only to better understand the product that was assessed.

Product or Product Group Description (for C2CPII internal use): [...]

Product Variations

Instructions: Use the Product Identifier Template to provide the full name and a unique identifier for all individually sold products covered by this report. Unique product identifiers include, for example UPC, EAN, GTIN, or SKU numbers. Separate lines should be added for each unique version of a product covered under the scope of certification (for example multi-packs, size variations, or packaging formats for different markets). In addition, provide a brief description of the scope of this assessment that will appear on the certificate and product registry. It needs to be clear from this list exactly which products that can be individually purchased are covered by the certificate to be issued.

The certification scope must be made clear in situations where the product names do not sufficiently define what is and is not certified. For example, if only product variations sold in certain markets are covered by the assessment and there are products sold under the same name in other markets that were not assessed, this must be made clear (i.e., markets covered or excluded must be listed). If the products are modular in nature, describe which variant or variants were assessed and list any relevant exclusions.

If it is not feasible to uniquely identify each variation of the certified product, and a sufficient description of the scope of the certification is too large to include on the certificate itself, please submit an editable MS Word document that includes a description of the products covered in scope of certification using only text and simple tables, if needed. This will be formatted by C2CPII into a standard List of Certified Products for publication on the Product Registry page.

Certification scope description for the certificate and product registry (approx. 15 lines of 100 characters each): [...]
The scope description must explicitly cover all uniquely certified products. If there are similarly named products or variations of a product that are excluded (e.g., by facility, region, product options, finishes, fragrance variations, etc.), these must be listed. Check one:
All possible variations with the above description are included within the scope of this certification project, OR
Certain related products are excluded from the scope of this certification, these exclusions are described in the scope description above.
Check one:
The Excel Product Idenitifier Template is attached. The filename is: [...]
It is not possible to list all covered product variations individually as required by the Product Identifier Template. The certificate scope description above completely and sufficiently describes the scope of certification.
It is not possible to list all covered product variations individually as required by the Product Identifier Template. An editable MS Word formatted description of the covered products is attached. The filename is: [...]
Number of product variations covered: [...]
The assessor has verified that the scope of certification as indicated by the product and product group names and the listed product variations, are accurate and unequivocally define the assessed product range. If the scope of certification is limited by facility, region, or otherwise, this information has been accurately noted in the fields above and/or in the List of Certified Products. The provided information is sufficient for a potential customer or third-party to clearly identify any products covered by this assessment and certification at the point of sale and distinguish them from any similar products that are not covered.

Conformance with Product Grouping Requirements

Check all that apply.

This application covers a single product.
This application covers multiple products or multiple product variations. The product group meets the following requirements in C2CPII’s product grouping policy (check all that apply):
Required. The products are in the same product category.
The products have a similar composition, OR
N/A (the product is modular). The product meets the modular product definition for the following reasons: [...]
Required. The products have the same manufacturing process.
Required. The products have the same function and have the same exposure scenarios.
Required. The product or products, including the number of product variations, are consistent with the standard’s definition of a product: “…any physical item that can be routinely and individually purchased from the applicant by other entities”

Product Registry Information: Description and Image

Please review the Product Registry Content Guidelines to confirm the product description and image meets these requirements. Please refrain from using promotional language in the description and write it in the third person, not the perspective of the applicant company. Images should be at least 700 pixels wide, 5 MB or less, JPG or PNG. Limit is one image per product. If you would like to include multiple photos, please compile into one composite image file.

Please be sure that images accurately represent the product. Images that do not meet these requirements will not be posted on the product registry.

Check all that apply.

The applicant has recently completed the application form including product registry information.
The product description submitted as part of the certification application completely and accurately describes the product or product group that was assessed for certification and meets the Product Registry Content Guidelines.
The product image submitted as part of the certification application accurately depicts the product or product group that was assessed for certification and meets the Product Registry Content Guidelines.
For recertification: The current product registry entry and image (as already included on the product registry) are up-to-date and accurate.
Please use the following product description for inclusion on the product registry. Please note that C2CPII reserves the right to edit product descriptions that do not comply with the guidelines: [...]
Please use the attached image for inclusion on the product registry. The filename is: [...]
An image of the product or product group is not currently available and market ready. An image for the product registry will be reviewed and sent to C2CPII once finalized. Required: If a market ready image is not available, please submit an image for C2CPII’s internal use and provide the file name here: [...]

Product Category(ies) or Classification

Instructions: In the space below, classify this product into one or more categories from the list provided in Appendix 1 of the product grouping policy. Additionally, provide any industry-specific classifications that may be relevant (e.g., Construction Specifications Institute (CSI) MasterFormat Division for building products).

Product Category(ies): [...]

Packaging

Check all that apply.

N/A (no packaging included in certification scope). Reason why packaging is excluded: [...]
The product is a liquid, gel, paste, or powder and is intended to be stored in its primary packaging during use or up until the moment of application (e.g., surface cleaner spray bottle, paint can, dishwasher powder box, nail polish bottle, wet-wipe pouch/packet/tub, hand soap bottle), or the product is dispensed from a paper core (e.g., tape, toilet paper). Furthermore, the product is not sold exclusively as material inputs for other products (i.e., it is not an intermediate product or raw material). In such cases, the primary packaging must meet the banned list requirements. Checking the next box is required.
Primary packaging, including inks, adhesives, and any materials used to label the package, meets banned list requirements. Signed declarations are attached. The filename(s) are: [...].
Required. Packaging material has been defined as a biological or technical nutrient
Packaging material is a biological nutrient
Packaging material is a technical nutrient
Packaging was included in the assessment. It was included in the following way (check one):
Packaging was assessed as individual homogeneous material(s) within the multi-material product applying for certification. Assessment results for packaging are included with those for the primary product.
Packaging was assessed separately from the main product and received separate scores in the Material Health & Material Reutilization categories. The Packaging Form has been completed and is attached. The filename is: [...]
Instructions: If packaging was assessed, describe in the space below the nature of the packaging that was included and list all homogeneous materials by generic name or trade name that are part of the packaging.
Packaging Assessed: [...]
Instructions: If the packaging received separate ratings for Material Health and Material Reutilization, select the recommended achievement level for these two categories. If the packaging did not receive a separate rating in these categories, select ‘N/A’. Note that packaging materials may also be directly included in the material assessment of the product.
Material Health Level:	Material Reutilization Level:

Certified Product Private Label Verification

Instructions: In the space below please provide a list of all private label products that are related to this certification. In addition, state whether they are in every way identical in production process and material composition to the certified product that is the subject of this ASF (the OEM Product). Otherwise, please provide BLDs for the private label packaging or provide reasoning for why packaging for the private labels is out of scope. These products will be permitted to receive Private Label certifications, based on the successful audit of this assessment, and subject to the Private Label Policy.

Product Name	Company	Identical Packaging Materials	BLDs Provided for Private Label Packaging	Packaging out of scope (identify reason)
No primary packaging	Intermediate Product	No exposure to packaging
[...]	[...]

Definitions of terms used in table above:

Identical Packaging Materials

The Private Label Product’s primary packaging uses the same materials (and no others) as the OEM Product’s primary packaging.

BLDs provided for Private Label Packaging

The Private Label Product’s primary packaging is different from the OEM Product’s packaging. Banned list declaration(s) have been provided for all homogeneous materials subject to review within the Private Label Product’s primary packaging including inks, adhesives, and any materials used to label the package.

Packaging Out of Scope

The product’s primary packaging is out of scope for the following reason and therefore banned list declarations are not required:

No primary packaging

The product is not contained within any primary packaging.

Intermediate Product

The product is sold exclusively as a material input for other products (rather than being sold to the general public).

No exposure to packaging

All packaging materials are intended to be removed prior to the product’s use (note: this does not include packaging intended to be kept with the product up until the moment of application; see primary packaging definition1).

Manufacturing Site(s)

[assessor notes]

Site Visit(s)

Instructions: Briefly summarize information on the general nature of the site visit(s) (e.g., type of facility, total number of final manufacturing facilities for this product, total number of facilities visited, on-site or remote visit) and what was achieved by the site visit(s). Also summarize key challenges and opportunities identified during each of the site visits. If a site visit was not conducted at all final manufacturing facilities, indicate the reason.

A Site Visit Report is attached (optional). The filename is: [...].
Site Visit Summary: [...]

Final Manufacturing Stage of Product

Instructions: Pick the appropriate product category from the Guidance for Applying the Final Manufacturing Stage Requirements in the Cradle to Cradle Certified Product Standard, Version 3.1. Then, check one below and provide the required information based on the selection. Note: In some cases, the final manufacturing stage may include processes that occur at supplier facilities (e.g., this is common for finished metal products and textiles). Please carefully review the Guidance to ensure that the final manufacturing stage has been accurately defined and supplier facilities included when required.

A Process Flow Diagram is attached (optional). The filename is: [...].
Required: The product belongs to the following category from the Guidance:
If “Other,” please specify: [...]
The final manufacturing stage processes included in this assessment are the same as the processes for this product type that are listed in the Guidance.
The final manufacturing stage processes included in this assessment differ from those listed in the Guidance.
Additional processes: [...]
Processes from the guidance not included: [...]
Reason for adding or excluding processes with respect to the guidance: [...]

Final Manufacturing Stage Facilities

Instructions: Use the provided table to list all facilities where the product undergoes final manufacture and fill out the columns for facility location, processes conducted, and site visit date (for each facility where a site visit is required). If additional rows are necessary, attach an additional document.

Facility Name	Facility Location	Processes Conducted	Date of Site Visit (if applicable)
[...]	[...]	[...]	[...]
Individual(s) conducting site visit(s):	[Name, Title, Company/Assessment Body]

Material Health

Overview

Instructions: Summarize the Material Health assessment outcomes in the table below by adding a checkmark next to each of the requirements that has been fulfilled.

Level	Requirement
Basic	The product is 100% characterized by its generic materials (e.g., aluminum, polyethylene, steel, etc.) and/or product categories and names (e.g., coatings).
The appropriate metabolism (i.e., technical nutrient (TN) or biological nutrient (BN) is identified for the product and its materials and/or chemicals.
The product does not contain any Banned List chemicals based on supplier declarations.
Bronze	The product is at least 75% assessed (by weight) using ABC-X or abc-x ratings. Externally Managed Components (EMCs) are considered assessed and contribute to the overall percentage of the product that has been assessed. Complete formulation information collected for BN materials that are released directly into the biosphere as a part of their intended use (e.g., cosmetics, personal care, soaps, detergents, etc.).
A phase-out or optimization strategy has been developed for those materials with an X/x or GREY/grey rating (if applicable).
Silver	The product has been at least 95% assessed (by weight) using ABC-X ratings. Externally Managed Components (EMCs) are considered assessed and contribute to the overall percentage of the product that has been assessed. Complete formulation information has been collected for products that are entirely BN in nature (e.g., cosmetics, personal care, soaps, detergents, etc.).
The product contains no substances known or suspected to cause cancer, birth defects, genetic damage, or reproductive harm (CMRs) after the A, B, C, X assessment has been carried out.
Gold	The product has been 100% assessed (by weight) using ABC ratings. All EMCs are considered assessed as non-X.
The product contains no x-assessed or grey chemicals (optimization strategy is not required)
Product meets Cradle to Cradle emissions standards.
Platinum	All process chemicals have been assessed and none have been assessed as x or grey.
[assessor notes]

Material Health Certificate

Instructions: Check the box if the applicant wishes to receive a Material Health Certificate (MHC) in addition to Cradle to Cradle certification.

A Material Health Certificate is requested. The Material Health Certificate Form has been completed and is attached. The filename is: [...]

Note: If a Material Health Certificate (MHC) is being issued, any of the requirements that have been fulfilled in this section (section 5) will be shown as fulfilled on the MHC, regardless of the Material Health achievement level the product is applying for. Please indicate fulfillment of requirements to be shown as fulfilled on the MHC in the corresponding sections below (for example, a Bronze-level product may fulfill the VOC emissions requirement, although it is not required to be fulfilled until the Gold level).

Product Metabolism (Basic)

Check one below.

Pure Biological Nutrient product
Pure Technical Nutrient product
Mixed (contains BN and TN materials, as denoted on the Bill of Materials)

Note: Biological Nutrient materials such as paper or bio-plastics may go through a series of technical cycles (e.g., recycling) before re-entering the biosphere (e.g., composting or incineration for energy recovery). They are still considered Biological Nutrients and are subject to the banned list requirements for Biological Nutrients.

Banned List Compliance (Basic)

All Materials

Required. No Banned List Chemicals are present above thresholds in any homogeneous materials subject to review in the product. This was determined as follows (check all that apply):
Banned list declarations have been obtained for any materials for which complete chemical composition information could not be obtained. These declarations were signed by (check all that apply and provide any additional required information based on the selection):
Suppliers.
The applicant. Explanation for how the applicant has sufficient knowledge regarding the chemical composition of covered materials to sign banned list declaration(s): [...]
The assessor. Explanation for how the assessor has sufficient knowledge to sign banned list declaration(s), given complete formulation information is not known: [...]
Analytical testing. Note: complete the appliable sections below for geological materials and/or recycled content.
Complete chemical composition information has been obtained for all materials not covered by banned list declarations and the Material Health assessor has confirmed that these materials meet the banned list requirements.
Banned list declarations are attached (optional). The filename is: [...].

Biological Nutrient Materials

Check the box if the following statement is true.

The product contains one or more Biological Nutrient materials. The biological material isn’t known to contain any toxic metals on the Biological Nutrient Banned List in the material above the allowable thresholds: Arsenic (10 ppm), chromium (100 ppm), mercury (1 ppm), cadmium (2 ppm), lead (90 ppm). Note: these are total concentration limits. Additional explanation (if needed): [...]

Geological Materials

Check the boxes if the following statements are true.

The product contains one or more geological materials. The geological material(s) have been tested as required per the Geological Materials Assessment Methodology. The following limits have been achieved: Arsenic (47 ppm), cadmium (17 ppm), chromium VI (0.2 ppm), lead (160 ppm), mercury (94 ppm). Note: these are leaching limits. Test report(s) are attached. The filename is: [...]. Additional explanation (if needed): [...]
Required for indoor use products containing bitumen, tar, and/or other complex/variable fossil-derived distillation residues. VOC emissions testing per standard section 3.9 has been conducted. Test reports are attached. The filename is: [...]. Note: this testing is required in all cases at the Basic level, although it may not be relevant to banned list compliance.

Recycled Content Materials

Check one below and complete any text fields required based on the selection.

The product contains no recycled content.
The product contains recycled content. All recycled content is banned list-compliant according to the biological nutrient or technical nutrient banned list and the Recycled Content Assessment Methodology (2017), or the Geological Materials Assessment Methodology (as relevant).
The following materials contain recycled content (list all recycled content materials or clearly label them in a separate bill of materials and reference the BoM here): [...]
Banned list compliance was determined in the following way(s). (check all that apply):
Metals: The material is fully defined based on the alloy grade specifications. No additional testing was required.
Glass and in some cases, other inorganic materials: The material is fully defined based on comprehensive elemental analysis. Detection limits are low enough to ensure banned list compliance. Test results are attached. The filename is [...]
Chemically recycled material (e.g., certain polymers): The chemical composition was controlled directly during the recycling process. No additional testing was required to determine banned list compliance.
Material type and explanation of the process including how chemical composition is controlled to ensure banned list compliance: [...]
Defined post-industrial recycled material (TYPE 1 & 2 including polymers, etc.): The material is from consistent and pure source(s). The manufacturer, trade name, and grade of material(s) are known. Banned list compliance has been determined based on banned list declarations and/or full material disclosure. No additional testing was required. (See the Recycled Content Materials Assessment Methodology (May 2017) for definitions of material Types 1-4.)
Material type, explanation of recycled content source (i.e., type of materials/products making up the recycling stream) and how banned list compliance is ensured: [...]
Defined post-consumer (TYPE 3) OR undefined mixed stream post-consumer (TYPE 4) recycled material: Analytical testing has been conducted per table 5 of the Standard. Sampling, analytical methods, and detection limits were appropriate for detecting banned substances at the required concentration thresholds. Test results are attached. The filename is: [...].
Testing was conducted for the following banned list substances that are common contaminants in this material and banned list limits have been achieved as listed below (see Table 5 in the standard for common contaminants). Note: Limits are total concentration limits, not leaching limits:
Required for all TN materials: mercury, chromium VI (1000 ppm each)
Required for all TNs without guaranteed management: cadmium (1000 ppm), lead (no limit for TNs but must be tested)
Required for all BN materials: arsenic (10 ppm), chromium (100 ppm), mercury (1 ppm), cadmium (2 ppm), lead (90 ppm)
Required for all polymers: banned organohalogens, including: [...]
Other as required per Table 5 [...]
Analytical testing of material has been conducted for the current certification period
The product contains recycled content that is Version 4.0 RSL-compliant per the Recycled Content Assessment Methodology (August 2020 or later), Restricted Substances List (March 2021), and Recycled Content Materials List of Analytes. The following materials were assessed per this methodology: [...] Note: It is optional to apply this methodology under Version 3.1. This is an alternative to applying the 2017 Recycled Content Assessment Methodology. The 2020 method may allow for ‘Type 4’ materials to achieve beyond the Bronze level.
Testing was conducted for the following restricted substances and limits achieved as follows. Test reports have been provided and the file name(s) are: [...]
Halogens (Br, Cl, F) do not exceed 1000 ppm each.
One or more halogen (Br, Cl, F) was present at > 1000 ppm. However, the exceedance was determined to be due to the following non-restricted substance(s). [...] This was determined as follows: [...]
Required for most products (those that are not in the categories listed below). Metals do not exceed the following limits: Total arsenic, chromium VI, lead, mercury (1000 ppm each); cadmium (100 ppm). Note: these are total concentration limits (not leaching limits). Limits apply to each metal and all of its compounds combined.
Required for brittle powder-like or pliable biological nutrient materials (e.g., paper). Metals do not exceed the following limits. Note: these are leaching limits. Limits apply to each metal and all of its compounds combined. If total concentration has been determined, the same limits may be applied.
Antimony: 45 ppm	Cobalt: 10.5 ppm
Arsenic: 3.8 ppm	Lead: 13.5 ppm
Cadmium: 1.3 ppm	Mercury: 7.5 ppm
Chromium III: 37.5 ppm	Nickel: 75 ppm
Chromium VI: 0.02 ppm	Selenium: 37.5 ppm
Required for liquid biological nutrient materials. Metals do not exceed the limits for liquid biological nutrient materials (refer to V4.0 RSL for limits)
Required for all other biological nutrient materials. Metals do not exceed the following limits. Note: these are leaching limits. Limits apply to each metal and all of its compounds combined. If total concentration has been determined, the same limits may be applied.
Antimony: 560 ppm	Cobalt: 130 ppm
Arsenic: 47 ppm	Lead: 160 ppm
Cadmium: 17 ppm	Mercury: 94 ppm
Chromium III: 460 ppm	Nickel: 930 ppm
Chromium VI: 0.2 ppm	Selenium: 460 ppm
Required for footwear, clothing or related accessories, and textiles which, under normal or reasonably foreseeable conditions of use, come into contact with human skin to an extent similar to clothing: Metals do not exceed the following limits: Total arsenic, cadmium, chromium VI, lead (1 ppm each after extraction); total mercury (1000 ppm).
Other applicable limits have been achieved as follows: [...] Note: refer to the RSL. Other limits apply to cement, leather, metallic jewelry, and metallic portions of apparel.

ABC-X Assessment Results (Bronze)

Percentage Assessed

Instructions: Enter the percentage assessed below.
Required. Percentage assessed for the product variation with the lowest percentage assessed (highest concentration of GREY materials) among all individual products in the group: [...]%
Check all that apply.
This is a single-homogeneous material product or a single-material product. The percentage assessed is based on the percentage of individually assessed chemical substances, rather than on the percentage of assessed homogeneous materials. Note: Single homogeneous materials with multiple color options are included in this category. Report percentage assessed based on the worst-case scenario (i.e., lowest percentage across all colors).
This is a multi-material product in which the percentage assessed is based on the percentage of the homogeneous materials in the finished product that received A, B, C, or X ratings, rather than the homogeneous inputs the applicant combines during the manufacturing process to form the homogeneous materials in the finished product.
This is a multi-material product in which the percentage assessed is based on the percentage of individually assessed chemical substances, rather than on the percentage of assessed homogeneous materials. The product contains at least one homogeneous material that makes up more than 25% of the finished product by weight and this material contains one or more GREY substances whose assessment is infeasible due to missing toxicity data or formulation information that the assessor is unable to obtain due to a supplier’s refusal to share the information. This homogeneous material is at least 95% assessed based on the weight fraction of the individual assessed chemical substances in the material. (Note: The bill of material must allow for checking of these percentages.)
Materials in the product are entirely BN in nature, entering the biosphere directly as part of their intended use (e.g., cosmetics, personal care, soaps, detergents, etc.). Complete formulation information has been collected for such materials, enabling the product to reach the Bronze level or above.
This product contains Externally Managed Components (EMCs). EMCs are counted as assessed and contribute to the overall percentage of the product that has been assessed. One EMC template has been completed and is attached for each EMC in this product. The filenames are: [...].

Assessment Table

Check all that apply. If more than one product is in scope for a single certification or MHC, a bill of materials that allows for checking that the product grouping rules have been met must be provided. In this case, using the table in the ASF (section 5.4.2) to report assessment ratings may not be sufficient.

In the Material/Substance Name column (either in the table below or in the attached assessment results as applicable), indicate the chemical’s name, specific function type (e.g., solvent, surfactant, chelating agent, plasticizer, UV stabilizer, filler) and/or class (e.g., acid, base, phthalate, organohalogen, silicone compound, bitumen).

In the Assessment Comments column (either in the table below or in the attached assessment results as applicable) note the following:

Key consideration(s) and reasoning that lead to each assessment rating, such as the H-phrases that were the determining factor(s) for assigning a specific rating.

Which specialized methodologies, other than the general Material Health Assessment Methodology where used, if any.

Whether the assessed substance is a CMR or PBT or whether the assessed material contains CMRs or PBTs.

For Silver level applications, how the absence of CMRs was verified.

Relevant case-specific information regarding the identity/type/function of chemicals/materials assessed (for example if the substance or material belongs to a chemical class of relevance for Material Health assessment).

Exposure considerations, if applicable.

Any atypical situations that would warrant further scrutiny/discussion, if any.

Assessment results have been provided by the Material Health Assessor. These are:
Included in a separate document. The filename is: [...].
Included in the summary table below.
The Updates to the Material Health Assessment Methodology (2020) have been employed (required for applications received on or after January 1, 2022 for Version 3.1 applications).
Assessment ratings on a homogeneous material basis are shown (ABC-X).
Required. All homogeneous materials as present in the finished product are represented by an ABC-X or Grey rating. If a homogeneous material occurs in a number of distinct variations in the finished product, it may be further subdivided to break out material components that vary (such as colorants) from the base material that remains the same. Such material components may receive separate ABC-X ratings if they are mixtures or separate abc-x ratings if they are individual chemicals, however, the top-level homogeneous materials present in the finished product must be used to calculate the percentage assessed.
Assessment ratings on a chemical substance basis are shown (abc-x).
Required. These correspond to chemical substances that are present as such in the finished product (i.e., not process chemicals which react to form unlisted chemicals or mixtures in the finished product).
This is a single homogeneous material product.
Required. Assessment results are not reported as a single ABC-X rating. Instead, an assessment rating for each chemical or formulation as used or purchased by the manufacturer is provided; these may have abc-x or ABC-X assessments depending on whether they are single chemicals or mixtures.
Optional. The applicant is applying for an MHC and meets all the following requirements for reporting assessment data:
The information provided in the bill of materials is in agreement with the total number of substances data provided in the MHC form.
If the product is a single homogeneous material product and any ABC-X assessment are reported for input formulations/mixtures, the number of chemicals within the input formulation are included in the MHC table.
Material/substance name (can be generic name or role)	MH Assessor ID	ABC-X / abc-x Rating	Assessment Comments
[...]	[...]	[...]	[...]

Polymers (if assessed)

Instructions: Complete this section if the product contains any polymers that are assessed.

Monomers have been evaluated when present at ≥ 1000 ppm per polymeric material (or ≥ 100 ppm for formaldehyde). Note: The subject to review limit for monomers is 1000 ppm per homogeneous material under Version 3.1. When applying under Version 3.1, an exposure assessment for monomers that are present above the subject to review limit may only be conducted for the inhalation route. Otherwise, plausible exposure must be assumed for any residual monomers present at a concentration of ≥ 1000 ppm (or ≥ 100 ppm for formaldehyde).
Monomers have been evaluated when present at 100 ppm or above per polymeric material. Note: This limit may optionally be applied under Version3.1 and is required under Version 4.0. However, if applying under Version 3.1 in Material Health, the limitation on conducting an exposure assessment noted in the line above still applies.

Biological Materials (if assessed)

Instructions: Complete this section if the product contains any biological materials that are assessed per the Biological Materials Assessment Methodology. Materials must have been assessed per the most recent version of the Methodology. [assessor comments]

The product contains the following tree-based materials: [...]
All stains, treatments and other coatings on the material have been identified in terms of their constituent chemicals, and assessed according to the Material Health Assessment Methodology.
The tree-based material is from a species that is known to have sensitizing effects (e.g., certain species of blackwood or rosewood).
Other hazards and/or additional explanation: [...]
Required unless the material is X-assessed or grey: The potential for wood dust exposure during the product’s final manufacture, installation, intended and likely unintended use and end-of use scenarios has been evaluated and included in the exposure assessment.
The product contains plant-based fibers, other plant-based materials, or animal-based fibers.
Dyes, auxiliaries, bleaching agents, treatments or other chemical additives present above subject to review limits have been assessed according to the conventional Material Health Assessment Methodology or Colorants Assessment Methodology (as relevant). Note: If some are x-assessed the material will be X-assessed overall. If some are grey and there are no X-assessed substances, the material will be grey overall. Otherwise, the overall rating for the material will depend on the methods and results per the lines below. Note that bleaching chemistry is subject to review at any level.
Plant and/or animal-based fibers are Global Organic Textile Standard (GOTS) certified or equivalent. Note: This allows for a B-assessment if all other substances subject to review have been a- or b-assessed. Fiber type(s): [...] GOTS or equivalent certificate file name: [...] Test results file name (required unless the material is GOTS certified): [...]
Plant-based materials are Oeko-Tex 100 certified (not applicable to animal fibers) Material type(s): [...] Certificate file name: [...] Test results file name: [...]
Total pesticides in the material are < 0.5 ppm. Note: This allows for a C-assessment if all dyes and other additives have been a, b, or c assessed.
Total pesticides are > 0.5 ppm and the material is X-assessed.
Plant and/or animal-based material(s) do not have GOTS or equivalent certification and/or were not grown according to organic farming practices (or are not Oeko-Tex 100 certified for plant-based material). Check all that apply below:
The source of the material has been determined, and a list of pesticides used has been obtained. The active ingredient(s) in the pesticide mixture(s) have been assessed according to the conventional Material Health Assessment Methodology. The raw fiber has been tested for any x and grey assessed pesticides. Fiber type(s): [...] Test results file name: [...]
The source of the material has not been determined. The raw fiber has been tested for the list of pesticides as required by the most recent version of the EU Ecolabel for Textile Products. Fiber type(s): [...] Test results file name: [...]
Animal-based: The source of the material has not been determined. The raw fiber has been tested for the list of pesticides as required per the Biological Materials Assessment Methodology. Fiber type(s): [...] Test results file name: [...]
Detection limits for pesticides listed by GOTS or the EU Ecolabel are < 0.1 ppm.
Testing has been conducted by an ISO 17025 accredited laboratory.
Material(s) contain x-assessed pesticides. The sum concentration of all x-assessed pesticides per material is/are: [...] Note: if the total is > 0.5 ppm (or if individual substances exceed the specified limits per the Biological Materials Assessment Methodology or EU Ecolabel as applicable) the material must be X-assessed.
Material(s) contain grey pesticides. The sum concentration of all grey assessed pesticides per material is/are: [...] Note: if > 0.5 ppm the material must be grey assessed (unless it is X for other reasons).
Other methods have been employed in assessing plant-based or animal-based materials as permitted per the Biological Materials Assessment Methodology as follows: [...]
The product contains other biological materials (beyond those listed above). These have been assessed as follows: [...]

Hazard and Risk Assessment Considerations (Bronze)

Instructions: Indicate the phases and processes considered in the chemical toxicity assessment (previously referred to as ‘assessed applications’) below. If a Material Health Certificate is requested, this list will be printed on the Material Health Certificate. These are the final manufacturing, use, and end-of-use phases and processes that were considered during the hazard and exposure assessment, and they indicate to the Material Health Certificate reader under which circumstances the assessment ratings are valid.

Phases and Processes Considered in the Assessment

Manufacturing (i.e., for intermediate products). Optional: List processes (per the Final Manufacturing Stage Methodology): [...]
Final manufacturing. Optional: List processes [...]
Professional use (i.e., use during subsequent manufacturing steps for intermediate products or use by a professional during installation/application)
Use (i.e., as end product). Optional: specify use(s): [...]
Intended end-of use processes:
Recycling
Composting (Note: Please do not select composting unless compost testing has been conducted)
Release to the environment (e.g., via wastewater treatment for cleaners and personal care)
Other: [...]
Unintended end-of use processes:
Landfilling
Incineration
Uncontrolled burning
Release to the environment
Other: [...]
Additional comments regarding assessed phases and processes: [...]

Check the box if the following statement is true.

Required. The end-of-use scenarios listed above include the intended and likely unintended end-of-use scenarios for this product, defined as the end-of-use fate of 80% or more of the products sold by the applicant.

If any common end-of-use fates have been excluded (landfilling, incineration, uncontrolled burning, etc.), explain how it was determined that the remaining end-of-use scenarios cover 80% or more of products sold: [...]

Exposure Routes

Check all that apply.

The single chemical risk ratings of all substances subject to review in all assessed materials in this product were based solely on the unmodified hazard ratings (i.e., exposure did not play a decisive factor in the material health assessment for this product).
For one or more substances subject to review in assessed materials, exposure relevant to an identified RED or GREY hazard was deemed non-plausible or negligible, leading to a YELLOW risk rating. This was the case for the following estimated number of materials: [...] The reasons why exposure was deemed non-plausible or negligible are noted:
In the assessment table or in the attached assessment results as noted in section 5.4.2 above.
In the table below. (Note: this option is preferred when applicable to ≤ 5 substances or materials.)
Stage Oral Dermal Inhalation Aquatic Other Environmental Release Final manufacturing stage [...] [...] [...] [...] [...] Professional use (subsequent manufacturing) [...] [...] [...] [...] [...] Professional use (installation etc.) [...] [...] [...] [...] [...] Use [...] [...] [...] [...] [...] End-of-use [...] [...] [...] [...] [...]
This is an intermediate product (e.g. polymer resin) or other professional use product (e.g. professional grade paint) sold only to professional users. The assessment results are valid becuase all professional users have been trained in the proper handling of the product and use of protective equipment for sensitizing and/or corrosive or irritating substances. The assessor has verified that professional customers are adequately informed of these issues and that adequate training has been provided as required per Appendix 2 of the Exposure Assessment Methodology. Note: this approach is only allowed for the sensitization and corrosion/irritation endpoints. The following disclaimer should be included on the certificate: [...] Documentation required for verification per Appendix 2 has been provided. The filename(s) are: [...]
This is an intermediate product (e.g. polymer resin) or other professional use product (e.g. professional grade paint) sold only to professional users. The assessment results are valid only when the product is transported and used with fully closed and sealed transport, transfer, and dosing systems (as relevant) to protect workers and/or the environment during subsequent manfuactuing or other professional use only application steps from RED or GREY hazards. The assessor has verified that all professional users are using closed systems as required per Appendix 2 of the Exposure Assessment Methodology. The following disclaimer should be included on the certificate: [...] Documentation required for verification per Appendix 2 has been provided. The filename(s) are: [...]

Determining Absence of CMR Substances (Silver)

Required. The product is ≥ 95% assessed and assessed materials do not contain known or suspected CMRs for which exposure is likely or significant.
Required when there are GREY substances in portion(s) of the product counting as assessed. The material supplier or other party with knowledge of the chemical composition of the material has signed a declaration stating that CMRs are not present in the material. Note: This also applies to materials for which percentage assessed has been calculated based on the percentage of individually assessed chemicals by weight. For example, this means that if the certified product is a homogeneous material, CMR declaration(s) are required for any unidentified portions of the material when applying at Silver level.

Geological Materials (Silver)

Required for indoor use products that contain rock or stone-based material (e.g., granite) or industrial by-products defined as geological materials (e.g., coal fly ash, phosphogypsum, blast furnace slag). Material(s) have been evaluated for the presence of radium, thorium, and potassium 40 (K40). Material type(s): [...] The activity concentration index (I) is: [...] Test results file name: [...] Literature review file name (if relevant): [...]
Required for materials that contain bitumen, tar, and/or other complex/variable fossil-derived distillation residues. Material(s) have been tested for the polycyclic aromatic hydrocarbons (PAHs) covered by REACH Annex XVII Article 50 at a minimum. The sum concentration of tested PAHs is < 100 ppm.
Required for indoor use products containing bitumen, tar, and/or other complex/variable fossil-derived distillation residues. The product has undergone VOC emissions testing per standard section 3.9. CMR substances have not been emitted above the detection limit, or detected CMRs are below (0.01) x [the lower of the TLV or MAK value].

Recycled Content (Silver)

The assessed portion of the product contains TYPE 3 recycled content material assessed per the Recycled Content Material Assessment Methodology (2017) Note: Type 4 recycled content materials are not eligible at the Silver level. See the Recycled Content Material Assessment Methodology (2017) for definitions of material Types 1-4. The material type(s) assessed via this method are: [...]
Required. Segregation of materials has limited the scope of material to a very consistent and narrow group of inputs of a single material type and variation. Provide an explanation for how material(s) meet this definition: [...]
Required. There is a high sophistication of collection, separation, identification, and cleaning technologies for the material such that the recycler is able to guarantee that the input material will always be the same. Provide an explanation for how the input stream is highly consistent, how there is extremely low variation in chemical content from batch to batch, and how the analytical testing regimen used ensures that problematic chemicals are consistently captured and determined to be present below 100 ppm: [...]
Required. Provide an explanation for how the presence of CMRs above the allowable limits can be ruled out. Provide test data if applicable. Note: CMR declarations alone are not sufficient for this material type. [...]
Required for a C-assessment of Type 3 material. Analytical testing of material has and will be conducted every 6 months.
The assessed portion of the product contains recycled content material(s) assessed for the Silver level and above based on analytical testing per the most recent version of the Recycled Content Assessment Methodology and Recycled Content Materials List of Analytes. Note: this is optional under v3.1. The material type(s) assessed via this method are: [...] The filtered List of Analytes (showing the relevant analytes and limits for these materials) and analytical test report files are provided. The file names are: [...] Additional comments (if needed): [...]
Check all that apply below:
One or more substance(s) included in the List of Analytes for the applicable material type(s) was/were not tested for. The substances and rationale(s) for removing these from the ‘worst case’ list(s) are as follows: [...]
All Silver level limits have been achieved for the substances included in the analysis. An exposure assessment was not required.
One or more substance(s) was/were determined to be below the RSL limits but above the Silver level limits per testing conducted. The material(s) may be used at the Silver level and above based on the exposure assessment. Provide explanation: [...]
All halogens were included in a total halogen screening test (Cl, Br, F, I). Limits achieved are as follows: [...] Note: Halogenated organic substances based on iodine are not on the RSL. Iodine must be tested for to confirm compliance with the organohalogen restriction at the Silver level (1% per homogeneous material) and Gold level (100 ppm per homogeneous material or less for specific substances if the RSL limit is lower or the Specific Concentration Limit (SCL) is lower). Iodine does not have to be tested for at Bronze level. Cl, Br, and F must be tested for to confirm compliance with the organohalogen restrictions at Bronze, Silver, and Gold. This screening test may also be employed to ensure that the Silver level limits are achieved for all organohalogens on the RSL and organohalogens that are SVHCs. Refer to the List of Analytes for additional information.
In the case that any halogen was determined to be below 100 ppm but above one or more of the RSL limits per the total halogen screen, signed RSL attestations were obtained from the applicable supplier or other entity with knowledge of material composition (refer to the List of Analytes for the substances for which this is allowable). [...]
The applicant is aware that if employing this methodology and applying for Silver level and above, quarterly testing is required in the first two years (i.e., until recertification). Test results must be provided to the assessor. If exceedances are identified, C2CPII must be notified. If no issues are identified, testing may then be conducted once every two years (i.e., prior to each subsequent recertification).

Volatile Organic Compound (VOC) Emissions Testing (Gold)

Check one below and provide any additional required information based on the selection.

VOC emissions testing is not required for this type of product, because the product is a (select one):
VOC emissions testing is required for this product, because it is permanently installed in indoor rooms, used to permanently install indoor products (e.g., adhesive, sealant), permanently applied to surfaces in indoor rooms, or used as permanent or long-term equipment of indoor rooms (e.g., furniture). The product meets the Cradle to Cradle Certified VOC emission standards as specified in Section 3.9 of the standard and guidance. Test results have been evaluated and are attached. The VOC emissions testing form has been completed and is also attached. The filenames are: [...]

Process Chemicals Assessed and not x-Assessed (Platinum)

Check one below.

The final manufacturing stage involves no process chemicals as per the definition in the v3.1 Standard.
The final manufacturing stage involves no process chemicals aside from those already included in the product assessment and the materials and chemical substances included in the product assessment are all assessed A/a, B/b, or C/c.
The final manufacturing stage involves process chemicals and all have been identified and assessed. None are x-assessed.
The list of process chemicals and their assessment ratings can be found (select one):
[...]

Material Optimization Strategy (Bronze)

Check one below and provide any additional required information based on the selection.

The product does not contain X/x and/or GREY materials/chemicals; a material optimization strategy is not required.
The product contains X/x and/or GREY materials/chemicals; a strategy is required. Check one below and fill in the relevant table based on the selection.
This application pertains to a new certification. An optimization strategy is summarized in the table below.
Note: A longer strategy may optionally be attached, but the summary in the table is mandatory. If additional rows are necessary, attach an additional document and note filename here: [...]
Material or Chemical Substance	Planned Optimization Actions	Approx. Timeframe
[...]	[...]	[...]
This application pertains to a recertification. Tangible steps toward optimization (e.g., conducting trials with new materials, contacting suppliers to learn about alternatives, replacing a problematic material, obtaining formulation information or completing an assessment for a previously GREY material) have been taken in the last certification period and are summarized in the table below. If the alternative compliance pathway (i.e., company-level progress) is being followed, the same table is to be used but the product(s) for which progress has been made should be specified in the first column in addition to the materials or chemical substances.
Note: Additional information may optionally be attached, but the summary in the table is mandatory. If additional rows are necessary, attach an additional document and note filename here: [...]
Material or Chemical Substance	Actions Taken toward Assessment or Optimization	Month and Year in which Action(s) Occurred
[...]	[...]	[...]

Material Reutilization

Overview

Instructions: Summarize the Material Reutilization assessment outcomes in the table below by adding a checkmark next to each of the requirements that has been fulfilled.

Level	Requirement
Basic	Each generic material in the product is clearly defined as an intended part of a biological or technical cycle (this is covered by the Material Health requirement at Basic level; see Material Health Section 3.2).
Bronze	The product has a Material Reutilization Score that is ≥ 35.
Silver	The product has a Material Reutilization Score that is ≥ 50.
Gold	The product has a Material Reutilization Score that is ≥ 65.
The manufacturer has completed a “nutrient management” strategy for the product including scope, timeline, and budget.
Platinum	The product has a Material Reutilization Score of 100.
The product is actively being recovered and cycled in a technical or biological metabolism.
[assessor notes]

Material Reutilization Score (Bronze)

Rapidly Renewable, Recycled, Biodegradable, and Recyclable Content

Instructions: Check all that apply and fill in the relevant text field for each item selected. Only list materials whose mass is being claimed in one or more of the categories for the material reutilization score.

The product contains rapidly renewable content (harvested in cycles of 10 years or fewer) or Forest Stewardship Council (FSC)-certified wood. For any FSC-certified materials, certificates and/or invoices demonstrating the purchase of certified materials for this product are attached. The filename(s) is/are: [...] If the applicant is not FSC certified themselves, provide an explanation of the process that is in place for ensuring that FSC materials are always used in the percentages claimed: [...]
Materials claimed as rapidly renewable or FSC-certified are (check one):
Clearly marked in the Bill of Materials.
Listed here: [...]
The product contains recycled content.
Required. Materials with claimed recycled content are (check one):
Clearly marked in the Bill of Materials.
Listed here: [...]
The product contains post-consumer recycled content.
The product contains pre-consumer (post-industrial) recycled content that comes from sources outside of the applicant manufacturer’s facility.
The product contains biodegradable materials. All materials counted as biodegradable are commonly known to biodegrade or have been assessed to be able to undergo biological decomposition according to the ASTM/OECD test specified in the standard. If biodegradation or compostability tests were required, test results are attached. The filename is: [...]. Materials claimed as biodegradable are (check one):
Clearly marked in the Bill of Materials.
Listed here: [...]
The product contains recyclable materials. All materials counted as recyclable can be recycled at least once after their initial use phase. They are easily separable under normal recycling conditions or by the consumer if this would be necessary for recycling to occur. Materials claimed as recyclable are (check one):
Clearly marked in the Bill of Materials.
Listed here: [...]

Material Reutilization Score:

Instructions: Fill in the % recycled content, % rapidly renewable content, % recyclable content, % biodegradable content, and Material Reutilization score in the list below. Number format must include 2 digits after the decimal separator (i.e., enter 70.00 for 70%). If the material reutilization score does not calculate automatically after numbers have been entered, right-click on corresponding number field and select “Update Field”.

For product groups, this information must pertain to the individual product or product variation with the lowest possible MR score among all products in the group. Averaging is not permissible.

The Material Reutilization (MR) score is determined as follows:

[(% recycled or rapidly renewable content) + 2 (% recyclable or biodegradable content)] / 3

Percent recycled content:	0.00%
Percent rapidly renewable content:	0.00%
Percent recyclable:	0.00%
Percent biodegradable:	0.00%
Material Reutilization Score:	0.0

Check one below.

The Material Reutilization score above is the lowest score among products in this group.
This application covers a single product.
This is a wet-applied product (e.g., a paint or adhesive that is applied as a liquid and then dries into a solid prior to use). The methodology for wet-applied products has been applied as described on standard page 51. [...]
This is a formulated consumer product (e.g., cleaning product). Water weight has been excluded from the numerator and denominator when calculating the score. [...]

Nutrient Management Strategy and Nutrient Cycling (Gold, Platinum)

Check one below.

The product is designed to be biodegradable (i.e., the percent biodegradable is considered in the MR score and not the percent recyclable) and no further intervention is needed to reclaim the nutrients since the most likely end-of-use scenario aligns with the intended end-of-use scenario (e.g., cleaners, detergents, etc.). No nutrient management or nutrient cycling required.
The product is designed to be biodegradable (i.e., the percent biodegradable is considered in the MR score and not the percent recyclable). However, the product is applied to a substrate during its intended use (e.g., paints, inks). No intervention by the applicant to reclaim the nutrients is possible because the applicant has no control over what substrate the product is used on or what happens to the substrate after use. No nutrient management or nutrient cycling required.
Recycling infrastructure is widely available for this product type and it is already commonly recycled in practice with no special disassembly required (e.g., office paper, aluminum cans). No nutrient management or nutrient cycling required.
The product is purely paper, aluminum, or steel.
The product is made from a different material for which recycling infrastructure is readily available in the markets in which it is sold.
Explanation of recycling infrastructure availability: [...]
Instructions: If none of the statements above apply, a nutrient management strategy is required. Check the box if the following statement is true.
A nutrient management strategy has been developed that addresses all points in standard section 4.2 and is summarized in the table below. Additional information may optionally be attached, but the summary in the table is mandatory. If additional rows are necessary, attach an additional document and note filename here: [...].
Required Nutrient Management Strategy Element	Description
Approximate implementation timeline	[...]
Method of recovering, reusing, recycling or composting individual materials within the product and for the product overall.	[...]
Method of informing customers regarding disassembly of product, if needed.	[...]
Method of informing customers and the public about the program and access to recycling or other options.	[...]
Additional Fields Required for Platinum-Level Applications Only	Description
Method for measuring recovery rates	[...]
Target recovery rate and timeline	[...]
Current recovery rate	[...]

Instructions: In the space below, describe any progress made since the last certification on any previous plans. Include a timeline and action list.

[...]

Renewable Energy and Carbon Management

Overview

Instructions: Summarize the Renewable Energy and Carbon Management assessment outcomes in the table below by adding a checkmark next to each of the requirements that has been fulfilled.

Level	Requirement
Basic	Annual purchased electricity and direct on-site emissions associated with the final manufacturing stage of the product are quantified.
Bronze	A renewable energy use and carbon management strategy is developed (if applicable).
Silver	For the final manufacturing stage of the product, 5% of purchased electricity is renewably sourced or offset with renewable energy projects, and 5% of direct onsite emissions are offset.
Gold	For the final manufacturing stage of the product, 50% of purchased electricity is renewably sourced or offset with renewable energy projects, and 50% of direct onsite emissions are offset.
Platinum	For the final manufacturing stage of the product, >100% of purchased electricity is renewably sourced or offset with renewable energy projects, and >100% of direct on-site emissions are offset.
The embodied emissions associated with the product from Cradle to Gate are characterized and quantified, and a strategy to optimize is developed. At reapplication, progress on the optimization plan is demonstrated.
≥ 5% of the embodied emissions associated with the product from Cradle to Gate are covered by offsets or otherwise addressed (e.g., through projects with suppliers, product re-design, savings during the use phase, etc.).
[assessor notes]

Final Manufacturing Stage Electricity & On-Site Emissions (Basic)

Electricity and On-Site Emissions Numbers

Instructions: Enter the numerical value for all appropriate categories in the table below. When reporting the estimated embodied energy, be sure to define the functional unit this estimate is based on by replacing the placeholder text.

The Energy Reporting Template is attached. The filename is: [...]
The Alternate Energy Inventory was used (Note: In this case, the electricity lines below may be left blank and only GHG data reported for combined emissions attributable to electricity and any on-site fuel use.)
Level	Quantity	Units	Value
all	Electricity associated with the final manufacturing stage of the product at all facilities	[kWh/year]	[...]
all	Percentage of electricity used in the final manufacturing stage that is renewably sourced	%	[...]
all	Total GHG emissions generated during the final manufacturing stage of the product at all facilities (excluding emissions from eligible renewable fuels, as per Appendix D of the Green-e® Renewable Energy Standard for Canada and the United States, and emissions associated with electricity counted above unless using the Alternate Energy Inventory)	[tCO2e/year]	[...]
all	Percentage of GHG emissions generated during the final manufacturing stage of the product that are offset	%	[...]
Platinum	Estimated lifecycle GHG emissions per functional unit of product	[tCO2e/ [unit (kg, m2, chair, etc.)]	[...]
Platinum	Percentage of the product’s embodied GHG emissions that are offset	%	[...]

Units and Data Sources

Instructions: Check if the following statements are true.

Required. Final manufacturing electricity has been reported in terms of kilowatt hours (kWh) per year.
Required. Final manufacturing GHG emissions have been reported in terms of tons of carbon dioxide equivalents (tCO2e)/year. These include any GHG emissions associated with purchased heat, on-site fuel combustion, water treatment, and fugitive GHGs used during final manufacture.
Required. The electricity use and emissions numbers in the table above pertain to the processes outlined in section 4.2 of this form (Final Manufacturing Stage of Product).

Instructions: Check one below and provide any additional required information based on the selection.

Facility-level electricity and fuel use was estimated based on utility bills from the previous year.
The utility bills are attached. The filename is: [...]
The utility bills are on file with the assessor and will be available for C2CPII to review at the next assessor audit, if requested.
Facility-level electricity and fuel use was estimated based on a source other than utility bills from the previous year.
Source of facility-level electricity and fuel use data: [...]

Allocation

Instructions: Electricity and emissions were allocated from the facility level to the applicant product by the following method (Check one below).

Allocation was based on the following for the applicant product, compared to other products produced at the facility (select one):
Product relevant electricity and emission quantities were estimated in a different way. Explain below.
Allocation method and reason why this approach was chosen: [...]

Renewable Energy and Carbon Management Strategy (Bronze)

Check one below and provide any additional required information based on the selection.

In the final manufacturing stage, 100% or more renewable electricity is used, and any product-relevant greenhouse gas emissions from the final manufacturing stage are offset. No further strategy is needed. Skip ahead to section 7.4.
In the final manufacturing stage, less than 100% of electricity used is renewable, and/or not all product-relevant greenhouse gas emissions from the final manufacturing stage have been offset. A Renewable Energy & Carbon Management Strategy is required.
Instructions: In this case, summarize the strategy by completing the table below. Additional information may optionally be attached, but the summary in the table is mandatory. All fields must be completed. The strategy must include a timeline with measurable goals to increase both the percentage of renewable electricity and the percentage of offset GHG emissions. Efficiency measures alone are only sufficient once a baseline investment in both renewable electricity and carbon offsets has been made.
Goal	Actions Planned to Reach Goal	Timeline
[...]	[...]	[...]

If this is a recertification application, check one below.

This is a recertification application. The original strategy is still in place and on schedule. It is summarized in the table above.
This is a recertification application. The original strategy has been completed, so the strategy in the table above is a new strategy with new goals.
This is a recertification application. The goals outlined in the original strategy have not been met. The strategy in the table above is a new strategy with new goals.
Explanation for why the original plans changed: [...]

Addressing Electricity & GHG Emissions (Silver/Gold/Platinum)

Addressing Final Manufacturing Electricity

Instructions: Indicate which of the following approaches has been taken to use renewable electricity and provide any additional required information based on the selection. Complete section 7.4.1 A if renewable electricity from a utility is being claimed, and/or 7.4.1 B if RECs are being claimed, and/or 7.4.1 C if renewable electricity produced on site is being claimed, or 7.4.1 D if electricity is addressed by purchasing GHG offsets (alternate energy inventory). Note: The relevant portions of any non-English, required supporting documentation (e.g., utility bills, RECs, etc.) must be translated. These documents include, but are not limited to: utility product, electricity use, expiration date contract, name of carbon retirement program etc.

Complete if renewable electricity from a utility is being claimed

Renewable electricity is purchased through a utility program, either through a voluntary Green Power Purchasing Program or through the standard utility mix.
Utility Name: [...]
Percentage of renewable electricity in the electricity product the applicant purchases: [...]%

Instructions: Check one below and complete the required information depending on the chosen approach in order to indicate how you confirmed that the renewable electricity percentage may be claimed by the applicant and has not already been attributed to other end-uses (e.g., to customers participating in a Green Power Purchasing Program aside from any used by the applicant).

The utility offers multiple electricity options to its customers at different prices and different percentages of renewable electricity. The applicant has claimed the percentage associated with the specific electricity product it purchases.
Name of electricity product the applicant purchases: [...]
Explanation of the electricity options the utility offers and how the electricity product purchased by the applicant was confirmed: [...]
The following are attached: Official documentation from the utility that shows the name of the electricity product, the percentage of renewable electricity associated with that electricity product, and a current contract or other official evidence that an agreement is in place. Filenames are: [...]
The utility does not offer any green power purchasing programs, so the applicant has a right to claim the electricity in the utility mix overall.
Explanation of how you determined that the utility does not offer any green power purchasing programs: [...]
The following are attached: Official documentation from the utility that states the percentage of renewable electricity in its overall mix as delivered to the applicant’s facility. Filenames are: [...]
The applicant received a statement from its utility indicating the percentage of renewable electricity the applicant may claim without renewable electricity being counted elsewhere in the system.
A copy of the utility statement is attached. The filename is: [...]

Complete if RECs are being claimed

Renewable Electricity Certificates (RECs) have been purchased. Check one below and provide the required documentation based on the selection.
One or more final manufacturing stage facilities are in the United States. Green-e certified RECs were purchased.
The following is attached: REC documentation that shows that the RECs are Green-e certified, indicates how many RECs were purchased, and shows the date or year of purchase. The filename is: [...]
All final manufacturing stage facilities are located outside the United States.
The following is attached: REC documentation that indicates how many RECs have been purchased and shows the date or year of purchase. The filename is: [...]

Complete if renewable electricity produced on site is claimed

Renewable electricity is produced on site.
Type of on-site renewable electricity generated: [...]
Amount of on-site renewable electricity generated per year: [...]
Percentage of on-site renewable electricity allocated to the applicant product: [...]
On-site produced renewable electricity allocated to this product has not been sold or allocated to other uses. Double-counting of the renewable energy attributes generated on site is prevented in the following manner (check one below):
Surplus electricity generated on site at the applicant facilities is sold to the utility and the right to claim the renewable electricity attribute for this surplus electricity is thus transferred. However, the amount of renewable electricity sold to the utility has not been included in the amount allocated to the applicant product.
No electricity generated on site is being sold.
Other. Please explain: [...]
Evidence for the on-site renewable electricity is attached. The filename is: [...]. The requirement is fulfilled as follows:

Complete if electricity is addressed by purchasing GHG offsets (alternative energy inventory)

Electricity has been converted to greenhouse gas emissions and carbon offsets supporting renewable energy projects have been purchased to address those emissions. Check one below to indicate which of the following applies.
The emissions factor and nuclear multiplier from the alternative energy inventory spreadsheet were used when converting electricity to greenhouse gas emissions.
A different emissions factor and nuclear multiplier were used.
Explanation for how a different emissions factor and nuclear multiplier were chosen: [...]
Carbon offsets were purchased through the following recognized program:
Clean Development Mechanism (CDM)
Climate, Community, and Biodiversity
Verified Carbon Standard
Gold Standard
Green-e Climate Certified Carbon Offsets
American Carbon Registry
Climate Action Reserve
Carbon offsets support the following renewable energy project: [...]
The following is attached: Carbon offset documentation that shows how many carbon offsets have been purchased and shows the date or year of purchase. The filename is: [...]

Addressing Final Manufacturing GHG Emissions

Check the appropriate box to indicate through which Standard-approved program(s) the carbon offsets that address direct on-site emissions were purchased. Note: The relevant portions of any non-English required supporting documentation must be translated.

Clean Development Mechanism (CDM)
Climate, Community, and Biodiversity
Verified Carbon Standard
Gold Standard
Green-e Climate Certified Carbon Offsets
American Carbon Registry
Climate Action Reserve
The following is attached: Carbon offset documentation that shows how many carbon offsets have been purchased and shows the date or year of purchase. The filename is: [...]

Renewable Electricity and Carbon Offset Timeframes

Check all that apply and provide any additional required information for each item selected.

Renewable electricity has been counted in the table in Section 7.2. It covers or will cover the required percentage throughout the certification period (two years). This assurance can be provided for the following reason(s) (check all that apply):
Sufficient RECs have already been purchased to cover the full two-year certification period. Certificates are attached and the applicant affirms that these RECs have not been and will not be allocated to uses other than certification of the applicant product.
Sufficient RECs have been purchased to cover part of the certification period. The applicant will purchase the remaining RECs partway through the certification period and send the documentation to the Institute. The Institute will also follow up at recertification to ensure this has been addressed.
Explanation of what portion of the certification period the RECs cover: [...]
Renewable electricity is purchased through a utility program and the applicant has a contract that covers the full certification period.
Renewable electricity is generated on site and there are no plans to change the current arrangement.
Other (please explain): [...]
Carbon offsets have been counted in the table in Section 7.2. They cover or will cover the required percentage throughout the certification period (two years). This assurance can be provided for the following reason(s) (check all that apply):
Sufficient carbon offsets have already been purchased to cover the full two-year certification period. Certificates are attached and the applicant affirms that these carbon offsets have not been and will not be allocated to uses other than certification of the applicant product.
Sufficient carbon offsets have been purchased to cover part of the certification period. The applicant will purchase the remaining offsets partway through the certification period and send the documentation to the Institute. The Institute will also follow up at recertification to ensure this has been addressed.
Explanation of what portion of the certification period the offsets cover: [...]
Other (please explain): [...]
This is a recertification application. Carbon offsets and/or renewable electricity were purchased to cover the previous certification period, as follows (check one):
Sufficient already purchased at the last certification renewal to cover the full previous certification period.
Sufficient purchased at the last certification renewal to cover part of the previous certification period. The applicant purchased the remaining partway through the previous certification period.
Documentation for the remaining offsets and/or renewable electricity is attached. It covers the portion of the previous certification period from: month, year to: month, year.

Embodied Emissions (Platinum)

Instructions: If applicable, check both statements and provide the additional required information.

The product’s embodied emissions have been characterized.
Explanation of how embodied emissions were estimated: [...]
An optimization strategy has been developed. For recertification, progress is demonstrated. (Please provide a summary.) [...]
≥ 5% of the embodied emissions are covered by offsets or is otherwise addressed.
Explanation of how ≥ 5% of embodied emissions were addressed: [...]

Water Stewardship

Overview

Instructions: Summarize the Water Stewardship assessment outcomes in the table below by adding a checkmark next to each of the requirements that has been fulfilled.

Level	Requirement
Basic	The manufacturer has not received a significant violation of their discharge permit within the last two years or a discharge permit is not required.
A qualitative description of effluent management is provided.
Local- and business-specific water-related issues are characterized (e.g., the manufacturer will determine if water scarcity is an issue and/or if sensitive ecosystems are at risk due to direct operations).
A statement of water stewardship intentions describing what action is being taken for mitigating the identified problems and concerns is provided. At re-application, progress on action plans is demonstrated.
Bronze	A facility-wide water audit is completed.
Silver	Product-related chemicals in effluent are characterized and assessed OR product related process chemicals are not discharged to water systems because effluent is kept flowing in a closed loop system (i.e., product relevant effluent is produced but it is not released from the facility)
OR
Supply chain-relevant water issues for at least 20% of Tier 1 suppliers are characterized and a positive impact strategy is developed (required for facilities with no product-relevant effluent).
Gold	Product-related process chemicals in effluent are optimized (chemicals identified as problematic are kept flowing in systems of nutrient recovery; effluents leaving facility do not contain chemicals assessed as problematic) OR not applicable.
OR
Demonstrated progress on the strategy developed for the Silver level requirements (required for facilities with no product relevant effluent).
Platinum	All water leaving the manufacturing facility meets drinking water quality standards OR product relevant effluent is kept flowing in a closed loop system.
[assessor notes]

Statement on violations of water discharge permits within the past two years (Basic):

Check all that apply and provide any additional required information based on the selection.

Manufacturer (operator(s) of final manufacturing stage facilities) has not received significant discharge permit violations within the past two years. A signed statement is attached. The filename is: [...]
Manufacturer has received minor discharge permit violation(s) within the past two years.
Description of discharge permit violation(s) and why they were deemed minor (for products manufactured in the United States, the description must explain how the violation did not lead to “Significant Noncompliance” status as defined in Title 40 Part 403.8(f) (2) (viii) of the U.S. Code of Federal Regulations, unless the violation was administrative): [...]
Manufacturer has received significant discharge permit violation(s) within the past two years, but they were unrelated to the applicant product.
Description of discharge permit violation(s) and how they were deemed unrelated to the applicant product: [...]
N/A. None of the facilities involved in the final manufacturing stage requires a discharge permit.

Qualitative description of effluent management (Basic):

In the box below, explain how the applicant manages wastewater. A detailed effluent management plan may optionally be attached, but the summary in the table below is mandatory.

[...]

Local and industry-specific water issues relating to this product (Basic):

Check the box if the following statement is true.

Required. The eight required water issues in Standard Section 6.2 have been characterized for each final manufacturing stage facility. Check one:
The results are attached, using the water stewardship template or similar format. The filename is: [...]
The results are provided in the table below.
Water Issue	Answer	Reference
Watershed or catchment name	[...]	[...]
Major water sources within catchment	[...]	[...]
Major demands on sources	[...]	[...]
Scarcity/stress level	[...]	[...]
Access to improved water (% of population) and risk category (SHdb) or rating (WBCSD)	[...]	[...]
Access to improved sanitation (% of population) and risk category (SHdb) or rating (WBCSD)	[...]	[...]
Impaired waterway, endangered wetland, or water bodies impacted by eutrophication, if any	[...]	[...]
Other issues	[...]	[...]

Strategy for addressing water issues identified (Basic):

Instructions: For any high risks found in the local- and business-specific water issues characterization, provide (1) an action plan that includes a timeline for implementation and numeric goals for major milestones, or (2) a description of why the issue is not relevant to the applicant product’s manufacture. Note: If scarcity is an issue, an action plan will always be required if any water is used at the facility, even if it is only for sanitary purposes. A more detailed strategy document may optionally be attached, but the summary in the table is mandatory.

Water Issue	Goal and Actions Planned to Reach Goal OR Reason the Issue is not Relevant to Applicant Product’s Manufacture	Timeline
[...]	[...]	[...]
No water issues have been identified, therefore no strategy is provided.

Results of water audit (Bronze):

A facility-wide water audit has been completed for each facility involved in the final manufacturing stage of the product. The water audit template is attached. The filename is [...].
Summarize the results of the water audit below (optional).
[...]

Results of effluent chemicals characterization and assessment (Silver for manufacturers with product-relevant wastewater):

If the following statement is true, check the box and provide the additional required information.

Facility produces product-relevant wastewater. Check one below.
Product-relevant effluent is discharged from the facility, so any chemicals potentially present in the effluent as a result of the applicant product’s manufacture have been assessed and given an abc-x rating. Effluent chemical assessment results are attached. The filename is: [...]. The requirement is fulfilled as follows:
The Updates to the Material Health Assessment Methodology (2020) have been employed. (Required for applications received on or after January 1, 2022 for Version 3.1 applications.)
No GREY rated chemicals/mixtures enter the effluent as a result of product manufacture.
One or more GREY rated chemicals enter the effluent as a result of product manufacture. However, any GREY ratings are due only to missing toxicological data, not formulation information.
Wastewater is produced, but no effluent is discharged from the facility, because a closed-loop water system has been installed to keep chemicals flowing in systems of nutrient and water recovery. Process chemical optimization is not required. Skip to section 8.13.
Evidence for the closed-loop system is attached. The filename is: [...]. The requirement is fulfilled as follows:
Wastewater is produced, but no effluent is discharged from the facility, because any waste is shipped and treated as chemical waste off site. Follow pathway for manufacturers without product-relevant wastewater (8.9, 8.10, and 8.12).
Evidence for the external waste treatment is attached. The filename is: [...]. The requirement is fulfilled as follows:

Optimization plan for product-relevant chemicals in effluent (Silver for manufacturers with product-relevant wastewater):

Check one box below and if applicable, complete the effluent optimization plan table.

Effluent chemicals are limited to residual product ingredients, so the effluent optimization plan is the same as the Material Health optimization plan.
The effluent contains one or more chemicals that are not found in the product itself. An optimization plan is summarized below.
Effluent chemicals include both residual product ingredients and one or more chemicals are not found in the product itself. The effluent optimization plan for residual product ingredients is the same as the Material Health optimization plan. The optimization plan for chemicals not found in the product is summarized below.
Chemical Substance	Planned Optimization Actions	Approx. Timeframe
[...]	[...]	[...]

Add rows as necessary.

Local and business-specific water issues identified among tier 1 suppliers (Silver for manufacturers without product-relevant wastewater):

If the following statement is true, check the box and provide the additional required information.

Supply chain-relevant water issues were characterized for 20% or more of tier 1 suppliers (at least one supplier) using the following approach(es): Check all that apply.
Investigated local and business-specific water issues, as is required for the final manufacturing stage facility(ies) at the Basic level. Completed water stewardship templates are attached. The filenames are: [...]
Confirmed whether suppliers had a significant discharge violation within the last 2 years, as is required for the final manufacturing stage facility(ies) at the Basic level. Signed statements are attached. The filenames are: [...]
Characterized and quantified supplier water use (i.e., performed water audits), as is required for the final manufacturing stage facility(ies) at the Bronze level. Completed water audit templates are attached. The filenames are: [...]
Number of Tier 1 suppliers investigated: [...]
Total number of Tier 1 suppliers: [...]

Strategy for addressing supply chain water issues (Silver for manufacturers without product-relevant wastewater):

Check one and provide the additional required information based on the selection.

Issues were identified in the supply chain water issues investigation and will be addressed.
Plan to address the issues identified:
Issue	Goal and Actions Planned to Reach Goal	Timeline
[...]	[...]	[...]
No issues were identified, so the positive impact strategy focuses on increasing the rigor of the investigation, as follows (check one):
The number of suppliers included in the investigation will be increased over time.
Plan to increase the number of suppliers included in the investigation:
Planned Action	Timeline
[...]	[...]
Additional information will be collected over time from the same suppliers that have already been investigated.
Plan to collect additional information from the suppliers that have already been investigated:
Planned Action	Timeline
[...]	[...]

Effluent Optimization (Gold for manufacturers with product-relevant wastewater):

Check the box if the following statement is true.

Product-relevant chemicals in effluent are optimized (no x- or GREY-assessed chemicals). NOTE: Applies to both process chemicals and intentional product inputs that are released with the effluent (see standard section 6.5 for further information).

Water Stewardship Optimization Progress (Gold for manufacturers without product-relevant wastewater)

Check the box if the following statement is true and provide any additional required information.

Progress has been demonstrated on the supply chain water issues strategy in the following way: Check all that apply.
More than 20% of tier 1 suppliers have been included in the investigation.
At least two of the three investigation options have been completed for 20% or more of tier 1 suppliers.
Tangible steps have been taken toward addressing one or more issues identified during the investigation. These steps are summarized in the table below.
Additional information may optionally be attached, but the summary in the table below is mandatory. Add rows as necessary.
Issue	Actions Taken toward Assessment or Optimization	Month, Year in which Action(s) Occurred
[...]	[...]	[...]

Drinking Water Quality (Platinum)

Check one and provide any additional required information based on the selection.

Water leaving the manufacturing facility meets local drinking water regulatory standards and this is demonstrated through routine analytical testing of the effluent. Test reports are attached. The filename is: [...]
Explanation: [...]
Wastewater is produced, but no effluent is discharged from the facility because a closed-loop water system has been installed to keep chemicals (including water) flowing in systems of nutrient recovery.
No product-relevant wastewater is produced and the appropriate Silver and Gold requirements (8.9, 8.10, and 8.12) are fulfilled.

Social Fairness

Overview

Instructions: Summarize the Social Fairness assessment outcomes in the table below by adding a checkmark next to each of the requirements that has been fulfilled.

Level	Requirement
Basic	A streamlined self-audit is conducted to assess protection of fundamental human rights.
Management procedures aiming to address any identified issues are provided. Demonstration of progress on the management plan is required for re-application.
Bronze	A full social responsibility self-audit is complete and a positive impact strategy is developed (based on UN Global Compact Tool or B-Corp).
Silver	Material specific and/or issue-related audit or certification relevant to a minimum of 25% of the product material by weight is complete (FSC Certified, Fair Trade, etc.).
OR
Supply chain-relevant social issues are fully investigated and a positive impact strategy is developed.
OR
The company is actively conducting an innovative social project that positively impacts employee’s lives, the local community, global community, social aspects of the product’s supply chain, or recycling/reuse.
Gold	Two of the Silver-Level requirements are complete.
Platinum	A facility-level audit is completed by a third party against an internationally recognized social responsibility program (e.g., SA8000 standard or B-Corp).
All Silver-Level requirements are complete.
[assessor notes]

Streamlined Self-Audit (Basic)

Streamlined Self-Audit Results

Check if the following statements are true.

Required. Streamlined self-audit has been completed for final manufacturing facility or facilities. Streamlined Self-Audit Results Are attached. The filename is: [...]
No "high" or "very high" risks have been identified.
"High" or "very high" risks have been identified (list identified risk issues): [...]
Required. Streamlined self-audit has been completed for all tier 1 suppliers. Check one:
No "high" or "very high" risks have been identified.
"High" or "very high" risks have been identified (list identified risk issues): [...]

Management Procedures to address “High” or “Very High” Risks

Instructions: This section is required if any “high” or “very high” risks were identified in the preceding section.

For final manufacturing facility(ies): Management and self-auditing procedures that address “high” or “very high” risks identified during the streamlined social self-audit are in place. The management and self-auditing procedures are (provide a summary here): [...] Supporting documentation (e.g., management system certificate and/or processes and procedures) has been provided. The file names are: [...]
For tier 1 suppliers: Plans or management procedures to address “high” or “very high” risks identified during the streamlined social self-audit have been developed. These plans or management procedures are (provide a summary): [...] Supporting documentation has been provided. The file names are: [...]
“High” or “very high” risks for child labor, forced labor, and/or provision of a living wage have been identified based on the location/industry of one or more tier 1 suppliers. Check one:
Those facilities identified as having high or very high risk or opportunity provide ≤1% of the value of the product combined.
A draft supply chain code of conduct to be integrated into supplier contracts has been developed. It prohibits child and forced labor, requires that a living wage be paid, and allows for unannounced audits. Child labor and living wage are defined according to the ILO and UN. The draft Supply Chain Code of Conduct is attached. The filename is: [...]

Actions taken over the previous certification period

Instructions: For recertifications, in cases in which “high” or “very high” risks were identified during the streamlined social self-audit, provide a list of actions taken to carry out the plan/management procedures or implement the supply chain code of conduct over the previous certification period.

[...]

Full self-audit (Bronze)

Full Self-Audit Approach

Check one below.

UN Global Compact Tool Self-Assessment has been completed and is attached. The filename is: [...]. Check one:
There is only one final manufacturing stage facility.
There are multiple final manufacturing stage facilities. A UN Global Compact Tool Self-Assessment has been completed and attached for each facility.
There are multiple final manufacturing stage facilities. A single UN Global Compact Tool Self-Assessment has been completed and attached that reflects the conditions and practices in all of the facilities.
B Impact Assessment has been completed and is attached. The filename is: [...].

Results and Positive Impact Strategy

Check one below.

The B Impact Assessment was completed, or the UN Global Compact Tool Self-Assessment was completed and one or more questions were not marked “Yes” or “N/A.” A positive impact strategy is required.
Summarize the positive impact strategy by completing the table below (at least one row). Additional information may optionally be attached, but the summary in the table is required. The positive impact strategy must be directly related to the self-audit results and it must include plans for improvement.
Issue	Goal and Actions Planned to Reach Goal	Timeline
[...]	[...]	[...]
The UN Global Compact Tool Self-Assessment was completed and all questions were marked “Yes” or “N/A.” Comments were provided within the spreadsheet to support the responses. No positive impact strategy is required.

Material-specific or issue-specific audit (Silver/Gold/Platinum)

Instructions: If the following statement is true, check the box and provide the additional required information.

25% or more of the product by weight is a material or materials with an issue-specific or material-specific certification. Evidence of certification is attached. The filename is: [...]. This requirement addresses the supply chain, so the certified materials are inputs to the finished product rather than the finished product itself.

Check one below and fill out the table to indicate which materials are covered by issue-specific or material-specific certifications. Add additional rows if necessary.

All individually sold product variations meet or exceed the 25%-by-weight requirement.
The weight requirement has been calculated. The filename is: [...]. The requirement is fulfilled as follows:
Products on average meet or exceed the 25%-by-weight requirement and it is not possible to differentiate the certified material from the non-certified material. The amount of certified material in individual products is not tracked, making it impossible to differentiate between products based on this attribute.
Materials subject to a social or material-related certification:
Material	Percentage of product (by weight)	Certification
[...]	[...]	[...]

Supply chain social issues investigation and impact strategy (Silver/Gold/Platinum)

Tier 1 or Tier 2 Supplier Investigation

Check one or both and provide the additional required information based on the selection.

A streamlined self-audit has been completed for all or most of the Tier 2 suppliers. Streamlined Self-audit Results are attached. The filename is: [...]
Description of the issues identified: [...]
Positive impact strategy: [...]
Primary data has been collected for Tier 1 suppliers (i.e., through supplier surveys or audits). Tier 1 supplier primary data are attached. The filename is: [...]
Description of what has been done and which issues were identified: [...]
Positive impact strategy: [...]

Identified issue(s) related to initial resource extraction

Instructions: In the space below, describe at least one relevant ‘material-specific issue’ related to initial resource extraction (palm oil, bauxite mining, fossil fuel extraction, conflict minerals, etc.) that was investigated as part of the supply chain social issues investigation. Include the social aspect of the issue identified (i.e., local pollution, habitat destruction, child labor, civil war, etc.) and how it is related to the material.

[...]

Instructions: In the space below, summarize the applicant’s positive impact strategy to address one or more of the issues related to initial resource extraction identified above. For recertification, provide updates and describe progress.

[...]

Innovative Social Project (Silver/Gold/Platinum)

Requirement: The company is actively conducting an Innovative Social Project that positively impacts employees’ lives, the local community, the global community, the social aspects of the product’s supply chain, or recycling/reuse.

Intent: The intent of the Innovative Social Project requirement is to develop and implement a company

program that positively impacts social issues and implements the Cradle to Cradle principles. The key

aspect of this requirement is that the program or project is an integrated part of company’s strategy.

Instructions: Describe the company’s innovative social project below and reference an innovative social project template that has been filled out and attached. It must be clear from reading the description that employees are actively involved in the project (i.e., it must involve more than financial donations) and the project is ongoing (one-time events do not qualify).

Summary of project: [...]
The innovative social project template is complete and attached. The filename is: [...]
The project meets the intent of the requirement as follows: [...]
The project is an integrated part of the company’s strategy (provide an explanation of how this has been achieved): [...]
The project is ongoing, rather than a one time event (provide an explanation): [...]
Employees are actively involved, as follows (provide an explanation): [...]
The project has not been used to achieve other Cradle to Cradle Certifed Standard requirements (e.g., the Social Fairness self audit requirements).

Two Silver Achievements Completed (Gold)

Instructions: Indicate which of the following requirements have been fulfilled.

Material-specific or issue-specific audit
Supply chain social issues investigation and impact strategy
Innovative Social Project

Facility-Level Audit by Third Party (Platinum)

Instructions: Indicate which of the following has been attained:
B Corp Certification.
Business Social Compliance Initiative (BSCI) audit.
Global Social Compliance Program (GSCP) audit.
SA 8000 certified (Social Accountability International).
Worldwide Responsible Apparel Production (WRAP).
Other; Contact assessor or Cradle to Cradle Products Innovation Institute for approval
Required: A current certificate is attached. The filename is: [...]

Recommendations for Product Optimization (Optional)

Instructions: Describe recommended next steps for product and production optimization. For each category, describe the actions that need to be taken in order to qualify for recertification and the criteria that need(s) to be fulfilled to attain the next higher certification level in the respective category.

Material Health

[...]

Material Reutilization

[...]

Renewable Energy and Carbon Management

[...]

Water Stewardship

[...]

Social Fairness

[...]

[assessor notes]

Assessment Documentation Overview

Instructions

These documentation overview tables may optionally be completed and submitted along with the Cradle to Cradle Certified Assessment Summary Form for certification applications.

To complete the tables, fill in the ‘Filename’ column next to each document type submitted with this assessment summary. The Filename column should be completed as follows:

If the required documentation is included in the body of the accompanying assessment summary form or in an appendix, write “Inline” in the Filename column.

If the required documentation is attached separately, enter the filename in the Filename column. Follow a systematic naming format. The suggested format is the following: ‘Section code’_’Document type’_’Company name’_’Product name’_’year’.pdf. Here is an example: ‘MH_BOM_AcmeCo_iAnvil_ 2015.pdf’. See the table below for the list of section codes.

Section Name	Section Number	Section Code
General/Administrative	Section 1 & 2	GA
Material Health	Section 5	MH
Material Reutilization	Section 6	MR
Renewable Energy & Carbon Management	Section 7	RECM
Water Stewardship	Section 8	WS
Social Fairness	Section 9	SF
Recommendations for Product Optimization	Section 10	RPO

If the required documentation is a webpage, enter the direct link in the Filename column.

Enter “N/A” for documentation that is not required due to the recommended certification category level or product type.

Refer to the table on the next page for sample entries. Note that the lists of documentation types included in the template are not exhaustive. Additional documentation may be required under special conditions as per the Standard (e.g., if the product contains recycled inputs). Also note that a complete Bill of Materials/Assessment Table must be provided at each recertification. Add additional rows to these tables for supplemental documents if needed.

Example Table

Material Health documentation

Level	Document Type	Filename
Basic	Bill of Materials (BoM)	MH_BOM_Companyname_Product_2013.pdf
Basic (submission optional)	Supplier declaration(s)	MH_BLD_Companyname_Product_2015.zip
Bronze (separate doc optional)	Material optimization strategy	Inline
Gold	Emissions test report	N/A
Gold	VOC Emissions Testing form	N/A
MHC	MHC form	N/A

Documents in English

Each application is likely to contain a number of supporting documents. Non-English documents may be submitted as long as the relevant information is translated within the application or attached to the non-English document itself. Untranslated non-English documents will not be considered as part of the certification application audit.

Document Submission

The supporting documents themselves may be submitted as separate attachments or in a zipped folder. Ensure that the file names match the ones entered on this form and that the total file size of all submitted forms and supporting documents does not exceed the 25 MB limit.

Product Information

Provide the company name and product group name below.

Company Name:

Product Group Name:

Documentation Overview Tables

Complete the ‘Filename’ column of the documentation tables below. Refer to the guidance on the previous page if necessary.

General/Administrative documentation

Level	Document Type	Filename
All	ASR Submission Authorization	[...]
All (if applicable)	List of Certified Products	[...]
All (if applicable)	Packaging Assessment	[...]
All (if available)	Site Visit Report	[...]
All (if available)	Process Flow Diagram	[...]
[add rows as necessary]	[...]

Material Health documentation

Level	Document Type	Filename
Basic	Bill of Materials (BoM)	[...]
Basic (submission optional)	Supplier declaration(s)	[...]
Bronze (separate doc optional)	Assessment Results	[...]
Bronze (separate doc optional)	Material optimization strategy	[...]
Gold (if applicable)	Emissions test report	[...]
Gold (if applicable)	VOC Emissions Testing form	[...]
MHC (optional)	MHC form	[...]
[add rows as necessary]	[...]

Material Reutilization documentation

Level	Document Type	Filename
Gold (separate doc optional)	Nutrient management strategy	[...]
Platinum (separate doc optional)	Description of Nutrient Cycling program	[...]
[add rows as necessary]	[...]

Renewable Energy & Carbon Management documentation

Level	Document Type	Filename
Basic	Energy Reporting Template	[...]
Bronze (separate doc optional)	Renewable Energy and Carbon Management Strategy	[...]
Silver	Documentation of Renewable energy use and carbon offsets	[...]
[add rows as necessary]	[...]

Water Stewardship documentation

Level	Document Type	Filename
Basic (separate doc optional)	Effluent management plan/Qualitative Description	[...]
Basic (separate doc optional)	Water stewardship strategy	[...]
Basic	Signed statement of local effluent compliance	[...]
Basic	Water issues template	[...]
Bronze	Water audit data sheet	[...]
Silver	Product effluent assessment table	[...]
Silver (separate doc optional)	Product effluent optimization plan	[...]
Silver	Tier 1 water stewardship documentation	[...]
Silver (separate doc optional)	Tier 1 water stewardship strategy	[...]
Platinum (if applicable)	Local drinking water standards	[...]
Platinum (if applicable)	Effluent testing information	[...]
[add rows as necessary]	[...]

Social Fairness documentation

Level	Document Type	Filename
Basic	Streamlined self audit	[...]
Basic (separate doc optional)	Management procedures for (very) high risks	[...]
Bronze	Full social self audit	[...]
Silver/Gold	Material/Issue-specific certificates	[...]
Platinum	Third party social audit certificate	[...]
[add rows as necessary]	[...]

Primary packaging refers to the container that envelops a liquid, gel, paste, or powder and is intended to be kept with the product during its use or up until the moment of application (e.g., surface cleaner spray bottle, paint can, dishwasher powder box, etc.). Any materials that are intended to be removed prior to the product’s use are not considered primary packaging (e.g., pallet, shrink wrap, carton).