Carrefour Factory name 
Prepared by PLACD
Sector/Office 
Prepared on File number

Social Compliance Self Assessment Checklist

Instructions concerning the Social Compliance Self Assessment C H A R T E R

Filling the following questionnaire will help the suppliers to better understand the practical requirements related to the "Carrefour Group 
Supplier Charter on Child Labor and Forced Labor"and better prepare the formal Social Audit performed by a third party on the behalf of Carrefour. 

Suppuer Charter

1. Review and answer to the 24 questions in the following questionnaire according to the true practices actually in place in the factory. 
2. Fill the column Supplier's answers 
3. Return the questionnaire duly signed to Carrefour for further reference. 

Wages and Benefits

NO. Checkpoint Supplier's answers Conclusion
1.1 What is the lowest salary paid in the factory? For which position? 
1.2 According to your best knowledge what is the legal minimum wage applicable in your country,region or district? 
1.3 Are wage slips provided to all workers when they receive their month salary? 
1.4 Has every employee from the factory signed a formal working contract? 
1.5 Is paid maternity leave provided to pregnant women? 
1.6 Are workers covered with medical insurance or any other benefits? 

ScoringA = Outstanding / B = Acceptable / C = Below requirement / D = Absent or irrelevant

D: Audit Kit aug.10,2005 Carrefour Social Audit ICS 7.Self Assessment Last printed 8/12/20051:55:00PM