CAPABILITY INVENTORY
INSTRUCTIONS: Please provide the following information (your best estimate) from your
last complete fiscal year.
I. GENERAL INFORMATION
1. Name of Your Corporation:
2. d/b/a (doing business as):
3. Address (main office):
4. Telephone:
5. Fax:
6. Hours of Operation (Work Center):
7. Chief Executive Officer:
8. Work Center/Industrial Manager:
9. Production Manager:
10. Sales/Marketing Manager:
11. Multiple Locations:
Yes
12. Facility Size (All Locations):
If yes, how many?
Total
A. Production Area:
13. Delivery Capability: Yes
sq. ft.
sq. ft.
No
No
Warehouse Area
Loading Dock: Yes
sq. ft.
No
14. Current Number of Work Shifts:
How many more shifts could be added?
15. Off-site Operations: # of Locations
# of People Working Off-site
16. Total Number of Staff (All Locations):
A. Number of Production Staff _______
Number of Sales/Marketing Staff _______
17. Total Number of Work Force (All Locations):
18. CARF/Other Accreditations:____________________________________________________________
__________________________________________________________________________________
Capability Inventory Breakdown
II. EMPLOYMENT INFORMATION
1. Total number of people with disabilities in work programs:
2. Total number of workers your work programs could accommodate:
3. Do you have a waiting list for your work programs? Yes
How many?
No
4. Average annual earnings per person with disability:
5. Over the past two years, did average earnings per person with disability in your work programs:
Increase
By what percentage?
%
Decrease
By what percentage?
%
Remain the Same
6. How would you rate the potential for career advancement in your work center?
Excellent ____
Good ____
Fair ____
Poor ____
None ____
7. In order of frequency (with “A” being the most frequent), please list the three principal types of work
performed by your work force during the past year.
A.
B.
C.
8. How many competitive placements did you make during the last three years?
(Include supported employment; exclude non-disabled in JTPA, etc.)
9. Please list major local employers in your area and identify by industry type.
A.
B.
C.
D.
10. What is the current local unemployment rate?
Capability Inventory Breakdown
III. MANUFACTURING/SERVICES CAPABILITIES
1. Please check all capabilities you currently have at your work center:
____ Assembling--Electrical
____ Machining--Metal Stamp.
____ Repair & Refurb.--Degreasing
____ Assembling--Mechanical
____ Machining--Punch Pressing
____ Repair & Refurb.--Die Cleaning
____ Auto--Collating
____ Machining--Reaming
___ _Repair&Refurb.--Dust Respirat
____ Binding--GBC
____ Machining--Riveting
____ Repair & Refurb.--Grit Blasting
____ Binding--Perfect
____ Machining--Swaging
____ Refurb.--Hydraulic Jack
____ Binding--Saddle Stitching
____ Machining--Tool Sharpening
____ Repair & Refurb.--Telephone
____ Car Washing
____ Machining--Vibra Peening
____ Repair & Refurb.--Wire Spl.
____ Clerical Service
____ Mailing--Addressing
____ Rust Proofing
____ Collating (Hand)
____ Mailing—Addressographing
____ Salvaging--Cable Stripping
____ Document Destruction
____ Mailing--Auto
____ Salvaging--Disassembly
____ Document Scanning/Archiving
____ Manufacturing--Boxes
____ Sewing--Industrial
____ Elect. Asmbly-Wire Harn.
____ Manufacturing--Medical Devices
____ Shelf Stocking
____ Elect. Asmbly-Other
____ Manufacture--Plasticware
____ Silicone Dipping
____ Engraving
____ Manufacture--Textiles
____ Splitting
____ Filling
____ Microfilming/Microfisching
____ Soldering--Electrical
____ Folding (Hand)
____ Packaging--Auto Bagging
____ Soldering--Hand Precision
____ Food Preparation
____ Packaging--Blister Packing
____ Soldering--Pot
____ Food Service
____ Packaging--Boxing
____ Soldering--Wave
____ Furniture Assembly
____ Packaging--Crating
____ Sorting
____ Gluing
____ Packaging--General
____ Stapling
____ Greenhouse Products
____ Packaging--Heat Sealing
____ Tapping
____ Groundskeeping
____ Packaging--L-Sealing
____ Textiles--Mtrl. Bailing
____ Inspect/Test--Calbrtng.
____ Packaging--Medical (nonsterile)
____ Textiles--Nonwoven
____ Inspect/Test--Gauging
____ Packaging--Medical (sterile)
____ Textiles--Power Cutting
____ Inspect/Test--General
____ Packaging--Shrink Wrap
____ Textiles--Rag Cutting
____ Inspect/Test--Vacuum
____ Packaging--Vacuum Form.
____ Warehousing/Logistics
____ Janitorial Services
____ Painting--Dip
____ Weigh Counting
____ Labeling
____ Painting--Electrostatic Spray
____ Welding
____ Label-Making
____ Painting--General
____ Woodworking--Chamferin
____ Laser Disk Storage
____ Painting--Spray
____ Woodworking--Custom
____ Laundry Services
____ Pallets--Manufacturing
____ Woodworking--General I
____ Machining—Buffing
____ Pallets--Repair
____ Woodworking--Gluing
____ Machining--Conduit Cut.
____ Printing--Digital
____ Woodworking--Lacquering
____ Machining--Cop. Tube
____ Printing--Offset
____ Woodworking--Lathing
____ Machining--Crimping
____ Recycling--Aluminum
____ Woodworking--Refinishing
____ Machining--Deburring
____ Recycling--Electronic
____ Woodworking--Routing
____ Machining—Drilling
____ Recycling--Glass
____ Woodworking--Sanding
____ Machining--Drill Tapping
____ Recycling--Paper
____ Woodworking--Sawing
____ Recycling--Plastic
____ Woodworking--Stripping
____ Machining--Filling (Metal)
Capability Inventory Breakdown
____ Machining--Grinding
____ Recycling--Other
____ Word Processing/Data Entry
Other (Please Explain; include custom or design capabilities):__________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
2.
Please list any quality management systems or registrations you might have (e.g. ISO9000:2008,
ISO13485, CE, UL, FDA, etc.):________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
3. Of the capabilities you checked on the preceding schedule, please list (in order of importance) your top
three revenue-producing activities during the past year and indicate approximately the amount of
revenue generated by each.
Activity
Revenue
A.
B.
C.
4. Do you own and produce any products which you would like to sell to state and local governments?
A.
B.
C.
Capability Inventory Breakdown
IV. FINANCIAL INFORMATION (From last complete fiscal year)
1. Total Annual Revenues from All Sources $
2. Total Annual Commercial/Industrial Revenue $
A. Contract Manufacturing/Subcontract $
B. Prime/Proprietary Products $
C. Wholesale/Retail $
D. Government:
1. Federal Contracts $
2. State $
3. Local Units of Government $
3. Total Revenues Generated from Off-site Operations $
4. Capital Resources
A. Funds Available for New Projects, Capital Purchases, etc. $
B. Do you have a line of credit?
Yes ______
No ______
If yes, please complete the following:
Amount$__________________
Secured_____
Unsecured_____