Non-GFSI Supplier Questionnaire
Prepared By: Justin Miller Approved By: Paul Scola Jr. Document Number: FS-2.3.4c Version Number: 2 Effective Date: April 16, 2021
First Name
Last Name
Email
Company Name and Address
Manufacturing Address (if different)
Phone Number
Fax Number
Sales Contact/Customer Service/Emergency contact
Technical/QA/PCQI/HACCP/SQF Practitioner
24 Hour Emergency Contact
Please list all products that will be supplied
Is your plant FDA registered?
Yes
No
If yes, please provide your registration number and expiration date
Has your facility been inspected by FDA, USDA, or other government agencies?
Yes
No
If yes, what is the name of the agency and what was the date of the last inspection?
If Yes, were any findings or citations issued? please explain
Do you have a foreign supplier verification program?
Yes
No
Are your carriers in compliance with the sanitary transportation act?
Yes
No
Has your company been involved in a recall in the past 3 years?
Yes
No
If yes, please explain
Is your company GFSI Certified? (SQF, BRCGS, FSSC22000, IFS etc.)
Yes
No
Do you have a HACCP/Preventative Controls/Food Safety Plan?
Yes
No
How often do you have a third-party audit performed, and what is the date of your last audit?
What type of third-party audit and who is the certification body?
Date of last audit
Do you perform internal audits and inspections?
Yes
No
If yes, how often?
If no, please explain why not
Do you audit/inspect GMP's during production?
Yes
No
If yes, how often?
If no, please explain why not
Do you have a foreign material (Glass & Brittle) control program?
Yes
No
Do you have a food defense program including a food defense team?
Yes
No
Do you test for microbiological contaminants?
Yes
No
If yes, what do you test for?
Did you calibrate all critical testing equipment (including scales)?
Yes
No
If yes, how often?
Do you have an allergen program?
Yes
No
If yes, upload allergen program here
Select a File
If no, explain
Do you have a recall program in place?
Yes
No
Do you conduct mock recalls?
Yes
No
If yes, how often?
Do you have written procedures for nonconforming products and equipment?
Yes
No
Are these products segregated from all other items?
Yes
No
Do you have a hold and release program for RTE products? (Ready To Eat)
Yes
No
Do you have sanitation procedures in place?
Yes
No
How often do you clean and sanitize equipment?
Are all cleaners and sanitizers approved by the FDA for use in food plants?
Yes
No
What is the water source for your facility?
Well Water
City/Municipal
If well water, do you test for potability and how often?
If city/municipal do you test for contaminants and how often?
Do you have a pest management control program?
Yes
No
Do you have a visitor policy in place?
Yes
No
If yes, attach visitor policy here
Select a File
If no, explain why not
Do you have a preventative maintenance program for manufacturing equipment in place?
Yes
No
Do you operate under a GMP program that complies with 21 CFR 117, 21 CFR 123?
Yes
No
If no, do you have a GMP program implemented?
Yes
No
How often do you hold GMP training classes/sessions?
Are there hand washing stations throughout the facility?
Yes
No
Is PPE (hair net, gloves, beard nets etc.) provided to employees?
Yes
No
Do employees wear uniforms?
Yes
No
Do you have designated areas for eating (Lunchrooms)?
Yes
No
Are there written policies and procedures in place for training of new/all employees?
Yes
No
Are all training sessions documented?
Yes
No
Do you have policies and procedures in place for proper storage and transportation?
Yes
No
Are all materials and equipment stored at least 18” from walls or appropriate distance?
Yes
No
Are all refrigerator and freezer temperatures monitored?
Yes
No
N/A
If yes, how often?
Are raw materials and finished products stored separately?
Yes
No
Do you have a stock rotation program?
Yes
No
If yes, please attach stock rotation program
Select a File
If no, please explain why not
Do you have a chemical control procedure?
Yes
No
Are transportation vehicles inspected for structural integrity, cleanliness, and overall suitability prior to loading?
Yes
No
What method is used for all incoming and outbound shipments during transportation?
Sealed
Locked
Do you have temperature monitoring methods used during transportation for temperature sensitive products?
Yes
No
Do you have an approved supplier program?
Yes
No
What documentation do you require from your suppliers?
Do you visit/audit your suppliers?
Yes
No
Do you monitor and verify suppliers?
Yes
No
HACCP Certificate (Required) / HACCP Letter of Guarantee
Select a File
HACCP flow chart with CCP's (Required)
Select a File
GMP Policy/Procedures (Required)
Select a File
Recall Policy (Required)
Select a File
Sanitation Polocy (Required)
Select a File
Last FDA inspection report if citations (If applicable)
Select a File
Recall information if any in the past 3 years (If applicable)
Select a File
MCS or other 3rd party certificate (If applicable)
Select a File
Submit
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