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Quality Assurance- Food Safety Questionnaire

General Information: Date: ___________________

Vendor# 2246352 Address:_________________________________________________________Vendor Name: __________________________ _____________________________________________________Main Contact: ___________________________ Phone: __________________________________________________________

Position: ________________________________ E-Mail:__________________________________________________________

Indicate if you have certication for one of the folloin!s: SQF !" IS#:FSS" 22$$$ #t%er:__________________________________________"Please rovide coy of current Certicate$Nature of %usiness: Primary Production &ood Manufacturin! &ood 'tora!e ( )ist*+ther"Please secify$: __________________________________________________________________________________,otal numer of sta. at main site: Permanent "aro/* #$ __01__________ ,emorary* "aro/* #$ ____23______

Social !es&onsi'ility(es)*o or *)A

4 )oes the comany rovide a safe5 healthy or6 environment for all emloyees7comly ith all las that re8uire the fair treatment of or6ers and rohiit theuse of forced5 tra9c6ed or child laor in connection ith the roduction of anymerchandise

;

< )oes the comany emloy a Non-)iscriminatory =or6in! Policy "race5 color5reli!ion5 national ori!in5 se/5 a!e5 disaility$ or other characteristics rotected yla

;

2 )oes the comany have a )iscilinary Procedure in lace "Please rovide a coyof olicy$*

;

Comments:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

+rocessin, "onditions +rocedures and ./ui&ment(es)*o or *)A

4 )o you have Inound Insections Procedures and >eceivin! >eorts ;

< Is the Processin! ?ine in strai!ht @o to avoid Cross-Contamination oints ;

2 Is the >a Material trac6ed from >eceivin! throu!h Processin! into &inishedProduct

;

Are &inished ProductBs ,emerature >e8uirements in lace and is there an ActionPlan for Non-Conformin! Product ;

1 )o you have &ood Aller!ens clearly identied and Control Procedures in lace"eanuts5 tree nuts5 soy5 mil65 e!!5 heat5 n sh and crustaceans$

;

)oes your facility have a Physical Daard Prevention Pro!ram "i*e*5 li!ht ulsrotected5 eelin! aint5 rust5 etc*$

;

0 )oes your facility have a method used to revent Metal Contamination "i*e*5metal detector e8uiment5 in-line ma!net tras5 lters5 etc* chec6in! for ferrous5non-ferrous5 and stainless steel$

;

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G Are all Processin!5 'tora!e5 'hiin! and >eceivin! areas clean5 in sanitaryconditions and ell or!anied

;

Comments:

_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

+lant Quality "ontrols(es)*o or *)A

4 )o you have &inished Product 'ecications Manual and an Action Plan for Non-Conformin! roduct

;

< )o you have a ,raceaility and Product >ecall Pro!ram ;

2 )o you have a Pesticide >esidual Analysis or a Pesticide ,rac6in! Pro!ram N )oes your facility have a current =ater Potaility Certicate or =ater Analysis

Certicate udated;

1 Is the temerature in all Processin!5 'tora!e5 'hiin! and >eceivin! areasmonitored and recorded

;

Are CalirationHCertication of scales and temerature monitors recorded ;

0 )oes your facility have a current DACCP Pro!ram for the roduction rocess INP>+C''

G )oes your facility have ?aoratory &acilities or is there microiolo!ical ,estserformed

; ( N

Comments: _________P>E'EN,?; IMP?EMEN,IN P>+>AM &+> DACCP______________________

+lant "leanin, and Sanitation (es)*o or *)A

4 )oes the facility have ade8uate ritten ood Manufacture Practices "MPBs$ ;

< Are emloyees usin! roer attire for or6 "i*e*5 !loves5 hair restraint5 aron5 noJeelry5 etc*$

;

2 Are Master 'anitation 'chedules and Pre-+eration Insections >ecordsavailale

;

)oes the facility has an e.ective PestH>odent Control Pro!ram ith the Control'tation Ma in lace and udated

;

1 Are chemicals and Pest Control materials roerly stored5 loc6ed and securedith Material 'afety )ata 'heets "M')'$ inder availale

;

Are Dand =ash 'tations roerly stoc6ed "hotHcold otale ater5 soa5 aer

toels5 !ara!e containers and a hand ash si!n osted$

;

0 )o you have a Plant 'afety and Dy!iene Pro!ram ith on!oin! emloyeestrainin!

;

G )o you conduct an +utound ,railers Insections " ensurin! all trailers arecleaned rior to loadin! and temerature of trailers recorded$

;

K Are the outside facility !rounds clean and ell maintained "i*e*5 ar6in! lotaved or dust control mechanisms5 !ara!e ins sealed5 etc*$

;

43 Are doors or entry ays 6et closed at all times andHor ith security !uards ;

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44 )oes the facility have all visitors access strictly controlled "i*e*5 si!n-in5temorarily visit ad!e5 etc*$

;

Vendor 'i!nature _________________________________

Comments:

_______________________________________________________________________________________________

_______________________________________________________________________________________________

Fanuary 5