Contact Info

  • Date of inspection completion:

  • Supplier Name:

  • Telephone:

  • Address:

  • Fax:

  • Technical Contact Name:

  • Technical Contact Email:

Product/Process Description

  • Products Supplied:

  • Summary of Process:

  • Is the supplier able to provide a GTIN/UPC code?

Requirements

  • Letter of Guarantee

  • Completion Date

  • Product / Service Specifications

  • Completion Date

  • Supplier FSMS / GMP / GAP Questionnaire (Satisfactory Responses)

  • Completion Date

  • Proof of QA / Lab Testing per product and Provide Analysis Certificates

  • Completion Date

  • Evidence of Coding, Traceability, and Recall Systems

  • Completion Date

  • Allergen Statements for Facility

  • Completion Date

  • Satisfactory Evidence of HACCP or GMP Plan

  • Completion Date

Supplier's Status

Conclusion

  • Is supplier clear for supply?

  • Is supplier suspended/de-listed?

  • Supplier Approved (or De-listed) By:

  • Date

Verification

  • Verified By:

  • Verification Date:

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