SUPPLIER EVALUATION FORM

COMPANY NAME:

Food Company name & logo

(To be completed by the Supplier)

DATE:

ADDRESS:
COMPLETED BY:

POSITION:

(Please fill all the sections in this questionnaire and send the original copy to our office.)
List of products supplying to: ________________________________
Tel: __________________________,
Products

Sec.No
A
1.
2.
3.
4.

5.

Fax: ___________________
Tick if applicable or specify here.

EVALUATION CRITERIA

YES/
NO

N/A
or
Not
Aware

Remarks

PRODUCT SAFETY MANAGEMENT

SYSTEM
Do you have a documented Product safety or
quality management system (e.g.HACCP,
GMP, ISO)?
Is it a local regulatory requirement for your
business to implement Product Safety or
HACCP program?
Have any of your customers requested for
implementation of Product safety
Management system?
If answer for Sec.No AI is No then-Do you
have any written policies and procedures to
ensure Hygiene and safety of Product in your
premises?
Do you have documented Product complaint
reporting procedure with corrective action
plan?
Can you provide, if required Microbiological

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SUPPLIER EVALUATION FORM

6.
B
7.
8.
C
9
10
11
12
13
D
14
15
16
17
18
E
19
20
21
22
F
23

Food Company name & logo

and chemical analysis results of your products

at least every 6 months?
FACILITY, PREMISES AND
EQUIPMENT
Do you have dedicated department or person
to look after maintenance issues?
Do you have facility, premises and equipment
maintenance procedures, schedules,
monitoring checklist and required record
keeping system?
CLEANING AND SANITATION
Do you have a proper cleaning schedule?
Are there written procedures of cleaning and
sanitation available?
Is there a procedure to train the staffs
involved in cleaning and sanitation on safe
use of chemicals?
Is there a separate area away from Product
preparation and storage available for cleaning
chemicals and equipment storage?
Do you use sanitizing chemicals specifically
for sanitizing or disinfecting all Product
contact surfaces?
PEST CONTROL
Do you have a contract with pest control
company?
Is the pest control record service record
available in your premises?
Are you keeping the list of all pesticides,
insecticides and rodenticides and the MSDS
for chemicals.
Are there any physical control devises like
EFK, Glue Boards etc installed?
Is the Pest Sighting Record Book accessible
to all staffs?
PURCHASING AND RECEIVING
Do you have an approved supplier list?
Is there a receiving procedure in place and are
the received items are recorded after
necessary checks.
Do you maintain rejection record for rejected
items?
Do you follow documented stock rotation,
date coding, store inspection procedures?
PERSONNEL & STAFF TRAINING
Do you have documented Personal Hygiene
standards and monitoring procedures?

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24
25
26
27
28
29
G
30
31
H
32
33
34
35
I
36
37

Food Company name & logo

Have your staffs received any Product

hygiene and safety training to date and
certificate copies are available?
Do all Product handlers have valid health
cards?
Is there any illness reporting procedure
available?
Are the staffs provided with clean protective
clothing everyday?
Is there adequate hand washing sinks installed
and hand washing procedures in place?
Do the staffs having separate changing facility
and toilet away from the Product handling
areas?
TEMPERATURE CONTROL
Is there a temperature monitoring system in
place during chilled or frozen storage, heat
processing, and cold processing?
Is there a calibration program available for the
temperature, volume and weight measuring
devices or any other critical equipment?
TRANSPORTATION
Are the vehicles carrying high risk Product
items installed with refrigeration or freezer
units?
Is the vehicle temperature is monitored during
transportation?
Is there a cleaning schedule for the vehicles
and verification system available?
Are the vehicles are only dedicated for
Product items transport?
LABORATORY ANALYSIS
Is there a system available to send Product
samples to laboratory for Microbiology and
Chemical analysis?
Do you take swab samples from employees
hand and other working surface for analysis?

Thank you for taking your valuable time to complete this form. Please send this completed
form back to us after signing.
SIGNATURE: -------------------------DATE: ----------------------Doc No.: XXXXX

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SUPPLIER EVALUATION FORM

Food Company name & logo

DECLARATION OF COMMITMENT
(The supplier should type this in company letterhead and sign)
We support the commitment of ________________________ towards their commitment
providing safest Product and we like to confirm the following:
1.

We hereby certify that the products to be supplied to _______________________

would be safe and confirm to local regulatory requirements.

2.

The products are tested for safety and quality standards.

3.

We shall support the Product safety measures of________________________ by

maintaining highest hygienic standards of our premises, equipments, vehicles,
Product handlers and processes from receiving till delivery of the product.

4.

We have no objection if ____________________ would carry out an audit for our

process.

NAME:

SIGNATURE &DATE:

POSITION:

COMPANY SEAL:

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