SUPPLIER QUESTIONNAIRE
I confirm that the information provided in this form is accurate.
Submitted By:
Title:
Email:
Phone:
Date:
All information must be fully completed and accurate. If changes to the product or facility are
required Kingsmill Foods must be advised in advance of the change being made.
SUPPLIER & MANUFACTURER INFORMATION
Note: A separate document must be completed for each manufacturing facility.
Supplier:
Supplier Name:
Address
City
Province / State
Postal Code
Manufacturer:
Manufacturer Name:
Address
City
Province / State
Postal Code
CONTACT INFORMATION
Technical Documentation:
Name Email:
Quality Assurance Representative:
Name Email:
Phone:
Recall Crisis Coordinator:
Name Email:
Phone: 24 hour Phone:
Form No. Q31-1 Supersedes: NEW
Revision No.: 00 Approved By: Director-QA/PD Revision Date: June 29, 2017
S:\Lab\QA\Forms\Q31-1 Supplier Questionnaire
EMPLOYEE TRAINING Yes / No / NA COMMENTS
Is there a documented
training program on Good
Manufacturing Practices?
Is there a documented
training program for
Critical Control Points
(CCPs) ?
PRODUCT TESTING Yes / No / NA COMMENTS
Is there an internal
laboratory? What testing is
done? Frequency?
Are external laboratories
used? What testing is
done? Frequency?
Is testing conducted on raw
materials before use?
Is testing conducted on
semi-processed materials?
Is testing conducted on
finished products before
shipment?
Is there an active release
system?
Are materials evaluated for
authenticity? (Protection
from fraud?)
PEST CONTROL Yes / No / NA COMMENTS
Is there a documented pest
control program? If yes,
specify who carries out the
service.
Form No. Q31-1 Supersedes: NEW
Revision No.: 00 Approved By: Director-QA/PD Revision Date: June 29, 2017
S:\Lab\QA\Forms\Q31-1 Supplier Questionnaire
BUILDING &
ENVIRONMENT Yes / No / NA COMMENTS
Is there a documented
internal inspection
program? Frequency?
Is there an environmental
monitoring program? What
indicator organisms are
used?
Is water analysed for
potability? Frequency?
Is air quality tested?
Frequency?
Is there a documented
cleaning / sanitation
program?
Are chemicals / cleaning
agents government
approved for use in a food
plant?
CONTROL of FOREIGN
MATERIAL Yes / No / NA COMMENTS
Is there a documented
foreign material control
program?
Are production lines
equipped with control
systems? Indicate type and
sensitivity: magnets,
screens, filters,..
Are there metal detectors
in place? Indicate location
in the process and
sensitivity.
Is there a program for the
control of glass and brittle
plastic in production and
warehousing?
Is there a documented
cleaning / sanitation
program?
Form No. Q31-1 Supersedes: NEW
Revision No.: 00 Approved By: Director-QA/PD Revision Date: June 29, 2017
S:\Lab\QA\Forms\Q31-1 Supplier Questionnaire
CALIBRATION /
PREVENTATIVE
MAINTENANCE Yes / No / NA COMMENTS
Is there a documented
calibration program?
Is there a documented
preventative maintenance
program?
TRACEABILITY Yes / No / NA COMMENTS
Is there a documented
recall program?
Are mock recalls conducted
from raw materials to
finished product and from
finished product to raw
material used? Frequency?
Are records of production
filed on site? How long are
records retained?
Are lot codes and
quantities of products(s)
shipped recorded on the
Bills of lading ?
Is there a complaint
handling program?
TRANSPORTATION Yes / No / NA COMMENTS
Is there a documented
truck inspection program?
Is there a system in place
to ensure proper product
rotation? FIFO, FEFO, ..?
Are seals used on vehicles
that are transporting
incoming / outgoing
goods?
Form No. Q31-1 Supersedes: NEW
Revision No.: 00 Approved By: Director-QA/PD Revision Date: June 29, 2017
S:\Lab\QA\Forms\Q31-1 Supplier Questionnaire
BIOSECURITY Yes / No / NA COMMENTS
Are employees trained in
security and biosecurity?
Are doors to the exterior
self closing and kept
locked? Or, is the property
fenced to limit access?
Do visitors / temporary
workers/ contractors sign
in and out? Are they
aware of GMP
requirements?
ALLERGEN CONTROL Yes / No / NA COMMENTS
Is there a documented
allergen control program?
Are employees trained in
allergen control?
Frequency?
Are allergens identified and
stored separately?
FOOD VULNERABILITY
ASSESSMENT Yes / No / NA COMMENTS
Is there a system in place
for identifying new risks to
the authenticity of raw
materials?
Is there a documented
vulnerability assessment of
all food raw materials?
Does your risk assessment
of each raw material or
group of raw materials
consider the potential for
substitution or fraud?
Form No. Q31-1 Supersedes: NEW
Revision No.: 00 Approved By: Director-QA/PD Revision Date: June 29, 2017
S:\Lab\QA\Forms\Q31-1 Supplier Questionnaire
Does the company have an
access to information on
historical and developing
threats relating to the risk
of adulteration or
substitution of raw
materials?
Where a raw material is at
risk of adulteration or
substitution, is there an
appropriate assurance
system and/or testing in
place to reduce the risk?
Are the raw materials you
supply to Kingsmill Foods
treated by irradiation? If
so, is the dose within the
acceptable level allowed by
government food and drug
regulations?
Form No. Q31-1 Supersedes: NEW
Revision No.: 00 Approved By: Director-QA/PD Revision Date: June 29, 2017
S:\Lab\QA\Forms\Q31-1 Supplier Questionnaire
