FSVP Verification checklist Dear Valued Supplier, To ensure compliance with Food Safety and regulatory standards from our sources of foreign suppliers, our ability to provide consistently safe and legal products to our customers we ask for your cooperation in completing the following questionnaire and returning it back to us. The list of questions outlined is to better understand your company’s compliance and capabilities. We have also included requirements for labeling and packaging. Thank you in advance for your cooperation. Section 1. Requirementsa. Documents We require a Continuing Letter of Guarantee from each supplier of food ingredients and/or food packaging be sent to us on Company Letterhead, indicating the suitability of supplied products for food use. These letters should be renewed in January of each year. Additional documentation requirements is listed below. b. Additional documentation requirements are listed below. Product Name & Description Net Weight # of units/count (if applicable) Lot Number Manufacturing Date / Best By Date Ingredient List (including allergens) Company Name & Address Recommended storage (if applicable) Specification/size (if applicable) Color (if applicable) Kosher Designation (if applicable) Halal Designation (if applicable) Product Specification Sheet (included with shipment) No Ethyl alcohol present in ingredients or flavorings- statement (where applicable) c. Packaging requirements Packages of any type should be well sealed to prevent contamination or intrusion by pests during storage or transportation. Corrugated packaging containing raw materials intended for food use should have inner bags or liners made from a food-grade material. Section 2. QuestionnaireWe believe that by responding to our supplier questionnaire, you will strengthen our line of communication and help us understand your food safety programs. In some cases, a particular requirement may not apply to your specific operation. If so, please state in the response section the reason(s) for exclusion.1) Food Safety Programsa) Food Safety Plan / Hazard Analysis and Critical Control Points (HACCP) Program with supporting documents (Critical Control Points - CCP Checks, Annual Reassessment, Verification, Validation, Corrective Action records etc.)*YesNoPlease attached a copy of your Food Safety Plan / HACCP Plan with process flow chart. Drop files here or If no, please state reason:b) Quality Control Program that records and documents QA/QC line checks on in-process and finished products verifying conformance to customer product specification*YesNoIf no, please state reason:c) Supply Chain Program / Raw Material Inspection Program*YesNoIf no, please state reason:d) Customer Complaint Program with investigation report: Root Cause(s), Corrective Action(s) and Preventive Action(s).*YesNoIf no, please state reason:e) Quality Systems / Regulatory Compliancei. Third Party Audit*YesNoDate of last audit:* Date Format: MM slash DD slash YYYY Auditing Agency:*Please attached a copy of your most recent third-party audit certificate with complete audit report.* Drop files here or ii. FDA Bio-Terrorism Facility Registration*YesNoPlease provide last 4 digits of registration #:iii. California Dept of Health Services Registration*YesNoPlease provide registration #:iv. Foreign Supplier Verification Program (if applicable)*YesNoForeign suppliers please provide DUNS #:v. Glass and Brittle Plastic Policy*YesNovi. Employee Training Program*YesNoIf no, please state reason:f) Allergen Information:i. Does your facility have an Allergen Control Plan?*YesNoii. Does the facility store or process any of the following allergens:Milk*Present in products supplied to us? (Yes / No)Present in other products made on the same line? (Yes / No)Present in facility? (Yes / No)Eggs*Present in products supplied to us? (Yes / No)Present in other products made on the same line? (Yes / No)Present in facility? (Yes / No)Fish*Present in products supplied to us? (Yes / No)Present in other products made on the same line? (Yes / No)Present in facility? (Yes / No)Shellfish Crustacean (shrimp, crab, lobster)*Present in products supplied to us? (Yes / No)Present in other products made on the same line? (Yes / No)Present in facility? (Yes / No)Tree Nuts (almonds, cashews, macadamia nuts, shea nuts, pistachios, pecans, walnuts, hazelnuts, brazil nuts)*Present in products supplied to us? (Yes / No)Present in other products made on the same line? (Yes / No)Present in facility? (Yes / No)Peanuts*Present in products supplied to us? (Yes / No)Present in other products made on the same line? (Yes / No)Present in facility? (Yes / No)Wheat*Present in products supplied to us? (Yes / No)Present in other products made on the same line? (Yes / No)Present in facility? (Yes / No)Soybeans*Present in products supplied to us? (Yes / No)Present in other products made on the same line? (Yes / No)Present in facility? (Yes / No)iii. If present, does the policy involves storage segregation of allergen containing ingredients?*YesNoiv. If present, does the policy involves Sanitation Procedure and/or other preventive controls?*YesNoIf no, please state reason:g) Sanitation, Pest, and Maintenance Programi. Good Manufacturing Practices*YesNoii. SSOP / Master Cleaning Schedule*YesNoiii. Pre-op Inspection*YesNoiv. Environmental Monitoring Program*YesNov. Integrated Pest Management Program*YesNovi. Preventive Maintenance Program*YesNovii. Designated Chemical Storage Area*YesNoIf no, please state reason:h) Process & Operational Controlsi. Raw Materials and Finished Product Spec Sheets*YesNoPlease provide most recent version Product Specification Sheet with nutrition information for each product supplied to The Coffee Bean & Tea Leaf. Drop files here or ii. Foreign Material Control / Metal Detectors in use*YesNoiii. Documented Traceability and Recall Program*YesNoiv. Mock Recall performed at least annually*YesNov. Documented Hold and Release Program*YesNovi. Documented Food Defense Program*YesNoIf no, please state reason:i) Transportation and Distributioni. Inbound and Outbound Shipment Inspection*YesNoii. FIFO Rotation Policy*YesNoIf no, please state reason:j) Laboratoryi. Finished product testing performed by ISO 17025 accredited laboratory?*YesNoii. Ability to produce Certificate of Analysis per shipment?*YesNoPlease provide Certificate of Analysis (COAs) for each shipment of each product supplied to The Coffee Bean & Tea Leaf. Drop files here or If no, please state reason:2) Additional Certifications:a) Kosher*YesNob) Halal*YesNoc) Organic*YesNod) Non-GMO*YesNoe) Gluten-Free*YesNof) Vegan*YesNog) Fair Trade*YesNoh) Other (please specify):Please provide most recent certificates of each certification listed “Yes” above. Drop files here or 3) Transparency in Supply Chain Information:a) Does your company comply with the requirements of the California Transparency in Supply Chains Act?*YesNob) Does your company certify that the materials incorporated into products supplied to International Coffee & Tea, LLC comply with the laws regarding slavery and human trafficking of the country/countries in which we do business?*YesNoInitials:4) Contact Information:Company Name:* First Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country *NameTitlePhone #Email Completed by:*Date:* Date Format: MM slash DD slash YYYY Signature* Share this:TwitterFacebookWhatsAppLinkedInLike this:Like Loading...