Category No Title Number Question Translation Acceptance Criteria Remarks Is Applicable Vendor Self Vendor Comments

Assessment
0 Identification
0 Identification
0 Identification
1 Certificates and
Registrations
1 Vendor identification Vendor Code; Name, address; vendor To be completed by the auditor, no Yes No
role (manufacturer, laboratory, score
logistics)
2 Audit identification Audit number, audit date To be completed by the auditor, no Yes No
score
3 Team identification Lead auditor, co-auditor, other To be completed by the auditor, no Yes No
participants score
4 Is the site certified for any GFSI Audit passed and certificate valid; e.g. If YES, please enclose a copy of the Yes Yes
recognized Food Safety standard? FSSC 22000, BRC, SQF, IFS certificate including amendments

1 Certificates and 7 Is the site certified for any Quality Audit passed and certificate valid; e.g. If YES, please enclose a copy of the Yes Yes
Registrations Management standard? ISO 9001, ISO 22000, ISO 14001, ISO certificate including amendments
45001, ISO 50001, ISO 27001
1 Certificates and 9 Is the site certified for any Audit passed and certificate valid; If YES, please enclose a copy of the Yes No
Registrations Sustainability, Social Accountability or SMETA 4-Pillar audit or similar certificate including amendments; In
Responsible Sourcing related standard? standard; EMAS, RSPO, UTZ, MSC, case of SEDEX registration, please
customer implied etc.; provide the registration number(s);

1 Certificates and 11 Are products and sites registered at e.g. food facilities to be re-registered at If YES, please list registration Yes Yes Product and Facilities registered by
Registrations regulatory bodies? FDA every 2 years if product is supplier number(s) and registered product BPOM and FDA
to the US; groups; when was the last regulatory
audit and were there any findings (e.g.
483s)?
1 Certificates and 13 Are facilities/products Organic certified? Audit passed and certificate valid If YES, please enclose a copy of the Yes No
Registrations certificate including amendments

1 Certificates and 14 Are facilities approved for Kosher Audit passed and certificate valid If YES, please enclose a copy of the Yes Yes Halal Certified
Registrations and/or Halal production? certificate including amendments

2 Management System and 19 Does the company consider all Clearly defined responsibility and Yes Yes
Standards applicable laws and regulations? systematic review process established;
2 Management System and 20 Does the site have a documented keeping trackFood
Documented on emerging changes
Safety/Quality and
Policy Yes Yes
Standards quality management system? signed by Senior management; periodic
2 Management System and 21 Is risk- and impact assessment an review ofmapping
Process quality objectives; all
and risk assessment Yes Yes
Standards essential element in case of incidents, for each process; Cross-functional
2 Management System and 22 deviation
Is there aand changes? change
comprehensive impact assessment;
Procedure risk assessment
in place; customers are Yes Yes
Standards management process? informed in advance and have to
2 Management System and 24 Is each customer complaint managed acknowledge
Complaints or approve
recorded and important
investigated Yes Yes
Standards appropriately to prevent recurrence? to systematically determine the root
2 Management System and 25 Are corrections and corrective cause and
Process corrective established;
descriptions actions developed Yes Yes
Standards measures for process deviations, audits follow-up on CAPA established; due
2 Management System and 26 observations
Is as well as product failures
there an appropriate dates process
clear monitored; verification
description namedof If YES, please state the date of the last Yes No
Standards recall/withdrawal procedure in place? responsibilities; emergency contacts, mock recall and/or confirm whether
incl. Phone; emergency contacts at there has been any true recalls during
authorities; mock recall performed the past 12 months;
2 Management System and 27 Is there a crisis management and regularly;
Comprehensive risk assessment; If YES, please elaborate on the risks Yes Yes Covid 19
Standards business continuity plan established for Disasters, e.g. fire, earthquake, that have been considered
2 Management System and 28 thethere
Is site in case of an incident
a documented supplier flooding,
Risk basedstorm etc.; Managerial
approach, considering the Yes Yes
Standards qualification system? inherent raw material risks as well as
2 Management System and 29 Does the supplier qualification system supply/performance
Process in place thathistory;
considersalllatest Yes Yes
Standards include aspects of food safety and food developments and modified regulatory
3 Product Realization 40 fraud all
Have prevention?
products and processes been requirements; food
Self-developed tool safety/food fraud
or using commonly Yes No
3 Product Realization 42 Have control measures been Fraud screening methods, e.g. mass Testing suitable to detect individual Yes Yes
implemented to detect adulterated raw balancing, inspection on origin, cases of fraud, examples could be GC-
materials and food ingredients? determination of provenance, MS/MS, LC-MS/MS, ELISA testing,
verification of specification conformity; C13/C14 isotope analysis; DNA
comprehensive inspection plans sequencing;
3 Product Realization 43 Have all material handling/production established;
Concept complying with the 7 HACCP Please attach the HACCP plan to Yes Yes
steps been subject to a comprehensive principles; significant biological, identify the hazards requiring a
HACCP study? physical, chemical food safety hazards CCP/preventive control
3 Product Realization 45 Have allergens been included as part of and allergens
Allergen assessed;
management annual in
program review If YES, please describe the preventive Yes Yes
the HACCP plan? place; Allergens are included and controls that have been established to
preventive measure/controls are in prevent cross-contact, cross-
place; Clear segregation; risk contamination and mislabeling;
mitigation measures; proper job order Please mention all allergens
planning considering allergen risks; stored/processed on site:
awareness about crop-rotation and
3 Product Realization 46 Are CCP/preventive control monitoring potential mix-ups with
Critical limits defined per non-allergenic Please list those hazards requiring a Yes Yes
measures established for hazards CCP/preventive control/OPRP for each CCP/preventive control where a
requiring preventive controls? identified hazard; validation of CCP and preventive control HAS NOT been
the critical limits done; verification of applied. Please attach documentation
CCP, recording and action criteria showing Givaudan has been made
defined, in case of CCP failure; review aware of this.
3 Product Realization 47 Is there a safety sieve or filter in place of records
Max. done
particle regularly
size of 2.0mmat (mesh
adequate
10); Please describe the mesh size/filter Yes Yes
right before packing/filling? typically defined as CCP/oPRP; checked pore size of sieve/filter as well as the
regularly on presence and integrity of material it is made of
3 Product Realization 48 Is there a metal detection and/or filter/sieve; verification
In place, regularly records
tested and Please describe the verified metal Yes Yes
removal (magnet) system in place? calibrated; evidence available; detector limits and strength of magnet
considering ferrous, non-ferrous and (if applicable)
3 Product Realization 49 Is the production conducted according stainless
Work steel
orders atspecimen; verification
point of use; recipes Yes Yes
3 Product Realization 52 Does the established production Process, personnel and material flows Yes Yes
3 Product Realization 53 Are all relevant process parameters Process parameters, e.g. temperature, Yes Yes
3 Product Realization 54 Are rework and reprocessing activities Process description and responsibilities Yes Yes
3 Product Realization 55 Are records of each manufacturing step Records in place and correctly filled-in If YES, please describe minimum Yes Yes base on shelf life product + 6 months
kept? by operators; documented line retention period
3 Product Realization 57 Is there a system in place that allows clearance before
Considering used start;
raw retention period Yes Yes
3 Product Realization 59 Is each probe / sensor for Accuracy and precision fit for purpose; Yes Yes
3 Product Realization 60 Is there a weighing/filling control Automated filling process; or manual Yes Yes
3 Product Realization 62 Is the labelling process controlled and Precautions to prevent mix up of labels; Yes Yes
3 Product Realization 63 Are finished products securely packed? All individual packages, e.g. drums, Yes Yes
3 Product Realization 65 Is each batch manufactured in a self- Quality parameters are homogeneous Yes Yes
3 Product Realization 66 Is there a unique batch code on each Unique code that allows product Please describe the definition of a batch Yes Yes YYMMDDVVBP dd/mm/yyyy Ann
delivery of goods? identification and traceability; clear link code: hh:mm nnnn
to purchase order possible;
YY = Year
MM = Month
DD = Date
VV = Variant Alphabet Numeric
Exm : A0 --> NDC LK........

A = Batch --> (Normal/Reproses)

A : Batch Normal
B : Batch Reproses

P = Plant/production line
A : Plant 1 Dryer
B : Plant 1 Blending
C : Plant 2 Dryer
Dst ........

dd : Tanggal pada saat produksi

mm : Bulan pada saat produksi
yyyy : Tahun pada saat produksi
A : Bulan pada saat packing
(Alfabet Kapital)
nn : Tanggal Packing
hh:mm : Jam pada saat pengemasan
nnnn : Nomor bag yang dikemas

3 Product Realization 67 Is there an internal GMP and hygiene Inspection plan in place that covers all Yes Yes
3 Product Realization 68 Is manufacturing equipment checked to Records for line clearance activities Yes Yes
3 Product Realization 70 Are cleaning activities planned and Documented cleaning/sanitation Yes Yes
3 Product Realization 71 Are cleaning tools managed properly? Designated storage location for all Yes Yes
3 Product Realization 72 Does all processing equipment with Easy cleanable surfaces; drainable Yes Yes
3 Product Realization 73 direct food contact meet industry Insulated
equipmentspray dryer is subject
and pipework; materials to Please describe age of spray dryer and Yes Yes
Is there anstandards
sanitary insulated spray dryer?
or guidelines? inert to crack
regular both processed
testing by product
a specialistand date of most recent crack test:
4 Material Handling and 79 Are there appropriate prerequisites (external)
cleaning company; test
detergents;
Specific requirements, where frequency
such as Baby Yes Yes
Inspection established that guarantee suitability of appropriate,
Food, individualequipment
customer made of
agreements;
4 Material Handling and 80 finished products
Are allergenic for thehandled
materials intendedsafely?
use? stainless
considering steel; further
specific hygienic
contractual
Allergen management described; design
list of Yes Yes
Inspection recommendations
all allergens handled by on
e.g. EHEDG
site; allergenic
4 Material Handling and 81 Are Genetically Modified Organisms considered;
materialsprocedures
Specific labeled as in such
placeand tokept
prevent Yes No
Inspection (GMO) ingredients handled safely? cross contamination of Genetically
4 Material Handling and 82 Is there an assessment approach Modified
Taking Organisms
into account, (GMO)
e.g. way ingredients
of Yes Yes
Inspection available for raw material related risks? sourcing and manufacturing, cold chain,
4 Material Handling and 87 Is there a comprehensive goods receipt origination, provenance;
Considering identity, hygienicappropriate
status, Yes Yes
Inspection procedure established for all raw tamper evidence, temperature (if
4 Material Handling and 88 material
Are and primary
raw materials, packaging and
intermediates applicable)
All materialsand labeling
solely stored of inside
delivered(incl. Please indicate how long retention Yes Yes base on shelf life
Inspection finished good as well as primary protected un-/loading activities); raw samples are typically kept
4 Material Handling and 89 packaging
Does materials
all primary and retention
packaging materials materialspackaging
Primary stored in is thefitcorrect
for purpose, Yes Yes
Inspection for finished products comply with the such as packaging for food ingredients;
4 Material Handling and 93 applicable
Are regulations?
laboratory equipment and specification,
Equipment in test
goodreports,
condition migration
and well Yes Yes
Inspection reference standards well maintained maintained; logbook for each major
4 Material Handling and 94 and
Is suitable for
laboratory the intended
equipment used use?
for equipment;done
Calibration reference
basedstandards
on protocols Yes Yes
Inspection release criteria (e.g. scales, and by external (accredited) service
4 Material Handling and 95 incubators)
Is calibrated
there a positive at appropriate
release of purchased provider;are
Batches internal
held (inverification
quarantine) until Yes Yes
Inspection raw materials? approval by a specifically authorized
4 Material Handling and 96 Is there a positive release of finished person (e.g.
Batches Quality
are held (in Control);
quarantine) until Yes Yes
Inspection goods? approval by a specifically authorized
4 Material Handling and 97 Are raw materials and/or finished goods person (e.g. Quality
Contaminants Control);
monitoring program Yes Yes
Inspection subject to a contaminants monitoring based on risk assessment and historical
4 Material Handling and 99 program?
Is there a written procedure dealing data; e.g. pesticides,
Management heavy rejections,
of quarantine, metals, Yes Yes
Inspection with non-conforming (i.e.. out-of- concessions or alternative use,
4 Material Handling and 100 specification)
Have raw materials,
all test methods been supported
Test methods by management
approved anddecision; all Yes Yes
Inspection documented and formally approved? documented in procedures; modified
4 Material Handling and 101 Have self-developed methods been methods andto
Contribution their
ringsuitability in
tests or specific Yes Yes
Inspection validated for the intended use? verification protocols to demonstrate
4 Material Handling and 102 Are sensory characteristics evaluated the method's
Reference precision,
standards used selectivity,
when Yes Yes
Inspection as part of a documented testing carrying out sensory evaluations (e.g.
4 Material Handling and 103 procedure?
Are microbiological tests carried out in paired comparison or
Laboratory properly equipped; triangular test); Yes Yes
Inspection compliance with internationally precaution to prevent spoilage and
4 Material Handling and 104 recognized
Are any of thestandards?
Quality Control tests biohazards;
All external labsinspections
accreditedfollowing
for ISO ISO If YES, please list the test and Yes Yes SGS, Biochem, TUV Nord
Inspection carried out by a qualified third party? 17025; certificates in place and all laboratories in the comments
external tests covered by accreditation
4 Material Handling and 105 Is there a Certificate of Analysis (CoA) CoA in compliance with customer Yes Yes
Inspection provided for each delivery? specification; clear indication with
4 Material Handling and 106 Are forwarders considered in the parameters
Carrier are checked per
vehicles batch and
for cleanliness Yes Yes
Inspection preventive action plan to ensure safe and suitability prior to loading;
5 Premises, Utilities and 117 deliveries
Is there antoeffective
customers?
segregation procedures
Different in place
hygiene to prevent
zones, such as If there are different hygiene zones, Yes Yes we have 3 different Zone, high,
Industrial Hygiene between high and low risk operations? dedicated areas for critical activities like please comment medium, low
5 Premises, Utilities and 118 Are there any measures to prevent sampling, packing, open product
Hand sanitation enforced on relevant Yes Yes
Industrial Hygiene contamination of the production locations; toilets must not open directly
5 Premises, Utilities and 120 environment by personnel monitoring
Is there an environmental movements? into production,
Swabbing fillingcontact
of product or packaging
surfaces Yes Yes
Industrial Hygiene program in place? and process environment; consider
5 Premises, Utilities and 121 Are there specific personnel hygiene drains; predefined frequencies
Documented requirements and adopted Yes Yes
Industrial Hygiene standards? by all personnel, including visitors to
5 Premises, Utilities and 122 Are there documented and validated the facilities;protocols
Procedures, jewelry,for wearing make-as
equipment Yes Yes
Industrial Hygiene cleaning/sanitation procedures? well as production-, warehouse- and
5 Premises, Utilities and 123 Are all cleaning and disinfection agents laboratorychemical
Approved environment;supplier;records kept;
list of Yes Yes
Industrial Hygiene properly handled? approved cleaning agents; food grade
5 Premises, Utilities and 124 Is there a formal health and safety letters available;
Depending on localcleaning agents
labor laws: Yes Yes
Industrial Hygiene program for control of employee illness employees are not allowed to work with
5 Premises, Utilities and 125 and laboratories
Are communicable anddiseases?
their activities open product
Safety in case ofisopen
of the products not wounds or Yes Yes
Industrial Hygiene segregated appropriately? jeopardized; Test results not influenced
5 Premises, Utilities and 126 Are premises and production equipment by production
Walls, floors, andenvironment; special and
ceilings inspected Yes Yes
Industrial Hygiene inspected regularly and in appropriate maintained (e.g. no loose paint, dirt,
5 Premises, Utilities and 127 condition?
Is there a preventive maintenance mold, wood
Planning and other contaminants
of maintenance activities; Yes Yes
Industrial Hygiene program? considering premises and equipment in
5 Premises, Utilities and 128 Is there an effective pest control place; protocols
Considering and records for
all relevant/applicable Yes Yes
Industrial Hygiene program in place? pests, like insects, rodents, birds,
5 Premises, Utilities and 129 Is the probability of pest infestation or spiders, reptiles
Preventive etc.; e.g.
measure, operated
Closed byDoor Yes Yes
Industrial Hygiene pest ingress minimized? policy and fly screens; traps and baits
5 Premises, Utilities and 130 Is there a glass policy in place? are installed,
Register accessible
or inventory forand fixed in
glass/brittle Yes Yes
Industrial Hygiene materials for regular checks; written
5 Premises, Utilities and 131 Are precautions established to maintain procedures forand
Temperature dealing
humiditywithof breakage
cold or of Yes No
Industrial Hygiene the cold chain? frozen storage rooms continuously
5 Premises, Utilities and 132 Is there a regular check of water, ice monitored; with
Monitoring automatic
regardalert system
to pathogens Yes Yes
Industrial Hygiene and steam which is used for and contamination; monitoring based
5 Premises, Utilities and 134 material/food
Are generator processing
and supply and
system for on operating
Process procedures
parameters and pre-
controlled (e.g. Yes Yes
Industrial Hygiene process water, ice and steam temperature, conductivity etc.);
5 Premises, Utilities and 135 monitored
Is and maintained?
there a regular check of process air maintenance
Monitoring schedule
with regard available,
to Yes Yes
Industrial Hygiene for material/food processing, microbiological and physical
5 Premises, Utilities and 136 equipment
Are cleaning
generator and drying?
and supply system for contamination;
Air filters regularly monitoring based on Please provide details on filters in use: Yes Yes
Industrial Hygiene process air monitored and maintained? maintained/exchanged according to
6 Human Resources and 150 Is there a regular competency maintenance
Job descriptions schedule; terminal filter
with responsibilities Yes Yes
Training assessment for personnel? and job requirements for all position;
6 Human Resources and 151 Have appropriate introduction and repeated
Comprehensive competency assessment
and systematic for
training Yes Yes
Training refresher training programs been program in place for entire staff;
6 Human Resources and 152 established for allemployees
Have all relevant positions? been reproducible and documented;
HACCP principles and identified CCPs; Yes Yes
Training trained in Food Safety basics? allergen handling; Food Defense;
6 Human Resources and 153 Are employees handling hazardous Regular training of staff handling of Yes Yes
Training materials instructed on the label dangerous good and hazardous
6 Human Resources and 154 meaning?
Are employees trained on operating fire materials;
regular training
training participation
of staff; training Yes Yes
Training extinguishers and emergency participation recorded; regular
7 Site Security and 167 evacuation?
Is there a Food Defense Program? evacuation
Product drills study
security in place; / vulnerability Yes Yes
Surveillance assessment carried out; risks identified
7 Site Security and 168 Are personnel and visitors registered? and mitigation
when entering and measures
leaving implemented;
the site; Yes Yes
Surveillance valid for entire staff and all visitors;
7 Site Security and 169 Are precautions in place that physically Site fenced; different buildings with Yes Yes
Surveillance prevent unauthorized access/entering individual access control and access to
7 Site Security and 170 to premises
Are and in
precautions materials?
place to detect sensitivesurveillance
Camera areas is limited;of the property in Yes Yes
Surveillance unauthorized access to premises and operation; controlled/patrolled by
7 Site Security and 171 materials?
Are computerized systems protected guards; protection; restricted access
Password Yes Yes
Surveillance against unauthorized access, to sensitive data; permission granted
8 Environment, Health and 180 manipulation
Did the companyand establish
alterationaof both to
system for relevant
EHS Manual data and activities
available describingonly;EHS Yes Yes
Safety manage environmental protection and policies, guidelines and procedures;
8 Environment, Health and 181 occupational
Does healthhave
the company and safety?
objectives in named
Aim senior management
to source energy from renewable Please elaborate on the objectives: Yes Under implementation
Safety place to reduce Green-House-Gas resources and to minimise the use of
8 Environment, Health and 182 emissions?
Has the company evaluated the energy generated
Prevent and minimise by fossil
impact fuels
on in Examples of biodiversity impact: Yes Yes
Safety impacts of its business activities on ecosystems, biodiversity, and the reduction in number of species,
biodiversity, especially in protected environment of the natural systems disturbance of wildlife habitats and
areas and areas of high conservation from which the company obtains, migration routes, soil quality and soil
value? sources, and produces raw materials; erosion, water quality and availability

8 Environment, Health and 183 Is there a documented fire-protection Fire fighting equipment (e.g. fire Yes yes
Safety concept in place? extinguisher, fire hose, sprinkler
8 Environment, Health and 184 Is the company prepared to control system)
Fire alarmsufficiently available
acoustically in
and optically Yes Yes
Safety emergency situations correctly? visible throughout; alarm devices
8 Environment, Health and 185 Is handling of hazardous materials, available
E.g. to detect
dangerous and engage
processes (highin cases Yes Yes
Safety dangerous goods and dangerous pressure processes, exothermic
8 Environment, Health and 186 processes done under
Are there measure safe and
in place to ensure processes) or products (high flammable
Personal protective equipment (PPE) Yes Yes
Safety occupational safety for all employees? available according to the type of
8 Environment, Health and 187 Are occupational accidents adequately activity;
Accidentseye showers
recorded and bodyofshowers
regardless the Please elaborate on the number of first Yes Yes
Safety managed? severity; first responders/first-aid responders/first-aid workers:
8 Environment, Health and 188 Is the site in compliance with local workers by
Abiding permanently
regulationsavailable during
for wastewater Yes Yes
Safety emission regulations? treatment as well as emissions of
polluted air and noise; no dumping of
8 Environment, Health and 189 Has the company evaluated the Water policy in place, water-related Yes Yes
Safety impacts of its business activities on the objectives defined and water risk
8 Environment, Health and 190 availability
Has the siteofidentified
water? all waste streams assessment
Ensure performed;
that waste water / non-
(hazardous Yes Yes
Safety and ensure those are handled in hazardous) is stored safely in dedicated
8 Environment, Health and 191 compliance
Does with local
the company laws
have and
objectives to waste bins,and
Objectives treated appropriately
planned actions toand Yes No
Safety reduce the use of plastics? reduce the use of single-use plastics
10 Social Accountability 209 Does the company have a system in and/or changing to is
Policy commitment renewable raw
the foundation; Yes Yes
10 Social Accountability 210 Are local labor regulations respected, Copies of regulation readily available to Yes Yes
10 Social Accountability 211 Are local labor regulations respected, Copies of regulation readily available to Yes Yes
10 Social Accountability 212 Is it ensured that there is no child Child labor is defined as work that is Please mention the legal age in your Yes Yes
under the legal age employed in the harmful to children i.e., work which is country
10 Social Accountability 213 factory?
Is it ensured that there is no use of exploitative,
No prevents
use of forced childrenlabor
labor/prison fromor Yes Yes
10 Social Accountability 214 Is it ensured that local regulation Legal working hours per week are not Please mention the local legal working Yes Yes
regarding legal working hours are exceeded; employees have at least one hours per week (or per month) in your
respected? day off per week; country
Classification Explanation
No The process/system is not inplace and it is not
planned to implement it at the moment.
Planned The process/system is planned to be implemented
in the near future and a concept exists. The
implementation has not started yet.

Under implementation The process/system is currently being implemented

and will be fully operational/in place short-term.

Yes The process/system exists or is in

place/operational.
Participants
Name Function Email

Auditors
Name Has Lead (Y/N) Email
 Audited Site Address
Telephone Vendor Company Name
Street
Postal Code
City
Country
Telephone
Web Page
Sanitary Approval / FDA Registration
Audit Date

Telephone