XXXXXXX SUPPLIER EVALUATION PROGRAM January 4, 2017

BOILER SERVICE SUPPLIER QUESTIONNAIRE

CONTRACTOR NAME:

CONTACT INFORMATION:

Section YES/ N/A

EVALUATION CRITERIA Comments
& No NO

A FOOD SAFETY MANAGEMENT

1 Do you have a proper and up to date license for the service you provide?

2 Do your personnel follow Good Manufacturing Practices rules and

requirements when providing compressor services?
3 Do you have a written procedure of the service you provide? If YES,
please attach
4 Do you provide your service on time?

B EQUIPMENT & CHEMICALS

5 Is your equipment designed to provide safe service and ensure there is
no risk of biological, chemical and physical contamination to company’s
food products?
6 Do the chemicals you use provide no risk of chemical and physical
contamination to company’s food products?

C AFTER-MAINTENANCE CLEANING
7 Do your personnel do after-maintenance cleaning (e.g. removal of wire
pieces, excessive chemicals, etc) to ensure there is no risk to company’s
food products?
8 Do your personnel count small parts (e.g. bolts, nuts, screws, etc.) to
ensure there is no risk of physical contamination to company’s food
products?

D ALLERGEN CONTROL
9 Do your personnel obey the requirement that no food or drinks are
allowed in production areas to prevent product contamination with
allergens?

E GLASS CONTROL
10 Do your personnel obey the requirement that no glass is allowed in
production areas to prevent product contamination with glass?

F PERSONAL HYGIENE & DISEASE CONTROL

11 Do your personnel cover their hair with hair restraint?

12 Do your personnel wash hands when entering production areas?

13 Do your personnel sanitize their footwear in Foot Baths?

14 Do your personnel obey the requirement that no jewelry is allowed in

production areas to prevent product contamination with physical objects?
15 Will you report to the Management if your personnel have infectious
disease?

Thank you for taking your valuable time to complete this form. Please send this completed form back to us after signing.

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