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DFM FSVP Assessment

This document is a foreign supplier verification program (FSVP) assessment for a supplier located in an unspecified foreign country. It asks a series of yes or no questions about the supplier's facilities, food safety plans, audits, and programs. These include whether they have allergen controls, a food safety plan, approved supplier lists, training programs, recall plans, and record retention policies. The assessor must determine if the supplier meets FSVP requirements and can be approved based on the answers provided.

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335 views2 pages

DFM FSVP Assessment

This document is a foreign supplier verification program (FSVP) assessment for a supplier located in an unspecified foreign country. It asks a series of yes or no questions about the supplier's facilities, food safety plans, audits, and programs. These include whether they have allergen controls, a food safety plan, approved supplier lists, training programs, recall plans, and record retention policies. The assessor must determine if the supplier meets FSVP requirements and can be approved based on the answers provided.

Uploaded by

dahil2711
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Dekalb Farmers Market FSVP Assessment

Suppliers Name: Country:


Address: Phone:
City: Main Contact:
State/Province: Contact Phone:
Zip: Contact Email:
Who is conducting the assessment?
Date Business Relationship Began:
What product does this foreign supplier supply?

Does your facility that delivers to our facility have any of ☐ Yes ☐No If yes, which one(s);
the big 8 allergens on their premises at any time? ☐ wheat, ☐shellfish, ☐scale fish, ☐soy,
☐ dairy, ☐peanuts, ☐tree nuts, ☐eggs
Does the facility have an allergen control program? ☐ Yes ☐No
Is the facility registered with the FDA or USDA? ☐ Yes ☐No If yes which one(s);
☐ FDA ☐USDA
Does the facility have a food safety plan? ☐ Yes ☐No If yes, which one(s);
☐ HACCP, ☐HARPC, ☐BRC, ☐GlobalGAP,
☐ FSSC 22,000 ☐IFS, ☐PrimusGFS,
☐ SQF,
☐ Other
If the facility has a food safety plan, when was it last
Date:
successfully audited by a third party?
Did we receive a copy of their certification? ☐ Yes ☐No
If the facility has been audited in the last 12 months. What
☐ Passed ☐In progress ☐failed
were their findings?
If the facility had a SUCCESSFUL 3rd party audit in the last 12 ask for a copy of the auditor’s
report and attach it to the assessment.
Does your facility have an Approved Supplier List? ☐ Yes ☐No☐NA
Does your facility have a Certified Supplier Program? ☐ Yes ☐No☐NA
Does your facility have a Customer Complaint Procedures? (tracking) ☐ Yes ☐No☐NA
Does your facility have an Employee Training Program? ☐ Yes ☐No☐NA
Does your facility have a Food Defense Plan? (Security) ☐ Yes ☐No☐NA
Does your facility have an Instrument Calibration Program? ☐ Yes ☐No☐NA
Does your facility conduct internal Plant HACCP & GMP Audits? ☐ Yes ☐No☐NA
Does your facility keep Material Safety and Data Sheets on file? ☐ Yes ☐No☐NA
Does your facility have a Metal Detector Program / Policy? ☐ Yes ☐No☐NA
Does your facility have a Micro Testing Program? ☐ Yes ☐No☐NA
Does your facility have a Mock Recall Program? Records on file? ☐ Yes ☐No☐NA
Does your facility have a net Weight Control Program? ☐ Yes ☐No☐NA
Does your facility have a Pest Control Program? ☐ Yes ☐No☐NA
Does your facility have a Preventative Maintenance Program? ☐ Yes ☐No☐NA
Does your facility have a Product Recall Program/Recall Team? ☐ Yes ☐No☐NA
Does your facility have a Specification Manuals? ☐ Yes ☐No☐NA
Does your facility have a Supplier Ingredient Testing Program? ☐ Yes ☐No☐NA
Does your facility have a Temperature Monitoring? ☐ Yes ☐No☐NA
Does your facility have a Water Testing Program / Policy? ☐ Yes ☐No☐NA
Does your facility have a Written HACCP Program? ☐ Yes ☐No☐NA
Does your facility have a Written Plant GMP Procedures / Policy? ☐ Yes ☐No
Does your facility have a Written Sanitation and Cleanup Procedures? ☐ Yes ☐No
Does your facility have Written SOPs? ☐ Yes ☐No
How long are Quality Assurance Records retained?
Does this supplier seem to have a healthy food safety culture? ☐ Yes ☐No
This supplier fulfills FSVP requirements and is an approved international supplier
☐ Yes ☐No

Signatory Information:
Print Authority Sign Authority Name: Enter Signatory Title: Date of Signing:
Name:

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