FOOD SAFETY AND QUALITY MANUAL

Supplier Self-Assessment Questionnaire

Section 1 – Supplier Details and Audit Summary

Supplier Name Name of Person

Completing SSAQ
Supplier Site Address Position

Date of Completion

Technical Contact
(Name, Email and Telephone)

Senior Manager for Quality / Food Out of Hours

Safety Contact
Products Supplied – Please List

Issue No : 1 Originated By : C. Mukherjee eDoc No : 1.6.1D Supplier Self Assessment Ques onnaire
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Company History

Section 2 – Management Systems

Yes No N/A Comments
2.1 Is there a documented food safety
management system in place?

2.2 Is the system audited by an

independent individual and does
the scope cover the supplied
products?
2.3 Is a quality / food safety policy in
place and signed by a Senior
Manager?

2.4 Is there an environmental

management system in place?

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2.5 Is there a procedure for customer

complaints?
2.6 How often are complaints reviewed
/ trended?
2.7 Is there an internal audit procedure
and schedule?

Does this cover food safety audits?

2.8 Is there a procedure covering the
control of records? How long are
records kept?
2.9 Is there an internal audit procedure
and schedule?

Does this cover food safety audits?

Yes No N/A Comments

2.10 Is there a procedure covering the

control of records?

How long are records kept?

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2.11 Is there a procedure for mock recall

/ crisis management?

How often is it tested and is the test

reviewed when completed?

2.12 Is there a procedure for training?

Does it cover food safety?

2.13 Have you been prosecuted in the

last 5 years (or are any
prosecutions pending) for breaches
of food safety, health and safety or
environmental legislation?

2.14 Do you have adequate insurance Details. Limit of cover?

covering all products supplied ?

Total Number of Questions:

Total (excluding N/A):

Score:

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Section 3 – HACCP
Yes No N/A Comments
3.1 Is there a documented HACCP plan in
place?

3.2 Is the HACCP plan based on Codex

Alimentarius?
3.3 Was the HACCP study conducted with
a multi-disciplinary team?

3.4 Are any CCP’s identified? List.

What are they?

3.5 When was the HACCP plan last
reviewed?

When is next review due?

3.6 What training have the operators who Competency assessment.

are monitoring CCP’s had?

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Total Number of Questions:

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Section 4 – Foreign Body Control

Yes No N/A Comments
4.1 Is a glass policy in place?

4.2 Is a glass breakage procedure in

place?

4.3 Are all lights protected with covers

(diffusers) or shatterproof tubes used?

4.4 Is a wood policy in place?

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4.5 Are metal detectors used? .

4.6 Are the detectors checked with ferrous Test piece size and frequency of test.
and non-ferrous test pieces?

4.7 What is the corrective action in the

event of a failure?

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Section 5 – Cleaning and Hygiene

Yes No N/A Comments

5.1 Is a cleaning schedule in place. Who, where, what & how – frequency
Does it cover all areas, including
storage?

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5.2 How is the effectiveness of Details.

cleaning monitored?

5.3 Are the chemicals used food safe?

MSDS available / Risk

Assessments completed?

5.4 How is ‘deep clean’ or high level

cleaning or other areas not covered
by the cleaning schedule planned?

5.5 Are contract cleaners used? What areas? Scope of duties?

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Section 6 – Premises

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Yes No N/A Comments

6.1 Is pest control done in-house or
contracted out to a 3rd party?

6.2 Frequency of visits (including

technical inspections)?

6.3 Is there 24 hour / 7 day security?

Are security surveillance cameras

used?

6.4 Is waste kept in closed containers,

with the containers kept away from
entrances to production and
storage areas?

6.5 Are walls, floors and ceilings

smooth, impervious and easy to
clean?
Total Number of Questions:

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Section 7 – Raw Materials / Finished Products

Yes No N/A Comments

7.1 Are all suppliers (including Detail
packaging) approved?

Is it the approval based upon risk?

7.2 Is all incoming product delivered in If no, how is product integrity maintained during transportation?
transportation that is sealed?

7.3 Is raw material verified checked

against specification before intake /
use?

7.4 What checks are done at intake?

Are results recorded?

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7.5 How often are raw material

specifications reviewed?

7.6 Do raw material specifications

contain limits for physical, chemical
and microbiological contaminants?

7.7 What is the corrective action in the

event of product being outside legal
compliance?

7.8 Are in-process specifications in

place?

7.9 Are finished product specifications

in place?

Frequency of review?

7.10 How are finished products

protected from contamination?

7.11 Are raw and finished products kept

separate?

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7.12 How is non-conforming product

identified, segregated and dealt
with?

7.13 Is there a documented procedure

for new product development /
introduction?

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Section 8 – Process Control

Yes No N/A Comments

8.1 Are procedures in place to enable
control of the process?

8.2 How is the process controlled to

meet agreed specifications?

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8.3 Is calibration of equipment carried Detail

out?

8.4 Are product contact materials food

safe?

8.5 Is equipment off (or sealed to) the

floor and away from walls?

8.6 How is product traceability

maintained?

8.7 Are any allergenic materials used

on site?
If yes, how are they controlled?
How do you ensure no cross-
contamination occurs with products
supplied, including any rework?
(Allergen List: Cereals containing
gluten, Shell fish, Fish, Peanuts, Milk
(including lactose), Tree Nuts, Celery,
Mustard, Sesame seeds, Lupins,
Molluscs, Eggs, Soya (incl lecithin) &
Sulphur dioxide and sulphites)

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Yes No N/A Comments

8.8 Are cleaning methods validated to

ensure that allergens are effectively
removed?
8.9 Is the site classified as nut free?

8.10 Are any genetically modified

materials used on site?

If yes, how are they controlled?

How do you ensure no cross-

contamination occurs with products
supplied?
8.11 Are any genetically modified
materials used in the manufacture
of your raw materials?
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Section 9 – Maintenance

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Yes No N/A Comments

9.1 Are preventive and predictive
maintenance techniques used?

9.2 Are food grade lubricants used

where necessary?

9.3 With maintenance work that can

affect food safety or quality, is a
‘sign off’ required before equipment
is handed back to production?

Does this include a check that all

spare parts and tools are
accounted for?

9.4 Are maintenance staff food safety

trained?

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Section 10 – Personal Hygiene / Staff Facilities

Yes No N/A Comments

10.1 Are all staff involved with the
handling of raw materials and
product required to wear protective
clothing?

10.2 Please give details of the company

jewellery policy.

10.3 All there hand wash stations at

each entrance to the production
areas and are the hand wash
stations hands-free operations with
hot and cold running water and
drying facilities?

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10.4 Is work clothing laundered by a

contract launderer?

If not, how is it done?

10.5 Are pre-employment medical Details.

assessments carried out?

10.6 Is there a return to work after Details.

sickness / foreign travel procedure?

10.7 Are visitors / contractors screened Medical questionnaire / induction?

before being allowed on to site?
Total Number of Questions:

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Section 11 – Packaging and Transportation

Yes No N/A Comments

11.1 Where is packaging stored?

11.2 Is all packaging used food grade?

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11.3 Is the packaging storage area

clean and pest free?

11.4 How are products protected against

splinters when on a wooden pallet?

11.5 Is transportation for supply of

products inspected before use?

Are records of the inspection

maintained?

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For Muk A G’s Use Only

Scoring
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2 = Fully Complaint 1 = Partially Compliant 0 = Non-Complaint

Section SCORE Comments

2 – Management Systems

3 – HACCP

4 – Foreign Body Control

5 – Cleaning and Hygiene

6 – Premises / Plant

7 – Raw Materials / Finished Products

8 – Process Control

9 – Maintenance

10 – Personal Hygiene / Staff Facilities

11 – Packaging / Transportation

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Score / 20

Total Percentage (%)

Grading
A = > 75% - 100% - complies or exceeds expectations, approve to supply.
B = 65% - 74% - improvements needed, follow up on site audit needed.
C = < 65% - not approved to supply.

Document Change Log

Date Issue Number Reason for Change Issued By State Loca on

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