This field is hidden when viewing the formSection 1Supplier Name(Required)Domestic/International?(Required) Domestic International Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code 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 FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email(Required) PhoneType of Supplier(Required)Raw MaterialIngredientPackagingProducts/Services(Required)What do you supply Northern Wind – Please list the products you supply us. Are you GFSI Certified?(Required) Yes No GFSI Document(Required)Accepted file types: pdf, Max. file size: 1 GB.HACCP Letter(Required)Accepted file types: pdf, Max. file size: 1 GB.GFSI Certification(Required)BRCSQFIFSFSSC:22000BAP/BSPPrimusOtherGFSI Certification - OtherSection 1: Questionnaire (please mark your selections)Do you have a written food safety policy?(Required) Yes No N/A Other Has a food safety risk assessment been undertaken?(Required) Yes No N/A Other Do you have a food safety plan, product protection program, risk management plan, HACCP, or other food safety system?(Required) Yes No N/A Other Do you have an employee hygiene program?(Required) Yes No N/A Other Do you have Sanitation Standard Operating Procedures (SSOP's)?(Required) Yes No N/A Other Are personnel trained in food hygiene and safety?(Required) Yes No N/A Other Do you have a pest control program?(Required) Yes No N/A Other Are cross-contamination risks controlled?(Required) Yes No N/A Other Do you have a recall program?(Required) Yes No N/A Other Do you have full traceability?(Required) Yes No N/A Other Do you have a system for handling customer complaints?(Required) Yes No N/A Other Do you have a supplier approval program?(Required) Yes No N/A Other Are manufacturing instructions documented?(Required) Yes No N/A Other Do you carry out any auditing, either internal or external?(Required) Yes No N/A Other Do you carry liability insurance?(Required) Yes No N/A Other Do you have any other food safety controls in place?(Required) Yes No N/A Other Section 2: Trace Exercise/Mock RecallPlease supply a trace exercise or commonly known as Mock Recall of any product you may produce, preferably one you sell to Northern Wind, LLC.Trace ExerciseAccepted file types: pdf, Max. file size: 1 GB.Migration StudyMax. file size: 1 GB.Section 3: Allergen InformationPlease check all applicable selectionsMILKIn Product?(Required) Yes No In Facility?(Required) Yes No Controlled?(Required) Yes No EGGSIn Product?(Required) Yes No In Facility?(Required) Yes No Controlled?(Required) Yes No WheatIn Product?(Required) Yes No In Facility?(Required) Yes No Controlled?(Required) Yes No Crustacean Shellfish (lobster, crab, shrimp)In Product?(Required) Yes No In Facility?(Required) Yes No Controlled?(Required) Yes No Tree Nuts (almonds, etc.)In Product?(Required) Yes No In Facility?(Required) Yes No Controlled?(Required) Yes No PeanutsIn Product?(Required) Yes No In Facility?(Required) Yes No Controlled?(Required) Yes No FishIn Product?(Required) Yes No In Facility?(Required) Yes No Controlled?(Required) Yes No SoyIn Product?(Required) Yes No In Facility?(Required) Yes No Controlled?(Required) Yes No SesameIn Product?(Required) Yes No In Facility?(Required) Yes No Controlled?(Required) Yes No Molluscan Shellfish (clams, oysters, etc.)In Product?(Required) Yes No In Facility?(Required) Yes No Controlled?(Required) Yes No Celery SeedIn Product?(Required) Yes No In Facility?(Required) Yes No Controlled?(Required) Yes No Mustard SeedIn Product?(Required) Yes No In Facility?(Required) Yes No Controlled?(Required) Yes No GlutenIn Product?(Required) Yes No In Facility?(Required) Yes No Controlled?(Required) Yes No Section 4: AcknowledgementI hereby declare that to the best of my knowledge the answers contained within this questionnaire are true and accurate. I understand that the information will be used in the evaluation process to assess the named organization's suitability as a supplier.Consent(Required) I agree to the above acknowledgement.Form Completed By:Name(Required) First Last Position(Required) Δ