This field is hidden when viewing the formSection 1Supplier Name(Required)Domestic/International?(Required) Domestic InternationalAddress(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 NoGFSI 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/BSPPrimusOtherExpiry Date(Required) MM slash DD slash YYYY GFSI Certification - OtherSection 1: Questionnaire (please mark your selections)Do you have a written food safety policy?(Required) Yes No N/A OtherHas a food safety risk assessment been undertaken?(Required) Yes No N/A OtherDo you have a food safety plan, product protection program, risk management plan, HACCP, or other food safety system?(Required) Yes No N/A OtherDo you have an employee hygiene program?(Required) Yes No N/A OtherDo you have Sanitation Standard Operating Procedures (SSOP's)?(Required) Yes No N/A OtherAre personnel trained in food hygiene and safety?(Required) Yes No N/A OtherDo you have a pest control program?(Required) Yes No N/A OtherAre cross-contamination risks controlled?(Required) Yes No N/A OtherDo you have a recall program?(Required) Yes No N/A OtherDo you have full traceability?(Required) Yes No N/A OtherDo you have a system for handling customer complaints?(Required) Yes No N/A OtherDo you have a supplier approval program?(Required) Yes No N/A OtherAre manufacturing instructions documented?(Required) Yes No N/A OtherDo you carry out any auditing, either internal or external?(Required) Yes No N/A OtherDo you carry liability insurance?(Required) Yes No N/A OtherDo you have any other food safety controls in place?(Required) Yes No N/A OtherSection 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 NoIn Facility?(Required) Yes NoControlled?(Required) Yes NoEGGSIn Product?(Required) Yes NoIn Facility?(Required) Yes NoControlled?(Required) Yes NoWheatIn Product?(Required) Yes NoIn Facility?(Required) Yes NoControlled?(Required) Yes NoCrustacean Shellfish (lobster, crab, shrimp)In Product?(Required) Yes NoIn Facility?(Required) Yes NoControlled?(Required) Yes NoTree Nuts (almonds, etc.)In Product?(Required) Yes NoIn Facility?(Required) Yes NoControlled?(Required) Yes NoPeanutsIn Product?(Required) Yes NoIn Facility?(Required) Yes NoControlled?(Required) Yes NoFishIn Product?(Required) Yes NoIn Facility?(Required) Yes NoControlled?(Required) Yes NoSoyIn Product?(Required) Yes NoIn Facility?(Required) Yes NoControlled?(Required) Yes NoSesameIn Product?(Required) Yes NoIn Facility?(Required) Yes NoControlled?(Required) Yes NoMolluscan Shellfish (clams, oysters, etc.)In Product?(Required) Yes NoIn Facility?(Required) Yes NoControlled?(Required) Yes NoCelery SeedIn Product?(Required) Yes NoIn Facility?(Required) Yes NoControlled?(Required) Yes NoMustard SeedIn Product?(Required) Yes NoIn Facility?(Required) Yes NoControlled?(Required) Yes NoGlutenIn Product?(Required) Yes NoIn Facility?(Required) Yes NoControlled?(Required) Yes NoSection 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