FSVP_Required.png

- Required

As required by Title 21 of the United States Code of Federal Regulations, part 1, subpart L, §1.505 and §1.506; all substantiating information and/or documentation for a supplier's food safety program must be maintained and updated over time. As your customer's properly designated and qualified FSVP representative, United Safety Agents respectfully requests that you provide the following information and documents.

 

All information will remain strictly confidential and will only be used during FSVP re-verification and related activities. An accurate and truthful response is required to successfully maintain FDA FSVP compliance.

FSVP_Required.png

Within the past calendar year...

1. Has a change occurred to your facility's Food Safety Program? 

FSVP_Required.png

No

Yes

If yes, please briefly describe the change and upload a copy of your facility's revised Food Safety Program

Upload New Document
Max File Size 15MB

2. Has a change occurred to any products'  ingredients?

FSVP_Required.png

No

Yes

Within the past calendar year...

If yes, please briefly describe the change and upload a copy of the revised ingredient list/specifications

Upload New Document
Max File Size 15MB

3. Has a change occurred to any products'  HACCP Plan?

FSVP_Required.png

No

Yes

Within the past calendar year...

If yes, please briefly describe the change and upload a copy of the revised HACCP Plan

Upload New Document
Max File Size 15MB

4. Has a change occurred to any of your facility's Hazard Control Procedures?

FSVP_Required.png

No

Yes

Within the past calendar year...

If yes, please briefly describe the change and upload a copy of the revised Hazard Control Procedure(s)

Upload New Document
Max File Size 15MB

5. Has a change occurred to your facility's Allergen Control Procedures?

FSVP_Required.png

No

Yes

Within the past calendar year...

If yes, please briefly describe the change and upload a copy of your facility's revised Allergen Control Procedures

Upload New Document
Max File Size 15MB

6. Has a change occurred to any products'  nutritional/allergen labeling?

FSVP_Required.png

No

Yes

Within the past calendar year...

If yes, please briefly describe the change and upload a copy of the revised labeling

Upload New Document
Max File Size 15MB

7. Has any change occurred to any products'  labeling?

FSVP_Required.png

No

Yes

Within the past calendar year...

If yes, please briefly describe the change and upload a copy of the revised labeling

Upload New Document
Max File Size 15MB

8. Has your facility's annual onsite audit expired and/or been renewed?

FSVP_Required.png

No

Yes

Within the past calendar year...

If yes, please upload a FULL copy of your facility's new onsite audit report

Upload New Document
Max File Size 15MB

9. Has your facility taken part in a product recall, for any reason?

FSVP_Required.png

No

Yes

Within the past calendar year...

If yes, please provide a detailed explanation and upload a copy of all substantiating documents

Upload New Document
Max File Size 15MB

10. Has your facility been inspected by the U.S. Food and Drug Administration (U.S. FDA) ?

FSVP_Required.png

No

Yes

Within the past calendar year...

If yes, please provide a detailed explanation and upload a copy of all substantiating documents

Upload New Document
Max File Size 15MB

11. Has any food item been stoped, held, or rejected by U.S. Customs, for any reason?

FSVP_Required.png

No

Yes

Within the past calendar year...

If yes, please provide a detailed explanation and upload a copy of all substantiating documents

Upload New Document
Max File Size 15MB

12. Has the U.S. FDA issued a Warning Letter in relation to your facility or products?

FSVP_Required.png

No

Yes

Within the past calendar year...

If yes, please provide a detailed explanation and upload a copy of all substantiating documents

Upload New Document
Max File Size 15MB

13. Has any product/batch/lot tested positive for a biological hazard?

FSVP_Required.png

No

Yes

Within the past calendar year...

If yes, please provide an explanation and upload a copy of all corrective measures

Upload New Document
Max File Size 15MB

14. Has any product/batch/lot tested positive for a chemical hazard?

FSVP_Required.png

No

Yes

Within the past calendar year...

If yes, please provide an explanation and upload a copy of all corrective measures

Upload New Document
Max File Size 15MB

15. Has your facility's conformance with FSVP (or its appendant regulations) changed?

FSVP_Required.png

No

Yes

Within the past calendar year...

If yes, please provide brief explanation and upload a copy of all substantiating documents

Upload New Document
Max File Size 15MB

16. Are the products that you supply Orlando Imports considered Ready-to-Eat?

FSVP_Required.png
Tool_Tip_Icon.png

No

Yes

If no, please provide a brief explanation

17. Has your facility put adequate procedures in place to address and control all FDA-identified biological, chemical, physical, and environmental hazards?

FSVP_Required.png

No

Yes

If no, please provide a brief explanation

18. Would you like to share any additional information?

No

Yes

19. Are there any additional documents that you would like to share?

Upload Document 01
Max File Size 15MB
Upload Document 02
Max File Size 15MB
Upload Document 03
Max File Size 15MB

No

Yes

Upload Document 04
Max File Size 15MB

20. How satisfied are you with the level of service provided by United Safety Agents?

21. How can United Safety Agents better serve you?

CERTIFICATION: By entering my name below, I certify that the information I provide on and in connection with this form is true, accurate, and complete to the best of your knowledge. I understand that any false statements or deliberate omissions on this document or any other document that I provide to United Safety Agents may be grounds for disqualification from successful Foreign Supplier Verification Program (FSVP) approval or, if discovered after FSVP approval takes place, could result in a product's FSVP approval status being revoked or terminated, and may result in a product or shipment being rejected from entry into the United States.

FSVP_Required.png
FSVP_Required.png
FSVP_Required.png

It may take several moments to load your submission.

Please be patient.

Kindly notify United Safety Agents immediately if any change occurs after this form is submitted.

 

Your time and effort are truly appreciated - thank you.

FSVP_Gov_Logos-1.png
FSVP_Gov_Logos-2.png
FSVP_Gov_Logos-3.png
FSVP_Gov_Logos-5.png
FSVP_Gov_Logos-4.png
FSVP_Gov_Logos-6.png

Copyright © 2019; United Safety Agents, LLC. All rights reserved.

Terms & Conditions