- 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.
Within the past calendar year...
1. Has a change occurred to your facility's Food Safety Program?
No
Yes
If yes, please briefly describe the change and upload a copy of your facility's revised Food Safety Program
2. Has a change occurred to any products' ingredients?
No
Yes
Within the past calendar year...
If yes, please briefly describe the change and upload a copy of the revised ingredient list/specifications
3. Has a change occurred to any products' HACCP Plan?
No
Yes
Within the past calendar year...
If yes, please briefly describe the change and upload a copy of the revised HACCP Plan
4. Has a change occurred to any of your facility's Hazard Control Procedures?
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)
5. Has a change occurred to your facility's Allergen Control Procedures?
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
6. Has a change occurred to any products' nutritional/allergen labeling?
No
Yes
Within the past calendar year...
If yes, please briefly describe the change and upload a copy of the revised labeling
7. Has any change occurred to any products' labeling?
No
Yes
Within the past calendar year...
If yes, please briefly describe the change and upload a copy of the revised labeling
8. Has your facility's annual onsite audit expired and/or been renewed?
No
Yes
Within the past calendar year...
If yes, please upload a FULL copy of your facility's new onsite audit report
9. Has your facility taken part in a product recall, for any reason?
No
Yes
Within the past calendar year...
If yes, please provide a detailed explanation and upload a copy of all substantiating documents
10. Has your facility been inspected by the U.S. Food and Drug Administration (U.S. FDA) ?
No
Yes
Within the past calendar year...
If yes, please provide a detailed explanation and upload a copy of all substantiating documents
11. Has any food item been stoped, held, or rejected by U.S. Customs, for any reason?
No
Yes
Within the past calendar year...
If yes, please provide a detailed explanation and upload a copy of all substantiating documents
12. Has the U.S. FDA issued a Warning Letter in relation to your facility or products?
No
Yes
Within the past calendar year...
If yes, please provide a detailed explanation and upload a copy of all substantiating documents
13. Has any product/batch/lot tested positive for a biological hazard?
No
Yes
Within the past calendar year...
If yes, please provide an explanation and upload a copy of all corrective measures
14. Has any product/batch/lot tested positive for a chemical hazard?
No
Yes
Within the past calendar year...
If yes, please provide an explanation and upload a copy of all corrective measures
15. Has your facility's conformance with FSVP (or its appendant regulations) changed?
No
Yes
Within the past calendar year...
If yes, please provide brief explanation and upload a copy of all substantiating documents
16. Are the products that you supply Orlando Imports considered Ready-to-Eat?
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?
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?
No
Yes
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.
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Your time and effort are truly appreciated - thank you.