Effective Date: 1st January

Ref: TIL/PRO/FM-02
2021
SUPPLIER EVALUATION FORM

As part of our commitment to food safety continual improvement, we ask our providers of
critical processes, products or services to complete this supplier assessment form, in order to
qualify your company for future purchases

If your company is currently ISO 9000, ISO 22000, FSSC 22000 or HACCP certified or any other
related to food safety certification, you may submit a copy of your certificate in lieu of this form.

All such certificates must be provided by a third party registrar accredited by KENAS or another
IAF signatory accreditation body. Unaccredited certificates are not recognized by Texplast
Industries Limited.

Please complete the following details and return as soon as possible. All details provided to us
will be treated as confidential and only used to support the approved supplier requirements of
our integrated management system

1.0 GENERAL INFORMATION

Company name:

Address:

Telephone:

Supplier’s primary business/product:

Applicable regulatory/ statutory

standard for the product considered

Points of contact Name

Food safety team leader

Purchasing Representative

Management representative

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SUPPLIER EVALUATION FORM

2.0 Description of Product to be Supplied/services to be offered

Please attach copies regarding product description, material safety data sheets, certificates of
analysis and/or any other relevant document(s).

Product / Service Name:

Description:

Other products produced/

services offered by the
facility:

3.0 Management Systems

3.1 Food Safety & Quality Section

3.1.1 Accredited HACCP, Food Safety &/or Quality Management System(s) in Place
Tick where appropriate. Please attach copies of relevant current certificates from audits and/or
inspections, MSDSs, TDSs, COAs and Food Grade Approval Cerficates.If accredited, please skip
section 3.1.2.

ISO 9001: YES NO Validity date: ……………………

ISO 22000: YES NO Validity date: ……………………

Food Safety Enhancement Programme: YES NO Validity date: ……………………

Safe Quality Foods Programme: YES NO Validity date: ……………………

Quality Management Programmes: YES NO Validity date: ……………………

Other HACCP Accreditation: YES NO Validity date: ……………………

Other Food Safety System: YES NO Validity date: ……………………

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SUPPLIER EVALUATION FORM

Please list name(s) of any other relevant management systems in place below

Certification name Validity date

i)
ii)
iii)
iv)
v)

3.1.2 Assessment Questionnaire

Please answer each of the following questions. Where your answer to the question is yes, please
provide additional information where applicable. If the answer is N/A to your establishment,
please explain why.

Question Yes No N/A ADDITIONAL INFORMATION

Do you have a documented food safety
&/or quality policy?
Has a quality &/or a food safety risk
assessment been undertaken?
Do you have a food safety plan, quality
plans, product protection program, risk
management plan, HACCP, or any other
food safety &/or quality system?
Do you conduct relevant food safety and
quality audits? Attach CAR reports of the
recent audits.
Cleaning & Sanitation:
 Do you have Cleaning & Sanitation
Standard Operating Procedures
(CSSOP’s)?
 What is the frequency of cleaning?
Daily, Weekly, Monthly or Annually.
 Is there an appropriate cover
available for cleaning to cover for
holidays, off days etc?
 Are cleaning and disinfection
materials legally approved for use in
food manufacturing environment?
 Are cleaning and other chemicals
stored separately (away from open
product) in a locked room or cabinet
with restricted access?

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SUPPLIER EVALUATION FORM

Do you have a personnel hygiene program

& quality management programs?
Is there a dedicated resource(E.g QA
Manager) for managing Quality & food
safety aspects?
Are personnel trained in food hygiene and
safety?
Pest Control:
 Do you have a pest control
program? Internally or Externally
managed?
 Which material/Ingredient is used as
a bait in the rodent trap boxes
 Are toxic baits used within
production areas and warehouses?
 Is fumigation carried out internally in
production areas and/or externally
by contracted company? Which
chemical is used for fumigation and
is it stored away from open product
areas?
Do you have measures for food-defence,
bio-vigilance and bioterrorism?
Security and Food Defense:
 Are all containers/tractors/trailers
inspected for tampering prior to
loading and unloading?
 Are finished product transported in
sealed, tamper evident
containers/packaging?
 Have any shipments or containers
experienced a theft or tampering in
the last 12 months? Specify details
 Is the container seal number noted on
all related shipping documentation?
Do you verify it with the actual load?
 Have any of the facilities experienced
a security incident in the last 12
months?
 Is there a security program in place
that makes employees aware of the
threat of the terrorists and
contraband smuggling?
 Do you have a documented food
defense program? Are all employees
provided security training and food
defense training?
 Do your facility/facilities have a
business continuity or disaster
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SUPPLIER EVALUATION FORM

recovery plan?
 Are all entrances to the facility locked
and/or have secured access (i.e. key
cards, security codes, guards, etc.)?
Are security cameras used to view
various interior or exterior locations?

Are cross-contamination risks controlled?

Do you have a recall program?

Are legally approved pesticides and

chemicals used? How do you verify?

Do you have an Allergen control program

on-site? Please outline all the allergens
present

How do you keep Texplast informed of any

changes which could impact Quality and
Food Safety of the products?

Do you have a supplier approval program?

What controls are in place for quality &/or
food safety during procurement and
outsourcing?

How many suppliers do you use? Suppliers

can be small farms, out growers, third party,
etc.
Do you audit your suppliers and how
frequently?
Incoming goods/ services & Testing:
 Are specifications in place for
incoming raw materials, packaging
& services?
 Are incoming raw materials checked
and tested against specifications?
(e.g., label check, COA, supplier
data, Micro tests, pesticides, heavy
metals, PA, allergens etc.) –Attach
recent result.
 Is a procedure operational for the
handling of “out of specifications” of
incoming goods or services?

Is irradiation applied on any sourced raw

material?

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Do you have full traceability programme?

Traceability and Logistics:

Tracking & Tracing
 Are materials, intermediate products,
rework and end products labelled
appropriately and properly identified
to track & trace?
 Give an example of product and lot
code identification used on finished
product with explanatory key.
 How is a batch and a lot code
defined in your production
processes?
 Are you able to track & trace the
products within 4 hours? - Indicate
time required. When was the last
date you completed trace? Can you
trace to the source
(supplier/farmers/co-op, etc.)?
 When was the last date you
conducted a mock traceability and
a mock recall exercise?
 Any product recalls or withdrawals in
the last 5 years?

Logistics: Storage & Transport

 Do you control stocks of raw
materials, packaging materials,
processing aids and intermediate
products concerning quantity,
quality, storage conditions and age?
 Is FIFO principle followed?
 Do you control stocks of the end
products concerning quantity,
quality, storage conditions and age?
 What is the shelf life of the final
product?
 Do you have internal warehouse? Do
you also use external/3rd party
warehouses? Are warehouses
temperature/humidity controlled?
 If these include 3rd party owned
warehouses, how do you control
quality and food safety?
 Are pallets and packaging clean, dry
and in good condition? (not
moldy/moldered/rotten, no
protruding nails, undamaged?
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SUPPLIER EVALUATION FORM

 Are pallets (used within factory and

for transport) treated? Are pallets
heat treated or chemical treated or
fumigated?
 Is transportation clean and suitable
for the product/materials intended
and checked before loading? (e.g.
to prevent damage and
deterioration, to prevent cross
contamination, to control
temperature)
Are manufacturing instructions
documented?
Manufacturing/Production site:
 Are the manufacturing premises
located in areas free from
objectionable odours, smoke, dust or
other contaminants and protected
from rain, snow, flooding, etc.
 Is the facility divided into risk zones of
different hygiene levels for food
safety reasons? High care, high risk
etc.?
 Are sanitary and changing facilities
adequately separated from
production areas?
 Do you have hand wash facilities
prior to entering production facilities?
Is it followed by everyone including
external visitors?
 Does the design and condition of
production facility enable safe
manufacture of food/drink products?

Do you have equipment suitability and

cleaning & how is it conducted?
Are controls in place for measuring and
monitoring?
Do you have a system for handling customer
complaints?
Do you have measures to control potentially
unsafe or non-conforming products? Give
details

Product Testing:
 Which checks are performed on the
final product? Are checks
conducted by trained staff?
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 Which checks are performed on

each batch/lot? Attach recent result
 If any results are out of spec or show
undesired trend what actions are
taken?
 Do you participate in ring tests
(= proficiency testing)?
 Which external lab do you use? Do
you have internal lab? Do you
validate the test equipment in the
production and in the laboratory?
 Do you keep retention samples of
the produced products?
 Describe your
sampling/testing/monitoring plan (or
submit as attachment) – Daily,
Weekly, Monthly and Annually.

How does the company stay informed and

up to date of changes in legislations and
regulations?

Are Key Performance Indicators (KPIs) part of

the QMS and discussed with management?
Are internal audits carried out? Regular GMP
audits in the factory and audit of quality
management system?
Do you carry liability insurance?

Other controls: Describe:

 Do you have any other food safety
controls in place? Give details

 Do you have any other quality

controls in place? Give details

3.2 Environmental, Safety & Health Section

3.2.1 Accredited Environmental, Safety & Health Management System(s) in Place

Tick where appropriate. Please attach copies of relevant current certificates from audits and/or
inspections, MSDSs, TDSs, COAs and Food Grade Approval Cerficates.If accredited, please skip
section 4.2.2.

ISO 14000: YES NO Validity date: ……………………

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Environmental, Health & Safety Enhancement Programme: YES NO

Validity date: ……………………

Occupational Safety & Health management program (ISO 45001: YES NO

Validity date: ……………………

Other Relevant Accreditation: YES NO Validity date: ……………………

Please list name(s) of any other relevant management systems in place below
Certification name Validity date
i)
ii)
iii)
iv)
v)
vi)
vii)

3.1.2 Assessment Questionnaire

Please answer each of the following questions. Where your answer to the question is yes, please
provide additional information where applicable. If the answer is N/A to your establishment,
please explain why.

Question Yes No N/A ADDITIONAL INFORMATION

Do you have an environmental, safety &
healthy policies?
Who has overall responsibility for EHS
protection matters in your
Has an environmental, safety & health (EHS)
risk assessment been undertaken?
Do you have any environmental
improvement programmes for any aspects
of your operations? If yes, please give
details:
Do you have an EHS plan?

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Do you conduct relevant food safety and

quality audits? Attach CAR reports of the
recent audits.
Do you conduct relevant EHS audits?
Attach CAR reports of the recent audits.
Do you have any pollution & safety
incidents caused by your operations in the
last three years?
Do you have EHS outsourcing controls?
Please give the control plan.
Do you have waste management plans?
Please give details and attach relevant
licences as per the obligatory compliance.
Do you have any other EHS controls in Describe:
place?

**Must be completed by the supplier before Approval can be granted**

Declaration
I hereby declare that to the best of my knowledge that 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.

FORM COMPLETED BY:

NAME: ………………………………………………………………

DESIGNATION: ………………………………………………………………….

SIGNED: ………………………………………………………………….

DATE: ………………………………………………………………….

TEL. NO.: ………………………………………………………………….

Please return the completed form to: Rajesh Vekariya / Lilian Adhiambo,
Procurement Officer/ Assistant Procurement Officer,
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Texplast Industries Limited,

Email: rajesh@texplast.co.ke/ procurement@texplast.co.ke

For internal use only:

QA/PROCUREMENT APPROVAL

IMPROVEMENTS:
Required improvement actions (if any):

1. ……………………………………………………………………………………………………………

2. ……………………………………………………………………………………………………………

3. ……………………………………………………………………………………………………………

4. ……………………………………………………………………………………………………………

5. ……………………………………………………………………………………………………………

Approval GRANTED / REJECTED (tick as appropriate)

NAME: ……………………………………………………………………

POSITION: ……………………………………….

SIGNED: ………………………………………………………………….

DATE: ………………………………………………

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