Form WIF04.

1a

SUPPLIER EVALUATION FORM

All prospective suppliers intending to supply goods and/or services to Clorpeace Foods (Clorpeace
Investments), are required to be registered in the company’s approved supplier database prior to any
supply of goods or services. The registration process involves the submission of a registration pack by the
supplier, where after a vetting process is conducted, prior to acceptance of the supplier.
It is Clorpeace Foods’ policy that goods and services are only sourced from suppliers who have been duly
approved and form part of the approved suppliers’ database.

Please note:
 Submission of a registration pack does not pre-qualify the submitter as an approved supplier to
Clorpeace Foods.
 Submission of a registration pack does not guarantee that the submitter will be contacted by
Clorpeace Foods procurement personnel to supply goods and/or services to Clorpeace Foods
operations.
 Upon receipt of a complete Supplier Registration Pack, vetting procedures which include
background checks into supplier operations will be performed by representatives of Clorpeace
Foods. Non-complying suppliers will be disqualified from the registration process.
 Suppliers will only be registered into the approved supplier database upon the successful
completion of all vetting processes and approval. Suppliers will receive a unique supplier number
up on approval.
 It is imperative that suppliers complete the registration form in full and accurately, sign and return
as soon as possible.

Pre-Requisites of Registration

For supplier registration to be considered, the following documents comprising the registration pack are
required to be submitted together:
 Completed Supplier Registration Form
 Company profile, including trade references.
 Valid Tax Clearance Certificate
 Valid VAT Certificate or a Valid Business Partner Certificate
 Certificate of Incorporation
 Form CR14
 Form CR6
Form WIF04.1a

Supplier Code. __________ Dated ___________

1. General Details of Supplier:

I. Name of Supplier: ___________________________________________

II. Address of Supplier: _________________________________________

III. Contact Person: ____________________________________________________

IV. Phone No. __________________ ____________________

V. Fax No. ____________________

VI. Email: ____________________________________

VII. Web Address: _________________________________________

VIII. Year of Establishment: ____________

IX. Facility Size/# of Employees: ____________________

X. Service or Product Category: ____________________

2. Manufacturing Facility/ Process Facility

i. As a supplier/vendor do you have adequate machinery and equipment to supply materials/

services? (Yes / No)
ii. What is your current available capacity? ................................................................................
iii. Describe available machinery/ equipment:
Sr. # Description No./Units State of Maintenance
a
b
c
d
e

iv. Do you have a preventive maintenance schedule? (Yes / No)

Form WIF04.1a

v. Who manages the preventive maintenance schedule? ……………………………………………...

a. Highest Qualification & Experience: ……………………………………………………..
………………………………………………………………………………………………
vi. Who is responsible for the manufacturing processes?
a. What is the level of knowledge of the manufacturing processes carried?
………………………………………………………………………………………………
……………………………………………………………………………………………
vii. Do manufacturing processes have technical processing specifications to guide the manufacturing
process? (Yes / No)
a. Are the files/specifications available for inspection? (Yes / No)
b. File references: ……………………………………………………………………………
………………………………………………………………………………………………
viii. Are products/materials you supply reconfirmed for compliance with manufacturing specifications
after prescribed intervals? (Yes / No)
a. Interval: …………………………………………………………………………………

ix. Do you allow us to perform a supplier audit of your company? (Yes / No)

3. Raw Material & Process Consumables Procurement

i. Are raw materials and process consumables tested/ certified at the time of procurement as per
required specifications? (Yes / No)
ii. Are records of raw materials and process consumables maintained? (Yes / No)
iii. Can you produce a sample for in-house testing? (Yes / No)
iv. Do you provide a warranty for the service or product supplied? (Yes / No)
v. Are all the specifications of the raw materials freely available to inspection, included
under a controlled system and promptly available any time for your customer? (Yes / No)
Form WIF04.1a

4. Workmanship, Training, etc.

i. Are employees recruited on the basis of a defined job description? (Yes / No)

ii. Are employees provided with any training to perform a specified job? (Yes / No)

iii. If the answer is yes, what type of training? (Tick in Box)

Outside Training
In-house Training
On job Training
Apprenticeship

iv. What training was provided in the last six months?

……………………………………………………………………………………………………
……………………………………………………………………………………………….........
v. Are employees properly briefed about the manufacturing processes to be carried out by them?
(Yes / No)
vi. Is the supervisory control to monitor if the quality of craftsmanship/ workmanship of
employees is satisfactory? (Yes / No)

5. Shop Floor Management

i. Is the working area designed according to process flow? (Yes / No)
ii. Are work stations designed to facilitate the process flow and manufacturing requirements? (Yes
/ No)
iii. Please indicate the sufficiency of the following:
1. Space for each work station (Yes / No)
2. Lighting arrangements (Yes / No)
3. Air ventilation (Yes / No)
4. Dust collection (Yes / No)
5. Cleanliness (Yes / No)
6. Arrangement of tools (Yes / No)
iv. Please indicate the sufficiency of the following:
1. Temperature control (Yes / No)
Form WIF04.1a

2. Chemical hazard control (Yes / No)

3. Electricity hazard control (Yes / No)
v. Do you provide workers with protective equipment appropriate to the work they do?
(Yes / No)
vi. Are there written working instructions for each machine or tool? (Yes / No)
vii. How do you make sure that workers understand those instructions?
……………………………………………………………………………………………
…………………………………………………………………………………………….
viii. Is machinery provided with adequate safety guards? (Yes / No)
ix. Do you have written procedures for storage, use and disposal of chemicals in a language
that workers understand? (Yes / No)

6. Quality and Food Safety Management System:

i. Does the company have a Quality and Food Safety Manual covering Quality and Food Safety
Policy, Quality and Food Safety Objectives and Standard Operating Procedures (SOPs)? (Yes /
No)
a. If answer is yes, which certification do you have?
……………………………………………………………………………………………....
(Submit copy of certificate for record)
b. If answer is no, how is the company controlling it’s product quality and food safety?
………………………………………………………………………………………………
………………………………………………………………………………………………
ii. Is Quality and Food Safety Policy communicated and implemented within the
organization?(Yes / No)
iii. Do you have a traceability and product recall program for each batch of product and raw
materials?
iv. For each batch of product/material delivered (supplied to Clorpeace Foods), will you
provide us a full certificate of analysis/guarantee in advance or accompanying the product/raw
material? (Yes / No)
a. Please attach an example of a certificate of analysis
v. Do you have a leading official responsible (qualified person) for approval of materials and for
the release of products? (Yes / No)
Form WIF04.1a

a. If yes, please specify qualification and position within your company:

………………………………………………………………………………………………
………………………………………………………………………………………………
vi. Do you have a standard procedure for qualification of each machinery, installation and
manufacturing equipment? (Yes / No)
vii. Do you have a standard procedures system in place to prevent cross contamination
among different batches of the same ingredient/or among different products/ingredients?
(Yes / No)
viii. Is there a certification of packaging material? (Yes / No)
ix. Are you willing to provide us with a copy of your certificate of packaging? (Yes / No)
x.How long do you retain documentation concerning quality control (including methods,
calculation, registration, results, Certificates of Analysis undersigned by the quality control
manager)? ………………………………………………………………………………………….

7. Suppliers/ Sub-Contractors:
i. Do you have an approved list of material/ service suppliers? (Yes / No)
ii. Do you have any record demonstrating that the sub-contractors have monitored the working and
environmental conditions and meet relevant standards? (Yes / No)
iii. Do your suppliers verify the quality of material/services they supply to you? (Yes / No)
iv. Do you verify the quality of supplied materials/services? (Yes / No)

8. Employment:
i. What is the employment procedure (i.e. the final recruiting authority etc.)?
………………………………………………………………………………………………………………
……………………………………………………………………………………………………………….
ii. Do you have a signed copy of contract of employment with each worker? (Yes / No)
iii. Are workers informed about their legal rights as employees? (Yes / No)
iv. Do you keep records of your workers contact details and residential address on their documents?
(Yes / No)
v. Does management require medical examination as a condition for employment? (Yes / No)
a. If yes, what kind of examination it requires?
………………………………………………………………………………………………
………………………………………………………………………………………………
Form WIF04.1a

vi. How are test results used? …………………………………………………………………….…

vii. Do you keep an up-to-date list of employees? (Yes / No)

9. Working Hours, Wages & Accommodation:

i. What are the standard working hours (excluding overtime) in a week? ...................................................
ii. How many shifts per day does your plant normally work? ……………………………………………
iii. How many hours of overtime per week? ………………………………………………………….
iv. What is the maximum number of hours that employees work in a week? ……………………………
iv. How many days off do workers have per week? ……………………………………………………..

10. Health and Safety:

i. Does the company have a policy on health and safety? (Yes / No)
ii. Does the company carry out health and safety risk assessments? (Yes / No)
iii. Have you developed plans for continual improvement based on risk assessments and accident logs?
(Yes / No)
iv. Is there a fire alarm that can be heard in all areas of the production site? (Yes / No)
v. If yes, is the alarm regularly tested? (Yes / No)
vi. Is the workplace provided with emergency exits? (Yes / No)
vii. How often do they check their firefighting equipment? …………………………………………
viii. Are sick workers allowed to take paid time off, if their sickness is likely to compromise their
safety May workers access first aid equipment in the workplace during all shifts? (Yes / No)
ix. Are medically competent personnel within reach if an accident occurs? (Yes / No)

11. Financial Strength:

i. Is the company financially strong enough to manage a secure supply chain? (Yes / No)
ii. Does the company maintain a bank account and accept payments through bank transfer? (Yes /
No)
iii. Is the company in a position to extend supplies on credit? (Yes / No)
a. If the answer is ‘Yes’, for what period?
……………………………………………………...
Form WIF04.1a

12. Self- Evaluation done by:

i. Quality Assurance Manager: Name ………………………… Signature ……………………..

ii. Sales & Marketing Manager: Name ………………………. Signature ………………………

iii. Production/Procurement Manager: Name …………………… Signature …………………

iv. Finance & Administration Manager Name ………………….. Signature ……………………

General Comments
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………

13. Declaration of Authenticity of Information Given

I………………………………………………………… Position………………………………………..
of……………………………………………………………………………………………………………
declare that information given in this form is authentic and accurate about our organization.
Signed this ………of……………………… 20….. Signature: …………………………

_________________________________________________________________
For Official Use by Clorpeace Foods Investments

14. Review and Verification done by:

v. Procurement Manager: Name ………………………… Signature ……………………..

vi. Quality Assurance Manager: Name ………………………. Signature ………………………

vii. Finance & Administration Manager Name ………………….. Signature ……………………

iv. Other: Title: …………………… Name…………………….. Signature …………………..
Form WIF04.1a

15. Evaluation Results:

Pre-requisites
………………………………………………………………………………………
………………………………………………………………………………………
Supplier Details
………………………………………………………………………………………
Facilities
………………………………………………………………………………………
………………………………………………………………………………………
Raw Materials Control
………………………………………………………………………………………
………………………………………………………………………………………
Training
………………………………………………………………………………………
……………………………………………………………………………………….
Process Control
………………………………………………………………………………………
……………………………………………………………………………………….
Quality and Food Safety Management
………………………………………………………………………………………
……………………………………………………………………………………….
Subcontractors
…………………………………………………………………………………….....
Overall Comments and Recommendations
………………………………………………………………………………………
………………………………………………………………………………………
………………………………………………………………………………………
Form WIF04.1a

Approved / Not Approved as Supplier by:

Food Safety Team Leader: Name _________________ Signature _____________ Dated __/___/ 20___
Procurement Manager: Name __________________ Signature _____________ Dated __/___/ 20___
Finance and Admin Mgr: Name __________________ Signature _____________ Dated __/___/ 20___