XXXXXXXXXXX SUPPLIER EVALUATION PROGRAM February 26, 2014

LAUNDRY SERVICE SUPPLIER QUESTIONNAIRE

CONTRACTOR NAME:

CONTACT INFORMATION:

Section YES/ N/A

EVALUATION CRITERIA Comments
& No NO

A FOOD SAFETY MANAGEMENT

1 Do you have a proper and up to date license for the service you provide?
2 Do your personnel follow Good Manufacturing Practices rules and
requirements when doing all service related activities?
3 Do you have food safety management system on place? If YES, please
specify. In case of GFSI certification, please provide a certificate copy
4 Do you have a written procedure of the service you provide? If YES,
please attach
5 Do you provide your service on time?

B EQUIPMENT & CHEMICALS

6 Do you use proper laundry equipment compliant to food safety
requirements?
7 Is your equipment designed to provide safe service and ensure there is
no risk of biological, chemical and physical contamination to company’s
food products through the uniform?
8 Do you use only CFIA approved laundry chemicals?

C TRANSPORTATION & DELIVERY

9 Is your transportation designed and properly equipped to provide the
pick-up and delivery services that are safe to company’s food products?
10 Do you provide proper coverage for the clean uniform when delivering?

D ALLERGEN CONTROL
11 Do you ensure proper separation of the laundry to avoid cross-
contamination?
12 When at company, do your personnel obey the requirement that no food
or drinks are allowed in production areas to prevent product
contamination with allergens?

E GLASS CONTROL
When at company, do your personnel obey the requirement that no glass
is allowed in production areas to prevent product contamination with
glass?

F PERSONAL HYGIENE & DISEASE CONTROL

13 When at company, do your personnel cover their hair with hair restraint?
14 When at company, do your personnel wash hands when entering
production areas and after touching potential contaminants (e.g. wall,
floor, etc)?
15 When at company, do your personnel sanitize their footwear in Foot
Baths?
16 When at company, do your personnel obey the requirement that no
jewelry is allowed in production areas to prevent product contamination
with physical objects?
17 Will you report to the Management if your personnel have infectious
disease?
Thank you for taking your valuable time to complete this form. Please send this completed form back to us after signing.

SIGNATURE: -------------------------- DATE: --------------------------------

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