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1、FACILITY QUESTIONNAIRE FOOD SAFETY食品安全-工廠調查問卷1.0 COMPANY PROFILE 廠商資料Company Name:公司名稱:Site Address:公司地址City城市:Prov./State省份:Country 國家 :Postal code,ZIP郵政編碼 :Website公司網(wǎng)址:Mailing Address:通訊地址(if different)(如與上述不同)Billing Address:發(fā)票寄送地址(if different)(如與上述不同)Please indicate if you are as
2、sociated with/or a division of another organization: 請說明是否隸屬于另一個機構或與其他機構有關系2.0 CONTACT INFORMATION 聯(lián)系人Contact Name:姓名Phone:電話Position:聯(lián)系地址Fax:傳真Please feel free to attach your business card 請盡量提供您的名片E-Mail:電子郵件Corporate Contact (if different): Name/Number:總公司聯(lián)系人(如不同)姓名/電話Billing Contact (if differen
3、t): Name/Number:發(fā)票接收人(如果不同)姓名/電話3.0 SITE INFORMATION場所描述Is there more than one facility to be registered?是否多于一個場所需要認證? No Yes (Please complete Multi-site Details PART III)否 是 (請完成本問卷第三部分-多重場所詳述)Size of your site (sq. ft / sq. m.):現(xiàn)場的面積(平方米)Please indicate the primary industry sector serviced by your
4、 company:請說明貴公司主要工業(yè)/服務領域If known, please indicate the 4-digit SIC code applicable to your activities:如果知曉,請給出貴公司業(yè)務活動的4位數(shù)標準工業(yè) SIC 分類參數(shù)4.0 REGISTRATION SERVICE OPTIONS認證服務選項Service Element:服務單元Options:選項Target Dates:預計完成時間When would you like the Documentation Review (DR) to be conducted? 您希望何時進行資料評審?P
5、rior to Reg. Audit, at our site 現(xiàn)場審核之前在貴公司Prior to Reg. Audit, at QMI 現(xiàn)場審核之前在QMIPre-Assessment現(xiàn)場預評估Combine with DR 與文件評審同時進行Registration Audit認證現(xiàn)場審核Surveillance Audit Frequency:年度跟蹤審核頻率 Semi-annual 半年度 Annual 年度QMIs practice is to provide all documents electronically. Does this meet your needs or wo
6、uld you prefer: Faxed QMI的宗旨是希望提供所有的文件為電子版本。請問這符合您的要求嗎?抑或會選擇: 傳真形式Do you have any special audit requirements? Please List:請問你方還有沒有別的一些特殊要求?如有請列表說明:i.e. Language?比如說審核語言?i.e. Health & Safety Risks?比如說健康與安全風險?5.0 REFERRAL INFORMATION 參考信息How did you hear about QMI? Training Advertising SCC RAB IQN
7、et QMI Customer 您是如何獲知QMI的?培訓 廣告 加拿大認可委 美國認可委 國際IQNET QMI客戶 Referred by our Consultant: 被我們的咨詢師推薦的:Name 他的名字:Company所屬公司: Other (Please indicate): 其他 (請詳述)FACILITY QUESTIONNAIRE PART II工廠調查問卷 第二部分6.0 MANAGEMENT SYSTEM INFORMATION FOOD SAFETY食品安全管理體系相關信息To which standard are you seeking registration?
8、您正在尋求的認證標準是什么 ISO 22 000 : 2005 ISO 22 000 : 2005 + ISO 9001:2000 QMI HACCP based FSMS QMI HACCP based FSMS + ISO 9001:2000 Others (Please describes) : _Scope of Activities: Please describe the scope of your activities, products and services as it relates to your Food Safety Management System (FSMS)
9、:請描述貴公司與食品安全管理體系相關聯(lián)的活動,產(chǎn)品和服務的情況Total number of employees affected by the scope? 受當前體系范圍約束的員工數(shù)目是多少?How many shiftsday? Start/Finish times: / 每天有多少班制 班制起始時間Does your organization currently hold registration for another standard? No 否貴公司目前是否持有其它標準的認證證書?Yes: Which Standard/Registrar:是:是何種標準Are you seeki
10、ng integrated audit services? Yes 是No 否您是否尋求多標準一體化認證服務?Are you seeking a transfer of registration? No, skip to the next section. Yes, please complete the following:您是否尋求轉換認證機構否,直接跳到下一節(jié) 是,請接著完成下面的內容Standard (including version):目前認證的標準(包括版本)Current Registrar:目前的認證機構Expiry Date of Current Certificate:
11、Please attach copy) 證書有效期(請附拷貝件):Last Audit Date/Next Audit Date:上次審核時間/下次審核時間 / 7.0 FOOD SAFETY MANAGEMENT SYSTEM (FSMS) INFORMATION食品安全管理體系信息Does your facility have a system for auditing/monitoring the applicable Industry sector requirements & specifications, the applicable Food Laws & Reg
12、ulations and the Prerequisite programs for your facilities (Good Food Safety Practices such as : GMP ; Good Manufacturing Practices GAP ; Good Agricultural Practices, GHP ;Good Hygienic Practices, GVP : Good Veterinarian Practices, GPP : Good Production Practices, GTP ; Good Trading Practices, Infra
13、structure & Maintenance Programs, etc.) 您的設備有適用的行業(yè)必備的條件及技術要求審核和檢測的體系,適用的食品法律法規(guī)和必備的程序(良好食品安全規(guī)范,例如GMP/良好生產(chǎn)規(guī)范:GAP/良好農(nóng)業(yè)規(guī)范,GHP/良好衛(wèi)生規(guī)范,GVP/良好獸醫(yī)規(guī)范,GPP/良好產(chǎn)品規(guī)范,GTP/良好貿易規(guī)范,基本設施和維護程序等)嗎?YesNo 是 否Please list all applicable food safety codes, specifications, regulations and other industry sector requirements
14、 relevant to the scope of your system: (Please attach a list as necessary)請列出所有您的體系范圍內相關食品安全規(guī)范,技術要求,規(guī)則和其他行業(yè)必備條件Operational Statistics: 操作統(tǒng)計Total Person hours worked per year: 員工每年工作的總小時數(shù)Level of process automation 自動化過程水平 High Medium LowFood processing required by your clients (High, Medium, Low) 您的
15、顧客必須的食品過程 High Medium LowBasic repetitive tasks (BRT) by percentage of workforce:基礎循環(huán)作業(yè)(BRT)的職工總數(shù)的百分比Highly specialized tasks (HST) by percentage of workforce:高度熟練作業(yè)(HST)的職工總數(shù)的百分比Seasonal workers? NoYes, % of total workforce:有季節(jié)工嗎? 沒有 有 百分比為:HACCP Plan: HACCP計劃Please complete the table below or prov
16、ide copy of your HACCP plan. (Attach a list if necessary)請完成以下表格或者提供貴公司HACCP計劃的復印件(必要時請附清單)How many operational processes on site?現(xiàn)場有多少操作流程?Activity/Product/Service/Facilities(i.e. process step: raw material receiving)活動/產(chǎn)品/服務/設備(例如:流程步驟:原材料加工)Identification of Hazards Category(i.e. physical, chemic
17、al, biological)危險類別的辨別(例如:物理,化學,生物)Critical Control Pts & Program or Procedures to Control ?有哪些危害控制關鍵點及相關的控制流程?Food Hazards & Associated Risks of Products, Activities and Facilities:食品危害及與產(chǎn)品,行為和設備有關的危險源In the table below, please mark N/A if not applicable. If applicable, choose the associate
18、d risk level: Low, Medium or High.在下表中,如果不相關請標注N/A,如果合適請選擇風險級別:高,中,低Note : Consider routine & non-routine activities at all facilities in the workplace, whether provided by the organization or external parties. Products means from the suppliers food chains : raw materials, additives, components,
19、 packaging up to t he finished products & delivery/distribution to the customer.N/ALow低Med中High高Biological hazards & associated risks (i.e. contamination of products by bacteria spore & non-spore forming, viruses, protozoa and parasites, etc.)生物危害源(例如細菌孢子產(chǎn)生的污染物和非孢子生物,微生物,原生物和寄生物等)Physica
20、l hazards & associated risks (i.e. contamination of products by glass, wood, stones, metal, bone, plastic, personal effects, building material, etc.)物理危害源(比如由玻璃、木材、石頭、金屬、骨頭、塑料、人為影響、建筑材料等污染的產(chǎn)品)Chemical hazards & associated risks (i.e. contamination of products by naturally occurring chemicals
21、 such as mycotoxins, allergens etc. and/or added chemicals such as antibiotics, lead, arsenic, food additives, etc.)化學危害源(比如由自然界的化學品:過敏源等或者添加的化學劑:抗生素、鉛、砷、食物添加劑等污染的產(chǎn)品Packaging materials hazards & associated risks (i.e. prinking inks, adhesives)包裝材料危害源(比如印刷業(yè)油墨、膠合劑等)Food-borne illness or disease re
22、lated to the products (i.e. based upon review or epidemiological data) 由該食品產(chǎn)品導致疾病的情況(比如基于之前的審核或者流行病學數(shù)據(jù))Please list other food hazards & associated risks(or annex document and data):請列出其他食品危害源和有關聯(lián)的風險(或附加文件和數(shù)據(jù))Which measurements do you periodically monitor to evaluate your Food Safety Management S
23、ystem ( FSMS ) Performance? Please attach a list if necessary貴公司將使用哪一種測量方法定期監(jiān)測評價您的食品安全管理體系的執(zhí)行情況?如果可能請附清單Please list any other Food Safety Management System (FSMS) concerns that have not been addressed. Please attach a list as necessary (i.e. Any notice(s) from the Food authority about a violation of
24、 the Food regulations & corrective actions taken, etc.) 請您列出其他任何有關于食品安全管理系統(tǒng)而在這里未有列出的項目。如果可能請附清單(例如:任何食品相關的政府部門頒發(fā)的有關食品守則的違反及相應糾正措施的執(zhí)行方面的通知等)Does your organization have a product recall system in place, supported by relevant procedures and associated records?請問貴公司在適當?shù)牡胤接蟹癞a(chǎn)品召回制,并且有相關流程和記錄支持的?Yes No
25、Please note: if there is more than one facility/site to be registered, please complete Part II of the facility questionnaire for each site. 請您說明:如有多于一個的工廠或者現(xiàn)場要認證,每一個現(xiàn)場請完成第二部分工廠問卷8.0 COMPETENCY ANALYSIS 能力分析 INTERNAL USE ONLY 此欄僅限QMI內部使用FACILITY QUESTIONNAIRE PART III工廠調查問卷-第三部分Please complete ONLY if your management system encompasses more than one site.如果在貴公司的管理體系與一個以上場地有關聯(lián)時,請完成本部分內容:9.0 ADDITIONAL SITE DETAILS其他場地情
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