FCI-QAD-A-F34

QUALITY ASSURANCE DEPARTMENT R0/01/15/19

Food Safety Questionnaire
Marilao, Bulacan Page 1 of 9

Supplier: CAPIZ SUGAR CENTRAL, INC. Date: JULY 1, 2019

Please complete and return to _________________________________within _____ days. Write NA if not applicable.

SECTION 1: SUPPLIER DETAILS

1.1 Full Legal Name of Supplier: CAPIZ SUGAR CENTRAL, INC.

Business Type: Manufacturer of Raw Cane Sugar
1.2
Distributor Importer Manufacturer / Packer
Processor Warehouse Trader Other
1.3 Business Address: Brgy.Poblacion, President Roxas, Capiz, Philippines

Postal Code: 5803

Ph #: (036) 658 0487 Email: csci@capizsugar.com Fax #: n/a
Manufacturing Address (if different than
above):

Postal Code:
Ph #: Email: Fax #:
1.4 Company Contacts: Name: Terence S. Uygongco Ph #: 09188926629
Name: Adonis G. Tan Ph #: 09088250779
Name: Mary Anne E. Ferrer Ph #: 09178158423
Name: Remington Salaya Ph #: 09989663688
Emergency Contacts: (1) QA/Technical – Carren Jane Cell #: 09175861587
Ramos
(2) Account Manager – Shiela Cell #: 09989663687
Doromal
(3) Customer Service – Jackielyn Cell #: 09178089105
De Guzman
(4) Plant/Production – Sidney Cell #: 09190605881
Delariarte
1.5 Products to be supplied to FOODCRAFTERS INC.
Product Components Lot Code Information & Format Shelf Life
Capiz Raw Sugar Sugar Cane (juice undergoes Production date and bagging Indefinite
subsequent heating, clarification, line number but best
crystallization, and separation within 2
processes with the aid of years
processing chemicals not directly
added on it)

1.6 Number of Employees: 286

1.7 Is the Company accredited to a recognized GFSI industry standard, i.e. ISO 2200,
BRC, IFS, SQF or minimum GMP & HACCP certification? If “yes”, please provide Yes / No
copies of certification.
1.8 Is your manufacturing facility registered with: Yes No
(a) The US Food and Drug Administration? Yes No /
(b) The Canadian Food Inspection Agency (CFIA)? Yes No /
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QUALITY ASSURANCE DEPARTMENT R0/01/15/19
Food Safety Questionnaire
Marilao, Bulacan Page 2 of 9

(c) Other (i.e., as a requirement for another country/jurisdiction?

Yes No /
If so, please specify.
Other:
1.9 Product certifications (Kosher, HALAL, Organic): Halal Product Registration – 2011-F-442-01

Section 2: Manufacturing Site

2.1 Give details of the type and nature of the surrounding industry:
Capiz Sugar Central, Inc. is located wherein it is flood-free and environmentally away from polluted areas and
processing plants that may pose hazard to the production.
2.2 Does the Company have temperature and humidity controls in processing areas?
Temperature: Yes / No
Humidity: Yes No /
2.3 Is waste removed from site by a recognized waste control contractor? Yes / No
2.4 Does the Company have a procedure for the control of wood in the Yes No
/
Manufacturing plant?
2.5 Does the Company have a glass and hard/brittle plastic registry? Yes / No
2.6 Does the Company have a documented glass/hard plastic breakage policy on Yes No
/
site?
2.9 Does the Company have a procedure for the control of loose items? Yes / No
2.10 Does the Company have a written cleaning schedule for all areas of the Yes No
/
Manufacturing plant?
2.11 Does the Company have a contract cleaning arrangement? Yes / No
2.12 Who trains the cleaning staff? Agency supervisor is trained with food safety requirement of the company
and he is responsible in cascading the information to all agency personnel
assigned in cleaning.
2.13 Are the cleaners trained to comply with all health and safety aspects of chemical
Yes / No
handling?
2.14 Does the Company employ its own engineering staff? Yes / No
2.15 Is a planned maintenance program followed? Yes / No
2.17 Are engineering staff trained in food safety issues? Yes / No
2.18 Does management carry out regular documented food safety audits of the Yes No
/
Manufacturing plant?
2.19 Are procedures regularly monitored, reviewed, and changed where applicable? Yes / No

SECTION 3: PEST MANAGEMENT

3.1 Does the Company have a pest control contract? Yes No /
What is the name of the contractor? N/A - the company has in-house pest control section
3.2 What type of coverage does the pest control contractor N/A
provide?
3.3 Does the Company have electronic fly killing units? Yes No /
3.4 Does the Company use glue traps? Yes / No
3.5 Who is responsible for corrective actions for pest control In-house pest control section is
issues? responsible for the implementation,
execution and monitoring of pest control
activities.
3.6 How often does the pest control contractor visit the premises? N/A
3.7 Are pest control records maintained and available for inspection? Yes / No
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QUALITY ASSURANCE DEPARTMENT R0/01/15/19
Food Safety Questionnaire
Marilao, Bulacan Page 3 of 9

SECTION 4: PROCEDURES FOR SUPPLIER APPROVAL

4.1 Does the Company have a documented supplier approval system? Yes / No
4.2 Does the Company audit raw material suppliers? Yes / No
4.3 Does the Company only use approved suppliers? Yes / No
4.4 Does the Company require raw material suppliers to complete food safety
Yes / No
questionnaires or quality surveys?
4.5 Does the Company require test certification and/or certificates of conformance
Yes / No
from its suppliers?
4.6 Is the origin of raw materials declared to Foodcrafters? Yes No /

SECTION 5: QUALITY CONTROL PROCEDURES

5.1 Has the Company undertaken hazard analysis (HACCP) of its processes? Does
the Company define, document, and monitor areas of potential risk to the Yes / No
product? Please provide a product flow diagram indicating CCPs.
5.2 Does the Company inspect all incoming raw materials? Yes / No
5.3 Does the Company carry out tests on all incoming raw materials? Yes / No
5.4 Are raw materials segregated from other stock prior to approval for use? Yes / No
5.5 Are raw materials passed by Quality Control before being handled? Yes / No
5.6 Does the Company maintain up-to-date product specifications for all Yes No
/
products?
5.8 Does the Company have documented calibration procedures for measuring
Yes / No
instruments?
5.9 Do all the Company’s finished products pass through a foreign body detection
Yes No /
system/X-ray?
Ferrous metal detector (1.5mm) Yes No /
Non-ferrous metal detector (2.0mm) Yes No /
Stainless steel (2.5mm) Yes No /
Visual magnets, rare earth magnets Yes / No
Plastic Yes No /
Glass Yes No /
Bone (where applicable) Yes No /
Other (please specify) Yes No /
How often are metal detection units tested to ensure they are working correctly? N/A

5.10 What system of weight checking does the Company use?

Minimum Yes No
Average Yes No
Both Yes / No
5.11 Is product sieved/screened as part of the manufacturing process? If so, please provide details,
including sieve/screen sizes:
Cane juice is screened through rotary juice screen with 0.5mm perforation.
Clarified juice is screened through 3 layers 100 mesh screen
Does the product passed through a magnet? If so, please provide details.
Finished product passes through series of magnetic separators installed along manufacturing and
bagging lines with gauss strength monitoring.

5.12 How often are sieves/magnets checked to make sure they are free from damage/debris?
Magnets are checked during bagging every 2 hours.
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QUALITY ASSURANCE DEPARTMENT R0/01/15/19
Food Safety Questionnaire
Marilao, Bulacan Page 4 of 9

NOTE: Process flow diagrams are extremely useful for communicating processes with customers –
please provide where available.
5.13 What quality control checks are carried out before releasing products to customers?
Quality control evaluation on polarization, color, safety factor/% moisture content, % grain size, and
absence of foreign materials
5.14 Does the Company keep retained samples for the life of the product? Yes / No
5.15 Is there a procedure for controlling non-conforming product? /
5.16 Does the Company have a comprehensive product recall procedure? Yes / No
5.17 Does the Company have a fully documented traceability system in place to support
Yes / No
product recall that covers backward and forward tracing of products?
5.18 How are finished products coded for traceability? Provide lot code interpretation.
Lot code is consisting the production date, shift number, and the bagging line used
5.19 Does the Company immediately notify customers of any specification changes to
Yes / No
products being supplied to them?
5.20 Is there a written procedure for dealing with customer complaints? Yes / No
5.21 Does the Company have its own transport vehicles for product? Yes / No
5.22 Are the transport vehicles temperature controlled Yes No /
5.23 PACKAGING
Describe the type of packaging used to pack your products:
Primary Packaging – Polypropylene bags with plastic liner
Secondary Packaging – N/A
Does the Company have specifications for packing material? Yes / No
Does all food contact packaging comply with FDA/CFIA legislation for contact with
Yes / No
food?
Please provide a copy of packaging specifications and certification, or a packaging supplier statement
confirming that the packaging meets legislation requirements.
5.38 List the minimum details which will appear on the finished product label:
Product Name, Manufacturer’s Name, Manufacturing Address, Net Weight, Halal Product Registration
Number

SECTION 6: PERSONNEL
6.1 Does the Company have an orientation program for all new staff? Yes / No
6.2 Does the Company have a written hygiene policy? Yes / No
6.3 What type of food hygiene training do employees receive? In-house? Yes / No
Foundation? Yes No Intermediate? Yes No
Advanced? Yes / No Other (specify)? Yes No
6.4 Who carries out hygiene training? - QM Representative Company staff? Yes / No
External resources? Yes No / Both Yes No
6.5 Do all employees undergo periodic refresher training? Yes / No
6.6 Are training records kept for all staff members? Yes / No
6.7 Does the Company provide protective clothing for all food handlers? Yes / No
6.8 What type of clothing is issued? Hats? Yes / No
Hair nets? Yes / No Coats/pants? Yes / No
Beard covers? Yes / No Gloves? Yes / No
Footwear? Yes / No Other? Yes No
6.9 How often are uniform changes made? Uniform provision once hired and changes every 2 years
6.10 Do you use a contractor for uniform cleaning? Yes No /
6.11 If uniform cleaning contractors are used, have their premises been audited? Yes No
6.12 Are lockers available to staff to ensure no personal possessions are taken into
Yes / No
production areas?
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QUALITY ASSURANCE DEPARTMENT R0/01/15/19
Food Safety Questionnaire
Marilao, Bulacan Page 5 of 9

6.13 What is the company policy on GMP?

This company’s GMP Policies through a documented manual, aims to provide assurance to consumers
that the raw sugar product being manufactured by Capiz Sugar Central, Inc.is suitable for its intended
use. It provides specific Pre-requisite programs, in compliance with Codex Alimentarius and HALAL
Guidelines that are being implemented to minimize if not to totally eliminate the introduction of
physical, chemical and biological contaminants that is also haram or mashboo and to provide a framework
for Hazard Analysis and Critical Control Point (HACCP) and HALAL Assurance System implementation
6.14 What is the company policy on smoking? Is there a separate smoking area?
Smoking is prohibited within the Plant premise. Smoking is allowed outside company perimeter
6.15 Are staff provided with separate areas for eating and drinking? Yes / No
6.16 Does the Company interview staff who return to work following sickness? Yes / No
6.17 Does the Company have a food defense program in place? If “yes”, list all Yes No
Vulnerable Processes and Company Corrective actions. Use separate sheet if /
necessary.
6.18 Does the Company have a food fraud program in place? If “yes”, list all Vulnerable Yes No
/
Ingredients and Controls. Use separate sheet if necessary.
6.19 Does the Company have a business continuity/contingency plan in place? Yes / No
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QUALITY ASSURANCE DEPARTMENT R0/01/15/19
Food Safety Questionnaire
Marilao, Bulacan Page 6 of 9

SECTION 7: FOOD SAFETY STATEMENT

We at CAPIZ SUGAR CENTRAL, INC. (company name), agree to comply at all times with all current and relevant
food hygiene and food safety legislation, and will take whatever steps may be necessary to ensure that the food supplied
by this Company is of good quality, the correct substance and nature, and completely safe for human consumption. We
will undertake to notify FOODCRAFTERS INC. of any hazard or risk to food safety pertaining to our products immediately
upon becoming aware of such an issue.

Completed by (print):

ENGR. REMINGTON SALAYA

Operational Excellence Manager
Food Safety Team Leader

Date: July 1, 2019

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QUALITY ASSURANCE DEPARTMENT R0/01/15/19
Food Safety Questionnaire
Marilao, Bulacan Page 7 of 9

SECTION 8: NO FRAUD STATEMENT

We at CAPIZ SUGAR CENTRAL, INC (company name), states that each delivery is guaranteed to be Not
adulterated or misbranded within the meaning of any state or local laws, regulations, or ordinances on adulteration and
misbranding provisions on Food Safety Act of 2013 (REPUBLIC ACT NO. 10611 of the Phils.). We ensure that the correct
substance and true nature of our products and / or ingredients of our products are declared to Foodcrafters Inc., and
completely safe for human consumption.

Completed by (print):

ENGR. REMINGTON SALAYA

Operational Excellence Manager
Food Safety Team Leader

Date: July 1, 2019

SECTION 9: ALLERGEN and ALLERGEN DERIVATIVES LIST

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QUALITY ASSURANCE DEPARTMENT R0/01/15/19
Food Safety Questionnaire
Marilao, Bulacan Page 8 of 9

Product Name: Capiz Raw Sugar Source: Sugarcane Country of Origin: Philippines
Manufacturer’s Name: Capiz Sugar Central, Inc.
Manufacturer’s Address: Brgy. Poblacion, President Roxas, Capiz
Issued by: Engr. Remington B. Salaya Position Title: Operational Excellence Manager
Date Issued: July 1, 2019

1) Listed ALLERGENS and other sensitive ingredients below and its derivatives, are present in the product as
food ingredient or intentionally added to form part of the finished product:

Yes No Yes No
Peanuts Celery
Tree Nuts (COCONUTS) Mustard
Eggs and Egg Products Sesame seeds
Soy and Soya Products Sulfites
Fish and Fish Products MSG
Wheat and Wheat Products F&C Yellow Color No. 5
Milk and Milk Products Gelatin
Crustaceans Hydrolyzed Proteins

2) Listed ALLERGENS and other sensitive ingredients below and its derivatives, are present in the product
because these were used by other products that were ran within the SAME equipment.

Yes No Yes No
Peanuts Celery
Tree Nuts (COCONUTS) Mustard
Eggs and Egg Products Sesame seeds
Soy and Soya Products Sulfites
Fish and Fish Products MSG
Wheat and Wheat Products F&C Yellow Color No. 5
Milk and Milk Products Gelatin
Crustaceans Hydrolyzed Proteins

3) Listed ALLERGENS and other sensitive ingredients below and its derivatives, are present within the
processing plant or storage areas of our plant:

Yes No Yes No
Peanuts Celery
Tree Nuts Mustard
Eggs and Egg Products Sesame seeds
Soy and Soya Products Sulfites
Fish and Fish Products MSG
Wheat and Wheat Products F&C Yellow Color No. 5
Milk and Milk Products Gelatin
Crustaceans Hydrolyzed Proteins

We agree to notify FCI of any changes to the allergen status of the ingredients we supply prior to any changes.

The above information was duly verified for its correctness by: ______________________________
Sign over Printed Name
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QUALITY ASSURANCE DEPARTMENT R0/01/15/19
Food Safety Questionnaire
Marilao, Bulacan Page 9 of 9

AGREEMENT TO COMPLY WITH FOODCRAFTERS INC. REQUIREMENTS AND SPECIFICATIONS

1. Recognizing that no one set requirements can cover all materials or situations, please attach a list of any
changes to or waivers from Food Crafters Inc. requirements or specifications that you feel need to be
implemented in order for provide reliable supply’s/products to Food Crafters Inc. Please include an explanation
as to why these modifications are needed. Any changes or waivers must be approved by Food Crafters Inc. as
part of the vendor approval process.

2. Vendor has received and reviewed the Food Crafters Inc. Vendor Packet. Vendor agrees to comply with Food
Crafters Inc. requirement and specifications and any agreed upon changes or waivers.

3. All deliveries, Materials and workmanship shall be of good quality and the material(s) shall be prepared, stored,
and shipped in accordance with Good Manufacturing Practices regulations under sanitary conditions to
minimize the potential for product contamination during manufacturing, storage, and/or shipment.

4. Initial acceptance is based upon products ability to comply with requirements and specifications. Changes in
formulation or method of manufacture, which could conceivably affect ingredient characteristics, and/or
performance in Food Crafters Inc. products, must have re-approval (lot specific sample to be submitted for
approval). Requirement or specification changes or waivers become effective only after agreed to in writing by
Food Crafters Inc.

5. Food Crafters Inc. reserves the right to receive and use out of specification product without compromising
requirements or specifications. Any out of specification material may be considered in vendor quality ratings.

6. Vendor shall individually identify each material packaged delivered to Food Crafters Inc. with the following
information:
a. Material Name; Traceable Production Lot Number; Net Weight; List of Ingredients (if multiple ingredients);
Expiration Date; Product or System certification Symbols; Country of Origin; Manufacturing Facility Address.
Vendor shall provide COA specific to each lot shipped or other relevant documents; seal number on all
documents for each container delivered.

7. Vendor shall not store product under conditions whereby the material may become contaminated and/or
spoiled, to include temporary storage and/or transit in shipping containers.

Having reviewed Food Crafters Inc. vendor requirements and specifications, we agree to comply with those requirements
and specifications and any mutually agreed upon changes or waivers.

Company Name CAPIZ SUGAR CENTRAL, INC.

Authorized Signature
Title OPERATIONAL EXCELLENCE MANAGER
Printed Name ENGR. REMINGTON B. SALAYA
Date JULY 1, 2019