Icelandic USA's policy is to purchase from suppliers who can assure supply and deliver materials on time, which are within controls and specifications. Complete the form below and click on the Continue button when you are finished. There will be an opportunity to attach supporting documents before final submission. All fields are required.

Read our complete vendor qualification documents to learn more before completing the certification/recertification form below. Please feel free to contact Fred Haller with any questions at (757) 820-3563 or fhaller@icelandic.com

Supplier Name:
Address:
Phone Number: Fax Number: Web Site: E-Mail Address:

Account Executive Contact: Phone: Fax:
Accounting Dept. Contact: Phone: Fax:
Contact Name With After Hours/ Emergency Phone #'s:
Current Products Supplied:
Plant Locations Supplying Icelandic USA:
Remit To Address:
Payment Terms:
Business Type:	Corporation Partnership Individual/Sole Proprietor Government Agency Non-Profit Organization Non-US Entity
Special Business Owner Category: Explanation of Diverse Suppliers	Minority Owned Woman Owned Small/Disadvantaged Business Veteran Owned Small Business None
Is this plant site ISO9000/QS9000 Certified?	Yes No
If "Yes", please mark area of certification:	ISO9001 ISO9002 ISO9003 QS9000
Please enter date of certification:
If "No", are you working towards ISO/QS9000 Certification?	Yes No
Expected date of certification:
Do you do third party audits (i.e. AIB International)?	Yes No
If "Yes", please identify which certification(s):
Has HACCP Plan been submitted?	Yes No Last Revision Year
Has the annual HACCP compliance letter been submitted?	Yes No
Manufacturer Self Survey Audit
QUALITY ASSURANCE PROGRAMS Yes In Process No Is there a Quality Manual? Do you have an Organizational chart? Do you have a Quality Improvement process? Do you use Control Plans? Do you have an Allergen Program? Do you have a Food Security Program? ORDERING Yes In Process No Do you have an Order Entry Processing System? PRODUCT DEVELOPMENT Yes In Process No Do you have a Design, Research, and Development group? DOCUMENT CONTROL Yes In Process No Do you have a Document Control System? PROCUREMENT Yes In Process No Is there a Raw Material Quality Assurance system? Do you evaluate your suppliers? PRODUCT IDENTIFICATION AND TRACEABILITY Yes In Process No Do you have lot or batch identification on all products? Do you have a system for rejected or non-conforming items? Do you segregate discrepant material (raw material/products)? PROCESS CONTROL Yes In Process No Do you have Process procedures? Do you have Manufacturing procedures? Do you have a Preventive Maintenance system? INSPECTION AND TESTING Yes In Process No Do you have Test Procedures for: Raw Materials? In Process Finished Products? Finished Products? TEST EQUIPMENT Yes In Process No Do you have a Calibration program? CORRECTIVE AND PREVENTIVE ACTION Yes In Process No Do you have a Corrective Action system? Do you use a disciplined problem solving method? HANDLING AND STORAGE Yes In Process No Does your Handling system address prevention of product damage? Are your storage facilities appropriate to prevent damage to products? INTERNAL QUALITY AUDITS Yes In Process No Do you have an Internal Quality Audit system? TRAINING Yes In Process No Do you utilitze in-house Training? STATISTICAL TECHNIQUES Yes In Process No Do you use Statistical Techniques in: Manufacturing Process Control? Raw Material Control? Are SPC/SQC charts available upon request? FINISHED PRODUCT Yes In Process No Do you have a COA program for supplying quality results to customers? Do you/or can you include "Manufacturing Date" on the COA? Do you have a determined "Shelf Life" for each of your finished products?
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