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De Bortoli Wines Approved Supplier Program questionnaire
As part of our Risk Management Program, we have a requirement to provide documentary evidence of our suppliers quality systems. We propose to do this with our supplier evaluation questionnaire, which we require you to complete every two years.
We will also be requesting product specifications and your confirmation that the product is within these specifications.
Company and Contact Details.
This must be the person who completed the form
Company Name: *
Please enter your company name in the box provided.
Your answer
Company ABN *
Your answer
Company Address: *
Please enter your company address in the box provided.
Your answer
First Name of Signatory filling out this form. *
Please enter your first name in the box provided.
Your answer
Surname of Signatory filling out this form. *
Please enter your surname name in the box provided.
Your answer
Email of Signatory filling out this form. *
Please enter your email address in the box provided.
Your answer
Phone number of Signatory filling out this form. *
Please enter your phone number in the box provided.
Your answer
Position of Signatory filling out this form. *
Please enter your job position in the box provided.
Your answer
Are you a Manufacturer or Distributer? *
Please tick the appropriate box. Distributers need to have this questionnaire completed by the manufacturers and others in the supply chain.
Required
We acknowledge that we have read and agree to abide by DBW Supplier Requirements *
Food safety and other Management Programs
Do you have current accreditation or certified food safety program? *
Please tick the appropriate box.
Required
List your accreditation, accrediting body and your certificate numbers and expiry dates. *
Please enter the company accreditation and certificate details (accreditation body, numbers and dates) in the area provided. Please email a copy of your ISO, BRC, or Food Safety Certificates to dbw_drygoods@debortoli.com.au
Your answer
Do you have a current recall procedure? *
Please tick the appropriate box, and if you want to add something tick the OTHER box and type what you need to add in the other box.
Required
Do you practice control of non-conforming product? *
Please tick the appropriate box, and if you want to add something tick the OTHER box and type what you need to add in the other box.
Required
Do you have documented evidence and a monitoring system to verify that you follow Good Manufacturing Practices and Personal Hygiene? *
Please tick the appropriate box, and if you want to add something tick the OTHER box and type what you need to add in the other box.
Required
Are specifications held for all raw materials and finished products? *
Please tick the appropriate box.
Required
Do you follow documented procedures for product identification and traceability? *
Please tick the appropriate box.
Required
Does your company provide Certificate of Analysis with every product? *
Please tick the appropriate box. The C of A needs to show that the product has been analysed and the results recorded on the COA. eg: pH or size,shape,colour displayed. A COA or a COC must be supplied with every batch of goods.
Required
Does your company supply a Certificate of Conformance with every product? *
Please tick the appropriate box. The C of C is a declaration that the company has tested the product and it conforms to the agreed specifications. This must be signed and dated, A COA or a COC must be supplied with every batch of goods.
Required
Do you have a monitored pest program? *
Please tick the appropriate box and if you need to add something tick OTHER and type your comment in the other box.
Required
Do you carry out laboratory testing including microbial testing? *
Please tick the appropriate box and if you need to add something tick OTHER and type your comment in the other box.
Required
Does your sampling conform to the Australian Standards (AS 1199)? *
Please tick the appropriate box and if you need to add something tick OTHER and type your comment in the other box.
Required
Do you have a transport policy in place? *
What training do your operators receive? *
Just enter the training programs in the square provided.
Your answer
Do you have documented procedures for plant hygiene? *
Please tick the appropriate box and if you need to add something tick OTHER and type your comment in the other box.
Required
Are your raw materials and finished goods segregated to prevent cross contamination? *
Please tick the appropriate box
Required
Which body does your product conform to or is approved by? *
Please tick the appropriate box and if you need to add something tick OTHER and type your comment in the other box.
Required
Do you have a supplier Evaluation System? *
Please tick the appropriate box and if you need to add something tick OTHER and type your comment in the other box.
Required
Environmental
Are you a signatory to the National Packaging Covenant? *
Please tick the appropriate box and if you need to add something tick OTHER and type your comment in the other box.
Required
Is the packaging and the supplied item able to be recycled, re-used or returned? *
Please tick the appropriate boxes and if you need to add something tick OTHER and type your comment in the other box.
Required
If using reusable pallets/packaging is the integrity of the pallets etal checked prior to use *
ie Are the pallets checked to see not damaged, is a sensory done to ensure no chemical spills on the package that could contaminate the product
Have you read our Buy Recycled Policy? *
Recycled Policy is located on the website with the supplier requirements documents
What is the percentage (%) recycled content, pre- and/or post-consumer of the packaging? *
The materials used are a mixture of recycled and virgin content. Approx X% of content is recycled content, of which X% is post consumer recycled.
Your answer
Have you calculated your green house gas emissions or carbon life cycle for your products. *
If the answer is no please detail any plans to do it in the future. It is something that may be required of DBW (from their customers) in the future and so we will need your info to calculate ours
Your answer
CSR - Corporate Social Responsibility
How do you practice Good Corporate Citizenship? *
Please tick the appropriate boxes and if you need to add something tick OTHER and type your comment in the other box. This may include ethical organisations that you are members of
Required
How do you engage in fair trade and business practices, as well as work place relations and comply with the relevant State, Territory or Federal Legislation in relation to:- *
Please tick the appropriate boxes and if you need to add something tick OTHER and type your comment in the other box.
Required
Do you conduct probity checks on your supplies to ensure they employ ethical labour practices? *
Please tick the appropriate box and if you need to add something tick OTHER and type your comment in the other box.
Required
Do you have a Management Review System in place which involves at least documented annual review? *
Please tick the appropriate box and if you need to add something tick OTHER and type your comment in the other box.
Required
Comments
This area is for any relevant comments you may wish to make.
Your answer
We acknowledge that all the information that has been provided by us in the De Bortoli Wines Supplier Evaluation Questionnaires is correct. *
If you wish to keep a copy of this form for your own records print to pdf or printer (control P) prior to pressing submit. Once submit has been pressed the form has been converted to our spreadsheet and is no longer available
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