Confectionery Industry Supplier & Product Information Form
Check all of the items that must be completed.
Part I Supplier Information
 Contact Information
 Regulatory Basis For Use
 HACCP Plan
 Audits
 Recall plan
 Food Security
 Supplier Guarantee Form
Part II Product Information
 MSDS Sheet
 Certificate of Analysis
 Physical/Chemical data
 Product Composition
 Ingredient Declaration
 Nutritional Information
 Allergens
 Kosher
 Halal
 Microbial Specifications
 Shelf life
 Shipping and Storage Conditions
 Packaging
Part III International
Part IV Additional Information
To be specified by individual companies.
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Confectionery Industry Supplier & Product Information Form
Part I Supplier Information
Supplier Contact Information:
Date
Company Name
Name of Individual
Completing Form
Title of Individual
Completing Form
Address
Phone Number
Fax Number
Email
Regulatory Basis For Use
Does this product, its ingredient(s) and its packaging conform to all applicable federal and
state laws, rules, regulations, codes, and guidelines for use in food products sold in the United
States?
HACCP Plan
Do you have a Hazard Analysis Critical Control Point (HACCP) plan in place?
Audits
Is your manufacturing facility routinely audited by a third party?
If yes, by whom? _______________________________________________
Recall plan
Do you have a recall plan in place?
Food Security
Is your manufacturing facility registered with the U.S. Food and Drug Administration?
Attach Supplier Guarantee Form.
Attach Certificate of Insurance.
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Confectionery Industry Supplier & Product Information Form
Part II Product Information Requirements
Product Name: ___________________________________________
Manufacturing Location:
Attach MSDS Sheet.
Attach typical Certificate of Analysis.
Physical/Chemical data: (Fill in data AND attach Specification Sheet)
Min.
Max.
Units
Moisture
Fat
Ash
Protein
Salt
pH
Acidity
Specific Gravity
Refractive Index
Viscosity
Flash Point
Granulation
Density
Volatile Oil
Lead
Arsenic & Cadmium
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Test Method
Confectionery Industry Supplier & Product Information Form
Product Composition
List all ingredients in the product in descending order of predominance including additives
and processing aids. List the percent (%) composition of each ingredient – a range is
acceptable. Flavor chemicals may be grouped together.
Ingredient
Percent (%) Composition
Ingredient Declaration
List ingredients as declared on the ingredient label (or attach label).
Nutritional Information
List all nutrients here or attach nutritional information. (Based on a sample size of 100 g.)
Nutrient
Value
Units
Test Method
Calories
Calories From Fat
Total Fat
Saturated Fat
Trans Fat
Cholesterol
Sodium
Total Carbohydrate
Dietary Fiber
Sugars
Protein (F=6.25)
Vitamin A
Vitamin C
Calcium
Iron
Value
Units
g
g
g
g
mg
mg
g
g
g
g
IU
mg
mg
mg
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Test Method
Confectionery Industry Supplier & Product Information Form
Allergens
Does your product contain protein from any of the following allergens? (Check all that apply.)
 Peanut
 Tree Nuts (almonds, brazil nuts, cashew, chestnuts, hazelnuts, hickory,
 macadamia, pecan, pine, pistachio, walnut)
 Milk
 Eggs
 Fish
 Shellfish and Molluscs
 Soy
 Wheat
Is there any likelihood of cross contact between the following allergens and your product
(through manufacture on the same equipment, contact with other raw materials, rework, etc)?
Do you have an allergen control plan to prevent or minimize allergen cross contact within your
facility?
Gluten
Does your product contain gluten derived from wheat, oat, rye, or barley?
Kosher
Is this product Kosher? ________
If yes, attach a copy of kosher certificate.
Halal
Is this product Halal? ________
If yes, attach a copy of the Halal certificate.
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Confectionery Industry Supplier & Product Information Form
Microbial Specifications
Test/Organism
Aerobic Plate Count
Yeast
Mold
Coliform
E. coli
Salmonella
Maximum Limit
Test Method
Shelf life
List the total shelf life of the product from the time of manufacture. Provide specific storage
conditions if they affect the shelf life.
Shipping and Storage Conditions
List any shipping and storage temperatures and humidity requirements.
Temp °F
Humidity %RH
Shipping
Storage
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Confectionery Industry Supplier & Product Information Form
Packaging
Packaging type
(drum, box, bag, tote, bulk, etc.)
Net weight/pack size
Piece count/pack size
(if applicable
Description of lot marking
Explanation of date marking
(if applicable
Pallet pattern
Pallet specification
Part III International
This ingredient and its packaging conforms to all applicable federal, state and provincial laws,
rules, regulations, codes, and guidelines for use in food products sold in (please mark all that
are applicable):
United States_________ Canada_________ Mexico_________ Other_________
Websites that contain information about Health Canada and the Canadian Food Inspection
Agency are:
http://www.hc-sc.gc.ca/fn-an/index_e.html
www.inspection.gc.ca
Information about the latest Mexico food labeling regulations can be found in the attached
Food and Agriculture Import Regulations and Standards (FAIRS) report at
http://www.fas.usda.gov/agx/market_research/market_research_resources.asp
Part IV Additional Information
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