A blank, fillable form for qualifying one supplier — contact, the materials they supply, the certifications they hold and when those expire, the basis you approved them on, and how often you verify and re-approve them — so your approved-supplier records are ready before an auditor asks for them.
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This is a blank form you fill in once per supplier: who they are, what they supply, the certifications they hold and when those lapse, the basis you approved them on, and the schedule you verify them against. Reach for it when you bring on a new supplier, when your hazard analysis says a supplier controls one of your hazards, or when you are building the approved-supplier records an audit will ask to see.
How to use this template
When your hazard analysis identifies a hazard that a supplier controls rather than your own process — a — FDA's preventive-controls rule asks you to run a : use only approved suppliers, verify them, and keep the records that prove it (21 CFR 117.410, verified July 2026). The approval decision is yours as the receiving facility, not the supplier's — this form is where you record it.
The rule lists four verification activities you can build an approval on: reviewing the supplier's relevant food safety records, sampling and testing the material, an onsite audit of the supplier, or another activity you justify by the supplier's performance and the material's risk (21 CFR 117.410(b)). You conduct them before the first receipt and periodically after; where the hazard could cause serious health consequences or death, the appropriate activity is an onsite audit before first use and at least annually, unless you document why an alternative gives the same assurance (21 CFR 117.430, verified July 2026).
Use one copy per supplier. Fill every blank, replace the example rows with your own, and keep the finished form — the record of the approval decision is itself what an auditor checks. Download a blank copy of this template to fill in offline.
Supplier and contact
Who the supplier is and how you reach them.
Field
Entry
Your facility (the one approving this supplier)
Supplier legal name
Trading name or brand
Ship-from address
Supplier type (grower, manufacturer, broker, distributor)
If a broker or distributor, the actual manufacturer
Primary contact (name, role)
Phone
Email
Materials supplied
Every raw material or ingredient this supplier provides. Flag the ones your hazard analysis says the supplier controls — those are the reason this form exists.
Material or ingredient
Your spec or item code
Supplier controls a hazard here? (Y / N)
If yes, the hazard
(example) Roasted peanuts
RM-PEA-01
Y
Allergen and pathogen control at roast
Certifications held
Every certification, registration, or document the supplier carries, and the date each lapses. Track the expiry so a certificate never goes stale on file without you noticing — an FDA food facility registration, for instance, renews on a two-year cycle.
Certification or document
Issuing body
Reference or number
Issued
Expires
Copy on file? (Y / N)
(example) SQF Food Safety Code, Edition 9
SQFI (via certification body)
____
2026-03-01
2027-03-01
Y
(example) FDA food facility registration
FDA
____
____
Biennial renewal
Y
Approval basis and verification activities
The activities you ran to approve this supplier. These are the four the rule recognizes — record which you used, the evidence, and the date. A is one way to satisfy the records review; it is not a substitute for deciding the activity fits the risk.
Verification activity
Used for this supplier? (Y / N)
Evidence or record reference
Date completed
Review of the supplier's food safety records (e.g., current GFSI certificate, third-party audit report, COA per lot)
Sampling and testing of the material
Onsite audit of the supplier
Other activity justified by supplier performance and material risk
(example) Review of records — Y — GFSI certificate + COA reviewed per lot — 2026-04-10
Verification schedule
How often you re-run the verification, and when it is next due. The rule sets no single interval for every supplier; you set the frequency from the hazard and the supplier's track record, and an onsite audit runs at least annually where the hazard could cause serious health consequences or death.
Field
Entry
Verification activities conducted before first receipt? (Y / N)
Ongoing frequency (e.g., COA every lot, audit annually)
Last verification completed (date)
Next verification due (date)
Approval and re-approval
The approval decision, who made it, and when it gets revisited. Re-approve on your set schedule and again after any change to the material, the supplier, or a verification that comes back short.
Field
Entry
Approved by (name, role)
Approval basis (one-line summary)
Approval date
Re-approval due (date)
Status (approved / conditional / on hold / removed)
