Self Assessment Facility Profile Information
Please complete this self assessment profile information and proceed to the self assessment questionnaire.
   
Facility Profile Information
* Customer Name:  
* Facility Name:  
* Address1:  
Address2:  
* City:  
* Country:  
State/Province:
Other(State/Province):  
postal Code:  
* Phone No:  
Fax:  
* E-mail:  
Website:  
* Industry Type/Sector:  
* Key/Main Product:  
Countries Of Operations  
Factory Representative  
* Contact Person name:  
Pack house dates of operation
*Only Applicable to the Food Industry
  
 [mm/dd/yyyy] 		 To 
[mm/dd/yyyy]
Upload Image
* Please upload photo of pack house
Comment
Business Overview

Export Requiring Special Attention: 		 
   High Value Parts
   Hazardous materials (Hazmats)
   Perishables
   Chemicals
   Munitions/Dual Use
   Biological Agent
Participating for other international Management Standard or US Security initiatives
   ISO-9000
   ISO-14001
   OHSAS
   BASC
   CIP
   SCIP
   ISPS
   Other Initiative
Description Of Other Initiative
Number of Employee
Permanent:  
Temporary:  
overseas/Migrant:  
Total  

Management
 
Production  
Administrative  
Facility Infrastructure
    Location - City Building
   Location - Floor OF Building
   Location - non - city - Building
   Location - Gated Campus
Number of Buildings:
 
Distribution Centers:  
Production:  
Warehouse:  
Container Yards:  
Other:  
Total  
Description Of Other Building
Prodominent language spoken Of the Facility
Native
Official
Other
Facility Land Size
Total Facility Floor Size
Are warehouse(s) customs bonded?
Free Trade Zone  
If So,Does the Zone provide security:
Structures(Fences,walls,lighting)  
Services(guard,emergency,law Enforcement)  
Logistics/Transportation For Shipment of U.S.
Truck Owned By The Company  
Percent Of Goods Exported to U.S.
 
Number of carriers        %
By Air  
By Sea  
By Rail  
By Truck  
   
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