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FORM 001 Ministry of Commerce, Business Development, Investment and Consumer Affairs BASELINE DATA SITE VISIT RECORD Year______Month____Day_____ Investigating Officer_________________ Time In ______Time Out_______ COMPANY_____________________________________________________ MANAGEMENT SYSTEM ISSUES Vision__ Mission__ Objectives__ Business Plan__ Quality Manual__ Quality Policy__ Management Audits__ Documented Procedures__ INDUSTRY CERTIFICATIONS GMP__GAP__ISO 9001___ISO 14001___ISO 22000__HACCP___ OTHER_________________________________________________________________ ________________________________________________________________________ STATUTORY REQUIREMENTS: Form Status ()Health Cert. Premises _____________ ()Emp. Health Card _____________ ()Liquor Lic. _____________ ()SLBS (facility) _____________ ()Business Name Registration_____________ ()NIC REG _____________ Trade Lic _____________ Form Status ()Import Lic ____________ ()Tobacco Lic ____________ ()SLBS (Labels) ____________ ()SLBS (wgts& meas) ____________ ()SLBS(cert of sale) ____________ ()IRD REG ____________ INCORPORATION ____________ RISK MANAGEMENT INSURANCE Life Health Stock Theft Fire Natural Disasters Automobile Building Business Interruption COMPANY ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ STATUS ________ ________ ________ ________ ________ ________ ________ ________ ________ 1 INSURED ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ AMOUNT __________ __________ __________ __________ __________ __________ __________ __________ __________ FORM 001 Succession plan Yes____ No_____ In progress ______ Other risk management measures ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ MANAGEMENT INFORMATION SYSTEM Internet Access_____________Email_____________Website______________________ HARDWARE_____ SOFTWARE__TELECOM: Land Line ___Fax_ Cell___ FINANCIAL RECORD KEEPING SYSTEM Sales __A/R__ Asset Reg__ Inventory system___ A/P__ Cash Rec___ Cash Disb___ Customer Database___ Supplier database___ Long Term Debt___ OTHER_________________________________________________________________ MARKETING MKTG. PLAN: YES [ ] NO [ ] IN PROGRESS________________________ CUSTOMERS: Gender __m _f___ Age range____ Local__ Regional__ Extra regional__ MAJOR COMPETITORS(3)________________________________________________ ASSISTANCE RECEIVED Training_ Fiscal Incentives__ Duty Free Concessions __ Market & Product Development___ Advocacy__Finance__HR_ Other___________________________________________________________________ RATINGS OF ASSISTANCE RECEIVED FROM THE MINISTRY OF COMMERCE Satisfied ___________ Somewhat Satisfied____Not Satisfied_______________ Recommendations_________________________________________________________ MAJOR CHALLENGES Area Major challenge Marketing Finance Operations Human Resource Other 2 FORM 001 Client Plans by March 31st, ________ 1. _______________________________________________________________ 2. _______________________________________________________________ 3. _______________________________________________________________ 4. _______________________________________________________________ 5. _______________________________________________________________ Ministry deliverables by March 31st, _______ 1. 2. 3. 4. 5. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Additional Information: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ I ___________________________________ am duly authorized to provide the information above and that, the information is true and correct to the best of my knowledge. I further understand that knowingly providing false information may lead to the revocation of my status as a declared business and or prosecution, under the Micro and Small-scale Enterprises Act of 1998. Client Acceptance_______________ Date___________________ Business Development / Commerce Officer __________________ Date___________________ Director Approval _____________________ Date____________________ acronyms SLBS NIC REG GMP GAP HACCP A/P A/R Saint Lucia Bureau of Standards National Insurance Corporation registration Good Manufacturing Practices Good Agricultural Practices Hazard Analysis Critical Control Point Accounts Payable Accounts Receivable 3
