COVID-19 Health Emergency - Cosmetics Alliance Canada

NOTE: This information is required of all manufacturers requesting that the Exchange assist them in being matched with supplies of ingredients and other inputs required to manufacture hand-sanitizers.

1. COMPANY INFORMATION:

NAME OF COMPANY:*

NAME OF PRINCIPAL CONTACT FOR THE EXCHANGE*

TITLE:*

EMAIL:*

CELL PHONE:*

BUSINESS TELEPHONE #:*

ALTERNATIVE CONTACT NAME

First Last

ALTERNATIVE CONTACT EMAIL

ALTERNATIVE CONTACT TELEPHONE

ADDRESS OF MANUFACTURING FACILITY*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

2. Regulatory Compliance (to ensure safe and efficacious products):

(a) Does your listed manufacturing facility have all required site licences from Health Canada?

Yes
Pending as of today
No

(b) Have you received the required product approvals from Health Canada for the formula(s) you are making (or would make if only alternative ingredients are available)?

Yes
Pending as of today
No

(c) Is your manufacturing facility in compliance with all applicable federal, provincial, and municipal requirements for manufacturing hand-sanitizers including the receiving and handling of alcohol (if applicable)?

Yes
No

(d) Does your company have experience in producing hand-sanitizers that pre-dates January 1st, 2020

Yes
No

3. Please Indicate Your Capacity to Use Active Ingredients (e.g. Alcohol) – Type & Volume:

(a) Ethanol (USP or “Food" Grade) Volume/Week -Check One

Under 50,000 kg/week
50,000 to 100,000 kg/week
Over 50,000 kg/week
Do not use

(b) Isopropyl Alcohol (USP) Volume/Week -Check One

Under 50,000 kg/week
50,000 to 100,000 kg/week
Over 50,000 kg/week
Do not use

(c) Non-Alcohol Actives - Volume/Week-Check One

Under 50,000 kg/week
50,000 to 100,000 kg/week
Over 50,000 kg/week
Do not use

4. Your Ability to Receive and Handle Alcohol at Your Manufacturing Facility (please check more than one if applicable):

a) How do you receive alcohol:

Tanker Truck (14,000 kg)
Totes (1,000 kg)
Drums (200 kg)
Other (please specific)

(b) What is your on-site storage capacity: (kg)

(c) Please check to confirm that your storage tanks are:

Inside your facility (internal)
Outside your facility (external)
Both (internal and external)

(d) If your storage tanks are inside your facility, is your storage area explosion proof and meets regulatory standards?

Yes
No

5. Your Capacity to Manufacture Hand-Sanitizers (Finished Products):

(a) How many dedicated and rated manufacturing lines do you have to produce ethanol- based hand-sanitizers?

One
Two to Four
Five or Greater
None

(b) How many dedicated and rated manufacturing lines do you have to produce isopropyl alcohol-based hand-sanitizers?

One
Two to Four
Five or Greater
None

(c) How many dedicated and rated manufacturing lines do you have to produce hand-sanitizers with other (non-alcohol) active ingredients?

One
Two to Four
Five or Greater
None

6. Packaging Requirements:

(a) Do you have sufficient filling capacity for the volume of product you are producing?

Yes
No

(b) Do you require additional (please check if required):

Bottles/Containers
Pumps
Closures
Labelling Capacity
Packaging Capacity

7. Other Ingredients and/or Services Required:

(a) Please list any additional ingredients which you are seeking to continue manufacturing hand-sanitizers

(b) Are their any services which you may require (please check):

Fillers
Packaging
Labelling
Warehousing/Storage
Shipping/Transportation
Regulatory/Legal Services
Other
Distribution Channels (see below)

8. Distributors & Distribution Networks:

(a) Into what distribution channels are you currently shipping your hand-sanitizers (please check as appropriate)?

Healthcare (Hospitals, Long-Term Care, Medical Clinics/Offices, etc.)
First Responders & Public Services (Police, Fire, Ambulance, Essential Government Services, etc.)
Industrial/Commercial (in Support of Essential Workers)
Consumer/Retail
Other

(b) Do you have hand-sanitizers to sell, donate or otherwise distribute, but need information as to accessing distribution networks?

Yes, and I would like further contact information to sell/donate or other wise distribute product.
No, I am already providing hand-sanitizers into distribution channels.

IMPORTANT NOTE: By Submitting this Form you are agreeing that the Hand-Sanitizer Manufacturing Exchange can share this information and contact information to facilitate matching manufactures and suppliers, to assess shortages of manufacturing ingredients, components and services (including advising governments of same), as well as any other purpose related to the current COVID-19 Health Emergency.

Hand-Sanitizers Manufacturing Exchange

This form is intended for MANUFACTURERS Of HAND-SANITIZERS

Please Complete & SUBMIT below.

1. COMPANY INFORMATION:

2. Regulatory Compliance (to ensure safe and efficacious products):

3. Please Indicate Your Capacity to Use Active Ingredients (e.g. Alcohol) – Type & Volume:

4. Your Ability to Receive and Handle Alcohol at Your Manufacturing Facility (please check more than one if applicable):

5. Your Capacity to Manufacture Hand-Sanitizers (Finished Products):

6. Packaging Requirements:

7. Other Ingredients and/or Services Required:

8. Distributors & Distribution Networks:

Important Notice To Manufacturers Of Hand-Sanitizers

Coordonnateur.trice aux affaires réglementaires cosmétiques

Gestionnaire intérim de la Qualité et du réglementaire (remplacement de congé de maternité 12 mois)

concepteur-rédacteur