Amazon S3
Please complete the following form for each product supplied. This is to establish the status and cross contamination risk of the product including all of its compound ingredients and the manufacturing process. Where the material can be manufactured from more than one site, please complete one form per site.Supplier:Raw Material Name:Manufacturing Site Address:Raw Material Product Code:Please complete the following questions for each allergen.Question 1Question 2Question 3Question 4Question 5AllergenIs this allergen within the raw material or product being supplied? Y / NWhat form is the allergen in? (liquid, powder or solid – please specify)Is the ingredient or product being supplied at risk from cross contamination within your manufacturing site from this allergen? Y / NDo your controls eliminate the risk of the cross contamination of allergens?Y / NPlease provide detail below on the allergen cleaning and testing procedures used to control cross contamination to eliminate risk below…PeanutsNuts *please specify which from the list belowFishEggsCrustaceans **please specify from the list belowSesameMilkSoyaCelery MustardLupinMolluscs ***please specify from the list belowCereals containing gluten ****please specify which from the list belowSulphites (≥10ppm)* Almonds, Brazil Nuts, Cashew Nuts, Cobnuts, Hazelnut, Macadamia Nuts, Pecans, Pistachio Nuts, Queensland Nuts, Walnuts ** Crab, lobster, prawns, shrimps, langoustine*** Squid, octopus, mussels, cockles**** Wheat, barley, rye, oats, spelt, kamut, or their hybridised strainsI can confirm that the above information is accurate at the time of completion and that we will notify any changes to the allergen risk of our raw materials, prior to the change taking place.PrintSignPositionDateCompany ................
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