FOOD SAFETY MANAGEMENT SYSTEM ... - ISO Registration
| | |
|[pic] |Perry Johnson Registrars, Inc. |
| |FOOD SAFETY CERTIFICATION AND COMPLIANCE PROGRAMS |
| |Client Certification Questionnaire and Application |
| | |
| |Thank you for your interest! Please fill out this form completely to avoid any delay in receiving your cost-free quote. |
| | |
|Supplier Name | |
|Street Address | |
|City, State/Province, Zip/PC, Country | |
|Postal Address (if different) | |
|Website Address | |
|Food Safety Management Representative | |
|Position Title within Organization | |Phone | |
|Email Address | | Fax | |
|HACCP training (as applicable) |Training Provider |Date and Duration |
|Standard-specific training (as applicable) |Training Provider |Date and Duration |
|FOOD SAFETY STANDARD/CRITERIA | |
| | |
|If checking more than one standard, |FSSC 22000 ISO 22000 OTHER: |
|please indicate whether you are requesting | |
|separate comparative quotes or | |
|a quote for a combined audit | |
|Additional customer-specific criteria/modules | No Yes – Describe |
|required as part of audit | |
|Applicable regulatory | |
|authorities and regulations | |
|Have you worked with a consultant | No Yes If yes, who? |
|to develop your current | |
|food safety management system? |Are you still working with the consultant? Yes No - completed (date): |
|Are you currently certified | No Yes Standard Date of last audit |
|to a food safety standard? | |
| | |
|Have any changes in your operations | |
|(products/facility/management, etc.) occurred | |
|which could affect the scope | |
|of certification for your next audit? | |
| |Exp. Date Certification Body Name of Auditor |
| |Changes since last audit? |
|Tentative audit dates preferred |Pre-Assessment (optional) |
|Month/Year | |
| |Stage 1 Audit |
| | |
| |Stage 2 Audit |
|Are any of your operations seasonal? | No Yes – Describe |
|(5 consecutive months or less) | |
|Do you produce any of | No Yes – Describe |
|your own product packaging? | |
|Do you warehouse any finished product which was | No Yes – Describe |
|not produced at your facility? | |
|Are any activities outsourced? | No Yes – Describe |
|Are you a contract manufacturer? | No Yes – Describe |
|FACILITY DESCRIPTION: |
|Please complete one line for each building which is part of the facility campus and is affected by the scope of the audit and/or certification. You may leave |
|the address field blank unless it differs from the address completed on Page 1. Add lines as needed. |
|If you have more than one facility and those facilities operate as independent production sites, please fill out an application for each production facility. |
|Building name |Size: |Address |Description of |
| |sqf/m2 | |activity |
|HACCP PLANS AND PRODUCT/PROCESS DESCRIPTIONS FOR THIS FACILITY: |
|Please identify all product types and major processing steps according to your HACCP plans. Please add lines as needed. |
|If possible, please attach process flow diagram(s). |
|HACCP |PRODUCTS/PRODUCT TYPES |MAJOR PROCESSING STEPS |CCPs |
|Plan(s) | | | |
|1 | | | |
|2 | | | |
|3 | | | |
|4 | | | |
|5 | | | |
|6 | | | |
|TOTAL HACCP PLANS |# Notes |
|Please list any products, processes, and/or | No Exclusions Requested (in terms of products, processes, and/or facility premises) |
|facility premises which you wish to be | |
|excluded from the scope of the audit and the |Exclusions Requested – Describe |
|final certification | |
|Additional information | |
|to know about your | |
|operations and/or facility | |
| |If completed electronically, please | |
| |indicate signature | |
|__________________________________________________________________ |here with an “X” | |
|Signature of Owner/Senior Executive or Manager | | |
|Name (Please Print): |Date: |
|Position Title: |Phone: |
|Perry Johnson Registrars Representative/Project Manager | |
PJR USE ONLY: APPROVED FOR QUOTATION BY ________________________________________ DATE _______________________
Perry Johnson Registrars, Inc.
755 W. Big Beaver, Suite 1340, Troy, MI 48084 USA
800-800-7910 or 248-358-3388 Fax: 248-358-0882
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