Address
Postcode
Position
E-mail address
Tel No:
Fax No:
HACCP
FSSC 22000
Others
(please
indicate)
Type of request
Certification
Certification
audit integrated
with existing
std.
Renewal of
Extension ,
existing
modificatio
certification
n
For integrated please identify your
existing certified standard you wish to
combine with the above certification.
> Does your company already have third party certification ?.. if yes, please indicate below.
Standard (s) :
ISO 9001:2008
ISO 14001:2004
OHSAS 18001:2007
ISO 22000
HACCP/GMP
SQF 1000/2000
BRC
IFS
GAP / Global GAP
Others
CB (Certification Body)
CB
CB
CB
CB
CB
CB
CB
CB
Please indicate
Section 3: Scope/Processes
Please define the scope of registration e.g. product produced
or attach/send supporting information)
Page 1
Exclusions:
Are there any local activities that are not included within the scope of the
certification?. If so, please describe the exclusions (if any)
Give details if any specialist operations or services carried out by a sub contractor?
Product/Process Information
Please list below each product family(ies) and product types
(A product family shown common process or technology)
Product Type
Exp. of product family: production of canned fruit juices and frozen fruit juices (2 product families)
Exp. of product types: canned mango juice, canned pineapple juice, canned guava juice and canned strawberry juice. (4
product types)
Product Family
> Please check off any of the following that apply to your business:
Labor intensive environment.
automation
Repetitive Tasks
________________________________________________________________________
Please indicate if you have a timescale(s) for the following
Implementation date of
Audit language
the system
Pre-audit(if applicable)
Certification audit
In case of seasonal product(s), please indicate the period(s) of production for each category of product including number
of employees (permanent & temporary ) included in the scope.
(m
2)
Gross annual turnover (Revenue) of your business (Required for SQF applicants only):
Q FOOD GP 4100 Issue 5
Page 2
Products or activities
# of staf
Documentation at
this site same as
the main office?
.same system ?
1
2
3
4
5
Section 5 Background Information
Has previous contact been made with SGS Personnel i.e. via telephone etc.?
YES/NO
If you have used or intend to use consultancy services for the activities to be certified please
give the name of the consultancy organisation and/or the name of the individual consultant(s)
Where did you hear about SGS?
Main reason for certification
competitive advantage
Page 3
Corporate
others______________________________
Appendix 1
ISO/FSSC 22000/HACCP/GMP BUSINESS CATEGORIES AND FOOD SECTORS
Please indicate with tick products produced (Internal use only_if indicate in proposal worksheet no need to submit this part )
For FSSC 22000 category C,D,E only
Food
Category
Codes
A
Farming 2 (Plants)
Processing 1 (Animal
perishable product) including
all activities after farming e.g.
slaughtering
Sector
A1
A2
A3
A4
A5
B1
Fruits
Vegetables
Grain
Spices
Nuts
Horticulture products
Red and white meat/Poultry /Meat product and
preparation
Lamb
Venison
Offal
Other meat
C1
C2
C3
Egg
Shell egg
C4
Dairy
Liquid milks
Cream (frozen)
Tick
Processing 2 (Vegetable
perishable product)
Hard cheese
Semi hard cheese
Soft cheese
Mould ripened cheese
Processed cheese / cheese food
Raw milk products
C5
Frozen desserts(pie..)
Sandwiches
Hot pie
Soup
Pasta (chilled)
Baby food
D1
Produce
Juice( fresh/chilled)
Preserved fruits/vegetable
Tobacco products
D2
Fresh pastries
Fresh pastas
E1
E2
Beverages
Alcopops
Coffee
Tea
Herbal drinks
Page 5
E3
Grain products/cereals/biscuit/flour/
Confectionary/snack
Pasta / noodles
Nut preparations
Chocolate
Cereals/Processed cereals
Oats
Muesli / mixtures
Crisps
Wheat snacks
Corn snacks
Nuts (Processed)
Poppadoms
Cake mixes
Sliced bread
E4
Cooking oils
Speciality oils
Vinaigrettes
Margarine
Butter
Analogues / ghee
Suet
E5
Dried goods
Soups
Sauces / gravies
Spices
Stock cubes
Herbs
Seasonings
Stuffings
Food ingredients
Liquid egg
Dried egg
Salt
Gelatin
Vinegar
Candies fruits
Flour improvers
Sugar/icing
Mill product
Cake decorations
Pectin
E6
F
G
H
I
Feed production
Catering
Distribution
Services
F1
G1
H1
I1
I2
I3
Waste disposal
I4
Technical services
Testing
Page 6
Cleaning /disinfection
Pest control
Industrial laundry
J
K
(Bio)Chemical manufacturer
Packaging material
manufacturer
Analysis
Product development
J1
K1
K2
L1
Biocultures
Pesticides /fertilizer
Drugs
M1
Packaging material
Appendix 3
Primary Sector
N of producers
Activity
Number of animals
Poultry:
No of house
Activity
Vegetables producers:
Type of vegetable
N of
producers
Activity
Page 7
Surface
Appendix 3
BRC Food
(Part 1)
Section 1
Disclosure Agreements (please tick the retailers with whom you have signed agreements to pass on
reports and/or certificates)
Asda
KwikSave
Somerfield
Boots
Littlewoods
Spar
Tesco
Burger King
Morrisons
Wal Mart
Netto
Other
Iceland
Sainsburys
Section 2
WAREHOUSING AND DISTRIBUTION
Please give a brief outline of your own warehousing and distribution activities.
Do you subcontract any warehousing and distribution? If YES, please tick and give details.
Page 8
Page 9
Shell Egg
Heat preserved
Raw Meat & Fish
Hermetically sealed
Other
Alcoholic
Beef / Veal
Soft drinks
Pork / Lamb
Fruit juices
Venison
Chicken / Turkey
Bread / Pastries
Duck / Goose
Biscuits / Cake
Dried Goods
Fish Frozen
Soup/Sauce/Gravy/Stock
Nut preparations
Pet food
Fruit
Vegetables
Salads
Prepared/ Semi Processed
To eat or heat
Food Ingredients
Chilled
Frozen
Cooked meat
Vitamins
Cooked fish
Salt / Vinegar
Ready meals
Sandwiches
Cake decorations
Soups / Sauces
Pectin
Pasta
Confectionery
Quiches / Flans
Snacks
Breakfast cereals
Dairy
Other
Chilled
Frozen
Page 10