Anda di halaman 1dari 1


If you are unsure about any of the questions whilst completing this form, please do not hesitate to contact LRQA Kuala
Lumpur Business Centre at
PIC: / /

Company name: Co. registration no :

Main correspondence address (Billing address) :

Email: Position:

Telephone: Fax number:

Contact name: H/P number:

No of full time
Full time employees employee during peak
Do you operating shift?
Higher No. of Employee on a single shift
Answer if YES
Do you use part time
employee? Answer if Total No.
Farming, preparing, processing, treatment, packing, transport and
distribution of food products and/or ingredients
 Farming, preparing, processing, treatment, packing of food products
B and/or ingredients, or
 Production of non-food product and delivery services
C Transport, distribution of UNPACKED food products
Products & Services.
(Please Tick as D Transport, distribution of PACKED food products
No. of product /
No. of process lines
service groups **
Process Flow Chart
No of HACCP Study
(Please attach)
General description of
** Same group imply made in the same way, on the same production lines and using the same raw materials
Risk Level 1 Other than those listed below
(Please Tick as
applicable) 2 Ready to eat, Catering premises, Egg, Dairy
FSSC22000 (Food Manufacturer) ( ) FSSC22000 (Packaging Material) ( )

Details on outsource activities:

1. Does your organisation currently outsource any of its operational processes? Yes / No
2. If the answer to (1) is ‘Yes’ please specify what type of process or activities that has been
Did you hire any consultant to assist you in setting up the system? If yes, please indicate name of
consultant/consultancy firm?:
Where did you hear about LRQA?
Signature : Date:

Improving performance, reducing risk

Lloyd’s Register Quality Assurance Limited is a limited company registered in England and Wales.
Registered number: 1879370. Registered office: 71 Fenchurch Street, London, EC3M 4BS, UK. A member of the Lloyd’s Register group.