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ENQUIRY FORM - FSSC22000 FOOD SAFETY MANAGEMENT

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: fiona.chong@lr.org / esther.tan@lr.org / siewboon.ong@lr.org

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
season
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.
YES
Farming, preparing, processing, treatment, packing, transport and
A
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
applicable)
No. of product /
No. of process lines
service groups **
Process Flow Chart
No of HACCP Study
(Please attach)
General description of
products/services
** 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
outsourced._______________________________________________________________________
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.