Form - Food Safety Self Inspection Form
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Form - Food Safety Self Inspection Form
Form - Food Safety Self Inspection Form
Food Safety Self Inspection Form
Note: Questions marked by * are mandatory
Company Name
Company Address
Trading Name (if applicable)
Telephone Number
Fax Number
Email Address
How long has your company been trading at this address?
Name of Food Business Operator(s)
Please state the type of company, if relevant
Please Select An Option
Private Company
Partnership
Individual
Self-employed
Other (please state)
Total number of food handlers
Please provide the address of your Head Office if different from above
Please provide the proprietors/partners name(s)
Have you ever traded under another name or from another address
Please Select An Option
Yes
No
If yes, please state
Yes
No
Do you manufacture, process or pack any food items that are sold for human consumption?
Yes
No
Do you sell food by retail?
Yes
No
Do you sell any food by wholesale?
Yes
No
Which of the following products do you use/sell?
Yes
No
Dairy products
Yes
No
Eggs
Yes
No
Prepacked cooked meats
Yes
No
Loose cooked meats
Yes
No
Loose raw meats
Yes
No
Sandwiches prepared on the premises
Yes
No
Sandwiches brought in
Yes
No
Other (please specify)
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