Application for Approval of a Food Business Establishment
Subject to Approval under Regulation (EC) No. 853/2004
To be completed by the food business operator
Print a copy of this form and fill it in with a black pen in BLOCK CAPITALS, or complete it on screen.
Complete Parts 1 to 8 inclusive, and the specific sections of Part 9 that relate to the products of animal origin in
respect of which you are applying for the approval of your establishment, then sign and date Part 10.
PART 1 - Establishment for which approval is sought
Trading name
Full postal
Address
PART 2 Type(s) of product(s) of animal origin for which approval is sought
Indicate the product(s) of animal origin in respect of which you are applying for approval to use the
establishment (tick all that apply)?
Minced Meat
Meat Preparations
Mechanically Separated Meat
Meat Products
Live Bivalve Molluscs (Shellfish)
Fishery Products
Dairy Products
Eggs (not Primary Production) / Egg Products
Frogs’ Legs / Snails
Rendered Animal Fats and Greaves
Treated Stomachs, Bladders and Intestines
Gelatine
Collagen
Postcode:
PART 3 Food business operator and management of the establishment
Name and full
Address of Food Business
Operator
Postcode:
Full names of managers
of the establishment
Job titles
1.
2.
3.
1.
2.
3.
Full Names of others
In control of the business
Job titles
1.
2.
3.
1.
2.
3.
PART 4 Use of the establishment
Which of the following activities will be conducted in / from the establishment (tick all that apply)?
Stand-alone cold store
Wholesale market
Manufacture
Other processing (please specify)
Packing
Storage
Distribution
Cash and carry / wholesale
Catering (preparation of food for consumption in the establishment)
Retail (direct sale to consumers or other customers)
Market stall or mobile vendor
Other (please specify)
PART 5 Transport of products from the establishment
How will products be transported from the establishment (tick all that apply)?
Your own vehicle(s)
Contract / Private Haulier
Purchaser’s own vehicle(s)
Other (please specify)
PART 6 Supply of products from the establishment to other establishments
Which of the following will be supplied with products from the establishment (tick all that apply)?
Other businesses that manufacture or process food
Wholesale packers
Cold stores that are not part of the establishment to which this application relates
Warehouses that are not part of the establishment to which this application relates
Restaurants, hotels, canteens or similar catering businesses
Take-away businesses
Retail shops, supermarkets, stalls, or mobile vendors that you own
Retail shops, supermarkets, stalls, or mobile vendors that you do not own
Members of the public direct from the establishment to which this application relates
Other (please specify)
PART 7 Other activities on the same site
Will any of the following activities be conducted on the same site as, or within, the establishment to which
this application for approval relates?
APPROVAL
YES
NO
CODE
Slaughter, including pigs, sheep, cattle,
poultry, game etc:
Cutting fresh (including chilled and frozen)
meat, poultry meat or game:
Storage of fresh (including chilled and
frozen) meat, poultry or game:
PART 8 Information and documentation
The following information is required in order to process your application and should be sent with this
application form if possible. Please indicate which information you are sending now (N.B. information that
is not sent now will still be required before your application can be determined).
A detailed scale plan of the (proposed) establishment showing the location of rooms and other areas to be
used for the storage and processing of raw materials, product and waste, and the layout of facilities and
equipment
A description of the (proposed) food safety management system based on HACCP principles
A description of the (proposed) establishment and equipment maintenance arrangements
A description of the (proposed) establishment, equipment , and transport cleaning arrangements
A description of the (proposed) waste collection and disposal arrangements
A description of the (proposed) water supply
A description of the (proposed) water supply quality testing arrangements
A description of the (proposed) arrangements for product testing
A description of the (proposed) pest control arrangements
A description of the (proposed) monitoring arrangements for staff health
A description of the (proposed) staff hygiene training arrangements
A description of the (proposed) arrangements for record keeping
A description of the (proposed) arrangements for applying the identification mark to product packaging or
wrapping
PART 9 - Products to be handled in the establishment / activities
Which of the following activities will be conducted in the establishment? Indicate by giving the
approximate quantities to be handled in kilograms or litres per week (tick all that apply).
PART 9(1) Minced Meat and Meat Preparations
Handling minced meat
Handling meat preparations
Full details of activities and specific products handled
How many tonnes of minced meat in total will be handled in the establishment per week on
average?
How many tonnes of meat preparations in total will be handled in the establishment per week
on average?
PART 9(2) Mechanically Separated Meat
Full details of activities and specific products handled
How many tonnes of mechanically separated meat in total will be handled in the establishment
per week on average?
PART 9(3) Meat Products
Full details of activities and specific products handled
How many tonnes of meat products will be handled in the establishment per week on average?
PART 9(4) Live Bivalve Molluscs (Shellfish) / Fishery Products
Full details of activities and specific products handled
How many tonnes of Live Bivalve Molluscs (Shellfish) / Fishery Products will be handled in the
establishment per week on average?
PART 9(5) Raw Milk / Dairy Products
Raw Milk
Dairy Products
Full details of activities and specific products handled
How many litres of Raw Milk will be handled in the establishment per week on average?
How many litres / tonnes of Dairy Products will be handled in the establishment per week on
average?
PART 9(6) Eggs (not Primary Production) / Egg Products
Full details of activities and specific products handled
How many tonnes of Eggs will be packed in the establishment per week on average?
How many litres of Egg Products will be handled in the establishment per week on average?
PART 9(7) Frogs’ Legs and Snails
Frogs’ Legs
Snails
Full details of activities and specific products handled
How many
average?
tonnes of frogs’ legs in total will be handled in the establishment per week on
How many tonnes of snails in total will be handled in the establishment per week on average?
PART 9(8) Rendered Animal Fats and Greaves
Rendered Animal Fats
Greaves
Full details of activities and specific products handled
How many tonnes of rendered animal fats will be handled in the establishment per week on
average?
How many tonnes of greaves will be handled in the establishment per week on average?
PART 9(9) Treated Stomachs, Bladders and Intestines
Treated Stomachs
Treated Bladders
Treated Intestines
Full details of activities and specific products handled
How many tonnes of treated stomachs in total will be handled in the establishment per week on
average?
How many tonnes of treated bladders in total will be handled in the establishment per week on
average?
How many tonnes of treated intestines in total will be handled in the establishment per week on
average?
PART 9(10) Gelatine
Full Details of Activities
How many tonnes of gelatine in total will be handled in the establishment per week on average?
PART 9(11) Collagen
Full Details of Activities
How many
average?
tonnes of collagen in total will be handled in the establishment per week on
PART 9(12) Stand-alone Cold Store
Full details of activities and specific products handled
How many tonnes of product will be handled in the establishment per week on average?
PART 10 APPLICATION
I hereby apply, as food business operator of the establishment detailed in Part 1, for approval to use that
establishment for the purposes of handling products of animal origin for which Regulation (EC) No.
853/2004 lays down requirements, as set out in the relevant Parts of this document.
Signature of Food
Date
Business Operator
Name in
BLOCK LETTERS
If you need any help or advice about how to complete this form, or about the products to which the
Regulation relates, or the circumstances in which approval under the Regulation is required, please
contact the officer named below.
When you have completed this form and collected the other information required, please send it to:
Contact: Health Protection and
Health Protection and Compliance
Compliance Team
IMPORTANT
Team
Cherwell District Council
Bodicote House
Telephone: 01295 227990
Please notify any changes to
the details you have given on
Bodicote
this form, in writing to the
Banbury
Fax: 01295 221878
Food Authority at the address
shown.
Oxfordshire
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