Fill - Free fillable Application For Approval Of A-food Business Establishment (Cherwell District Council) PDF form

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:

Tel (Incl. Dialling code)

Fax (incl. Dialling code)

E-mail

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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