Approval of establishments under regulation 853/2004 template forms




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APPROVAL OF ESTABLISHMENTS UNDER REGULATION 853/2004 - TEMPLATE FORMS


Template forms which may be used by authorised officers in connection with the approval of establishments are provided from A.11.1 to A.11.6, as detailed the following table:




Practice Guidance Reference


Template Form


A.11.1

Application for Approval


A.11.2

Notification of Grant of Full Approval / Conditional Approval


A.11.3

Notice of Decision Not to Grant Approval


A.11.4

Notice of Decision to Withdraw Approval / Conditional Approval


A.11.5

Notice of Decision to Suspend Approval / Conditional Approval


A.11.6

Notification of Refusal to Grant Full Approval to an Establishment which is Conditionally Approved

As stated in Paragraph 5.1.5 of the Code of Practice, although the content of these documents should be regarded as the minimum required, Food Authorities may adapt them as necessary to meet local requirements.


Model Application for Approval



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







Postcode:      


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


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

1.      

2.      

3.      

of the establishment

Job titles

1.      

2.      

3.      
















Full Names of others

1.      

2.      

3.      

In control of the business

Job titles

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?





YES

NO




APPROVAL

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 tonnes of frogs’ legs in total will be handled in the establishment per week on average?

     




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 tonnes of collagen in total will be handled in the establishment per week on average?

     


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 Business Operator







Date

     
















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 Name:      




IMPORTANT
Please notify any changes to the details you have given on this form, in writing to the Food Authority at the address shown.








Telephone:      










Fax:      










E-mail:      



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