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Bureau Veritas Certification
APPLICATION
Food Safety Management System Standards
ISO 22000 / FSSC 22000
Bureau Veritas Certification
Local office address
Before we can prepare an offer, we need some information about your organisation and staff. Would you please complete the application form
below (from section A to D) and return it by e mail. All information supplied will be treated with strict confidence. Your application does not
commit you to using our services and no application fee is charged.
SF01 - Food Schemes Application Form - Issue 7–12/03/2015
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Please select from the drop down box which certification you require:ISO 22000
Please select from the drop down box which accreditation you require:ACCREDIA
If not in the list specify which certification you require:
SECTION A
COMPANY DETAILS
Company Name or Head Office
Company full address:
Company Registration Number:
Country:
E Mail Address :
Desk phone Number :
Mobile phone Number:
Contact Name:
Job Title:
If more than 1 site please detail each site address
Other:
PRODUCTS AND SERVICES (please detail the products you produce and /or the services you provide)
Number of product types
please list products
DRAFT SCOPE (Please note that this description will be the Certification scope shown on the certificate issued by Bureau Veritas
Certification)
NUMBER OF EMPLOYEES:
Head
office
Site 2
Name
Site 3
Name
Site 4
Name
Site 5
Name
Site 6
Name
Site 7
Name
Site 8
Name
Site 9
Name
Site 10
Name
1 Administration/Office
2. Production/Processing
3. Maintenance/Service
4. Logistics
Subcontracted:
Seasonal:
Temporary:
TOTAL
WORK PATTERN (for shift working please detail shift times and the number of employees per shift i.e. days, nights, 6am-2pm , 2pm -10pm
Employees Shift 1
Employees Shift 3
Employees Shift 2
Employees Shift 4
Premises, location & production lines
Please state the size of the production facilities (in sq. metres)
m2
Please state the number of production lines
Please state the size of any warehouse facilities on site (in sq. metres)
m2
Please state location of facilities i.e. industrial estate
If any part of the site is sub-let or under different management ,
please give details
SECTION B
Please detail the processes or activities involved in manufacture or provision of service (if possible please provide your process
flow diagram):
1. Incoming Materials (please list the main ingredients and packaging materials)
2. Product Storage – (please provide details of on-site product storage including in process)
3. Building and Site Aspects (Please provide any significant details, e.g., Any neighbour whose activity may affect operations, etc.)
SF01 - Food Schemes Application Form - Issue 7–12/03/2015
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4. Waste and Discharges (Please list main wastes and effluents)
5. Transport (Please provide details of transport or distribution etc.)
6. Sub Contracted Activities (Please detail any subcontract activities i.e.: maintenance, calibration, delivery, transport etc.).
SECTION C
HACCP (please provide details on number of HACCP plans and any identified CCP’s
HACCP Plan 1
HACCP Plan 2
HACCP Plan 3
HACCP Plan 4
HACCP Plan 5
HACCP Plan 6
Do you have documented PRP’s in
place (please detail)
SECTION D
Current & Other Management Systems (Please detail current and other management systems you have)
Standard (i.e. 9001, 14001, 22000, BRC, IFS…)
If you are certified to the standard please give details
If yes:
If yes:
A.
Certification Body:
B.
Standard:
C.
Approval Date:
D.
Expiry Date:
E.
Copy of certificate attached
(required for transfer of certification)
A.
B.
C.
D.
E
A.
B.
C.
D.
E
If yes:
A.
B.
C.
D.
E.
TARGET DATE FOR AUDIT:
AUTHORISED SIGNATORY:
THANK YOU FOR COMPLETING THIS APPLICATION FORM
SF01 - Food Schemes Application Form - Issue 7–12/03/2015
POSITION
DATE
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Bureau Veritas Certification - ACTION ONLY:
ISO 22000 / FSSC 22K Food & Animal Feed Categories
ISO/TS 22002-4 / FSSC Packaging categories
A1A – Farming of Animal
C4E – Oils & fats
FSC01 – Plastic
A1B – Raw milk production
A1C – Egg production
A1D – Beekeeping
C4F– Dried goods & food ingredients
D1 – Animal Feed
D2 – Production of pet food
FSC02 – Paper, board, wood
FSC03 – Metal
FSC04 – Glass
A2 – Farming of fish and seafood
B1 – Farming of plants (other than
grains and pulses)
B2 – Farming of grains and pulses
C1A – Red & white meat / poultry
/ meat products & preparation
C1B – Dairy & liquid egg
C1C – Fish & fish products
C1D – Shell egg
C2A – Produce
C2B – Ready to eat perishable
plant products
C3 – Perishable animal and plant
products (mixed products)
C4A – Ambient stable
hermetically sealed packs
C4B – Alcoholic beverages
C4C – Non-alcoholic beverages
E – Catering
F1 – Retail / wholesale
F2 - Food broking / trading
G1 – Provision of transport & storage
services for perishable food & feed
G2 – Provision of transport and storage
services for ambient stable food and feed
HA – Water supply
HB – Cleaning, disinfection, pest control,
laundry, maintenance & auxiliary services
HC – Water disposal & sewage
HD – Technical services: testing, analysis
& product development
I - Production of food packaging and
packaging material
J – Equipment manufacturing
K1 – (Bio)Chemical used as ingredients:
additives, vitamins & bio cultures
K2 – (Bio)Chemical used as noningredients: pesticides, fertilizers, drugs &
cleaning agents
C4D – Grain products, cereals,
biscuits, flour, confectionary & snacks
Allocated auditor or audit team :
Country:
Code:
For single site
Stand-Alone
Initial Audit - Stage 1 – Print MD
Certification Audit – Stage 2 - Print MD 
Surveillance Audit – Print MD
Re – Certification Audit - Print MD 
Combined Audit:
Standard - ____
_________
Initial Audit Stage 1 – Print MD
Certification Audit –Stage 2 - Print MD 
Surveillance Audit – Print MD
Re – Certification Audit - Print MD 
Preparation & Planning
On-site audit
Report
Annual
Preparation & Planning
For multi-site, please copy paste above table (one per site)
Transfer of Certification( Please refer to BMS procedures)
Is this application a transfer from another accredited certification body
Name of Certification Body
Is the transfer within the current certification cycle
Is the transfer at re-certification stage
Comments
Re Certification including transfer Stage 1
Is a full on site stage 1 to be carried out
Is an on-site documentation review to be carried out
Is an off-site documentation review to be carried out
Stage 1 audit is not carried out
SF01 - Food Schemes Application Form - Issue 7–12/03/2015
On-site audit
Annual
Report
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Please justify the above answers
The MD- and code allocation is performed by:
Position:
Bureau Veritas Certification office:
Sign & date:
APPROVAL BY THE COMPETENCE CENTRE or Critical Location or Locally accredited country
Comments & Remarks:
Note 1
Note 2
This review is done by:
Position:
Bureau Veritas Certification office:
Sign & date:
SF01 - Food Schemes Application Form - Issue 7–12/03/2015