Application for FSSC 22000
Certification
REC313:
1213 Bakers Way
P.O. Box 3999
Manhattan, KS 66505-3999
AIB International –
Certification Services
Tel: 785-537-4750
Fax: 785-537-0106
e-mail:[email protected]
The following information is required to enable us to schedule an audit against the FSSC 22000 Food Safety
Certification Scheme (ISO 22000 + ISO/TS 22002-1: 2009 or ISO/TS 22002-4).
Company
Name:
Street
Address:
City:
State:
Zip/Post Code:
Country:
Telephone:
Fax:
e-mail:
Website:
COMPANY INFORMATION
Parent Company
(if relevant):
Street Address:
City:
State:
Zip/Post Code:
Country:
Telephone:
Fax:
e-mail:
Website:
Legal status
(Corporation, sole proprietor, etc.):
VAT no./Tax ref. No.:
CERTIFICATION DETAILS
This information is required to help plan the number of audit days
Are you certified to another MS or GFSI scheme?
Yes
No
If yes, please list the certification type, certificate
expiry and scope of certification.
Are you currently FSSC certified?
Yes
No
Yes
No
If yes, please list certificate expiry date and provide
a copy of your certificate and report:
Has your plant received any consulting?
If Yes, please provide the name of the individual
who provided consulting in your facility.
Please note that our FSSC audit staff is not allowed
to provide consultancy relating to the client’s
management system.
Details of Company Membership in Trade Bodies,
Research Organisations, etc.:
Statutory Regulations/Codes of Practice Applicable
to the Type of Products Manufactured
REC313:
Application for FSSC 22000
Certification
CONTACT DETAILS
Primary Contact:
Job Title:
Street Address:
City:
State:
Zip/Post Code:
Country:
Direct phone:
Mobile/cell:
e-mail:
Receive a copy of the report:
Yes
No
Report receipt preference:
e-mail
Mail
Secondary Contact:
Job Title:
Street Address:
City:
State:
Zip/Post Code:
Country:
Direct phone:
Mobile/cell:
e-mail:
Receive a copy of the report:
Yes
No
Report receipt preference:
e-mail
Mail
Invoice Contact:
Job Title:
Street Address:
City:
State:
Zip/Post Code:
Country:
Direct phone:
Mobile/cell:
e-mail:
Receive a copy of the report:
Yes
No
Report receipt preference:
E-mail
Mail
REC313:
Application for FSSC 22000
Certification
Do you require a Pre-Assessment?
AUDIT REQUEST
Yes
No
Note: A pre-assessment is an optional audit used to
assess the level of a system’s compliance against the
FSSC 22000 Standard.
If yes, please specify preferred time frame:
(please note that the certification audit should
be scheduled no earlier than three months after
the pre-assessment)
Audit Type Requested
Stage 1 Only
Transfer from
Another CB
Requested audit date/ time frame:
Multiple sites?
Yes
No
If yes, please complete an application (REC 313) for each site.
CUSTOMERS
List main retailers/customers:
Are you a supplier to
McDonalds?
If yes, do you require the
McDonalds addendum to be
completed in addition to the
FSSC audit?
Are you a supplier to Costco?
Yes
No
Yes
No
Yes
No
If yes, do you require the
Costco addendum to be
completed in addition to the
FSSC audit?
Yes
No
SITE DETAILS
Please detail the range of products:
Number of process lines:
Number of packing lines:
HACCP study in place:
Check to confirm
How many do HACCP plans do you
have?
REC313:
Application for FSSC 22000
Certification
If you have more than one please list
what each relates to:
A study corresponds to a hazard analysis
for a family of products/services with similar
hazards and similar production technology
List any regulated HACCP Plans, e.g.
Processing for meat, pasteurized milk/juice,
low acid canning, retort, seafood, fresh cut
produce, etc.
Number of CCP’s:
Number of oPRP’s:
Number of prerequisite programs:
Square footage of production and support
areas:
Square footage of warehouse area:
Work/Shift Pattern:
Details of the warehousing and distribution
system in place:
FOR PACKAGING MANUFACTURES ONLY
Packaging facilities may have process cells or processing lines. Any printing, blown film, and/or corrugator
will be considered a processing line.
Each glass blowing line is considered a processing line.
Cells would be considered things such as blow mold, extrusion, folding, gluing, forming, etc. (typically
single to three step operations with the exception of blown film and printing).
Number of process “cells”
Number of Process lines
PERSONNEL DETAILS
This information is required to help plan the number of audit days
Total Number employees: All employees including
office staff, all management, production and
support employees and regular casual / temporary
employees.
Total Number of employees on the primary shift:
all employees including office staff, all
management, production and support employees
and regular casual / temporary employees.
SCOPE DETAILS
The following information will be used to determine the scope of your certification.
Scope should include the processes, products and intended user.
An example of scope of certification could be: The processing (cleaning, milling,
sterilization) and bulk packaging of spice supplied to the food industry.
Processes to be included in certification:
(e.g. cleaning, milling, heat-sterilization)
Products to be included in certification:
(e.g. bread, buns, sugar, spices, sauces)
Application for FSSC 22000
Certification
REC313:
Packing to be included in certification:
(e.g. in bulk containers, canning, in glass jars)
End use to be included in certification:
(e.g. retail sale, food service, bulk ingredient)
PRODUCT CATEGORY
Please mark the category (ies) that best describes your site.
Category currently is
ISO/TS 22003:2007
Category will
be: ISO/TS
22003:2013
C: Food
Manufacturing
Subcategory will be:
ISO/TS 22003:2013
Subsection
CI: Processing of
perishable animal
products
D: processing 1
perishable vegetable
products
C: Food
Manufacturing
CII: Processing of
perishable plant
products
C: processing 1
perishable animal
products after farming
AND OR
D: processing 1
perishable vegetable
products
E: processing 3
Products with a long
shelf life when stored
at room temperature
C: Food
Manufacturing
CIII: Processing of
perishable animal
and plant products
Fish / Seafood
Meat
Poultry
Eggs
Dairy
Fruits
Fresh Juices
Vegetables
Grains
Nuts
Pulses
Pizza
Lasagne
Sandwich
Dumpling
Ready to eat meals
C: Food
Manufacturing
CIV: Processing of
ambient stable
products
L: (Bio) chemical
manufacturing
K: Production of (Bio) Chemicals
C: Processing 1
perishable animal
products after farming
Canned foods
Breads and biscuits
(could be frozen)
Snacks
Oils
Beverages
Pasta
Flour
Sugar
Food grade salt
Other
Yeast
Spices for commercial
use (as ingredient)
should be
Food and feed
additives
Aroma and flavour
compounds
Processing aids
including Food Grade
phosphates of
calcium, aluminium,
This applies
to my site
REC313:
M: Packaging material
manufacturing
Application for FSSC 22000
Certification
I: Production of Food Packaging and
Packaging Material
sodium, potassium,
and ammonium and
sulphates of
aluminium and sodium
Glass
Paper/paper board
Wood
Can
Plastic
Please check to confirm you have read PR. 3C: Overview of the AIBI -CS Certification Scheme
FSSC 22000:
Please check to confirm you have read PR.4: Rules for Certification:
I agree to assist in the AIBI-CB training process Yes
No
by allowing shadowing and trainee conducted
audits in our facility with prior notification
If any of the above are not checked, please read or obtain a copy.
Signed by:
(Signatory is authorized by the company/firm to sign this application and ensure that
products conform to requirements)
Print name:
Job Title:
Company:
Date:
Upon receipt of this completed questionnaire AIBI-CS will calculate expected audit duration and
confirm the scope applied for. Our auditors will then be notified of your request and will begin looking
for available dates to offer. Our office will contact you as soon as dates are available.
AIBI-CS Review
Date:
Name of reviewer:
Signature:
REC313:
Application for FSSC 22000
Certification
By signature, the Reviewer is approving the audit can be conducted and a Business Proposal (REC.115/132) can be
sent to the Client for approval.