COMPANY OR ORGANISATION TO BE AUDITED

Company Name:

Address:

City:
Region/State:
Postcode: Country:
Contact Name:
Contact Position:
(PCQI name – FSMA only)
Contact E-mail Address:
Tel No. Website:
Is this site part of a group? Please specify the group name

COMPANY TO BE INVOICED
(if same as above please leave blank)

Company Name:

Address:

City:
Region/State:

Postcode: Country:
Contact Name: Contact Position:
Contact E-mail Address:
Tel No.

STANDARD REQUIRED
☐ BRC Food Issue 8 ☐ FSSC 22000 ☐ ISO22000:2005 ☐ ISO22000:2018
(please complete section A) (Until 31 December 2019)
☐ IFS Food ☐ IFS Logistics ☐ IFS Broker ☐ IFS C&C/Wholesale
(please complete section B) (please complete section B) (please complete section B) (please complete section B)
☐ FSMA FSVP ☐ FSMA VQIP
(please complete section C) (please complete section C)
☐ Initial/First Certification
☐ Renewal of existing
☐ Extension to scope of existing certification
certification
☐ Do you want the audits selected above combined? Date the certification is
required by?

Document: GF 0101 Issue n°: 2 Page n°: 1 of 7

 CURRENT CERTIFICATION
(Please indicate any third-party certification you already have. Please provide a copy of latest certificate and report)
CERTIFICATION BODY SCHEME ID#
SCHEME EXPIRY DATE
(e.g. SGS) (e.g. BRC Site code/IFS COID)
BRC
IFS
FSSC
ISO22000
Other

SCOPE
What is the proposed scope of certification:
(detail product/s manufactured and key processes, packaging
e.g. Processing of sliced pre-packed chilled pineapple and
pineapple in cans.)
Exclusions – detail any product lines/operations to be
excluded from certification
Justification for exclusion
Detail any operations included in the scope that are
performed on another site?
What is the distance from this site?
Is any part of the process and/or product sub-
contracted(out-sourced)? If Yes please detail what.
If warehousing is off site and managed by the same
team as the main site detail size of site and distance
from the main site

COMPANY DETAILS
(please complete fully this section as it determines the audit time)
Please list below each product family(ies) and product types (A product family showing common process or
technology)
Exp. of product family: production of canned fruit juices and frozen fruit juices (2 product families)
Exp. of product types: canned mango juice, canned pineapple juice, canned guava juice and canned strawberry juice. (4
product types)
PRODUCT FAMILY
PRODUCT
TYPE

Number of HACCP Plans

Plant size (metres square including storage on site)
Headcount (total employees including temporary workers)
Number of production FTE on main shift
Number of production lines
Is the process fully automated

Document: GF 0101 Issue n°: 2 Page n°: 2 of 7

Section A (BRC)

Multi-sites and Head Office functions can be audited – however please make it clear on this form so we can
give specific advice
NB - Traded Goods is now incorporated into the Issue 8 standard, but is still voluntary.

BRC AUDIT OPTIONS

There will be a follow-up questionnaire if you require an unannounced audit.
Announced Full Unannounced
BRC ADDITIONAL VOLUNTARY MODULES/ADDENDUM AUDITS
Please detail any modules required, refer to BRC Global Standards Website

There will be an additional registration form if you require an unannounced audit.

Document: GF 0101 Issue n°: 2 Page n°: 3 of 7

Section B (IFS)

Multi-location and Head Office functions can be audited – however please make it clear on this form so we
can give specific advice

IFS Food
Audit language
Language of quality manual /
documents
To be combined with other IFS
☐ IFS Broker ☐ IFS Logistics
standards?
Does your company manufacture
any products under retail brands?
☐ Announced ☐ Unannounced Option 1 ☐ Unannounced Option 2
There will be an additional registration form if you require an unannounced audit.

Product Scope(s)
Red and white meat, Fish and fish
1☐ 2☐ 3☐ Egg and egg products
poultry and meat products products
Grain products, cereals, industrial
Fruits and
4☐ Dairy products 5☐ 6☐ bakery and pastry, confectionary,
vegetables
snacks
7☐ Combined products 8☐ Beverages 9☐ Oils and fats
Dry goods, food additives
10 ☐ 11 ☐ Pet food
and supplements
For Logistics
☐ Storage ☐ Transport ☐ Cross Docking

Technology Scope(s)
Technology oriented classification
IFS tech IFS processing step – including
which takes also into consideration
scope processing/treating/manipulation/ storing
product risks
Sterilisation (in final packaging) with the
purpose to destroy pathogens
A ☐ P1 Sterilisation (e.g. cans)
Sterilised (e.g. autoclaved) products in
final packaging.
Thermal pasteurisation, UHT/aseptic filling; Pasteurisation / other heat treatment or
hot filling; Other pasteurisation techniques other technology applied with the purpose
B ☐ P2
e.g. high pressure pasteurisation, to reduce food safety hazards (and UHT
microwave process)
☐ P3 Irradiation of food Processed products: Treatment with
Preserving: Salting, marinating, sugaring, purpose to modify product and/or extend
C
☐ P4 acidifying/pickling, curing, smoking, etc. the shelf life and/or reduce food safety
Fermentation/acidification hazards by preservation techniques and

Document: GF 0101 Issue n°: 2 Page n°: 4 of 7

 other processing techniques Note -
Evaporation/dehydration, vacuum filtration,
exception: Irradiation is attributed to this
☐ P5 freeze drying, microfiltration (less than 10ì
category although aimed at the destruction
mesh size)
of microorganisms.
Freezing (at least -18°C) including storage Systems, treatments to maintain product
☐ P6 Quick freezing, Cooling, chilling processes integrity and or safety: Treatment with
and respective cool storing purpose to maintain the quality and/or
D
integrity of the products including
☐ P7 Antimicrobial dipping/spraying, fumigation treatments to remove contamination
and/or prevent contamination
☐ P8 Packing MAP, Packing under vacuum
Processes to prevent product
Systems, treatments to prevent product
contamination esp. microbiological
contamination Processes to prevent
contamination, by means of high hygiene
product contamination especially
control and/or specific infrastructure during
microbiological contamination, by means
handling, treatment and/or processing e.g.
☐ P9 of high hygiene control and/or specific
clean room technology, „white room“,
E infrastructure during handling, treatment
(controlled working room temperature for
and/or processing and or packaging (e.g.
food safety purpose, disinfection after
MAP)
cleaning, positive air pressure systems
(like filtration below 10 μ).
Specific separation techniques: e.g. Not limited to the examples given, also
☐ P10 filtration like reverse osmoses, use of techniques like centrifugation in oil
active charcoal manufacturing etc. need to be considered
Cooking, baking, bottling, filling of viscous
products, brewing, fermentation (e.g.
☐ P11
wine), drying, frying, roasting, extrusion,
churning
Coating, breading, battering, cutting,
slicing, dicing, dismembering, Any other manipulation, treatment,
F
mixing/blending, stuffing, slaughtering, processing not being listed in A,B,C,D,E
☐ P12
sorting, manipulation, packaging, storing
under controlled conditions (atmosphere)
except temperature
Distillation, purification, steaming,
☐ P13
damping, hydrogenating, milling

Document: GF 0101 Issue n°: 2 Page n°: 5 of 7

 All Standards – Please provide any further relevant information

For BRC and IFS only:

Signature:
Date:

Document: GF 0101 Issue n°: 2 Page n°: 6 of 7

Section C (FSMA)

Which FSMA scope applies to the facility?

FSMA Human Food
FSMA Seafood
FSMA Juices
FSMA Dietary supplements
FSMA Other: _________________________
What type of Audit/Certification is requested?
FSMA VQIP Consultative audit
FSMA VQIP Regulatory audit
FSMA FSVP Certification
Gap assessment
Other: _______________
Products covered by the audit/certification Scope:
(Also attach a list of ingredients for each product)

FDA product code(s): (https://www.accessdata.fda.gov/scripts/ora/pcb/index.cfm?action=main.pcb)

What are the US FDA regulations that apply to the product(s)?

(Applicable regulations will be verified prior to onsite audit)

Is the facility Registered with FDA? Yes No

Within the past 2 years, has the facility issued a food safety recall? Yes No
Does the facility have any pending/recent FDA compliance actions? Yes No
Is this a supplier audit required by a US importer? Yes No
If yes, please specify US importer name (if available):
Is the facility a Low Acid Canned Food facility? Yes No
Does the facility manufacture or process seafood products for sale to the US? Yes No
Does the facility manufacture or process juice for sale to the US? Yes No
Does the facility manufacture dietary supplements for sale in the US? Yes No
Please provide the following information. To be verified prior to onsite audit:
 Does the certification applicant confirm all ingredients/raw materials are approved or allowed for
use in the US? Yes No
 Does any of the following apply to the product(s) listed in the certification scope?
o Categorized as GRAS? Yes No
o A petition for approval has been submitted? Yes No
o Subject to prior sanctions? Yes No
o On the banned substances list? Yes No

Document: GF 0101 Issue n°: 2 Page n°: 7 of 7