Lisburn Online Forms - Food Business Establishment Approval Form

Trading name:

Street no and name:

City or Town:

Country:

Postcode:

Type of Product:

Street no and name:

City or town:

Post Code:

Country:

Main telephone:

+

Fax (including dialling code):

E-mail:

Full name of managers of the establishment:

Job title:

Full name of managers of the establishment:

Job Titles:

Full name of managers of the establishment:

Job Title:

Full name of others in control of the business:

Job Title:

Full name of others in control of the business:

Job Title:

Full name of others in control of the business:

Job Title:

Tick all that apply:

Please specify:

Tick boxes:

Your own vehicle(s)
Contract/Private Haulier
Purchasers own vehicle(s)
Other (please specify)

Please specify:

Tick boxes:

Please specify:

Slaughter, including pigs, sheep, cattle, poulltry, game, etc:

Yes
No

Approval Code:

Cutting fresh (including chilled and frozen) meat, poultry, meat or game:

Yes
No

Approval Code:

Storage of fresh (including chilled and frozen) meat, poultry, meat or game:

Yes
No

Approval Code:

Tick boxes:

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?:

Full details of activites and specific products handled:

How many tonnes of mechanically separated meat in total will be handled in the establishment per week on average?:

Full details of activities and specific products handled:

How many tonnes of meat products will be handled in the establishment per week on average?:

Full details of activities and products handled:

How many tonnes of Live Bivalve Molluscs (Shellfish) / Fishery Products will be handled in the establishment per week on average?:

Tick boxes:

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?:

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?:

Tick boxes:

Frogs legs
Snails

Full details of activites and specific products handled:

How many tonnes of frogs' legs in total will be handled in the establishment per week on aveage?:

How many tonnes of snails in total will be handled in the establishment per week on average?:

Tick boxes:

Rendered Animal Fasts
Greaves

Full details of activites 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?:

Tick boxes:

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 establsihment per week on average?:

How many tonnes of treated intestines in total will be handled in the establishment per week on average?:

Full details of activities:

How many tonnes of gelatine in total will be handled in the establishment per week on average?:

Full details of activities:

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

Full details of activities and specific products handled:

How many tonnes of product will be handled in the establishment per week on average?:

Signature of food business operator:

Name in BLOCK CAPITALS:

Date:

PART 1: Establishment for which approval is sought
Trading name:
Street no and name:
City or Town:
Country:
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)?
Type of Product:	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
Street no and name:
City or town:
Post Code:
Country:
Main telephone:	+
Fax (including dialling code):
E-mail:
PART 3 - Section A
Full name of managers of the establishment:
Job title:
Full name of managers of the establishment:
Job Titles:
Full name of managers of the establishment:
Job Title:
Full name of others in control of the business:
Job Title:
Full name of others in control of the business:
Job Title:
Full name of others in control of the business:
Job Title:
PART 4 - Use of the establishment
Which of the following activites will be conducted in /from the establishment?
Tick all that apply:	Stand-alone cold store Wholesale market Manufacturer 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)
Please specify:
PART 5 - Transport of products from the establishment
How will products be transported from the establishment?
Tick boxes:	Your own vehicle(s) Contract/Private Haulier Purchasers own vehicle(s) Other (please specify)
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)?
Tick boxes:	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)
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?
Slaughter, including pigs, sheep, cattle, poulltry, game, etc:	Yes No
Approval Code:
Cutting fresh (including chilled and frozen) meat, poultry, meat or game:	Yes No
Approval Code:
Storage of fresh (including chilled and frozen) meat, poultry, meat or game:	Yes No
Approval Code:
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):
Tick boxes:	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 arrangement 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
Tick boxes:	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 activites 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 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
Tick boxes:	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
Tick boxes:	Frogs legs Snails
Full details of activites and specific products handled:
How many tonnes of frogs' legs in total will be handled in the establishment per week on aveage?:
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
Tick boxes:	Rendered Animal Fasts Greaves
Full details of activites 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
Tick boxes:	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 establsihment 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 the approval to use that establishment for the purposes of handling products of animal origin of which Regulation (EC) No. 853/2004 lays down requirements, as set out in the relevant parts of this document:
Signature of food business operator:
Name in BLOCK CAPITALS:
Date: