Form - Food Safety Self Inspection Form

Food Safety Self Inspection Form

Note: Questions marked by * are mandatory

Company Name

Company Address

Trading Name (if applicable)

Telephone Number

Fax Number

Email Address

How long has your company been trading at this address?

Name of Food Business Operator(s)

Please state the type of company, if relevant

Other (please state)

Total number of food handlers

Please provide the address of your Head Office if different from above

Please provide the proprietors/partners name(s)

Have you ever traded under another name or from another address

If yes, please state

	Yes	No
Do you manufacture, process or pack any food items that are sold for human consumption?
Do you sell food by retail?
Do you sell any food by wholesale?

Which of the following products do you use/sell?

	Yes	No
Dairy products
Eggs
Prepacked cooked meats
Loose cooked meats
Loose raw meats
Sandwiches prepared on the premises
Sandwiches brought in

Other (please specify)

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