SKU002 – UNCERTIFIED KERNEL USERS FSQM1

Are you in a position to sign this document for your company*

By ticking this box, I confirm that I am authorised and knowledgeable to supply the information below on behalf of the company named below, and that I will do so to the best of my ability, and that I would rather leave a field blank if I have doubt about what that field pertains to. I also understand and accept that it is my responsibility to inform MSM, by email to info@macsm.org, if any of the information that I provide changes.

Full Legal Name of Company *

Please fill in all fields as they are required annually for FSQM assurance. If you already have a document on hand that describes something then you can just refer to that document.

Physical Address where Cracking Happens

In addition to selling from this company, do you plan on buying product from the MSM platform through this company or an affiliated company?

Yes No

FOOD SAFETY COMPLIANCE

Key Contact Name for FSQM Queries:

Key Contact Cell/Tell Number:

Key Contact Email Address:

Certificate of acceptability (R638) or applicable local certification:

Detailed signed Product Specification:

You will have to provide samples and MRL's (maximum residue levels) for every consignment. Please provide an example of a previous MRL test:

You will have to provide samples and COA's (Certificates of Analysis) for every consignment. Please provide an example of a previous COA result:

Certifications and audit reports. GAP/Organic/FDA etc.. Attach multiple in one go

If you have FSSC, BRC or HACCP certification - you don't have to fill this entire form, you can fill out the Certified Kernel Seller forms which are significantly shorter.

Product Flow Diagram:

Kosher certificate:

Halal certificate:

MAIN ACTIVITIES / PRODUCT PROVIDED / SERVICE PROVIDED

Please list all the product and services provided at this facility

FACILITY/MATERIAL DESCRIPTION

Describe packaging types and sizes available.

Material Safety Sheet if Available:

Are external transportation and storage facilities used as part of the distribution process?

Yes No

Where are they situated and how is the process monitored?

Does the company manufacture the product or only distribute it?

If the company only distributes the product, will there be any decanting / tampering / change in labels with the product?

Shelf life and recommended storage conditions of product.

MICROBIAL STANDARDS

Is Microbial testing done on your products?

Yes No

Is the approval of product release dependent on the outcome of Microbial testing?

Yes No

Is Microbial testing of processing water being done?

Yes No

MAINTENANCE

Do you have a preventative Maintenance program?

Yes No

Maintenance and Calibration Program:

HYGIENE AND HOUSEKEEPING

Do you have a Cleaning / Hygiene Manager?

Yes No Not Applicable

Do you use Contract Cleaners?

Yes No Not Applicable

Do you have a documented Cleaning Schedule?

Yes No Not Applicable

Cleaning Schedule:

Documented Cleaning Checklist if Available:

Are your Detergents used approved for use in food Production Plants?

Yes No Not Applicable

Is cleaning equipment colour coded?

Yes No Not Applicable

Are all staff required to wear protective clothing?

Yes No Not Applicable

Are hand washing stations available at entrances of processing and warehousing areas?

Hand Washing Procedure if available:

FOREIGN BODY CONTROL

Do you have a foreign body policy in place?

Yes No Not Applicable

Foreign Body Control Poicy

Do you have Metal Detectors?

Yes No Not Applicable

Are all products metal detected?

Yes No Not Applicable

How often, and at what points do you test?

Do you have magnets?

Yes No Not Applicable

Do you have a glass breakage policy and procedure in place?

Yes No Not Applicable

Do you have a glass register?

Yes No Not Applicable

Do you carry out regular audits of glass and hard plastic?

Yes No Not Applicable

Are all lights protected?

Yes No Not Applicable

Are all foreign objects found logged and kept?

Yes No Not Applicable

Do you have rework procedure in place?

Yes No Not Applicable

Do you have Food Fraud program in place?

Yes No Not Applicable

SUPPLIER RAW MATERIAL CONTROL

Do you have a Supplier assessment program?

Yes No Not Applicable

Do you Audit your Suppliers?

Yes No Not Applicable

Do you make use of a Risk System to Audit your Supplier against?

Yes No Not Applicable

Do you have specifications for all the raw materials used in the final product supplied?

Yes No Not Applicable

SIGN-OFF

Full Name and Surname*

Date of Signing*

Please sign in the block by drawing your signature with your finger or mouse*

SKU002 – UNCERTIFIED KERNEL USERS FSQM1

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