DVS/GVHP EBN NO.

1
PERMOHONAN SKIM PENSIJILAN DVS
AMALAN KEBERSIHAN VETERINAR YANG BAIK
UNTUK PEMPROSESAN RAW CLEAN - EDIBLE BIRDNEST (EBN)]
APPLICATION FOR DVS CERTIFICATION SCHEME
GOOD VETERINARY HYGIENIC PRACTICES FOR PROCESSING OF
RAW CLEAN - EDIBLE BIRDNEST (GVHP EBN)]

DEPARTMENT OF VETERINARY SERVICES

MINISTRY OF AGRICULTURE AND AGRO-BASED INDUSTRY
MALAYSIA
Wisma Tani, Podium Block 1A, Lot 4G1,
Precinct 4, Federal Government Administrative Centre,
62630 Putrajaya, Malaysia
Tel: 603-88702022 Fax:603- 88885755

A) PARTICULARS OF ESTABLISHMENT/PREMIS
(Sila sertakan profil syarikat / premis)
(Please attach Company/Premise Profile)

1. Nama Pemohon: 2. Tarikh:

Applicant’s Name : Date :
3. E-mail (jika ada):
E-mail ( if available):
4. Nama dan alamat Syarikat : 5. No. Telefon:
Company Name and Address : Telephone No. :

6. No. Faks:
Fax No. :

7. Nama dan Alamat Premis Pemprosesan (jika berlainan): 8. No Lesen Loji (dari DVS/ PBT/ Agensi
Name and Address of processin plant (if different): lain jika ada):
Premise Licence No
(from DVS/Local Authority/other agencies
if available):

9.Jenis operasi (Sila tandakan / ): 10. Jenis Establishment (Sila tandakan /):
Type of Operation (Please tick /) : Type of Establishment (Please tick /) :

i. □ Sarang Burung Mentah Bersih (Raw-clean EBN ) i. □ Bersendiri (Detached )

ii. □ Sarang Burung Mentah Tidak Bersih (Raw-Unclean EBN) ii. □ Lot /rumah kedai (Shop lot)

iii. □ Lain-lain (Others) Sila nyatakan iii. □ Berkembar (Semi detached)

(please state)........................
iv. □ Lain-lain (Others) Sila nyatakan
(please state)...........................

11. Tahun loji beroperasi: ..........................

Year of operation: ...............................

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GVHP : Application for Good Veterinary Hygienic Practices for Processing of Raw Clean - edible Birdnest (GVHP EBN )
Accreditation Scheme –DVS EBN No.1
 B) AMALAN KEBERSIHAN VETERINAR YANG BAIK UNTUK PEMPROSESAN
RAW CLEAN - EDIBLE BIRDNEST (EBN)]
GOOD VETERINARY HYGIENIC PRACTICES FOR PROCESSING OF
RAW CLEAN - EDIBLE BIRDNEST (GVHP EBN)

12.Adakah Amalan Kebersihan Veterinar yang Baik (GVHP) dilaksanakan di loji.

State whether you have Good Veterinary Hygienic Practice (GVHP)
YES NO
Jika YA sila tandakan perkara yang berkaitan:
If Yes please ticks the relevent matters;

12.1 □ Rekabentuk dan Kemudahan (Design and Facilities)

12.2 □ Penyimpanan (Storage)
12.3 □ Kawalan Operasi (Control of Operation )
12.4 □ Prosidur Kawalan Keselamatan Produk (Product safety Control Procedures)
12.5 □ Penyelengaraan dan Kebersihan (Maintenance and Cleaning)
12.6 □ Kawalan Makhluk Perosak (Pest Control)
12.7 □ Kebersihan Personal (Personnel Hygiene)
12.8 □ Latihan (Training)
12.9 □ Keperluan Perundangan (Legal Requirements)

(Sila sertakan dokumen sokongan bagi perkara tersebut di atas. Sila rujuk senarai semak di Appendix 1)
(Please submit supporting documents as mentioned above. Please refer checklists at Appendix 1)

13.a) Bilangan Pekerja. Sila nyatakan;

No. Of Staff, please state:

Kategori Jawatan (Position) Bil. pekerja

(No. of staff)
Pengurusan dan Pentadbiran
(Management)
Supervisor (Supervisory)
Pegawai Kawalan Kualiti
(Quality Control Officer)
Pekerja Pemprosesan (Worker)
Lain-lain (Others)

b) Kebajikan/Kemudahan Pekerja (Staff welfare/facilities)

Sila tandakan (/) (Please ticks (/)):
□ Tandas (Toilet)
□ Loker (Locker)
□ Bilik Persalinan (Changing rooms)

(C) DECLARATION BY MANAGER/OWNER

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GVHP : Application for Good Veterinary Hygienic Practices for Processing of Raw Clean - edible Birdnest (GVHP EBN )
Accreditation Scheme –DVS EBN No.1
I declare that the information given above are true and correct. The company under-takes to comply with all
requirements of the GVHP EBN Accreditation Scheme of Department of Veterinary Services Malaysia .

Signature :

Company Name and

Name and Designation : Stamp

Date :

(D) Witness to Signatory (checked and Verify by)

Signature :

Company Name and

Name and Designation : Stamp

Date :

(E) For Official Use Only (DVS Malaysia)

Comments :

Name :

Designation of DVS Officer : __________________________________________

Signature and Official Stamp:__________________________________________

Date:_____________________________________________________________

Appendixs 1

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GVHP : Application for Good Veterinary Hygienic Practices for Processing of Raw Clean - edible Birdnest (GVHP EBN )
Accreditation Scheme –DVS EBN No.1
SENARAI SEMAK DOKUMEN SOKONGAN UNTUK MENGUKUHKAN PERMOHONAN SKIM
PENSIJILAN GVHP EBN:
(LISTS OF DOKUMENTS FOR FURTHER SUPPORT THE APPLICATION OF GVHP EBN
ACCREDITATION SCHEME):
__________________________________________________________________________________________

(Bagi mengukuhkan lagi permohonan ini, sila semak dan sertakan dokumen sokongan bersama
permohonan ini seperti berikut. Kekurangan maklumat/ tidak lengkap akan melambatkan proses
permohonan GVHP EBN).
(You are kindly requested to check and submit supporting documents together with this application as followed.
If your information is inadequate / incomplete, it may result in delays in processing of GVHP EBN application).

Nama Loji/ establishment : __________________________________________________________________

(Name of PremiseEstablishment)

Maklumat yang diperlukan oleh DVS untuk Skim Pensijilan GVHP EBN Tandakan
Information Required By DVS For GVHP EBN Accreditation Scheme (/)

A) Maklumat Loji (Particulars of Premise)

Salinan Lesen Perniagaan (A copy of business licence)

B) Dokumen Pengurusan Loji. Documents on Premise Management
Termasuk Amalan Kebersihan Veterinar yang baik (GVHP):
Include Good Veterinary Hygiene Practice (GVHP):
1. Lokasi (Location)
a. Salinan pelan ke lokasi loji yang menunjukkan persekitaran di sekitar loji.
(Copy of location plan showing clearly the surroundings where the premise is
located.)
2. Infrastruktur & kemudahan (Infrasturcture and facilities)
a. Salinan pelan premis yang menunjukkan kemudahan asas di loji dan
pemisahan antara operasi (Copy of Layout plans which indicate basic
premise facilities and separation between different operations)
b.Gambar kemudahan /aliran proses di loji
i. (Photographs of farm facilities/process flow in premise)
3. Rekabentuk dan Kemudahan (Design and Facilities)

4. Stor (Storage)
5. Kawalan Operasi (Control of Operation)
6. Prosidur Kawalan Keselamatan Produk (Product Safety Control Procedures)
7. Penyenggaraan dan Kebersihan (Maintenance and Cleaning)
8. Kawalan Makhluk Perosak (Pest Control)
9. Kebersihan Personal (Personnel hygiene)
10. Latihan (Training)
11. Keperluan Perundangan (Legal Requirements)

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GVHP : Application for Good Veterinary Hygienic Practices for Processing of Raw Clean - edible Birdnest (GVHP EBN )
Accreditation Scheme –DVS EBN No.1
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GVHP : Application for Good Veterinary Hygienic Practices for Processing of Raw Clean - edible Birdnest (GVHP EBN )
Accreditation Scheme –DVS EBN No.1