FOOD CERTIFICATION QUESTIONNAIRE

COMPANY OR ORGANISATION TO BE AUDITED

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

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

Company Name:
Address:
City
Region/State
Zip code / Postcode: Country:
Contact Name: Contact Position:
Contact E-mail Address: Tel No.

STANDARD & AUDIT TYPE REQUESTED

(Please complete pages 1& 2 and any additional section requested below)
☐ BRCGS Gluten ☐ BRCGS Gluten ☐ BRCGS Plant
☐ BRCGS Food ☐ BRCGS START! Free Certification Free Certification Based Global
(Please complete (Please complete section Program Program plus AOECS Standard
section A) A) (Please complete (Please complete (Please complete
Section A) Section A) Section A)

☐ FSSC 22000 ☒ ISO22000:2018 ☐ FSMA FSVP ☐ FSMA QIC (FDA TPP)

☐ IFS Food
(Please complete section B)
☐ Initial or first time for
certification
☐ IFS Logistics
(Please complete section B)
☐ Renewal of existing or
expired certification
(Please complete section C)
☐ IFS Broker
(Please complete section B)
☐ Extension to scope of
existing certification
(Please complete section C)
☐ IFS Wholesale/C&C
(Please complete section B)
☐ Do you want the audits
selected above combined?

ADDITIONAL AUDIT OPTIONS (can be conducted on the same visit as the above main visit)
☐ AOECS Addendum ☐ V-Label – Vegan and vegetarian food products
(Please provide a copy of your licence or application to AOECS) (Separate questionnaire will be sent)

CURRENT OR PREVIOUS CERTIFICATION

(Please indicate any third-party certification you already have or have previously had.
Please provide a copy of last certificate and report)
CERTIFICATION SCHEME ID# DATE OF LAST
SCHEME BODY (e.g. BRCGS Site code/IFS EXPIRY DATE UNANNOUNCED
(e.g. SGS) COID) AUDIT

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FOOD CERTIFICATION QUESTIONNAIRE

REMOTE AUDITING
☐ Would you like to be assessed about the suitability for your audit to be conducted remotely or part remotely?
(a separate form will need to be completed)

SCOPE
What is the proposed scope of certification?
(Detail product/s manufactured and key processes, packaging e.g. Processing of Línea de producción de producto panificado
sliced pineapple in cans.)
(If Traded Goods are stored on site, they must be either included in the audit or
(almojabanas) congelado para consume directo
listed as an exclusion)
Exclusions – detail any product lines/operations or product
NA
groups you would like to be excluded from certification
Justification for the exclusions NA
Detail any operations included in the scope that are performed
on another site? NA
What is the distance from this site?
Is any part of the process and/or product sub-contracted (out-
NA
sourced)? If Yes, please detail what.
If warehousing is off site and managed by the same team as
NA
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 sharing 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 and canned strawberry juice. (3 product types)
PRODUCT FAMILY
PRODUCT

Producto
TYPE

Number of HACCP Plans/studies

Plant size (metres square including storage on site)
Headcount (total employees including temporary workers)
Are any products mentioned
Please provide the number 1 in the scope produced No
of shifts outside of normal working
hours (day shift)?
Number of production Full
Time Equivalents (FTE) on 8 horas Number of production lines 1
main shift
Is the process fully automated? No
Was a consultant used in the development of the
Management System? If yes, please provide the name of No
the consultant used.

REALIZE; FOOD SAFETY CULTURE ASSESSMENT

Number of Operators:
Number of Supervisors/Managers:
Number of Leadership personnel:
What languages do your employees read?
What language do you want the report in?
(please complete if required)
A member of staff who typically has a line role and is not
responsible for managing or supervising others
A member of staff who typically works on the “shop floor”
and has the responsibility to supervise or manage
others within their area or team
A member of staff whose work is not typically on the
“shop floor” and who plans and manages the work of
others
Español
Español

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FOOD CERTIFICATION QUESTIONNAIRE

Section A (BRCGS)

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

BRCGS AUDIT OPTIONS

There will be a follow-up questionnaire if you require an unannounced audit.
☐ Announced ☐ Full Unannounced

PRODUCTION RISK ZONES

Does the site contain any of the following production risk zones?
☐ High Care ☐ High Risk ☐ Ambient High Care

BRCGS ADDITIONAL VOLUNTARY MODULES/ADDENDUM AUDITS

Please detail any modules required – FSMA ready, Meat Supply Chain assurance

Do you supply Costco? The BRCGS Costco addendum is compulsory for North America sites, and
optional for all other locations

BRCGS START! AUDIT OPTIONS

Please confirm the level of assessment required
☐ Basic ☐ Intermediate

BRCGS GFCP (Gluten Free Certification Program) & BRCGS PBGS (Plant Based
Global Standard)
BRCGS must be contacted prior to requesting an audit. A certificate will not be issued without a Program
Licence Agreement (PLA) or signed Schedule A (or equivalent). Please confirm the following -
A PLA has been set up with BRCGS
Schedule A application is in progress with BRCGS (A non conformity will be raised at
the audit if this has not been signed by both yourselves & BRCGS)
BRCGS GFCP only - If you have selected ‘plus AOECS’ option, in order to
display the Cross Grain trademark on your products, do you hold an
agreement with AOECS member and have an equivalent ‘Schedule A’
confirming the products approved?
*SGS team – if the AOECS option has been chosen, then you must contact info@aoecs.org, as you will need to liaise
with the correct member society to obtain the applicable ‘Site cross grain certificate’.

Completed by:
Date:

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FOOD CERTIFICATION QUESTIONNAIRE

Section B (IFS)
Multi-legal entities, 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, IFS Logistics, IFS Broker, IFS Wholesale/C&C

Audit language
Language of quality manual / documents
For IFS Food: are there any traded
products and/or fully outsourced products?
If yes, please give details
For IFS Food: are there any processing
activities carried out at a decentralised
location? If yes, please give details
For IFS Logistics: does the company also
have own broker activities? If yes, please
give details
For IFS Broker: does the company also
have own logistics activity? If yes, please
give details
☐ Unannounced-Renewal ☐ Unannounced-Initial
☐ Announced
(unannounced options are not applicable for IFS Wholesale/C&C)
There will be an additional registration form if you require an unannounced audit.
Please note! If the deadline for registration for unannounced renewal is missed, an unannounced initial registration can be done only, this
may result in the interruption of the certification cycle.

Food Product Scope(s) for IFS Food, IFS Logistics, IFS Broker, IFS Wholesale/C&C
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

Non-Food Product Scope(s) for IFS Logistics, IFS Broker, IFS Wholesale/C&C
Household and personal Other non-food products
☐ ☐ Packaging materials ☐
care products (applicable for IFS Logistics only)
If your company deals with such non-food products but does not want them certified,
please indicate theseproducts as ‘Exclusion’ on the 2nd page of this questionnaire

Logistic services for IFS Logistics

☐ Storage - ambient ☐ Transport - ambient
☐ Storage – temperature controlled ☐ Transport – temperature controlled
☐ Cross docking

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FOOD CERTIFICATION QUESTIONNAIRE

Modules for IFS Wholeale/C&C

☐ Wholesale Classic – no treatment / processing (e.g. labelling, sorting, washing, packaging, etc.)
☐ Cash & Carry Classic – no treatment / processing (e.g. labelling, cutting, packaging, etc.)
☐ Wholesale Plus – with treatment / processing (e.g. labelling, sorting, washing, packaging, etc)
☐ Cash & Carry Plus – with treatment / processing (e.g. labelling, cutting, packaging, etc.)
Please tick which most applicable to your company’s activity

Technology Scope(s) for IFS Food, IFS Wholesale Plus, IFS C&C Plus
IFS Tech IFS processing step – including
scope processing/treating/manipulation/ storing
A ☐ P1 Sterilisation (e.g. cans)
Thermal pasteurisation, UHT/aseptic filling; hot
B ☐ P2 filling; Other pasteurisation techniques e.g. high
pressure pasteurisation, microwave
☐ P3 Irradiation of food
Preserving: Salting, marinating, sugaring,
☐ P4 acidifying/pickling, curing, smoking, etc.
C
Fermentation/acidification
Evaporation/dehydration, vacuum filtration, freeze
☐ P5
drying, microfiltration (less than 10ì mesh size)
Freezing (at least -18°C) including storage Quick
☐ P6 freezing, Cooling, chilling processes and respective
D cool storing
☐ P7 Antimicrobial dipping/spraying, fumigation
☐ P8 Packing MAP, Packing under vacuum
Processes to prevent product contamination esp.
microbiological contamination, by means of high
hygiene control and/or specific infrastructure during
handling, treatment and/or processing e.g. clean
☐ P9
room technology, „white room“, (controlled working
E
room temperature for food safety purpose,
disinfection after cleaning, positive air pressure
systems (like filtration below 10 μ).
Specific separation techniques: e.g. filtration like
☐ P10
reverse osmoses, use of active charcoal
Cooking, baking, bottling, filling of viscous products,
☐ P11 brewing, fermentation (e.g. wine), drying, frying,
roasting, extrusion, churning
Coating, breading, battering, cutting, slicing, dicing,
dismembering, mixing/blending, stuffing,
F
☐ P12 slaughtering, sorting, manipulation, packaging,
storing under controlled conditions (atmosphere)
except temperature, labelling
Distillation, purification, steaming, damping,
☐ P13 hydrogenating, milling
Technology oriented classification which takes
also into consideration product risks
Sterilisation (in final packaging) with the purpose to
destroy pathogens
Sterilised (e.g. autoclaved) products in final
packaging.
Pasteurisation / other heat treatment or other
technology applied with the purpose to reduce food
safety hazards (and UHT process)
Processed products: Treatment with purpose to
modify product and/or extend the shelf life and/or
reduce food safety hazards by preservation
techniques and other processing techniques Note -
exception: Irradiation is attributed to this category
although aimed at the destruction of microorganisms.
Systems, treatments to maintain product integrity and
or safety: Treatment with purpose to maintain the
quality and/or integrity of the products including
treatments to remove contamination and/or prevent
contamination
Systems, treatments to prevent product contamination
P9 is applicable in any case when there are at least 2
procedures / methods implemented in a company to
guarantee product safety / product hygiene. E.g.:
• disinfection of equipment + chilled room temperature
(e.g. dissection of meat)
• disinfection + special hygiene equipment for
employees (e.g. hygiene sluice)
• room with over-pressure + special hygiene
equipment for employees (e.g. hygiene sluice),
• air filtration + room with over-pressure
Not limited to the examples given, also techniques like
centrifugation in oil manufacturing etc. need to be
considered
Any other manipulation, treatment, processing not
being listed in A, B, C, D, E

Signature:
Date:

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FOOD CERTIFICATION QUESTIONNAIRE
Section C (FSMA)

Which FSMA scope applies to the facility?

Human Food Dietary supplements
Animal Food Low Acid Canned Food
Seafood HACCP Produce Safety
Juice HACCP Intentional Adulteration
Other:
What type of Audit/Certification is requested?
FSMA QIC (FDA TPP) Consultative audit
FSMA QIC (FDA TPP) 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 codes - required for FSMA QIC (FDA TPP): (To determine FDA product codes of food products
manufactured at the facility, please visit : 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

All Standards – Please provide any further relevant information

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