过敏源调查表.doc

.QR-05.02-03过敏源调查表 修订日期：2012年12月Supplier Questionnaire for Allergen Management供应商过敏原调查表According to the quality policy of Sanquan Food, food safety management for all raw material is essential for food supply chain safety control, sincerely we wish that you understand and support our corresponding requirement. To identify corresponding food safety risk, please provide following information to Quality Center of Sanquan Food, you should promise all the information provided is true and objective.根据三全食品的质量政策，原料的食品安全管理是我公司整个供应链安全控制的重要部分，我方诚恳希望贵方理解和支持我方的有关要求。为了界定我方所需产品的食品安全风险，请向三全食品质量中心提供以下材料和声明，并承诺所有提供的信息真实并客观。Note: for all item marked with “*”, supplier should present official announcement to Sanquan Food. 以下要求提供的声明 / 证明中, 凡标有 “*” 星号的, 请贵方提供正式的文件给三全食品 (即要求加盖公司印鉴或管理层签字)。Basic information基本信息1Item name and description 原料名称及产品描述(如产品外观, 性状, 包装等等):2Supplier/agent name 供应商或代理商名称:3Manufacturer name 生产商名称:4Manufacturer location 生产商地址:5Quality assurance representative 质量保证代表:6Process flow chart 工艺流程图（please also mark down the step where the raw material will be added in the process；if the process is covered in HACCP system please also high light the CCP in the process请在流程图中原料/辅料加入的工序标出原料/辅料的名称; 另一方面, 如贵方已实行HACCP体系且该工艺也在体系中请标出各CCP点）Allergen management 过敏原管理1 Please advise if there is any ingredient in below list be used in the production process of the products provided to Sanquan Food ?+= contains - = free from ?= might contain traces, or unknown请告知贵方提供给三全食品的产品中是否含有使用以下表中所列的成分的原料或辅料，如含有请在括号中写正号（+），如果不含有请写负号（-），如果不确定请写问号（？）。01( )cows milk / protein 牛乳及其析出蛋白16( )cocoa 椰子02( )lactose 乳糖17( )nuts 坚果类03( )chickens egg 鸡蛋18( )nut oil 坚果油04( )soya / protein 大豆及其析出蛋白19( )peanuts 花生05( )soya oil 大豆油20( )peanut oil 花生油06( )gluten 麸质21( ) sesame 芝麻07( )wheat 小麦22( )sesame oil芝麻油08( )rye 黑麦23( ) chicken 鸡肉09( )mustard 芥菜 / 芥子/芥未24( )pork 猪肉10( )sulphite 亚硫酸盐25( )coriander 胡荽11( )glutamate谷氨酸酯/盐26( )celery 芹菜12( )fish 鱼类27( )carrot 胡萝卜13( )shellfish and crustaceans 贝壳/甲壳类28( )lupine 狼肉14( )maize 玉米29( ) beef 牛肉15( )legumes/pulses 豆荚类 30( )others其他2 If there is any ingredient in above list be used in the production process in the manufacturer for other clients products?（which allergen in what kind of product）In same production line?生产商在生产其他非三全食品产品的生产过程中是否有使用以上表中所列成分的原料或辅料？（请告知是何种过敏原，用于何种产品）是否使用同一生产线?3 Please advise how the manufacturer to manage the allergen using？how the manufacturer to manage the allergen status of its raw material？and avoid the cross contamination to the products provided to Sanquan Food . Is there an allergen control program in place?请告知我们生产商如何管理含过敏原成分的材料在生产中的使用？如何管理其原材料的过敏原状态？以及如何保障提供给三全食品的产品不受含过敏原成分的材料交叉污染或受其他过敏原交叉污染的威胁。是否有一份过敏原控制程序?4 Please issue an official allergen statement* to Sanquan Food, indicating that the products provided with or without the use of ingredients containing allergens materials, if any ask you to confirm allergen ingredients once again in the space below, if not, please issued a statement, promising that all products provided to Sanquan Food will be avoided cross-contamination by materials with allergens in the whole supply chain (include production, storage an