食品不接受和过敏原调查问卷2(中英文版）

FOOD INTOLERANCE ALLERGEN DATA SupplierDate Material IT IS VITALLY IMPORTANT THAT THE INFORMATION SUPPLIED IS CORRECT AND THAT NO UNAUTHORISED CHANGES ARE MADE TO INGREDIENTS OR RECIPES HP FOODS LIMITED 2nd Revision updated 20 02 03 Food Intolerance Allergen Questionnaire Page 1 of 17 Please fill in the boxes below with a Tick for YES if the ingredient is absent from the finished product or a Cross for NO if the ingredient is present CRITICALCRITICALCRITICAL MAJORMAJORMAJOR ALLERGENSALLERGENSALLERGENS Food allergies can in certain cases threaten consumers health It is for this reason that HP Foods Ltd has decided in line with the policy of our Parent Company Danone to provide consumer with better information on the presence of potentially allergenic ingredients in the products In order to answer very specific requests from our customers we would be grateful for as much details as possible on the allergen status of the finished product section called PRODUCT as well as on the risk of cross contamination in your factory section called FACTORY SITE We trust that by supplying this information we are anticipating any future issues that may arise concerning this subject We thank you for your co operation in advance FOOD INTOLERANCE ALLERGEN DATA SupplierDate Material IT IS VITALLY IMPORTANT THAT THE INFORMATION SUPPLIED IS CORRECT AND THAT NO UNAUTHORISED CHANGES ARE MADE TO INGREDIENTS OR RECIPES HP FOODS LIMITED 2nd Revision updated 20 02 03 Food Intolerance Allergen Questionnaire Page 2 of 17 FREE FROM MILK MILK DERIVATIVES PRODUCT YESNO Free from means absolute absence of Milk cow goat sheep Milk solids non fat solids Milk powders Cream artificial cream Cheese cheese powder Yoghurt yoghurt powder Butter Margarine or shortening containing whey Whey hydrolysed whey protein hydrolysed whey sugar Casein caseinates hydrolysed casein Lactose If answered no please give further details below Free from Critical Allergens YESNO Casein Lactoglobuline Lactalbumin If the answer to the above question is NO is the ingredient free from Production Enhancing Growth Promoting Hormones including Bovine Somatotrophin BST YESNO WARNING This information will be used to generate information for consumers who suffer severe and potentially fatal allergic reactions to very small quantities of Milk or Milk ingredients FACTORY SITE For all of the above are ANY of these products ingredients brought onto site for any purpose whatsoever YESNO If answered YES please give further details below Do you have a company policy for the use of Milk YESNO If answered NO please give further details below Where Milk products are used and or handled are there documented procedures in place for their control and ensuring minimum risk of cross contamination To include YESNO HandlingYESNO StorageYESNO Processing Manufacture or repackaging YESNO Clean down ProceduresYESNO If answered NO please give further details below Should certification of any policies or procedures be required for inspection are these available YESNO FOOD INTOLERANCE ALLERGEN DATA SupplierDate Material IT IS VITALLY IMPORTANT THAT THE INFORMATION SUPPLIED IS CORRECT AND THAT NO UNAUTHORISED CHANGES ARE MADE TO INGREDIENTS OR RECIPES HP FOODS LIMITED 2nd Revision updated 20 02 03 Food Intolerance Allergen Questionnaire Page 3 of 17 FREE FROM EGG EGG DERIVATIVES PRODUCT YESNO Free from means absolute absence of Egg dried egg Egg albumen Egg lecithin Egg yolk If answered no please give further details below Free from Critical Allergens YESNO Ovomucoide Ovalbumine Conalbumine Lysozyme If the answer to the above question is NO is the ingredient free from Production Enhancing Growth Promoting Hormones including Bovine Somatotrophin BST YESNO WARNING This information will be used to generate information for consumers who suffer severe and potentially fatal allergic reactions to very small quantities of Egg or Egg ingredients FACTORY SITE For all of the above are ANY of these products ingredients brought onto site for any purpose whatsoever YESNO If answered YES please give further details below Do you have a company policy for the use of egg products YESNO If answered NO please give further details below Where egg products are used and or handled are there documented procedures in place for their control and ensuring minimum risk of cross contamination To include YESNO HandlingYESNO StorageYESNO Processing Manufacture or repackaging YESNO Clean down ProceduresYESNO If answered NO please give further details below Should certification of any policies or procedures be required for inspection are these available YESNO FOOD INTOLERANCE ALLERGEN DATA SupplierDate Material IT IS VITALLY IMPORTANT THAT THE INFORMATION SUPPLIED IS CORRECT AND THAT NO UNAUTHORISED CHANGES ARE MADE TO INGREDIENTS OR RECIPES HP FOODS LIMITED 2nd Revision updated 20 02 03 Food Intolerance Allergen Questionnaire Page 4 of 17 FREE FROM WHEAT WHEAT DERIVATIVES PRODUCT YESNO Free from means absolute absence of Wheat Wheatflour wheatgerm wheatgerm oil Wheatbran wheatgluten Wheat starch raising agent containing wheat starch Wheat thickener wheat binder Breadcrumbs Hydrolysed wheat protein Rusk If answered no please give further details below FACTORY SITE For all of the above are ANY of these products ingredients brought onto site for any purpose whatsoever YESNO If answered YES please give further details below Do you have a company policy for the use of Wheat YESNO If answered NO please give further details below Where Wheat products and are used and or handled are there documented procedures in place for their control and ensuring minimum risk of cross contamination To include YESNO HandlingYESNO StorageYESNO Processing Manufacture or repackaging YESNO Clean down ProceduresYESNO If answered NO please give further details below Should certification of any policies or procedures be required for inspection are these available YESNO FOOD INTOLERANCE ALLERGEN DATA SupplierDate Material IT IS VITALLY IMPORTANT THAT THE INFORMATION SUPPLIED IS CORRECT AND THAT NO UNAUTHORISED CHANGES ARE MADE TO INGREDIENTS OR RECIPES HP FOODS LIMITED 2nd Revision updated 20 02 03 Food Intolerance Allergen Questionnaire Page 5 of 17 FREE FROM MAIZE AND MAIZE DERIVATIVES PRODUCT YESNO Free from means absolute absence of Maize Maize based starches thickeners If answered no please give further details below WARNING This information will be used to generate information for consumers who suffer severe and potentially fatal allergic reactions to very small quantities of Maize or maize ingredients FACTORY SITE For all of the above are ANY of these products ingredients brought onto site for any purpose whatsoever YESNO If answered YES please give further details below Do you have a company policy for the use of maize YESNO If answered NO please give further details below Where maize products are used and or handled are there documented procedures in place for their control and ensuring minimum risk of cross contamination To include YESNO HandlingYESNO StorageYESNO Processing Manufacture or repackaging YESNO Clean down ProceduresYESNO If answered NO please give further details below Should certification of any policies or procedures be required for inspection are these available YESNO FOOD INTOLERANCE ALLERGEN DATA SupplierDate Material IT IS VITALLY IMPORTANT THAT THE INFORMATION SUPPLIED IS CORRECT AND THAT NO UNAUTHORISED CHANGES ARE MADE TO INGREDIENTS OR RECIPES HP FOODS LIMITED 2nd Revision updated 20 02 03 Food Intolerance Allergen Questionnaire Page 6 of 17 FREE FROM GLUTEN PRODUCT YESNO Free from means absolute absence of protein derived from Wheat wheat derivatives Rye rye derivatives Barley barley derivatives Oats oats derivatives If answered no please give further details below WARNING This information will be used to generate information for consumers who suffer severe and potentially fatal allergic reactions to very small quantities of Gluten FACTORY SITE For all of the above are ANY of these products ingredients brought onto site for any purpose whatsoever YESNO If answered YES please give further details below Do you have a company policy for the use of Gluten products YESNO If answered NO please give further details below Where Gluten products are used and or handled are there documented procedures in place for their control and ensuring minimum risk of cross contamination To include YESNO HandlingYESNO StorageYESNO Processing Manufacture or repackaging YESNO Clean down ProceduresYESNO If answered NO please give further details below Should certification of any policies or procedures be required for inspection are these available YESNO FOOD INTOLERANCE ALLERGEN DATA SupplierDate Material IT IS VITALLY IMPORTANT THAT THE INFORMATION SUPPLIED IS CORRECT AND THAT NO UNAUTHORISED CHANGES ARE MADE TO INGREDIENTS OR RECIPES HP FOODS LIMITED 2nd Revision updated 20 02 03 Food Intolerance Allergen Questionnaire Page 7 of 17 FREE FROM SOYA DERIVATIVES PRODUCT YESNO Free from means absolute absence of Soya Soya protein products beans flour milk tofu Lecithin from Soya E322 Hydrolysed Soya protein Soya based flavour emulsifier stabiliser If answered no please give further details below Free from Critical Allergens YESNO Gly m 1A Gly m 1B Gly m Bd WARNING This information will be used to generate information for consumers who suffer severe and potentially fatal allergic reactions to very small quantities of Soya or Soya ingredients FACTORY SITE For all of the above are ANY of these products ingredients brought onto site for any purpose whatsoever YESNO If answered YES please give further details below Do you use machinery lubricants which contain Soya oils YESNO If answered YES please give further details below Do you have a company policy for the use of soya products and Soya oils YESNO If answered NO please give further details below Where Soya products and Soya oils are used and or handled are there documented procedures in place for their control and ensuring minimum risk of cross contamination To include YESNO HandlingYESNO StorageYESNO Processing Manufacture or repackaging YESNO Clean down ProceduresYESNO If answered NO please give further details below Should certification of any policies or procedures be required for inspection are these available YESNO FOOD INTOLERANCE ALLERGEN DATA SupplierDate Material IT IS VITALLY IMPORTANT THAT THE INFORMATION SUPPLIED IS CORRECT AND THAT NO UNAUTHORISED CHANGES ARE MADE TO INGREDIENTS OR RECIPES HP FOODS LIMITED 2nd Revision updated 20 02 03 Food Intolerance Allergen Questionnaire Page 8 of 17 FREE FROM NUTS ALLERGENIC SEEDS PRODUCT Free from means absolute absence of all nuts nut products allergenic seeds and their oil derivatives including YESNO AlmondsPeanuts Groundnuts BrazilnutsPecans CashewnutsPistachio ChestnutsWalnuts Cobnuts Hazelnuts Macadamia nuts Sesame Seeds Pinenuts Pine Kernals All Cold Pressed Nut Oils All Unrefined Nut Oils Please identify type of nut Sesame Seeds Pine Kernals Oils and sources of vegetable protein containing derivatives of any of the products listed Please state if Hot or Cold Pressed and if the Oil conforms to SCOPA standards If answered NO please give further details below PEANUT GROUNDNUTS Free from Critical Allergens YESNO Conarachine A Arachine Sesame seed oil and derivatives multiple components btwn 8 84kD WARNING This information will be used to generate lists of nut allergenic seed free products to provide information to consumers who suffer severe and potentially fatal allergic reactions to very small quantities of nuts allergenic seeds or seed nut derivatives FOOD INTOLERANCE ALLERGEN DATA SupplierDate Material IT IS VITALLY IMPORTANT THAT THE INFORMATION SUPPLIED IS CORRECT AND THAT NO UNAUTHORISED CHANGES ARE MADE TO INGREDIENTS OR RECIPES HP FOODS LIMITED 2nd Revision updated 20 02 03 Food Intolerance Allergen Questionnaire Page 9 of 17 FACTORY SITE For all of the above are ANY of these products ingredients brought onto site for any purpose whatsoever YESNO If answered YES please give further details below Do you use machinery lubricants which contain nut sesame pine kernal oils YESNO If answered YES please give further details below Do you have a company policy for the use of nut products and nut oils sesame pine kernals YESNO If answered NO please give further details below Where nut sesame pine kernals products and nut sesame pine kernal oils are used and or handled are there documented procedures in place for their control and ensuring minimum risk of cross contamination To include YESNO HandlingYESNO StorageYESNO Processing Manufacture or repackaging YESNO Clean down ProceduresYESNO If answered NO please give further details below Should certification of any policies or procedures be required for inspection are these available YESNO FOOD INTOLERANCE ALLERGEN DATA SupplierDate Material IT IS VITALLY IMPORTANT THAT THE INFORMATION SUPPLIED IS CORRECT AND THAT NO UNAUTHORISED CHANGES ARE MADE TO INGREDIENTS OR RECIPES HP FOODS LIMITED 2nd Revision updated 20 02 03 Food Intolerance Allergen Questionnaire Page 10 of 17 FREE FROM FISH AND FISH DERIVATIVES PRODUCT YESNO Free from means absolute absence of any product derived from fish If answered no please give further details below Free from Critical Allergens YESNO Parvalbumine If the answer to the above question is NO is the ingredient free from Production Enhancing Growth Promoting Hormones including Bovine Somatotrophin BST YESNO WARNING This information will be used to generate information for consumers who suffer severe and potentially fatal allergic reactions to very small quantities of Fish or Fish ingredients FACTORY SITE For all of the above are ANY of these products ingredients brought onto site for any purpose whatsoever YESNO If answered YES please give further details below Do you have a company policy for the use of Fish products and Fish oils YESNO If answered NO please give further details below Where Fish products and Fish oils are used and or handled are there documented procedures in place for their control and ensuring minimum risk of cross contamination To include YESNO HandlingYESNO StorageYESNO Processing Manufacture or repackaging YESNO Clean down ProceduresYESNO If answered NO please give further details below Should certification of any policies or procedures be required for inspection are these available YESNO FOOD INTOLERANCE ALLERGEN DATA SupplierDate Material IT IS VITALLY IMPORTANT THAT THE INFORMATION SUPPLIED IS CORRECT AND THAT NO UNAUTHORISED CHANGES ARE MADE TO INGREDIENTS OR RECIPES HP FOODS LIMITED 2nd Revision updated 20 02 03 Food Intolerance Allergen Questionnaire Page 11 of 17 FREE FROM CRUSTACEANS Shellfish PRODUCT YESNO Free from means absolute absence of any product derived from Crustaceans If answered no please give further details below Free from Critical Allergens YESNO Tropomyosine If the answer to the above question is NO is the ingredient free from Production Enhancing Growth Promoting Hormones including Bovine Somatotrophin BST YESNO WARNING This information will be used to generate information for consumers who suffer severe and potentially fatal allergic reactions to very small quantities of Crustaceans or Crustaceans ingredients FACTORY SITE For all of the above are ANY of these products ingredients brought onto site for any purpose whatsoever YESNO If answered YES please give further details below Do you have a company policy for the use of Crustaceans YESNO If answered NO please give further details below Where Crustaceans are used and or handled are there documented procedures in place for their control and ensuring minimum risk of cross contamination To include YESNO HandlingYESNO StorageYESNO Processing Manufacture or repackaging YESNO Clean down ProceduresYESNO If answered NO please give further details below Should certification of any policies or procedures be required for inspection are these available YESNO FOOD INTOLERANCE ALLERGEN DATA SupplierDate Material IT IS VITALLY IMPORTANT THAT THE INFORMATION SUPPLIED IS CORRECT AND THAT NO UNAUTHORISED CHANGES ARE MADE TO INGREDIENTS OR RECIPES HP FOODS LIMITED 2nd Revision updated 20 02 03 Food Intolerance Allergen Questionnaire Page 12 of 17 DIETARYDIETARYDIETARY SUITABLE FOR OVA LACTO VEGETARIANSYESNO Suitable means absolute absence of 1 Slaughterhouse products or fishing 2 Ingredients which contain or derive from slaughterhouse or fishing products such as bovine extract rennet fish extract rennet fish extract 631 Inosine 5 sodium phosphate or emulsifiers E471 E472 E475 If answered no please give further details below SUITABLE FOR VEGANSYESNO Suitable for means absolute absence of all products of animal origin Free from all animal products including eggs milk products and honey Also free from all products of the fishing industry and from vegetable matter which has been modified by animal copy genes where present in the final product If answered no please give further details below CERTIFIED SUITABLE FOR A KOSHER DIETYESNO If yes is a copy of the certification available on requestYESNO CERTIFIED SUITABLE FOR A HALAL DIETYESNO If yes is a copy of the certification available on requestYESNO FREE FROM BEEFYESNO Free from beef means absolute absence of all beef and beef derivatives including stocks beef extract beef gelatine beef fat beef blood beef extract derived additives and pork extract used as processing aids e g clarifying finings for drinks and food machine lubricants If answered no please give further details below If the answer to the above question is NO is the ingredient free from Production Enhancing Growth Promoting Hormones including Bovine Somatotrophin BST YESNO FREE FROM PORK Free from pork means absolute absence of all pork YESNO Pork derivatives including stocks pork extract pork gelatine pork fat pork blood pork extract derived additives and pork extract used as processing aids e g clarifying finings for drinks and food machi