SF01 Food Application Form

Bureau Veritas Certification

Local office address
Before we can prepare an offer, we need some information about your organisation and staff. Would you please
complete the application form below (from sections A to C, including Annexes), and return it by email. All information
supplied will be treated with strict confidentiality. Your application does not commit you to using our services and no
application fee will be charged.

SECTION A – COMPANY DETAILS

Company name or head office: Please ensure that you use Company registration number: Please ensure this
the correct legal name matches the legal name given
Company full address: Prime Meat Packers (U) Limited, Old Port Bell Road.

Country: Uganda Spoken language of the company: English

If more than 1 site, please detail each site address:

VAT number: FDA Establishment number: FDA Registration number:

Company webpage: None
Other:

CONTACT
Contact name Julius Muhimbo
E mail address juliusmuhimbo@gmail.com
Mobile phone number +256751700348
Desk phone number
Job title: Quality Analyst
ONLY COMPLETE IF BILLING DETAILS ARE DIFFERENT
Company name or head office: Please ensure that you Company registration number: Please ensure this
use the correct legal name matches the legal name given
Company full address:

Country: E mail address:

VAT number:

AUDIT TYPE
Is it a combined audit? ☐ Yes ☒ No
☐ ISO 22000 ☒ FSSC 22000 ☐ BRCGS ☐ IFS ☐ GFSI Global Market ☐ FSMA TPP
If yes, for which standard(s)/ norm(s)?

Which type of audit do you request? ☒ Initial ☐ Renewal ☐ Transfer

☐ Surveillance ☐ Extension
CURRENT GFSI AND/ OR MANAGEMENT SYSTEM CERTIFICATION
Please detail and provide certificate(s)
Standard/ norm (i.e. ISO 9001, ISO 14001, ISO 22000, FSSC 22000
BRCGS, IFS, FSSC 22000, etc.)
For IFS only, IFS site number (COID):
For BRCGS only, BRCGS site number:
BRCGS grade of the last 3 previous audits:
For GFCP only, BRCGS site number (if known):

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SECTION B – CERTIFICATION NEEDED (please select product category(ies) in Annex)

☐ ISO 22000:2005 ☐ ISO 22000:2018 Transition to be made during: ☐ Renewal ☐ Surveillance
BRCGS
☐ BRCGS Food ☐ Announced ☐ Unannounced
☐ BRCGS Packaging High Hygiene ☐ Announced ☐ Unannounced option 1 ☐ Unannounced option 2
☐ BRCGS Packaging Basic Hygiene ☐ Announced ☐ Unannounced option 1 ☐ Unannounced option 2
☐ START (Global Market BRCSG Food) ☐ basic level ☐ Intermediate level
BRCGS Food Modules: BRCGS Modules:
☐ BRCGS AVM 09_ Traded Goods ☐ BRCGS ASDA AA module
☐ BRCGS AVM 11_ Meat Supply ☐ BRCGS ASDA FF (Freefrom) module
Chain
☐ BRCGS AVM 12_ AOECS_ Gluten
Free
☐ BRCGS AVM 15_ FSMA
☐ BRCGS Agents & Brokers – Please Complete BRCGS Annex Only
☐ BRCGS Storage & Distribution
☐ Global Market BRCSG Packaging ☐ basic level ☐ Intermediate level
BRCGS Packaging Modules:
☐ BRCGS AVM Traded Goods

☐ BRCGS Gluten-Free Certification Program ☐ Combined with ☐ Unannounced

☐ Standalone
(GFCP) Combined with

☐ IFS Food ☐ Announced ☐ Unannounced option 1 ☐ Unannounced option 2

☐ Global Market IFS Food ☐ basic level ☐ Intermediate level
☐ IFS Broker
☐ IFS Logistics ☐ Announced ☐ Unannounced option 1 ☐ Unannounced option 2
☐ Global Market IFS Logistics ☐ basic level ☐ Intermediate level
☐ IFS PACsecure
☐ Global Market IFS PACsecure ☐ basic level ☐ Intermediate level

FSSC 22000
☐ Announced ☐ Unannounced
☒ FSSC Food Manufacturing (cat C) ☐ FSSC Transport and storage (cat G)
☐ FSSC Feed (cat D) ☐ FSSC Biochemicals (cat K)
☐ FSSC Catering (cat E) ☐ FSSC Packaging and Packaging Materials (cat I)
☐ FSSC Quality
☐ FSSC FSMA Addendum
☐ Global Market ☐ basic level ☐ Intermediate level

FSMA VQIP TPP Third Party Accredited Certification Program

☐ FSMA VQIP TPP Regulatory audit

EXTRA CUSTOMERS AUDITS

☐ ALDI GFSI Addendum
☐ COSTCO GFSI Addendum ☐ COSTCO full audit GMP or others EFA number:
☐ Mc DONALD’S (SQMS) GFSI Addendum ☐ Mc DONALD’S (SQMS) full audit Rizepoint number:
☐ Mc DONALD’S Animal Welfare & Health Audit ☐ Mc DONALD’S (DQMP) ☐ Mc DONALD’S (SWA)
☐ GFSI Global Market ☐ basic level ☐ Intermediate level
Other:

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SECTION C – AUDIT SCOPE AND COMPANY PROCESSES

AUDIT SCOPE (to be confirmed by technical review of Bureau Veritas Certification)
Note: in case of exclusion of products/ processes in the audit scope, please justify (for IFS only, please fill in the Exclusion questionnaire)

☐ I would like to exclude some products of the audit scope (please tick only if applicable):

☐ Scope change since last certification/audit. (If Yes; Please explain and justify including changes in product and
technology scope)

PRODUCTS AND SERVICES PROVIDED (please detail the products you produce and /or the services and activities
you provide). Please provide your process flow diagram:
Beef and Goats Meat

Activity of the internal laboratory: None

Activity of product development: None
1. INCOMING MATERIALS (please list the main ingredients and packaging materials)
Cattle and Goats

2. PRODUCT STORAGE (please provide details of on-site product storage including in process)
Cold Rooms both chilled and frozen.

3. OFF SITE STORAGE AND WAREHOUSING

None

4. BUILDING AND SITE ASPECTS (please provide any significant details, e.g., any neighbour whose activity may
affect operations, etc.)
None

5. SUB CONTRACTED/ OUTSOURCED ACTIVITIES (e.g. maintenance, calibration, delivery, transport, etc.)
Calibration, Waste Management,Maintenance, Delivery and Transport

6. FUNCTIONS CENTRALLY MANAGED BY A HEAD OFFICE (e.g. purchase, quality management, etc.)
Puchase, Production, Quality Management, Admin

NUMBER OF EMPLOYEES
Site 1 Site 2 Site 3 Site 4 Site 5 Site 6 Site 7 Site 8 Site 9 Site 10
Name Name Name Name Name Name Name Name Name Name

1. Administration/office 6
2. Production/processing 10
3. Maintenance/service 2
4. Logistics 5
Subcontracted: 3
Seasonal: 5
Temporary: 5
TOTAL 36
For BRCGS only:
Percentage of employees involved in food activities production:
Labour-intensity of processes:
WORK PATTERN
Employees shift Shift times (i.e. days, nights, 6am-2pm , Activities Number of employees
2-10pm) per shift
1 7am- 6pm Purchase, Production, QA, 36
Admin
2
3
4
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PREMISES, LOCATION & PRODUCTION LINES

Please state the size of the production facilities (in sq. metres) 500sqm
Please state the number of production lines 1 production line.
Please state the size of any warehouse facilities owned or managed by site (in sq. None
metres)
Please clarify if warehouse location (within 50 km) ☒ On-site ☐ Off-Site
Please state location of facilities i.e. industrial estate Industrial Area
If any part of the site is sub-let or under different management, please give details No
Has any consultancy relating to the product/ management system to be certified ☐ Yes ☒ No
been provided? If yes, by whom?
For BRCGS only: age of the site impacting the material flow
For BRCGS only: please state the percentage of the total manufacturing and
storage facility site used as production or storage space
TYPICAL FOOD-RELATED LEGAL, STATUTORY OR REGULATORY FRAMEWORK AND/OR ANY SECTOR-
SPECIFIC REQUIREMENTS APPLICABLE FOR THE PROPOSED SCOPE OF CERTIFICATION

HACCP PLAN / Food Safety Details on HACCP plans Details on CCP’s

Plan(*)
HACCP Plan 1 Meat Products
HACCP Plan 2 Goat Products
HACCP Plan 3
HACCP Plan 4
HACCP Plan 5
HACCP Plan 6
Do you have documented
PRP’s in place (please detail)
(*) A HACCP plan/ Food Safety plan corresponds to a family of products with similar hazards and similar production technology

TARGET DATE FOR AUDIT

25th APRIL 2021
For unannounced audits, please state dates when the site will not be operating (e.g. Saturday & Sunday, plant
maintenance, break weeks - don’t indicate bank holidays)

TRANSFER OF CERTIFICATION
For ISO 22000 or FSSC 22000 only:
When is the transfer planned? ☐ Within the current certification cycle
☐ At re-certification
What are the reasons of the transfer?
Please provide certificate and audit report from previous audit
(including evidences of outstanding non-conformities)
For IFS only: In case your next audit is performed with Bureau
Veritas, please release the access of your data in the IFS database
ADDITIONAL REQUESTS FOR THE AUDIT
Is there a need of translator during the audit? ☐ Yes ☒ No
Have some processes already been audited during a head-office audit (e.g. ☐ Yes ☐ No
purchasing, quality insurance, etc.)?
Does a head office representative plan to attend the audit at the ☒ Yes ☐ No
manufacturing site?

NAME OF THE PERSON WHO FILLED IN THIS FORM:

Date: 3.02.2021
Name: Julius Muhimbo Position: Quality Analyst
Company Representative authorize to sign quotations and contracts, if different from above:
Name: Julius Muhimbo E-Mail address: juliusmuhimbo@gmail.com
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ISO 22000 ANNEX

Please tick the category(ies) related to your activity and to the audit scope (these will be reviewed by Bureau
Veritas technical team).
Please Category ISO 22000 Food chain subcategory
tick
☐ A Farming of AI Farming of Animals for Meat/ Milk/ Eggs/ Honey unaccredited
☐ Animals AII Farming of Fish and Seafood unaccredited
☐ B Farming of BI Farming of plants (other than grain and pulses) unaccredited
☐ plants BII Farming of grains and pulses unaccredited
☒ CI Processing of perishable animal products
☐ C Food CII Processing of perishable plant products
☐ manufacturing CIII Processing of perishable animal and plant products (mixed products)
☐ CIV Processing of ambient stable products
☐ D Animal Feed D1 Production of Feed
☐ Production D2 Production of Pet Food unaccredited
☐ E Catering E Catering
☐ FI Retail/ Wholesale unaccredited
F Distribution
☐ FII Food broking/ trading unaccredited
☒ G Provision of GI Provision of Transport and Storage Services for perishable food and feed
Transport and
☐ Storage GII Provision of Transport and Storage Services for Ambient Stable Food and Feed
Services
☐ H Services unaccredited
Auxiliary
☐ I Production of Food Packaging and Packaging Material
services
☐ J Equipment manufacturing unaccredited
☐ Biochemicals K Production of (bio)chemicals

FSSC 22000 ANNEX

FSSC Food Manufacturing
Please tick FSSC category
☒ CI Processing of perishable animal products
☐ CII Processing of perishable plant products
☐ CIII Processing of perishable animal and plant products (mixed products)
☐ CIV Processing of ambient stable products
☐ DI Production of Feed
☐ DII Production of Pet Food (dogs and cats only)
☐ E Catering
☐ GI – Transport and storage services for perishable food and feed
☐ GII – Transport and storage services for ambient stable food and feed
K Production of (bio)chemicals (limited to food, feed additives, vitamins, minerals, biocultures
☐
flavourings, enzymes and processing aids)

FSSC Packaging
Please tick FSSC category
☒ 1) Plastics
☐ 2) Paper and board
☐ 3) Metal
☐ 4) Glass and ceramics
☐ 5) Wood
☐ 6) Other (e.g. burlap, textile, etc.)

FSSC Quality
Please tick ☒

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BRCGS ANNEX
Please tick the category(ies) related to your activity and to the audit scope (these will be reviewed by Bureau
Veritas technical team).
BRCGS Food
Please BRCGS Food product category Field
tick
☐ 1. Raw red meat
☐ 2. Raw poultry 1. Raw products of animal or vegetable
☐ 3. Raw prepared products (meat and vegetarian) origin
☐ 4. Raw fish products and preparations
☐ 5. Fruit, vegetables and nuts
2 Fruit, vegetables and nuts
☐ 6. Prepared fruit, vegetables and nuts
☐ 7. Dairy, liquid egg 3 Dairy and similar pasteurised liquids
☐ 8. Cooked meat/ fish products
☐ 9. Raw cured and/ or fermented meat and fish 4 Processed foods, ready-to-eat or heat
☐ 10. Ready meals and sandwiches, ready-to-eat desserts
☐ 11. Low/ high acid in cans/ glass 5 Ambient stable products with
☐ 12. Beverages pasteurisation or sterilisation
☐ 13. Alcoholic drinks and fermented/ brewed products
☐ 14. Bakery
☐ 15. Dried foods and ingredients 6 Ambient stable products not involving
☐ 16. Confectionery sterilisation as heat treatment
☐ 17. Cereals and snacks
☐ 18. Oils and fats

PLEASE INDICATE ALL PRESENT RISK LEVEL AREAS IN YOUR FACTORY WITH RATIONALE FOR
THE DECISION
Rationale for the decision
Risk level area Yes/No e.g. low risk area as all products ambient stable, require full
cook before consumption

Enclosed

Low Risk

High Risk

High Care

Ambient High Care

BRCGS Packaging
Please tick BRCGS Packaging manufacturing
category
☐ 1. Glass manufacture and forming
☐ 2. Papermaking and conversion
☐ 3. Metal forming
☐ 4. Rigid plastics forming
☐ 5. Flexible plastics manufacture
☐ 6. Other manufacturing
Examples of key processes Identify the key
processes
undertaken
One glass furnace into one or multiple IS machines,
blow-moulding of ampoules
Pulping and papermaking, corrugating board,
conversion of board without any print process
Manufacture of a beverage can, pressing of
aluminium foil containers
Injection moulding of caps and closures, injection
moulding/production of in-mould labelled containers,
stretch Blow Moulding PET Preform, extrusion Blow
Mould HDPE Milk jug
Extrusion of flexible film, lamination of multi-layer
materials, slitting of film reels
Manufacture of hessian sacking, assembly of
wooden pallets

☐ 7. Print processes Print and conversion of one material type (e.g.

paperboard), where the print and conversion of a
flexible film constitutes an additional process
☐ 8. Chemical processes Manufacture of ink, of glue

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BRCGS Agents & Brokers

Total Number of suppliers used:

Additional Services Provided (e.g. arranging product storage, arranging distribution or delivery of product from the
manu manufacturer and/or to the customer, new product development, import or export):

Number of satellite offices:

Location of satellite offices:

Type of products managed by the agent/ broker:

Please Tick Category description Product Examples
☐ Raw red meat Beef, veal, pork, lamb and venison, offal
☐ Raw poultry Chicken, turkey, duck, goose and quail; farmed and wild game; shell egg

☐ Raw prepared products Bacon , comminuted meat products (e.g. sausages), ready-to-cook
(meat and vegetarian) meals, ready prepared meat products, pizzas and vegetable prepared
meals
☐ Raw fish products and Wet fish, molluscs and crustacea, comminuted fish products (e.g. fish
preparations fingers), ready prepared fish products (e.g. fish pie)

☐ Fruit, vegetables and nuts
☐ Prepared fruit, vegetables and
nuts
☐ Dairy and liquid egg
☐ Cooked meat/fish products
☐ Raw cured and/or fermented
meat and fish
☐ Ready meals and sandwiches,
ready-to-eat desserts
☐ Low/high acid in cans/glass
☐ Beverages
☐ Alcoholic drinks and
fermented/ brewed products
☐ Bakery
☐ Dried foods and ingredients
☐ Confectionery
Fruit, vegetables, salads, herbs and unroasted nuts
Prepared/semi-processed fruit, vegetables and salads; prepared ready-
to-eat salads, coleslaws and frozen vegetables
Liquid egg , liquid milk/drinks, cream and butter, yogurts, fermented milk-
based products, fromage frais and crème fraiche, ice cream, cheeses,
fruit juices (includes freshly squeezed, pasteurised and smoothies), dried
whey powder, dried egg and dried milk/milk formulation
Cooked meats (e.g. ham, meat pâté, hot eating pies, cold eating pies),
molluscs (ready to eat) and crustaceans (ready to eat), hot smoked fish
Parma ham, cold smoked fish and cured fish (e.g. gravlax), air-dried
meats/salami, fermented meats, dried fish
Ready meals, sandwiches, soups and sauces, quiche and flans, cream
cakes, trifles and assembled high-risk sweet desserts
Canned products (e.g. beans, soups, meals, fruit, tuna), products packed
in glass (e.g. sauces, jams, pickled vegetables); pet food
Soft drinks including flavoured water, isotonics, concentrates, squashes
and cordials, mineral and table waters
Beer, wine and spirits; vinegars
Bread, pastry, biscuits, cakes and tarts
Soups, sauces and gravies, spices, stocks, herbs, seasonings and
stuffing’s, pulses, rice, legumes and noodles, dried pet food, vitamins,
salt, sugar and additives, glacé fruit and home baking, tea, instant coffee
and non-dairy coffee creamers
Sugar confectionary, chocolate, gums and jellies

☐ Cereals and snacks Oats, muesli and breakfast cereals, roasted nuts, crisps

☐ Oils and fats Cooking oils, suet and ghee, margarine, shortening and spreads, salad
dressings, mayonnaise and vinaigrettes
☐ Glass Glass bottles, jars, pots, decanters and glass closures, ceramic bottles,
jars and decanters
☐ Paper Paper bags and sacks, paper labels, tags and neck collars, solid and
corrugated board cartons and sleeves, corrugated cases, trays and
fitments
☐ Metal Tinplate and aluminium containers, cans, and aerosol containers,
aluminium foil, foil trays and containers
☐ Rigid plastics Bottles and jars, caps and closures, thermoformed trays, tubs and pots,
buckets and pails and bulk containers
☐ Flexible plastics Cast and blown plastic film, including vacuum metallised films and labels,
multi-ply laminates of combinations of paper, plastics and aluminium foil,
flexible, intermediate, bulk containers, regenerated cellulose film
☐ Other packaging products Pallets, boxes, crates and decorative wooden boxes, wood for food and
cosmetic use, wooden utensils (e.g. for lollipops), natural cork and
rubber, hessian sacks, jute products, woven string (plastic or cotton)
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☐ Packaging and printing Resins, adhesives, inks, varnishes and coatings

chemicals

BRCGS Storage and distribution

Type of products handled:
☐ 1. Chilled and frozen food products ☐ 2. Ambient food products
☐ 3. Packaging ☐ 4. Consumer products
Exclusion of distribution from the scope of a storage site (please tick in case of exclusion): ☐
Sites applying only for distribution: ☐
Number of suppliers used:
Need to witness the unloading of vehicles or to accompany drivers: ☐

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IFS ANNEX

Please tick the scope(s) related to your activity and to the audit scope (these will be reviewed by Bureau Veritas
technical team).

IFS Food
Please tick IFS Food product scope Please tick IFS Food product scope
☒ 1. Red and white meat, poultry and meat ☐ 7. Combined products
products - Raw red meat
☐ 2. Fish and fish products ☐ 8. Beverages
☐ 3. Egg and egg products ☐ 9. Oils and fats
☐ ☐ 10. Dry goods, other ingredients and
4. Dairy products
supplements
☐ 5. Fruit and vegetables ☐ 11. Pet food
☐ 6. Grain products, cereals, industrial
bakery and pastry, confectionary,
snacks

Please IFS Food technology scope Please IFS Food technology scope
tick tick
☐ A P1 Sterilisation ☐ P8 Packing MAP, under vacuum
☐ P9 Processes to prevent product contamination,
P2 Thermal pasteurisation, UHT/ by means of hygiene control and/ or specific
B ☒
aseptic filling, hot filling E infrastructure during handling, treatment and/ or
processing
☐ P10 Specific separation techniques, e.g. filtration
P3 Irradiation of food ☐
like reverse osmose, active charcoal
☐ P4 Preserving, fermentation, P11 Cooking, baking, bottling, brewing,
☐
acidification fermentation, frying, frying, roasting, extrusion
C
☐ P12 Coating, breading, battering, cutting, slicing,
P5 Evaporation/ dehydration,
dicing, mixing, stuffing, slaughtering, sorting,
vacuum filtration, freeze drying, ☒ F
storage under controlled conditions (except
microfiltration
temperature)
☒ P6 Freezing including storage, P13 Distillation, purification, steaming, damping,
☐
cooling, chilling processes hydrogenating, milling
D
☒ P7 Antimicrobial dipping/ spraying,
fumigation

IFS Broker
Type of products managed by the agent/ broker:
☐ Food products ☐ Household and Personal Care products
☐ Packaging materials ☐ Combination of product types

IFS Logistics
Type of products and activities:
☐ 1. Storage ☐ 2. Transport
☐ a. Food products ☐ b. Non-food products

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Mc Donald’s Annex
Please tick the category(ies) related to your activity and to the audit scope (these will be reviewed by Bureau
Veritas technical team).

Please PRODUCTS SUPPLIED TO

tick Mc Donald’s Product Categories MCDONALD’S &
AUDIT SCOPE:
Mc Donald’s Category 1 products
☐ Cooked eggs (or egg products)
☐ RTE fresh/frozen produce (vegetables, fruit, etc.)
☐ Bakery items with a high food safety risk Component.
☐ Beef, poultry, pork, RTE-meat,
☐ Fish, fish/seafood (chilled & frozen)
☐ Natural cheese with non-pasteurized raw milk
Mc Donald’s Category 2 products
☐ Buns/English Muffins/biscuits.
☐ Shell eggs
☐ Fries/Hash Browns
☐ Sandwich sauces (Ph >4.6)
☐ Dairy (pasteurized fluid and cultured), cheeses (natural and processed)
Mc Donald’s Category 3 products
☐ Coke/ beverages/pasteurized juice
☐
Pies, Confectionary Items and Bakery items with a LOW food safety risk
☐ Component, shake syrups/toppings
☐ Dry products (rice, pasta, cereals, oatmeal),
☐ Processed fruits & veg (shelf stable),
☐ dehydrated onions, nuts,
☐ all other condiments/ seasonings, pickles, sauce/ ketchup
☐ Frying oil
☐ Others (specify)

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FSMA VQIP TPP Third Party Accredited Certification Program

Certification against the FSMA VQIP TPP is intended for food processing companies outside the United States of
America which export their products to the U.S.A and which are registered with FDA.

Intended Purpose for Achieving Certification:

My customer/importer requires this supplier certification for the purpose of:
VQIP: ☐Yes ☐No ☐
FDA required for Import Certification (IC) of high risk supplier or product ☐Yes ☐No
Others (please specify):

General Audit Scope Check box to apply

117 - Preventive Controls for Human Food ☐
112 - Produce Safety Rule ☐
123 - Seafood HACCP ☐
120 - Juice HACCP ☐

Applicable Product Categories Check box to Please specify applicable FDA product regulations
apply
Farming of Plants ☐
Farming of Grains and Pulses ☐
Meat products ☐
Dairy products and liquid egg ☐
Fish and seafood products ☐ ☐ 161 Fish and shellfish (standardized identities/measures)
Process perishable plant production ☐
Perishable animal & plant production ☐
Canned food ☐
Alcoholic drinks ☐
Beverages ☐
☐ ☐ 136 Bakery products
Cereals, biscuits and snacks ☐ 137 Cereal flours and related products
☐ 139 Macaroni and noodle products
Oils and fats ☐
Dried foods ☐
Production of (bio) chemicals ☐
Other FDA applicable regulations:

30 days operating schedule (Please provide the preferred audit period):

January February March April May June July August September October November December
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Please confirm expected date for first
commercial transaction with US
Only list dates of planned production
shut-down where the site will not be
operating during selected period.
Personnel vacations and illness are not
justified reasons for blackout dates.
All audits performed unannounced

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