Allergen Checklist for Food Suppliers or Manufacturers

• Product Name

• Conducted on

  Date

• Conducted by

• Company address
  Address

• Instructions:
  
  1. Select the allergen present in the product by clicking '+' below
  2. Answer with a YES or NO on questions below and when applicable specify the name of the ingredient being referred to.

Allergen

• Select allergen present in the product

  Select Milk Eggs Fish Crustacean shellfish Tree nuts Peanuts Wheat Soybeans Other

  • Milk
  • Eggs
  • Fish
  • Crustacean shellfish
  • Tree nuts
  • Peanuts
  • Wheat
  • Soybeans
  • Other

• Please specify

• Are selected allergens present in other products manufactured using the same equipment, but at different times?

  Yes

  No

• Select allergens present in other products manufactured on the same equipment but at different times

  Yes

  No

• Attach a photo of the finished product label here

  Media

• Is there a policy or procedure to prevent allergen contamination?

  Yes

  No

• Describe the policy or procedure

Completion

• Supplier Name

• Contact #

• Name & Signature of Supplier

  Sign