Checklist

ALLERGEN CHECKLIST FOR FOOD SUPPLIERS AND MANUFACTURERS
Original Form [pic] Amended Form [pic]
Product name: ________________________________ UPC#: __________________
Please fill the following table for each product. Column I indicates the allergens that may be found in the product, from addition or cross-contamination. Column II indicates the allergens present in other products that are run on the same equipment but at a different time. Column III indicates whether any allergens are present in your plant.
Please fill in each cell of the table with a YES or a NO and, when applicable, include the name of the ingredient. Do not leave empty cells.
|Component |Column I |Column II |Column III |
| |Present in the |Present in |Present in |
| |product |other products |the same manufacturing |
| | |manufactured on the |plant |
| | |same line | |
|Peanut or its derivatives, e.g., Peanut - pieces, protein,| | | |
|oil, butter, flour, and mandelona nuts (an almond | | | |
|flavoured peanut product) etc. Peanut may also be known as| | | |
|ground nut. | | | |
|Tree Nuts (almonds, Brazil nuts, cashews, | | | |
|hazelnuts(filberts), macadamia nuts,