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, pecans, pine...
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