US Eurofins Food Assurance Service Request Form

Company Information
Company Name*
Full Legal Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Company Name *
Company Contact's Name*
Company Contact’s Title
Email Address*
example@example.com
Telephone Number*

Audited Facility Information
Same as Company Information

YesNo
Facility Name
Full Legal Name
Facility Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Facility Contact Name
Facility Contact’s Title
Facility Contact’s E-mail Address
example@example.com
Facility Contact’s Phone Number
Off-site Operations to be Audited (i.e. Warehouse)?

YesNo
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Billing Information
Invoice To

Same as CompanySame as FacilityOther
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Billing Contact
Billing Email Address
example@example.com
Billing Phone Number
example@example.com

Facility Size, Employees, & Regulatory Info
Total Facility Size*
sq ft or sq m
Production Area
sq ft or sq m.
Cold Storage
sq ft or sq m.
Dry Storage
sq ft or sq m.
Number of Buildings*
Number of Production Lines*
Number of Production Shifts
Number of Full Time Employees*
Number of Casual Employees
Export To
List Countries/Regions
Import From
List Countries/Regions

Basic Facility Info
Product(s)*
Description of Manufacturing Process*
Days of Operation*
Hours of Operation*
Number of HACCP Plan(s)*
Additional Questions

Food Safety Plan?On site Lab?

FSSC 2200
FSSC Scope Description
FSSC 2200 Category List

FAMI-QS
Active Substance(s)
Number of Assured Sources
Number of Non-Assured Sources
Number of Manufacturing Process(es)
Type of Manufacturing Process(es)

BRC
BRC Scope Description
BRC Product Category

SQF
SQF Food Sector Category(s)
SQF requires one (1) unannounced re-certification audit within three (3) certification cycles.

Please indicate if this year your facility wishes to pursue an unannounced audit. If not selected within the time period, on the third cycle, the unannounced audit will be mandatory. The audit must occur within the sixty (60) day re-certification window (anniversary date of initial audit +/- 30 days). Full requirements can be found under SQF Code Part A.
Unannounced Year

Yes
Indicate blackout dates

Certification History
Is there a Certified Relevant Management System (ISO 9001, ISO 22000, etc.) in place?

Yes
Is your site currently certified to any standards?

Yes
Has your site's certification ever been withdrawn or suspended?

Yes
Has any Industry, Local, State, or Federal regulatory agency filed charges, assessed fines or taken action against this business entity, partners in ownership, or any facility under the same ownership?

Yes
Receipt of Privacy Notice*

By submitting this enquiry form you acknowledge having received, read and understood our Privacy Notice as made available above.
Please verify that you are human*
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