Local Product Marketing
We appreciate your interest in our Local Product Marketing program. Please complete this form and one of our Team Members will get back to you.
Who is completing this checklist?
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Manufacturer
Broker
Importer
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Complete if Manufacturer - Manufacturer Information
Manufacturer Name
Facility Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
First Name
Last Name
Contact Title
Title
Contact Office Phone
Please enter a valid phone number.
Contact After-Hours Phone
Please enter a valid phone number.
Contact Email
example@example.com
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Food Safety/QC Contact
Food Safety/QC Contact Name
First Name
Last Name
Contact Title
Title
Contact Office Phone
Please enter a valid phone number.
Contact After Hours Phone
Please enter a valid phone number.
Contact Email
example@example.com
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Complete if Broker/Importer - Broker/Importer Info
Broker/Importer Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
First Name
Last Name
Contact Title
Title
Contact Office Phone
Please enter a valid phone number.
Contact After Hours Phone
Please enter a valid phone number.
Contact Email
example@example.com
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Recall Contact
Recall Contact Name
First Name
Last Name
Contact Title
Title
Contact Office Phone
Please enter a valid phone number.
Contact After Hours Phone
Please enter a valid phone number.
Contact Email
example@example.com
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Product Information
If there is a story behind your product, tell us here.
Product Story
Product Descriptions & GTINs
*
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Food Safety Information
Level of Government Inspection *Attach copy of most recent inspection report*
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Federal
Provincial
Municipal
Inspection Report
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Date of last inspection
*
-
Month
-
Day
Year
Inspection Date
Are you HACCP recognized?
*
Yes
No
Is product produced according to Good Manufacturing Practices?
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Yes
No
Are workers trained in food safety?
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Yes
No
Are workers trained in handwashing and personal hygiene?
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Yes
No
Product is prepared, stored and distributed with appropriate temperature controls?
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Yes
No
Sanitation protocols are developed?
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Yes
No
If produce, are you certified by a GFSI benchmarked growing program? *If yes, document to be included for review.*
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Yes
No
GFSI Document
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Are you an organic produce grower? *If yes, certification document from a CFIA recognized certification body to be included for review*
*
Yes
No
Organic Produce Grower Certification
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Are you certified by a third party food safety management system? (e.g. BRC, AIB, CanadaGAP, FS22000, etc.) *If yes, attach copy of certificate*
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Yes
No
Please specify which food safety management program:
*
Food Safety Management Certificate
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Do you have documented recall procedures? (Attach copy of procedures)
*
Yes
No
Recall Procedures
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Do you have liability insurance? (Attach copy of certificate)
*
Yes
No
Liability Insurance Certificate
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Please specify amount of liability insurance:
*
Do you have recall insurance? (Attach copy of certificate)
*
Yes
No
Recall Insurance Certificate
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Please specify amount of recall insurance:
*
Does the product contain priority allergens (as per CFIA)?
*
Yes
No
If yes, which allergens?
*
Does labelling comply with CFIA regulations? (including ingredients, allergens, nutrition information, claims, production dates, etc)(Attach a copy of label)
*
Yes
No
Product Label
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Method of Distribution? Provide Details (e.g. temperature control, etc)
*
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Declaration
I declare that the products being offered and the facility where they are produced comply with all applicable Canadian food safety and labelling requirements.
*
Yes
No
Date
*
-
Month
-
Day
Year
Date
Print Your Name
*
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Safe Food for Canadians Supplier Confirmation
Name of Supplier
Address of Supplier
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SFC License Number
License #
Preventative Control Plans
Yes
No
Lot code traceability - Supplier maintains record of lot codes shipped to Co-op stores?
Yes
No
Provide Details:
Lot code tracing details
I declare that the products being offered and the facility where they are produced comply with all applicable Safe Food for Canadians Regulations.
*
Yes
No
Print Your Name
*
Your Name
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: