Annual Food Safety Declaration
Please complete this form to declare your compliance with food safety standards for the year.
Full Name
*
First Name
Last Name
Position/Title
*
Company/Organization Name
*
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you confirm that your food handling and safety practices comply with the current food safety regulations?
*
Yes
No
Have you completed any food safety training or certification in the past year?
*
Yes
No
If yes, please provide details of the training or certification.
Please list any food safety incidents or violations reported in the past year.
Additional comments or notes
Signature
*
Date of Declaration
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: