Food Item Screening Declaration Form
Please complete this form to declare and screen your food items for compliance and safety.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Organization or Company Name (if applicable)
Food Item Name
*
Type of Food Item
*
Please Select
Fresh Produce
Processed Food
Baked Goods
Dairy
Meat/Poultry/Seafood
Beverage
Other
Quantity (Specify units: kg, liters, pieces, etc.)
*
Country/Region of Origin
*
Please answer the following screening questions regarding your food item:
*
Rows
Yes
No
Not Sure
Contains any of the following allergens: peanuts, tree nuts, dairy, eggs, soy, wheat, fish, or shellfish?
1
2
3
Has been exposed to contamination (chemical, biological, or physical)?
4
5
6
Has been stored according to recommended temperature and hygiene guidelines?
7
8
9
Is labeled with all ingredients and expiry date?
10
11
12
Has undergone any inspection or certification?
13
14
15
Please describe the packaging and storage conditions of the food item.
*
Upload supporting documents (e.g., inspection certificate, ingredient list, packaging photos)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Declaration
Should be Empty: