Sushi Ingredient Declaration Form
Please complete the Sushi Ingredient Declaration Form to provide detailed information about ingredients used in your sushi preparation and handling.
Sushi Item Name
*
List All Ingredients Used
*
Are any of the following allergens present?
*
Fish
Shellfish
Soy
Egg
Wheat
Sesame
None of the above
Other
Are any ingredients raw?
*
Yes
No
Country or Region of Origin for Main Ingredients
Preparation Notes (e.g., handling, marinating, freezing)
Supplier or Brand (if applicable)
Date of Preparation
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Responsible Person Name
First Name
Last Name
Submit Declaration
Should be Empty: