GF Application Form, Kitchen Safety Checklist and Declaration 1. Your Company Details Company Name Company Address Your Name Contract Signatory Name Contract Signatory Contact Telephone No. Website Address Registered Company Name (if different from the above) Registered Company Address (if different from the above) Registered Company Number VAT Number PR Agency or Marketing Contact Details: Agency Name Contact Name Telephone No. Accounts Payable Details: Contact Name Telephone No. - 1 -
2. About Your Company 1. Annual turnover 2. Annual profit 3. Total number of venues to be accredited 3. About Your Venues (Please list the venues that you wish to have accredited.) Venue Name Venue Address Email Address Telephone Number Venue type (e.g. restaurant) Cuisine type (e.g. French) - 2 -
Kitchen Safety Checklist For Head Office/Management Team Team are aware of actual legal regulations in force (i.e. EC/41/2009 and 1169/2011) Site has a documented Food Safety Management System or HACCP Plan which addresses gluten Training in handling & preparation, storage, segregation and communicating with customers is provided for all staff. Records kept and available Gluten-free training is part of the induction process for new staff and is supported by work instructions or other visual aids System is in place to communicate changes in gluten status of ingredients, menu changes & other factors affecting serving GF food to all sites, e.g. staff meetings Reputable suppliers of ingredients are used Preparation areas of sites are designed to minimise cross contamination risks - work flows identified to reduce risk, e.g. timings, distance and equipment Internal audits/risk assessments are carried out and cover gluten-free production Customer complaints are logged For all staff 1. The law on gluten-free Staff know that there is a law on gluten-free Staff know where to find information about preparing gluten-free foods in company s information system 2. Training and knowledge Staff are up to date on gluten-free training Staff know to always check whether a dish contains gluten Staff know how to check food labels for gluten 3. Communication Staff know how to find information about which dishes are gluten-free Staff are told when changes occur which affect gluten-free, e.g. new ingredients, new suppliers, Sites are able to demonstrate system in place to provide customer with clear information relating to the gluten status of all foods served, e.g. on menu, leaflets Business encourages customers to discuss GF requirements with staff Business can demonstrate effective system of communication between front of house and back of house for gluten-free foods There is a system in place to monitor incoming products and ingredients to ensure any changes in gluten content are identified - 3 -
4. Supply chain controls Ingredients are sourced from approved suppliers Current packaging is retained for reference should a customer request to see it If site can order ingredients from alternative suppliers, there is a system in place to record ingredient details and presence of gluten There is a system in place for checking ingredients that comes in before using for gluten-free dishes. Ingredients checked each time for cereals containing gluten and products thereof 5. Storage Storage conditions are suitable to prevent cross contamination Gluten-containing ingredients are stored separately from gluten-free. If stored in the same area, gluten-containing ingredients are stored below gluten-free When ingredients are opened and decanted this should be into easily identifiable containers Partly used gluten-free ingredients are re-sealed before being returned to the store 6. Preparation and cooking Clean or dedicated utensils and equipment are used for preparing and serving gluten-free foods A separate area is used when handling gluten-free cereal flours to prevent cross contamination Separate dunk baths are used for gluten-containing and gluten-free ingredients. Staff are aware which should be used for which Fresh water is used for boiling gluten-free ingredients or foods Fresh clean oil and a cleaned fryer are used to fry gluten-free foods A dedicated griddle/grill or dedicated area of the griddle is used for gluten-free A dedicated toaster or toaster bags for gluten-free bread is used Separate basting brushes are used for gluten-free and gluten-containing foods Separate temperature probe is used, or if not possible, is cleaned before use Gluten-free pizzas are cooked on a baking tray or clean pizza screen, rather than directly on the oven shelf Gluten-free dishes are clearly labelled or easily identifiable from glutencontaining Gluten-free dishes that are held in a holding service must be clearly distinguishable Gluten-free foods supplied for consumption off the premises are clearly labelled In self serve areas, such as salad bars, gluten-free foods are clearly separated from gluten-containing foods and have dedicated utensils Unused gluten-free foods are clearly labelled and securely covered to allow easy identification for next shift - 4 -
7. Cleaning and hygiene Good hygienic food safety practices are in place to prevent cross contamination with gluten Staff wash hands before handling gluten-free ingredients Clean utensils are used for gluten-free Clean surfaces are used to prepare gluten-free Spillage of gluten-containing ingredients is cleaned up to prevent cross contamination of gluten-free ingredients Spare aprons or protective clothing are available to staff if their apron or protective clothing become soiled with gluten-containing flour. Clothing regularly laundered Commercial, domestic or effective manual washing practices (hot water, detergents, rinsing) are used Declaration I confirm that the above is true for my Venue/ all of my Venues (delete as applicable). I understand that this declaration is a formal part of the licensing agreement. Signature Date - 5 -