Canadian Grain Commission
Symbol of the Government of Canada

Application Package - CIPRS, CIPRS + HACCP and CGC HACCP



Appendix A Application for certification

__ CIPRS   __ CIPRS + HACCP   __ CGC HACCP

Company name: ___________________________________________________________

Address: ________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Contact name: ___________________________________________________________

Title: ________________________________________________________

Telephone number: ______________________________________________________________

Email address: ____________________________________________________________

Licensed by CGC: __ Yes   __ No (Applies only to facilities in Thunder Bay and Western Canada.)

Number of employees: ______________________________________________________

Date of application: _______/_______/_______ (YYYY/MM/DD)

Existing QMS or FSQMS? (e.g. ISO certification or HACCP recognition) __ Yes   __ No

If yes, please specify. ______________________________________________________

Consultant used to develop QMS/FSQMS? __ Yes   __ No

If yes, please provide name and organization:

________________________________________________________________________

________________________________________________________________________

Processes to be included in program scope:

__ Production (by applicant)   __ Production (grower contracts)

__ Storage   __ Packaging   __ Processing (receiving, cleaning, sizing)

__ Retail product

Other (please specify): ______________________________________________________

Shipping method:

__ Bulk (vessel)   __ Container – bulk   __ Container – bag

_________________________________________________________________________

Crops to be included in program scope:

__ Soybean   __ Wheat   __ Corn   __ Beans   __ Lentils   __ Peas

__ Feed Peas   __ Canary Seed   __ Canola   __ Barley   __ Oats   __ Mustard

Other (please specify): ______________________________________________________

_________________________________________________________________________

Multi-site: __ Yes   __ No

Sites to be included in program scope:  (use separate sheet if necessary)

_________________________________________________________________________

_________________________________________________________________________

Signature: ________________________________________________________________

Date: _______/_______/_______ (YYYY/MM/DD)

Client note: This document details the information that is typed on your Certificate of Recognition. It is important that it is completed to prevent errors on your certificate.