Donor Registration Form
Donor Organisation Information
Donor Organisation Name
Street Address
Town / City
County
Country
Eircode / Postcode
Contact Information
Contact First Name
Contact Last Name
Mobile Phone Number
Office Phone Number
Contact Email Address
What is the nature of your enquiry?
Please select...
I am a food business who would like to enquire about surplus redistribution
I am a food business who has food available to donate
I am a retail outlet who would like to enquire about surplus redistribution
What is the primary service of your organisation?
Please select...
Supplier
Manufacturer
Distribution Centre
Distributor/Hauler
Foodservice Supplier
Primary Producer
Other
If other, please specify
What type of retail outlet do you operate?
Please select...
Supermarket
Restaurant
Cafe
Canteen/Food Service
Bakery
Other
If other, please specify
Food Type
What type(s) of food are typically available for donation?
Bread
Breakfast
Condiments
Confectionery
Cooking Suace
Dairy
Dessert and Cake
Eggs
Fruit
Fish
Herbs
Hot Drinks
Meat
Non Food
Prepared Salads/Prepared Vegetables
Preserves
Readymeals
Rice/Pasta/Pulses
Sandwiches
Savoury Snacks
Soft Drink
Soup
Tinned
Vegetables Whole
If other, please specify
Please provide a description of the food you have available for donation
What quantity of product is available for donation? (Equivalent pallets)
Product Details
What is the best before/use by date on the product?
Is the product suitable for freezing?
Please select...
Yes
No
Is the product labelled with all of the mandatory labelling information in the English language?
Please select...
Yes
No
Hub Delivery / Collection
Can you arrange delivery to your local FoodCloud Hub?
Please select...
Yes
No
If yes, which hub can you deliver to? (Please tick all that apply)
Dublin (8 Broomhill Business Park, Broomhill Road, Tallaght)
Cork (Unit 3, Ballytrasna, o'connell Commercial Park)
Galway (9 Glenascaul Manufacturing and Technology, Glenascaul Business Park, Oranmore)
If no, where is the food available to collect from?
When would surplus be available for donation?
Please select...
Moring
Afternoon
Evening
Other
If other, please specify.
How often would surplus typically be available for donation?
Please select...
Daily
Weekly
Monthly
Ad-Hoc
Terms and Conditions
I have read and understood the
terms and conditions
*
Accept
Supplier Self Audit Questionnaire
The following questions are designed to assess the ability of contractors and suppliers to provide food that is safe and of the nature, substance and quality required by FoodCloud. As part of the due diligence and legal responsibilities,Supplier assurances are required on their Food Safety Policies, Supply Chain Management Procedures, Product Traceability (Regulation (EC) No 178/2002), Hazard Analysis Critical Control Point (HACCP) (Regulation (EC) No 852/2004) plus amendments in document I.S. 340:2007 & appendix 1 / 2015 and all other relevant regulations under the Food Safety Act 1990 and associated Industry Guidance. ALL FIELDS ARE MANDATORY AND MUST BE COMPLETED BEFORE SUBMITTING Please complete the following questionnaire on behalf of your company. Please provide copies of any supporting documents (certificates, statements, policies etc.) with your questionnaire response. If you answer 'no' then please provide full details in the comments box below each question. APPROVAL / ACCREDITATION - Registration with the Health Board or relevant government authority
Is your company registered with the Local Authority as a food business operator under the requirements of article 6 (2) Regulation (EC) Number 854/2004?
Please select...
Yes
No
Regulatory Authority
Approval Number
Additional Accreditation (e.g. ISO /EFSIS / BRC)
At your last inspection by an authorised body were you in compliance with all requirements?
Please select...
Yes
No
Are you willing to allow FoodCloud and/or their representative carry out hygiene audits in your facilities if necessary?
Please select...
Yes
No
Other
If other, please specify
Do you operate a food safety management system within your food business?
Please select...
Yes
No
Other
If other, please specify
Are records of your HACCP team activities and meetings held on file, and used during system reviews?
Please select...
Yes
No
Other
If other, please specify
Do you have an allergen control plan / policy implemented?
Please select...
Yes
No
Other
If other, please specify
Does your food safety management system have procedures for the traceability of your products as laid down in Regulation (EC) No178/2002 and its amendments incl. of 2014?
Please select...
Yes
No
Other
If other, please specify
Is all food contact packaging ‘food grade’ & meets the requirements of legislation for ‘articles in contact with food’?
Please select...
Yes
No
Other
If other, please specify
Do you carry out any microbiological testing of food products?
Please select...
Yes
No
Do you conduct internal audits?
Please select...
Yes
No
Are your delivery vehicles (or those of outside couriers used by you) maintained in a clean,sound condition with appropriate controls?
Please select...
Yes
No
Do you have a managed pest control system on site?
Please select...
Yes
No
Does your traceability system allow for the effective recall of your product range in the case of a 'Food Alert ' issued by the Food Safety Authority?
Please select...
Yes
No
Does your traceability and labelling system allow for the effective identification of the origin of any given product?
Please select...
Yes
No
Key Contacts
Please enter details including contact numbers for TWO key contact persons for this procedure
Contact One
Contact One First Name
Contact One Last Name
Contact One Phone Number
Contact Two
Contact Two First Name
Contact Two Last Name
Contact Two Phone Number
ON BEHALF OF THE DONOR, I HAVE FULLY COMPLETED AND AUTHORISED ALL ANSWERS GIVEN IN THIS DOCUMENT & HAVE ATTACHED ADDITIONAL INFORMATION REQUESTED.
Please select...
Yes
No
Contact Information
