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CFIA Facility Questionnaire for Export of Bovine Liver Powder from the United States to Canada

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TAHD-DSAT-IE-2002-10-10 Annex 4

This facility questionnaire must be completed by any facility that wishes to export bovine liver powder to Canada. The purpose of the questionnaire is to identify risks of cross contamination with any other ruminant products (including ruminant rendered products). An annual on-site inspection by the endorsing Central Competent Veterinary Authority is required to verify that the information provided within this questionnaire is complete and accurate as presented.

Only establishments receiving bovine livers from abattoirs, processing plants or storage plants supervised by the Central Competent Veterinary Authority (FSIS) are eligible to export bovine liver powder to Canada.

Facility information

Name of facility being inspected:

Physical address of facility:

Mailing address of facility if different than physical address:

List activities that the facility performs:

Facility representative information

Name of facility representative completing questionnaire:

Name of facility representative present during annual inspection (if same person then indicate "same"):


Contact information:

Telephone number:

Email address:


Attach additional documentation, as required

1. List all the animal origin ingredients, species of origin and country of origin and industry source in the table below for all animal origin materials received, stored, processed or otherwise handled in this facility, and all animal origin ingredients for all products produced in the facility

Animal origin materials Species of origin and tissue type (if relevant) Country of origin Source of product: Central Competent Veterinary Authority (CCVA) inspected Abattoir; Dead stock yard; Other

2. Does the establishment receive, store, or handle any ruminant origin materials, other than:

  1. The following bovine origin materials – milk and milk products, gelatin or collagen (bone or hide-derived), rawhide, and tallow containing a maximum level of 0.15% insoluble impurities)
  2. Bovine origin materials originating from an FSIS-inspected slaughter establishment that can be verified to be free of SRM (such as edible meat, livers, kidneys, etc.)
  3. Ovine or caprine origin materials originating from an FSIS-inspected slaughterhouse that can be verified to be derived from animals less than 12 months of age
  4. Ruminant materials legally imported from Australia or New Zealand

If the answer to question 2 is yes, the establishment is not eligible to export bovine liver powder to Canada

3. Does the facility have a preventative control plan (PCP) (for example HACCP, GMP)

If yes :

3.1 What are the hazards named in the PCP? List them by category type: chemical, biological and physical:

3.2 What are the mitigation measures used to control these hazards?

3.3 Does the facility have a traceability program and recall plan in place?

3.3.1 If yes, does the facility carry out a test of their traceability/recall program? If yes, how? When was the last test? What were the results?

4. Does the facility maintain sanitation and prevent adulteration or contamination of finished products with incoming raw materials or products? This may occur by proper use of chemicals, product direction flow protocols, cleaning & disinfection procedures, using signs and labels, cleaning and sanitizing procedures for processing equipment, conveyances storage areas, other equipment and trucks, etc.

5. Describe the processing method of the bovine liver powder (type, time-temperature combination, processing steps, etc). Include processing flow chart.


Signature of Facility Official

Date (yyyy/mm/dd)

Name of Facility Official

Title of Facility Official

I, the salaried veterinary inspector of the United States Department of Agriculture do hereby certify that the questionnaire above is complete and accurate as submitted.

Signature of Veterinary Inspector

Date (yyyy/mm/dd)

Official Seal of CCVA


Name of Veterinary Inspector

Title of Veterinary Inspector

Date of annual inspection:

Date modified: