This questionnaire must be completed for any facility applying to export raw inedible animal by-products to Canada that is not approved to export edible meat products to Canada. Raw inedible animal by-products to be exported to Canada must originate from animals slaughtered in an establishment approved for export of edible meat to Canada. However, the animal by-products may be processed, packaged, handled, and/or stored in intermediate facilities. The purpose of the questionnaire is to identify any risk of contamination of animal by-products with reportable animal diseases as defined by CanadaFootnote 1 or by specified risk material (SRM) during handling at an intermediate facility. An on-site inspection by the endorsing Central Competent Veterinary Authority (CCVA) is required to verify that the information provided within this questionnaire is complete and accurate as presented.
Facility information
Name of Facility Being Inspected:
Physical Address of Facility:
Mailing address of Facility if different than physical address:
List all activities that the facility performs (slaughter, processing, packaging, storage, etc.):
Facility representative information
Name of facility representative completing questionnaire:
Person present during inspection (if same person then indicate "same"):
Title:
Contact information:
Telephone Number:
Email address:
Competent authority veterinarian or inspector information
Name and title of CCVA Veterinarian or CCVA Inspector Performing Inspection:
Name of CCVA Veterinarian endorsing the questionnaire and inspection (if inspection was carried out by a non-veterinary inspector):
Attach additional documentation, as required.
1. List all animal origin ingredients, species of origin, country of origin and industry source in the table below for all animal origin materials received, stored, processed or otherwise handled in this facility.
| Species of Origin and Tissue type (if relevant) | Country of Origin | Source of product: Central Competent Veterinary Authority – inspected Abattoir/ Other (describe) | Is source approved to export edible meat to Canada (Y/N) Table Note a (Approval number) |
|---|---|---|---|
2. The following questions pertain to ruminant ingredients received, stored, handled, or processed in the facility. They deal with risk of cross-contamination of non-ruminant material with ruminant-origin material (prohibited for feeding to ruminants in Canada) as well as with Specified Risk Material (SRM) (prohibited for feeding to any animal in Canada).
2.1.
Does the facility receive, store, handle or process any ruminant origin ingredients?
Yes Box No Box
2.2.
If YES, please describe what ruminant tissues are received, handled, processed or stored.
2.3.
Does the facility receive, store, handle, or process any ingredients that contain or could be cross-contaminated with Specified Risk Material (SRM) as defined by Canada? SRM is the skull, brain, eyes, trigeminal ganglia, tonsils, spinal cord, vertebral column (excluding the vertebrae of the tail, the transverse processes of the thoracic and lumbar vertebrae, and the wings of the sacrum), and dorsal root ganglia of cattle 30 months of age and over sourced from countries of controlled BSE Risk Status, or of cattle 12 months of age and over sourced from countries of undetermined risk for BSE, as well as the distal ileum of cattle of all ages sourced from countries of controlled or undetermined risk of BSE.
Yes Box No Box
3. Does the facility have a preventative control plan (PCP) (for example HACCP, GMP)
Yes Box No Box
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?
4. Does the facility have a traceability program and recall plan in place?
Yes Box No Box
4.1
If YES, does the facility carry out a test of their traceability/recall program?
Yes Box No Box
4.2
If YES, how? When was the last test? What were the results?
5. 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.
Yes Box No Box
6. Does the facility have a written separation protocol on file that outlines separation of material that is eligible for export to Canada from material that is not eligible?
Yes Box No Box
6.1
If "Yes", does the facility demonstrate effective implementation of this protocol?
Yes Box No Box
7. Describe how the exported products are packaged
8. Are the products to be exported to Canada denatured with a denaturant approved by the Canadian Food Inspection Agency?
Yes Box No Box
8.1
If "Yes", please specify:
Box Liquefied charcoal or charcoal powder
Box Active carbon product
Box Fish meal
Box Green intestinal contents
Box Denaturant listed in the Reference Listing of Accepted Construction Materials, Packaging Materials and Non-Food Chemical Products Database (name)
Box Food colouring agent listed in Health Canada's List of Permitted Colouring Agents (name) *must be of a contrasting colour to the byproducts
8.2
If "No", are the products to be exported likely by their nature to be mistaken for edible products?
Yes Box No Box
Please provide details
9. The products will be exported:
Fresh Box Frozen Box
10. What is the name of the central competent veterinary authority (CCVA) which oversees (inspects and approves) the facility and which has the authority to provide government certification for products being exported to Canada?
Signatures/endorsements
Facility offical
Signature of Facility Official
Date of signature (yyyy/mm/dd)
Name of Facility Official
Title of Facility Official
Veterinary inspector
I, the salaried veterinary inspector of (insert name of CCVA) do hereby certify that the questionnaire above is complete and accurate as submitted and that:
(Insert appropriate clause below)
Either the facility does not receive any ruminant material; Or the facility receives ruminant material.
Signature of Veterinary Inspector
Date of signature (yyyy/mm/dd)
Official seal of CCVA
Name of Veterinary Inspector
Title of Veterinary Inspector
Date of inspection:
Non-veterinary inspector (optional)
The section below should only be completed for facilities inspected by a non-veterinary inspector. The questionnaire must also be endorsed by an official veterinarian of the CCVA.
Signature of Inspector
Date of signature (yyyy/mm/dd)
Name of Inspector
Title of Inspector
Signature of official veterinarian of the CCVA
Title of official veterinarian of the CCVA
Name of official veterinarian of the CCVA
Date of signature (yyyy/mm/dd)
Official seal of CCVA