Food Safety Cohort Program Application Food Safety Cohort Program Application Questions or need assistance? Please contact Wendy White, GaMEP Project Manager – Food Safety & Quality. First Name*Last Name*Company*Job Title:*Email*Phone (Enter phone number in the following format: 0000000000)*Address*City*County:*ApplingAtkinsonBaconBakerBaldwinBanksBarrowBartowBen HillBerrienBibbBleckleyBrantleyBrooksBryanBullochBurkeButtsCalhounCamdenCandlerCarrollCatoosaCharltonChathamChattahoocheeChattoogaCherokeeClarkeClayClaytonClinchCobbCoffeeColquittColumbiaCookCowetaCrawfordCrispDadeDawsonDecaturDekalbDodgeDoolyDoughertyDouglasEarlyEcholsEffinghamElbertEmanuelEvansFanninFayetteFloydForsythFranklinFulton (North of I-20)Fulton (South of I-20)GilmerGlascockGlynnGordonGradyGreeneGwinnettHabershamHallHancockHaralsonHarrisHartHeardHenryHoustonIrwinJacksonJasperJeff DavisJeffersonJenkinsJohnsonJonesLamarLanierLaurensLeeLibertyLincolnLongLowndesLumpkinMaconMadisonMarionMcDuffieMcIntoshMeriwetherMillerMitchellMonroeMontgomeryMorganMurrayMuscogeeNewtonOconeeOglethorpePauldingPeachPickensPiercePikePolkPulaskiPutnamQuitmanRabunRandolphRichmondRockdaleSchleyScrevenSeminoleSpaldingStephensStewartSumterTalbotTaliaferroTattnallTaylorTelfairTerrellThomasTiftToombsTownsTreutlenTroupTurnerTwiggsUnionUpsonWalkerWaltonWareWarrenWashingtonWayneWebsterWheelerWhiteWhitfieldWilcoxWilkesWilkinsonWorthOut of StateZip Code*CEO or COO Name:Number of Facilities (including stand-alone warehouses):Number of Facilities needing this class:Company Annual Gross Revenue:Number of Employees (company wide):What are the key categories of products produced at your facility? (i.e. dairy, baked goods, snack foods, carbonated beverages)Processing type(s): (check all that apply) Fresh Produce Seafood Meat Dairy Honey Egg Bakery Fruit and Vegetable Canning, UHT, aseptic Ice, Drink and Beverage Confectionary Preserved (jams, sauces, dressings, pickles) Dry blending, Repackaging Oils, Fats, Spreads Cereal Grains and Nuts Ready to Eat (soups, salads, deli, etc.) Fresh Produce Distribution Packaged Food Distribution Grinding Other Which governmental agencies inspect your facility? USDA FDA Ga Dept. Agriculture Other Where is your product sold? Food Service Retail How is your product stored? Frozen Refrigerated Ambient (room temp) What type of packaging do you use? Aseptic (can, bottle, pouch) Sealed Pouch/Bag Jar/bottle Vacuum Box Modified Atmosphere Unsealed Pouch/Bag No Packaging Do you have a manager level employee responsible for quality and food safety at your facility?YesNoIf you answered yes, please list name & title:Has anyone at your company been trained as a PCQI (preventive controls certified individual)?YesNoIf you answered no, please click here to view suggested Georgia PCQI Training options.If you answered yes, please list name & title:Does your process include a "kill step"? (for pathogens)YesNoIf you answered yes, please list step(s):Do you have customer (second party ) audits?YesNoIf you answered yes, which:Do you have third party audits (BRC, SQF, GMP, etc.)?YesNoIf you answered yes, which:Do you fall under special govenmental inspection (Shellfish, Pasturized Milk Ordinance, etc.)?YesNoIf you answered yes, which:Please check the box if you already have the following plans implemented: HACCP FSMA Preventive Controls Food Safety Plan HACCP or Food Safety Team Food Safety Policy GMPs (Good Manufacturing Practices) Food Safety Training Program Recall Program Defined Product Lotting for Traceability SSOPs (Sanitation Standard Operating Procedures) Allergen Control Program Chemical Control Program Foreign Object Control Program (metal detection, etc.) Approved Supplier List Supplier Approval / Vendor Management Document Control (numbered programs with index) Equipment/Tool Calibration Product Testing Program Environmental Testing Program (equipment, surfaces, etc.). Preventive Maintenance Program Shelf-Life Testing Receiving / Raw Material Evaluation Program Shipping Program Food Defense Program Internal Audits Specifications Employee Job Descriptions Internal Audits Customer Complaint Process Additional Comments or Questions: