Date first notified to New Zealand Food Safety
New Zealand Business Number (if known) You can find your NZBN at companies-register.companiesoffice.govt.nz if you have one. MPI Food Registration Number (if known) Business Name Business Trading Name (if different) Business Address Address of manufacturing site (if different) Email Address Phone Number
Contact Name Contact Position Contact Email Address Contact Number (Business) Contact Number (After Business)
Is your business the brand owner? YesNo If yes, please skip to ‘Section 4: Verifier Details’ below.
Have you discussed the recall with the brand owner? YesNoN/A Brand owner Name Brand owner Address Brand owner Phone Number If you are not the brand owner, are you taking primary responsibility for the recall? YesNoN/A
What is the name of your verification agency, and the name of your last verifier? Verification Agency Select Verifier AgencyAdvance Food Safety LimitedAll Systems Go Auditing LimitedAPlus Audits Limited trading as A+ FoodSafetyAshburton District CouncilAsureQuality LimitedAuckland CouncilAuditing Solutions NZ LimitedBuller District CouncilCarterton District CouncilCentral Hawkes Bay District CouncilCentral Otago District CouncilChatham Islands CouncilChristchurch City CouncilClutha District CouncilDunedin City CouncilFar North District CouncilFOOD COMPLIANCE NZ LIMITEDGisborne District CouncilGore District CouncilGrey District CouncilHamilton City CouncilHastings District CouncilHauraki District CouncilHorowhenua District CouncilHurunui District CouncilHutt City CouncilInvercargill City CouncilKaikoura District CouncilKaipara District CouncilKapiti Coast District CouncilKawerau District CouncilMackenzie District CouncilManawatu District CouncilMarlborough District CouncilMasterton District CouncilMatamata-Piako District CouncilMPI Verification ServicesNapier City CouncilNelson City CouncilNew Plymouth District CouncilOpotiki District CouncilOtorohanga District CouncilPalmerston North City CouncilPorirua City CouncilQuality Auditing Specialists LimitedQuality Consultants New Zealand LimitedQueenstown-Lakes District CouncilRangitikei District CouncilRotorua Lakes CouncilRuapehu District CouncilSandra de Vries t/a Snap Audits NZSelwyn District CouncilSGS New Zealand LimitedSouthland District CouncilSouth Taranaki District CouncilSouth Waikato District CouncilSouth Wairarapa District CouncilStratford District CouncilTararua District CouncilTasman District CouncilTaupo District CouncilTauranga City CouncilTelarc LimitedThames-Coromandel District CouncilThe Food Auditor LimitedTimaru District CouncilUpper Hutt City CouncilVeritAg LimitedWaikato District CouncilWaimakariri District CouncilWaimate District CouncilWaipa District CouncilWairoa District CouncilWaitaki District CouncilWaitomo District CouncilWellington City CouncilWestern Bay Of Plenty District CouncilWestland District CouncilWhakatane District CouncilWhanganui District CouncilWhangarei District Council Verifier Name Select Verifier NameAchal Arishma ChandAdri Elize HammanAhmed Al-SafiAhmed TayebAleisha Jane CampbellAlicia Maree PrattAlison Jane SmithAlison May BlairAmber-Marie MarshAna Paula Da CunhaAndrew Richard MossAnish ChandAnnette Elizabeth DavidsonAnnette Marree MundayAnoop LalApai PongputthachartArpna Shanaya LalArthur Jonathan PhilipAshlee Paige PartridgeAtish HanchamniBabita Nandani ChandBenjamin Carl SchnackenbergBianca Claudia StainesBonnie Biying FanBronwyn Gloria JohnsonBryan Lloyd BrettCarlo BellCarolyn Ann BrownCassandra Louise PullanCatherine Alison SheerinCatherine May FaramCharleen Marie OmundsenCharlotte Emma TaylorCharlotte YoungCharmaine EludoChelsea (Jingxiu) DuChen Lily LiChristopher Vincent John DunnClaire Joanne KiddCraig Richard SmithCynthia Jane NorthcoteCynthia Kay McKeeDavid John GoldingDavid Kenneth GallagherDeirdre Margaret JohnstonDilan JayaweeraDipal Mansukh DhananiDylan le RouxElena ChernyshovaElizabeth Jane GowerEman KhorshidEmelita Bueno AgillonEmmanuel PlateroFern Elesha MaccabeeFiona Joy BossFrancis Denis WeleGina VanceGlynn Howarth JonesGordon CouttsGregory DavisHans Adriaan BuikHarish KumarHelen Jane McDonaldHelen Jayne Lloyd EvansHetesh ChandHimanshu Gopalbhai ParekhHua Jessie ZhongJacqueline Mary MartinJaimi Lee ScottJane Margaret BeardJeremy Luke PeatJessica-Luisa BrueckJo-Anne Marie ElstobJoanne Marie OrchardJoape Vibose Clive NainocaJonathan HamlynJoo Hee (Julie) ParkJune ChhourJune HuynhKapila KumarKaren Elizabeth PerryKaren GoughKaren Julie HeathmanKathryn Janette MaskeryKathryn Jean HarrisKathryn Margaret WealthallKelly Rose HumphriesKetura LambertKirill SemenovKristinna Payal SinghLai-Peng ChiewLauren Paige VarcoeLesley Sandra HouseLinda Margaret FerrierLindah GambahayaLisa Ann ZwartsLisa MillicanLuis Fernando Villegas BeronLynette Ann PopeMaddison Rae BerryManasa RayasidamuManuel Tamamutu LoffleyMaree Lisa HaddonMargaret Ruby Jane WhiteMaria UrtubeyMarija RadevskaMark Anthony McLeanMark Rowland HaymanMary FernandezMeldin Frank MoosMelissa Margaret AbelardMichael BrandtMichael Hardy Gerard SmithMichelle EllisMonique Maree Tui GoodhewMuhammad Jibran KhanMylene Matic MeraNadezda (Nadya) NimmoNahla BayoumiNatalia Alexeyevna ThompsonNatalia Dadirayi MakotoNeha NatashaNicholas Rex MacDonaldNicola Gay KinzettNicolene WiidNidhi Pallavi SharmaOksana BartlettPatrick Kenneth BarberPaul James LynchPauline June HolmesPennie Gillian SmithPeter ChallisPhilip Ian HunterPhoncy Jose AynikkalPiyarach NoreePoonam PatelPrem Sagar LakshmanQinghua David TuRachael Megan Victoria BrightRajesh Kuldip SamiRandall GrayRebecca Puarangi ClarkeRepeka Marama VuetiRiteshni TarakRodney FromontRodney Richard WalkerRonald de VriesRonel Venessa ArnoldRosemary BurgessRosita MalaSagar Sudhir NimkarSamuel Oliver GeersSandra de VriesSarah FellSarah Jane DrennanSarah TsuiSarah-Jane ElsSegundo Raymundo Junior ManahanShane Cameron HancockShane Derrill HopgoodSharmila NarayanShelley Jane AdamsShintyall Siwani ReddySiân Cristyn HortonSneh LataSonja Rochelle TaegeSonya Marie Dorothea KnightStephanie CarboneStephen Michael MansfieldSudhir Mahendra KumarSukhdeep Kaur GrewalSuzanne Elizabeth MelvilleSwee Chan PhangTamzen WinderTanya Jeanette MorrisonTherese Denise BackTracey Anna FearyTyler Joseph AndrewsUrsula Hermina Josepha Catharina Bil-TeitinkValerie Jean AdamsVanja MareticVanshika Divya KumarVarsha Vandana PrasadVarun GuruvayurappanVeena Wati Lal-BoonVijay Jayanti PatelVincenzo PetrellaWayne Adam BossWeibin QinWilson LauYan Tong JiangYanan LiYanqi GongYasmin AgnewZaheira IdirZoe Elizabeth MoulamOther If Other, please provide the Verifier Name
Verifier Email Address Verifier Phone Number
Undeclared AllergenForeign MatterMicrobiologicalChemicalIncorrect LabellingPackaging FaultOther
What is/are the allergen/s? Crustaceans (e.g., prawns, lobster, crab)EggFishLupin (a legume often found in flour)Milk (dairy)Molluscs (e.g., mussels, oysters, squid)PeanutsSesame seedsSoybeansTree nuts (almonds, Brazil nuts, cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios, walnut)Wheat (and other cereals containing gluten)Sulphites (if in concentrations of 10 mg/kg or more)
What is/are the foreign matter/s? Animal hairBone fragmentsBroken machine parts (nuts, bolts, washers, screws, springs)Ceramic or porcelain (chips from equipment or tools)Charred material (e.g. from over-fried or scorched product)Crystallised sugar or salt clumps (when large and sharp)Egg shell fragmentsFeathersFingernailsFragments from worn conveyor belts or O-ringsFruit pitsFruit pits fragmentsGlass (broken jars, light bulbs)Hair (human)Hard PlasticHard plastic (e.g. from scoops, containers)Insects (dead or alive)Jewelry (rings, earrings, watch parts)Matchsticks or toothpicks (from handling or serving)Metal shavings or fragments (from blades, machinery)Paper or cardboard fragmentsPersonal items (pens, buttons)Plasters/bandagesPlastic fragments (hard)Plastic fragments (soft)Rodent or pest body partsRubber fragments (e.g. from seals, gaskets, belts)Seed husks or hard hullsShell fragments (nut)Shell fragments (crustacean)Shell fragments (egg, nut, crustacean shells)Shot pellets (in game meat)Soft plastic films or packaging wrapSoil contaminationSoil or sand (clinging to produce or root vegetables)Staples or pins (e.g. from boxes or bags)StonesStones or pebbles (from vegetables, grains, legumes)Welding slag or wireWire bristles (e.g. from wire brushes)Wood splinters (e.g. from pallets or crates)
What is/are the microbiological hazard/s? Bacillus cereusSalmonella sppCampylobacter sppSTEC (E coli O157 and others)Listeria monocytogenesClostridium botulinumClostridium perfringensStaphylococcus aureusPseudomonas sppAspergillus flavus(aflatoxins)Penicillium sppNorovirusHepatitis A virusCryptosporidium parvumGiardia lambliaTrichinella spiralisFusarium spp(e.g. fumonisins)Thermophilic anaerobesLactic acid bacteriaEnterobacteriaceaeTotal coliformsEscherichia coli (generic)Prions (BSE, vCJD)Yersinia enterocoliticaToxoplasma gondiiEnterobacter sakazakii (Cronobacter)Mycobacterium bovisPrions (BSE, vCJD)Taenia saginata
What is/are the chemical hazard/s? Detergent residuesDisinfectant residues (e.g. quaternary ammonium compounds, chlorine)Sanitiser carryover (e.g. peracetic acid, hydrogen peroxide)Inadequate rinsing post-CIP (Clean-In-Place)Mycotoxins (e.g. aflatoxins in grains, nuts, spices)Alkaloids (e.g. solanine in green potatoes)Cyanogenic glycosides (e.g. in cassava, apricot kernels)Lectins (e.g. in undercooked red kidney beans)Histamine (e.g. in scombroid fish like tuna, mackerel)Shellfish toxins (e.g. paralytic shellfish poison, domoic acid)Ciguatoxins (reef fish)Pesticide residues (organophosphates, pyrethroids, etc.)Herbicide residues (e.g. glyphosate)Fungicide residuesHeavy metals (lead, mercury, cadmium, arsenic)Dioxins and PCBs (persistent organic pollutants)Nitrate/nitrite accumulation (e.g. in leafy greens)Migration of plasticisers (e.g. phthalates, BPA)Ink or adhesive migration from packagingLubricants (non-food grade or over-applied food-grade)Machine oilPaint flakes or coatings from equipmentResidues from fumigation (e.g. ethylene oxide)Incorrect dosing of food additives (e.g. nitrites in meats)Contaminated processing aidsNon-approved or undeclared additives (e.g. sulphites in fresh meat)Improperly formulated preservatives (e.g. benzoate/sorbate above legal limits)Vitamin or mineral overdose (e.g. in fortified foods)Illegal dyes (e.g. Sudan Red in chilli powder)Melamine (e.g. in dairy fraud)Ethanol or methanol (in beverages)Unauthorized preservatives or colourantsAllergen residues due to poor line cleaningResidues from previous product batches (cross-contamination)Reaction byproducts (e.g. acrylamide from high-heat processing)PhosphateSulphiteSodium NitritePolycyclic Aromatic Hydrocarbons (PAHs)Herbicide ResiduesFumigant ResiduesPatulinAnthelminticsTutinMarine biotoxinsPhomopsins
Describe the problem and how you found out about it?
Barcode/Global Trade Item Number (Retail Unit) Barcode / Global Trade Item Number (Shipper) Product Name Brand Name Individual product weight/volume Select Unit GramMilligramKilogramMillilitreLitre Food Storage Category AmbientChilled (Below 5°C)Frozen (Below 18°C) What is the date mark format? Use-byBest-beforeBaked OnNo date code (more than 2 years exemption)Other If Other, describe Intended Shelf-life Select Unit Day/sMonth/sYear/s Serving Size Select Unit MilligramGramMillilitreLitre Is it sold as ready-to-eat? (E.g. no cooking or further processing required before eating.) YesNo Was the product imported? YesNo If Yes, from which country? —Please choose an option—AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Congo-Brazzaville)Costa RicaCroatiaCubaCyprusCzechia (Czech Republic)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (fmr. Swaziland)EthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorth MacedoniaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweOther
Amount produced
Select Unit MilligramGramMillilitreLitreKilogramUnitsOutersPalletsOther
Amount sold to Trade customers (Use Same Units as Above) Amount sold to Consumers Affected batches(code/use-by) Are batches before and after affected/ suspected? YesNoDon't know Details (codes/dates) if Yes
Has the product reached consumers? YesNoDon't know List all customers/retailers and include their location Or attach distribution list/spreadsheet (example) Has product been exported? This includes all product sold outside of NZ including exports to Australia and the Pacific Islands YesNoDon't know If Yes, please provide Export details: Country(s): Exporter Name: Vessel/Flight: Departure Date Certificate Number(s):
Are you aware of any consumer complaints about the product? YesNo If Yes, provide details Are you aware of any reports of illness or injury? YesNo If Yes, provide details
Has any testing about this problem been completed on affected product(s)? YesNoTesting underway If yes, where are the results held?
Are there any other relevant factors? Use this section to record anything else that influences the recall decision. E.g. Experts consulted, and results of consultation.
Other relevant factors
Assessment indicates recall required? If you decide on a consumer-level recall for some products and trade-level for others, please indicate the products associated with each. Consumer-level recallTrade-level recall (incl. precautionary trade recall/hold product pending further investigation and assessment)Maybe – seek advice from NZFS (0800 00 83 33)No Details on reason for decision:
What are you planning to do with affected product? Destruction (retailer managed)Destruction (supplier managed)Re-labellingRe-processingRe-purposingDon't know yetOther If Other (please describe) Product in distribution or transit: Destruction (retailer managed)Destruction (supplier managed)Re-labellingRe-processingRe-purposingDon't know yetOther If Other (please describe)
What methods are you planning to use to inform consumers? Point-of-sale noticeMedia releaseCustomer database - Email/DigitalCustomer database - PhoneNewspaper advertisementRadio advertisementSocial mediaCompany websiteTelevisionAllergyNZDon’t know yetOther If Other(please describe)
What should consumers do with the product? Do not consumeHandle with careConsume only if cooked thoroughlyConsume only if heated to 72°C for 1 minReturn to retailer for refundReturn to manufacturer for refundOther If Other(please describe)
Product Distribution ListPhoto showing batch identification (if available)Photo of product showing nameAgree for NZFS to use images from business website
Upload an image of your product. Must be square and less than 1mb in size This image will be added to a mock recall poster for you.
Detail
Batch 1
Batch 2
Batch 3
Product Name
Batch Code
Date Code
Amount Produced
Amount in Stock
Amount with Distributors / Transporters / Wholesalers
Amount with Retailers
Amount sold Online
Amount with Consumers / Unaccounted For Calculated as Produced − (Stock + Distributors/Transporters/Wholesalers + Retailers + Online)
