Dairy Ingredient Verification
Appendix - Ingredient Verification Worksheet

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Date of Inspection:



Reg. No:

Product Description:

  • Check Bulk
  • Check Prepackaged
  • Check CAPA product
  • Check Graded
  • Check Standardized
  • Check non-CAPA product
Example of blank form for List of Ingredients
Table Summary

This table is used to write down the list of ingredients and additives as listed on the label, the ingredient (additives) and quantity (recipe), the components and to indicate if the ingredient listing is correct

List of Ingredients (and Additives) as listed on label Ingredients (Additives) and Quantities (Recipe) Components Correct Ingredient Listing
Overall Evaluation:
Yes No
1. Are all potential allergens (nuts, sulphites etc.) declared on the label? checkbox for yes checkbox for no
2. Are ingredients (additives) added according to the listing on the label, and do they appear in descending order by weight? checkbox for yes checkbox for no
3. Are all ingredients (additives) approved for use in this product? checkbox for yes checkbox for no
4. the food additives used meet the prescribed levels of use as outlined in the List of Permitted Food Additives? checkbox for yes checkbox for no



Canada Agricultural Products Act, Dairy Products Regulations, Food and Drug Act and Regulations, and Consumer Packaging and Labelling Act and Regulations.

Note: Please attach a copy of the label to this worksheet.

Date modified: