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Food Safety Management System Forms

Information about my child’s special diet

Please fill in this form in BLOCK CAPITALS and return it to your child’s school.


Section a - General

section b - allergy details

Does your child have food allergies? If YES, fill in this section.  If NO, go to Section C.Please include as much information as possible about your child’s food allergy in the space below.  For example:




  • Can they tolerate products that say ‘may contain traces’?

  • What types of nuts are they allergic to – or should they avoid all nuts?

  • Should they avoid all forms of the allergen - or can they tolerate some forms, for example raw, baked or cooked?



If possible, please provide a copy of any relevant medical assessment or confirmation.



(Sodexo cannot guarantee the absence of any specific allergen. Our staff will be happy to talk to you about what we do in the kitchen to reduce the risks of allergen cross-contamination.)



ALLERGENS


Celery*
Cereals*
Crustaceans*
Egg*
Milk*
Molluscs*
Fish*
Lupin*
Mustard*
Nuts*
Peanuts*
Sesame Seeds*
Soya*
Sulphur Dioxide (Sulphites)*
Does your child have an adrenaline auto-injector?*

section c - Other dietary related conditions
My child manages his own allergies on a day-to-day basis and I give full permission for him to make his own food choices within the school environment. (Please note, we will still need the information on your child’s food allergy).*

section d - declaration

In submitting this form you are confirming that:




  • Any information provided above relates to a food allergy, intolerance or other dietary-related medical condition and NOT about my child's food preferences.

  • Where applicable, I agree to information about my child’s allergy and any related doctor’s or registered dietician’s medical assessment being provided to the school’s catering partner Sodexo (including any other relevant personal data, like photographs, if I’ve agreed with the school), solely so they can provide suitable meals for my child.