Halal Dietary Compliance Form
Organization / Company Name
Contact Person
Email
Phone Number
Product / Menu Details
Product / Menu Name
List of Ingredients
Source of Ingredients
Are all ingredients Halal-certified?
Yes
No
Partial
Preparation & Handling
Separate utensils and surfaces for halal and non-halal items
Preparation is supervised by a Muslim staff
Measures in place to avoid cross-contamination
Additional Notes / Description