Allergen Declaration Sheet
Restaurant Name
Date:
- 1. Cereals containing gluten
- 2. Crustaceans
- 3. Eggs
- 4. Fish
- 5. Peanuts
- 6. Soybeans
- 7. Milk
- 8. Nuts
- 9. Celery
- 10. Mustard
- 11. Sesame seeds
- 12. Sulphur dioxide & sulphites
- 13. Lupin
- 14. Molluscs
| Dish Name |
Description |
Allergens Present
(Refer to number above) |
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Notes: