Appendix 2. Food Safety Plan Worksheets
Appendix 2. Food Safety Plan WorksheetsWorksheets are recommended to document the product description, hazard analysis andpreventive controls. The hazard analysis form should contain information to justify theidentification of the hazards requiring preventive controls and the types of preventive controlsapplied. Information in the Food Safety Plan must explain the details for each preventive control.There is no standardized or mandated format for these worksheets, but the information shouldbe arranged in a progressive manner that clearly explains the thought process for the hazardanalysis and the individual steps in the Food Safety Plan. Forms used for process preventivecontrols may be adapted for allergen preventive controls, but other formats are entirely acceptableif it works for your organization and contains all of the required information.The following worksheets are provided as examples. The information is arranged in a similarmanner, but the layouts are in either a landscape or a portrait form to suit individual preferences.Other forms can be adapted from those in the Food Safety Plan example.Special Note: These worksheets can be copied for routine use, but if they are used for official use,they must include details that identify the commercial firm and related information. The additionalinformation must include: Firm name and location Dates and, when appropriate, the time of the activity Product identification Usually, record review signature (or initial) and dateAll forms can beadapted or modified asneeded. There is NOrequired form.FSPCA Lead Instructor GuideA2‐1
Appendix 2PLANT NAMEISSUE DATEPAGEADDRESSSUPERSEDESPRODUCT CODEProduct Description Distribution, Consumers and Intended UseProduct Name(s)Product Description,including Important FoodSafety CharacteristicsIngredientsPackaging UsedIntended UseIntended ConsumersShelf LifeLabeling Instructionsrelated to SafetyStorage and DistributionApproved:Signature:Print name:A2‐2Date:For FSPCA Lead Instructor Use Only
Food Safety Plan WorksheetsPLANT NAMEISSUE DATEPAGEADDRESSSUPERSEDESPRODUCT CODEHazard identification (column 2) considers those that may be present in the food because the hazard occurs naturally, thehazard may be unintentionally introduced, or the hazard may be intentionally introduced for economic gain.B Biological hazards including bacteria, viruses, parasites, and environmental pathogensC Chemical (including radiological) hazards, food allergens, substances such as pesticides and drug residues, naturaltoxins, decomposition, and unapproved food or color additivesP Physical hazards include potentially harmful extraneous matter that may cause choking, injury or other adverse healtheffectsHazard Analysis(1)(2)Ingredient /ProcessingStepIdentify potentialfood safety hazardsintroduced,controlled orenhanced at this step(3)Do anypotentialfood safetyhazardsrequire apreventivecontrol?Yes(4)Justify your decision forcolumn 3No(5)What preventive controlmeasure(s) can be applied tosignificantly minimize orprevent the food safetyhazard?(6)Is thepreventivecontrolapplied atthis step?Process including CCPs, Allergen,Sanitation, Supply‐chain, otherpreventive controlYesNoBCPBCPBCPFor FSPCA Lead Instructor Use OnlyA2‐3
For FSPCA Lead Instructor Use OnlyPAGEFrequencyISSUE DATEHowVerificationPLANT NAMEWhatCorrectiveActionPRODUCT CODEMonitoringSUPERSEDESHazard(s) Parameters,values orcritical limitsADDRESSProcessControlsRecordsWhoAppendix 2A2‐4Process Preventive Controls – Landscape Layout
Food Safety Plan WorksheetsPLANT NAMEISSUE DATEPAGEADDRESSSUPERSEDESPRODUCT CODEProcess Preventive Controls – Portrait Format[This is an alternate layout for process preventive control.]Process Control StepHazard(s)Parameters, values orcritical limitsWhatHowMonitoringFrequencyWhoCorrective ActionVerificationRecordsFor FSPCA Lead Instructor Use OnlyA2‐5
FrequencyFor FSPCA Lead Instructor Use OnlyPAGEHowISSUE DATEWhatCorrective Verification RecordsActionPLANT NAMEMonitoringPRODUCT trolWhoAppendix 2A2‐6Form Name: Food Allergen Preventive Controls
Food Safety Plan WorksheetsPLANT NAMEISSUE DATEPAGEADDRESSSUPERSEDESPRODUCT CODEPeanutWheatSoyFish(market name)Shellfish(market name)SupplierTree Nut(market name)Raw Material NameMilkEggFood Allergens in IngredientFormulationAllergens inPrecautionaryLabelingForm Name: Food Allergen Ingredient AnalysisNOTE:The above format is an alternative for an allergen specific hazard analysis. If you choose to use a form like this,then there is no need to duplicate allergen considerations in your hazard analysis chart. Duplication ofinformation in multiple forms can create extra work and may lead to inconsistencies.Some organizations may even choose to do an ingredient hazard analysis that considers not only allergens, butalso other hazards. This may be a useful option for you.How to Use the ChartList all ingredients received in the facility. Identify allergens contained in each ingredient by reviewing ingredientlabels or contacting the manufacturer. Any allergens listed in “May contain” or other precautionary labeling oningredients should be listed in the last column and reviewed to determine if allergen labeling is needed on thefinished product.For FSPCA Lead Instructor Use OnlyA2‐7
Appendix 2PLANT NAMEISSUE DATEPAGEADDRESSSUPERSEDESPRODUCT CODEForm Name: Food Allergen Label Verification ListingProductA2‐8Allergen StatementFor FSPCA Lead Instructor Use Only
Food Safety Plan WorksheetsPLANT NAMEISSUE DATEPAGEADDRESSSUPERSEDESPRODUCT CODEForm Name: Production Line Food Allergen AssessmentShellfish(market name)PeanutWheatSoyFish(market name)Production LineTree Nut(market name)Product NameMilkEggIntentional AllergensScheduling Implications:Allergen Cleaning Implications: (Required)How to Use This FormComplete for each production line. Identify each allergen contained in each product produced on theline. Identify any allergens unique to a specific product, then indicate scheduling information (i.e., rununique allergens last) and allergen cleaning information (i.e., full allergen clean before running cheeseor plain omelets after a biscuit run.For FSPCA Lead Instructor Use OnlyA2‐9
Appendix 2PLANT NAMEISSUE DATEPAGEADDRESSSUPERSEDESPRODUCT CODEForm Name: Sanitation Preventive ringCorrectionsRecordsVerificationA2‐10DateFor FSPCA Lead Instructor Use Only
Food Safety Plan WorksheetsPLANT NAMEISSUE DATEPAGEADDRESSSUPERSEDESPRODUCT CODECorrective Action FormDate of Record:Code or Lot Number:Date and Time of Deviation:Description of Deviation:Actions Taken to Restore Order to the Process:Person (name and signature) of Person Taking Action:Amount of Product Involved in Deviation:Evaluation of Product Involved with Deviation:Final Disposition of Product:Reviewed by (Name and Signature):Date of Review:For FSPCA Lead Instructor Use OnlyA2‐11
Appendix 2PLANT NAMEISSUE DATEPAGEADDRESSSUPERSEDESPRODUCT CODEFood Safety Plan Reanalysis ChecklistReason for reanalysis:TaskDateReviewedandInitialsIs UpdateNeeded?(yes/no)Date TaskCompletedList of Food Safety Team withindividual responsibilitiesProduct flow diagramsHazard analysisProcess Preventive ControlsFood Allergen Preventive ControlsSanitation Preventive ControlsSupply‐chain ProgramRecall PlanUpdated Food Safety PlanimplementedUpdated Food Safety Plan signed byowner or agent in chargeReviewer Signature:Date issued: dd/mm/yyA2‐12Date Review:Supersedes: dd/mm/yyFor FSPCA Lead Instructor Use OnlySignature or Initials ofPerson Completing theTask
Appendix 2. Food Safety Plan Worksheets Worksheets are recommended to document the product description, hazard analysis and preventive controls. The hazard analysis form should contain information to justify the iden
Issue of orders 69 : Publication of misleading information 69 : Attending Committees, etc. 69 : Responsibility 69-71 : APPENDICES : Appendix I : 72-74 Appendix II : 75 Appendix III : 76 Appendix IV-A : 77-78 Appendix IV-B : 79 Appendix VI : 79-80 Appendix VII : 80 Appendix VIII-A : 80-81 Appendix VIII-B : 81-82 Appendix IX : 82-83 Appendix X .
Appendix G Children's Response Log 45 Appendix H Teacher's Journal 46 Appendix I Thought Tree 47 Appendix J Venn Diagram 48 Appendix K Mind Map 49. Appendix L WEB. 50. Appendix M Time Line. 51. Appendix N KWL. 52. Appendix 0 Life Cycle. 53. Appendix P Parent Social Studies Survey (Form B) 54
Appendix 1 - School Food and Beverage Policy 66 Appendix 2 - Trans Fat Standards (O.Reg. 200/08) 83 Appendix 3 - Calculating Trans Fat 84 Appendix 4 - A-Z Food and Beverage List 86 Appendix 5 - Cafeteria Food Service Provider Checklist 92 Appendix 6 - Caterer Checklist 93 Appendix 7 - School Event Menu Ideas 94
Appendix H Forklift Operator Daily Checklist Appendix I Office Safety Inspection Appendix J Refusal of Workers Compensation Appendix K Warehouse/Yard Inspection Checklist Appendix L Incident Investigation Report Appendix M Incident Investigation Tips Appendix N Employee Disciplinary Warning Notice Appendix O Hazardous Substance List
Types of food environments Community food environment Geographic food access, which refers to the location and accessibility of food outlets Consumer food environment Food availability, food affordability, food quality, and other aspects influencing food choices in retail outlets Organizational food environment Access to food in settings
5. Fill in the templates and log sheets for your plan. There are various types provided in Appendix C. You only need to prepare one type of food safety plan. Using Your Food Safety Plan Train Your Staff Once your food safety plan is complete the next step is to
Appendix#10 Pre-Job Briefing and Post-Job Review Attendance Form Appendix#11 Safety Task Assignment (STA) Appendix#12 Physiological Monitoring for Heat Stress Appendix#13 Weekly Hour Usage Report Appendix#14 Project - Training Matrix A or B Appendix#15 Excavation Trench Inspection Form Appendix#16 Inbound Equipment Inspection Form
1 Food Safety Plan Builder v.1.3 Legal Disclaimer The Food Safety Plan Builder (FSPB) v.1.3 is a user-friendly tool designed to help owners and operators of a food establishment with the development of a food safety plan that is specific to their facilities. The food safety plan is developed using a systematic approach to identify those
