FDA Procedures for Standardization and Certification
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Cover Memo
Contents
Expanded Contents
(For Subparagraph 3-302 (B)(3))
| Establishment Name: | Type of Facility: | ||||||||
| Physical Address: | Person in Charge: | ||||||||
| City: | State: | Zip: | County: | ||||||
| Insp. Time In: | Insp.Time Out: | Date: | Candidate's Name: | ||||||
| Agency: | Standard's Name: | Indicate Person Filling Out Form:
(circle one) Candidate's Form / Standard's Form |
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| Cold Holding Requirement For
Jurisdiction: [5 °C (41 °F)_____] or [7 °C (45 °F)_____ ] or [5 °C (41 °F) and 7 °C (45 °F) combination:______] |
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| Chart 2: HACCP Plan Verification Summary | |||
|---|---|---|---|
HACCP Plan Verification Summary (circle YES or NO) |
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Record #1 |
Record #2 |
Record #3 |
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| Today's Date: | 2nd Selected Date: | 3rd Selected Date: |
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| Required Monitoring Recorded 1 | YES/ NO |
YES / NO |
YES / NO |
| Accurate and Consistent 2 | YES / NO |
YES / NO |
YES /NO |
| Corrective Action Documented 3 | YES / NO |
YES / NO |
YES/ NO |
| Total # of record answers that are in Disagreement with the Standard =________ (This box for Completion by Standard only) | |||
The use of a HACCP plan by a food establishment can be verified through a review of food establishment records and investigating the following information:
Does the food establishment's HACCP documentation indicate that required monitoring was recorded on the 3 selected dates? A "YES" answer would indicate that all required monitoring was documented. If any required monitoring was not documented, a "NO" answer would be circled in this section.
Does the food establishment's HACCP documentation for the selected dates appear accurate and consistent with other observations? A "YES" answer would indicate that the record appears accurate and consistent. A "NO" answer would indicate that there is inaccurate or inconsistent HACCP documentation.
Was corrective action documented in accordance with the HACCP plan when CLs were not met on each of the 3 selected dates? A "YES" answer would indicate that corrective action was documented for each CL not met for each of the 3 selected dates. A "Yes" can also mean that no corrective action was needed. A "NO" answer would indicate any missing or inaccurate documentation of corrective action.
Retail Food Inspections Table of Contents