Form Non Conforming Product Form
2
Authorised By: Susan Sunny Hotel Manager Document Date: Next Review Date: 1 st March 2013 1 st March 2014 Document Number HACCPPROGRAM Revision 0 Page No 1 of 2 Form owner: Site Manager Frequency: As required Form 9: Non-Conforming Product Form Note: This form must only be completed by referring to the Non Conforming Product Procedures (HACCP24-1) and may only be completed by either the Site Manager or the Head Chef PART 1. INCIDENT SUMMARY – INFORMATION PROVIDED BY CUSTOMER DATE of INCIDENT TIME of INCIDENT DATE OF INCIDENT REPORT TIME of INCIDENT REPORT CUSTOMER NAME(S) (if available): COMPLAINANT NAME (if different to customer name) ADDRESS PHONE (H) (w) NATURE OF PROBLEM/ COMPLAINT Food Product Product contamination Quality of Service Presentation Other TYPE OF FOOD IMPLICATED SYMPTOMS HAS EXTERNAL ADVICE BEEN SOUGHT? E.g. medical, council, Food Authority, legal, media LOCATION OF ALLEGED INCIDENT SUMMARY OF PROBLEM/ COMPLAINT
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Transcript of Form Non Conforming Product Form
Authorised By: Susan Sunny Hotel Manager
Document Date: Next Review Date:
1st
March 2013 1
st March 2014
Document Number HACCPPROGRAM Revision 0 Page No 1 of 2
Form owner: Site Manager Frequency: As required
Form 9: Non-Conforming Product Form
Note: This form must only be completed by referring to the Non Conforming Product Procedures (HACCP24-1) and may only be completed by either the Site Manager or the Head Chef
PART 1. INCIDENT SUMMARY –
INFORMATION PROVIDED BY CUSTOMER DATE of INCIDENT TIME of INCIDENT
DATE OF INCIDENT REPORT
TIME of INCIDENT
REPORT
CUSTOMER NAME(S) (if
available):
COMPLAINANT NAME (if
different to customer name)
ADDRESS
PHONE (H) (w)
NATURE OF PROBLEM/
COMPLAINT
Food Product Product contamination Quality of Service Presentation
Other
TYPE OF FOOD
IMPLICATED
SYMPTOMS
HAS EXTERNAL ADVICE BEEN SOUGHT? E.g. medical, council, Food Authority, legal, media
LOCATION OF ALLEGED INCIDENT
SUMMARY OF PROBLEM/ COMPLAINT
Authorised By: Susan Sunny Hotel Manager
Document Date: Next Review Date:
1st
March 2013 1
st March 2014
Document Number HACCPPROGRAM Revision 0 Page No 2 of 2
PART 2. INTERNAL INVESTIGATION
What foods were involved? _______________________________________________________________
How many other similar/ same items were sold on the same day? ________________________________
Supplier’s names if ready to eat foods are implicated?
____________________________________________
Has supplier been contacted? (Attach details)
____________________________________________
Number of other people possibly affected? ____________________________________________
HACCP REVIEW
All relevant forms scanned in file/ attached:-
Food Safety Audit
Incoming Goods Records
Storage Records
Labelling Records
Microbiological Analysis Records
Cleaning Records
Sales Records for Day
Functions records etc.
Documents relating to complaint (letters etc).
Other:
CORRECTIVE ACTION TAKEN (to prevent a re-occurrence)
Immediate Corrective Action(s) follow up action:
Preventative Corrective Action(s) to Prevent a Recurrence:
Copied to: Site Manager Site Manager Reviewed by: ___________ Date: ___________
