Information
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Date of incident:
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Date Code:
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Production Line:
- Gram
- Glacier
- SS1
- SS2
- B&J
- Rollo
- Vita
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Equipment:
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Product:
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Product SAP#
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Work Order#:
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Number of cases affected:
Incident Types
Microbiological Contamination
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Select the correct input
- Finished product OOS coliform or APC
- Finished product failed zone1testing
- Post Sanitation Swabs OOS (coliform or APC)
- Finished product coliform results of 10
- Finished product APC >1000 but <5000
Chemical Contamination
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Select the correct input
- Cleaning chemical
- Grease/ Oil/ Lubricant
- Allergen
- Other
Foreign Material Contamination
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Select the correct input
- Metal
- Rubber
- Hard Plastic
- Soft Plastic
- Wood
- Paper/ Cardboard
- Paint/ Sticker material
Ingredients or Materials
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Select the correct input
- Supplier Issue
- Cross contamination at the line
- Under dosing materials (not enough)
- Incorrect material or mix use
- Missing material or ingredient
Date Code Issues
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Select the correct input
- Missing/ illegible code date
- Incorrect code date
Metal Detection Issues (CCP 2P)
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Select the correct input
- Missed Operator monitoring check
- Metal detection failed to detect testing stick
- Metal detection reject system did not activate
- Metal detection reject system failed to reject proper pack
Documentation Non Conformances
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Select the correct input
- Incomplete records
- Incorrect calculations
- Incorrect paperwork
- Lack of verification
Defects
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Photos or Videos of the incident or non conformance
Ingredient or Material Issues
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Material Description (note take photo of the required information)
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Supplier
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Lot number
1G - GEMBA - List all observations (Go to the spot where the problem occurred; check for External Influences, observe the current conditions and talk to operators)
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Observation 1
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Observation 2
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Observation 3
2G - GEMBUTSU (Have a close look at the machine conditions, equipment and/or tools. Check for wear, damages, leaks and/or any contamination) Note: take photos as evidence
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Machine or Equipment Components
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Other
3G - GENJITSU (Collect relevant data to have a better understanding of the problem. Check machine parameters, operating conditions, downtime information) Note: take photos as evidence
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Machine or Equipment Components
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Informance downtime information
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Other
Immediate Actions Taken
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Line Shutdown
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Product placed on Hold
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Quantity of the product on hold
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Actions taken at the line
Investigators Information
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Investigation Completed By:
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Support Personal:
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Additional Operator(s)