Information

  • Date of incident:

  • Date Code:

  • Production Line:

  • Equipment:

  • Product:

  • Product SAP#

  • Work Order#:

  • Number of cases affected:

Incident Types

Microbiological Contamination

  • Select the correct input

Chemical Contamination

  • Select the correct input

Foreign Material Contamination

  • Select the correct input

Ingredients or Materials

  • Select the correct input

Date Code Issues

  • Select the correct input

Metal Detection Issues (CCP 2P)

  • Select the correct input

Documentation Non Conformances

  • Select the correct input

Defects

  • Photos or Videos of the incident or non conformance

Ingredient or Material Issues

  • Material Description (note take photo of the required information)

  • Supplier

  • 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)

  • Observation 1

  • Observation 2

  • 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

  • Machine or Equipment Components

  • 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

  • Machine or Equipment Components

  • Informance downtime information

  • Other

Immediate Actions Taken

  • Line Shutdown

  • Product placed on Hold

  • Quantity of the product on hold

  • Actions taken at the line

Investigators Information

  • Investigation Completed By:

  • Support Personal:

  • Additional Operator(s)

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.