FSQ Incident or Non Conformance Investigation

• Date of incident:

  Date

• Date Code:

• Production Line:

  Select Gram Glacier SS1 SS2 B&J Rollo Vita

  • Gram
  • Glacier
  • SS1
  • SS2
  • B&J
  • Rollo
  • Vita

• Equipment:

• Product:

• Product SAP#

• Work Order#:

• Number of cases affected:

Microbiological Contamination

• Select the correct input

  Select 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

  • 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

• Select the correct input

  Select Cleaning chemical Grease/ Oil/ Lubricant Allergen Other

  • Cleaning chemical
  • Grease/ Oil/ Lubricant
  • Allergen
  • Other

Foreign Material Contamination

• Select the correct input

  Select Metal Rubber Hard Plastic Soft Plastic Wood Paper/ Cardboard Paint/ Sticker material

  • Metal
  • Rubber
  • Hard Plastic
  • Soft Plastic
  • Wood
  • Paper/ Cardboard
  • Paint/ Sticker material

Ingredients or Materials

• Select the correct input

  Select Supplier Issue Cross contamination at the line Under dosing materials (not enough) Incorrect material or mix use Missing material or ingredient

  • Supplier Issue
  • Cross contamination at the line
  • Under dosing materials (not enough)
  • Incorrect material or mix use
  • Missing material or ingredient

Date Code Issues

• Select the correct input

  Select Missing/ illegible code date Incorrect code date

  • Missing/ illegible code date
  • Incorrect code date

Metal Detection Issues (CCP 2P)

• Select the correct input

  Select 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

  • 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

• Select the correct input

  Select Incomplete records Incorrect calculations Incorrect paperwork Lack of verification

  • Incomplete records
  • Incorrect calculations
  • Incorrect paperwork
  • Lack of verification

• Photos or Videos of the incident or non conformance

  Media

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

  Yes

  No

  N/A

Immediate Actions Taken

• Line Shutdown

  Yes

  No

  N/A

• Product placed on Hold

  Yes

  No

  N/A

• Quantity of the product on hold

• Actions taken at the line

Investigators Information

• Investigation Completed By:

  Sign

• Support Personal:

  Sign

• Additional Operator(s)

  Sign