Living Earth Farm - Recall Log

• Date

  Date
• Location
  Address

• HACCP Coordinator Signature

  Sign

Recalled Raw Ingredients (Initiated by a Supplier)

• Name of Supplier Issuing Recall.

• List Ingredients & Lot #'s, PLU #'s, or Identifier.

• Reason for Supplier Recall.

• What is the Recall Level (per CFIA).

  Select MOCK Level 1 Level 2 Level 3

  • MOCK
  • Level 1
  • Level 2
  • Level 3

• List Quantity(s) of Recalled Product Received.

• List Quantity(s) of Recalled Product On-Hand.

Recalled Finished Goods Recall (Initiated by Living Earth Farm)

• List Ingredients & Lot #'s, PLU #'s, or Identifier.

• Reason to Initiate Recall.

• What is the Recall Level (per CFIA).

  Select MOCK Level 1 Level 2 Level 3

  • MOCK
  • Level 1
  • Level 2
  • Level 3

• List Quantity(s) of Product Affected.

• List Quantity(s) of Recalled Product On-Hand.

• List of Customers Product was sold too

Communication of Recall

• HACCP Coordinator notified

  Yes

  No

  N/A

• Affected Customers Notified.

  Yes

  No

  N/A

Disposition

• Affected Product Segregated.

  Safe

  At Risk

  N/A

• Disposition Plan outlined

• Is this a mock recall?

  Yes

  No

  N/A

• Employee Name & Signature.

  Sign

• Owner Name & Signature.

  Sign