Title Page
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Site conducted
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Document Number: QC1009C
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Document Name: Crisis Incident Report
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Issue Date: 17-Sep-20
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Revision Date: 01-Apr-21
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Revision Number: 1
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Revised By: Steven Grant
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Approved By: Ranjeet Singh
Crisis Incident Details
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Date of Incident:
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Time of Incident:
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Indicate type of exercise:
- Actual
- Mock
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Indicate type of crisis:
- Power Failure
- Server Interruption
- Fire
- Bio-terrorism
- Bomb Threat
- Snow Storm
- Storm Damage
- Equipment Interruption
- Ingredient Interruption
- Weather
- Other
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Describe type if other:
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Total number of similar crisis situations in the past 12 months:
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Please provide details of incident:
Food Safety Hazard Risk Assessment:
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Food Safety Hazard Risk Assessment:
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Risk Assessment Table
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Please indicate Likelihood rating for Crisis incident:
- 1
- 2
- 3
- 4
- 5
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Please indicate Severity rating for Crisis incident:
- 1
- 2
- 3
- 4
- 5
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Please indicate overall risk rating (Likelihood x Severity)
- 1 - Low
- 2 - Low
- 3 - Low
- 4 - Low
- 5 - Low
- 6 - Low
- 8 - Medium
- 9 - Medium
- 10 - Medium
- 12 - Medium
- 15 - High
- 16 - High
- 20 - High
- 25 - High
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Incident Root Cause: 5 Why's OR Fishbone
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What is the Problem?
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Why is the problem happening?
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Why is that?
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Why is that?
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Why is that?
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Why is that? (Root Cause)
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Fishbone Causes; Materials, Environment, People, Equipment, Processes, Methods
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Effect - Problem?
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Cause - Materials?
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Cause - Environment?
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Cause - People?
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Cause - Equipment?
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Cause - Processes?
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Cause - Methods?
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Corrective actions taken to eliminate or reduce hazards:
Crisis Incident Assessment
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Decision making questions: Chose one answer per question, explain if necessary. Complete disposition sections for Actual Crisis incidences only:
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Is the building structure damaged?
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Can you enter the plant?
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Is the computer software data intact and accessible?
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Are cleaning chemicals accessible to clean the lines prior to starting?
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Are there any types of odor or airborne food safety hazards present?
Employee Assessment
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Are there any employee injuries as a result of incident?
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Outcome of injured employee:
Equipment Assessment
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Has any equipment been affected/damaged by incident?
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Has the affected/damaged equipment been segregated?
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Is the facility able to produce safe/quality product with affected/damaged equipment?
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Test performed on suspect equipment:
- Yes
- No
- N/A
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Type of test performed:
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Date of test performed:
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Outcome of Test:
Equipment Disposition
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Description of affected/damaged equipment:
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Has any equipment been replaced or modified? If yes, please provide details:
Ingredient Assessment
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Has any ingredients been affected by incident?
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Has affected ingredients been segregated?
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Test performed on suspect ingredient:
- Yes
- No
- N/A
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Type of test performed:
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Date of test performed:
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Outcome of Test:
Ingredient Disposition
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Code & description of affected raw ingredients:
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Lot Number:
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Quantity:
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State disposition of affected raw ingredients (Release/Dispose/Rework etc):
Packaging Assessment
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Has any packaging material been affected by incident?
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Has affected packaging material been segregated?
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Test performed on suspect packaging material:
- Yes
- No
- N/A
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Type of test performed:
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Date of test performed:
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Outcome of Test:
Packaging Disposition
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Code & description of affected packaging materials:
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Lot Number:
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Quantity:
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State disposition of affected packaging material (Release/Dispose/Rework etc):
Product Assessment
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Has any product (finished/work in-process/raw) been affected by incident?
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Has any affected finish product been packed?
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Has all affected product been segregated?
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Has any affected product left the facility?
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Has all affected product been retrieved? If no, follow product recall procedure.
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Name of recall team member contacted (if applicable).
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Test performed on suspect finished product:
- Yes
- No
- N/A
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Type of test performed:
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Date of test performed:
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Outcome of Test:
Product Disposition
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Code & description of affected finished products:
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Lot Number:
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Quantity:
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State disposition of affected product (Release/Dispose/Rework etc):
Crisis Incident Communications
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Have suppliers been contacted?
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Do suppliers need to be rerouted?
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Have customers been contacted?
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Do customers need to be rerouted?
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Has the Media been contacted in regards to crisis incident?
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Has certifying body / SQFI been contacted in regards to crisis incident?
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Has CFIA or FDA been contacted in regards to crisis incident?
Production Re-Commencing
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Are there enough employees available to start production?
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Have employees been contacted and communicated with new plan?
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Are there enough functional equipment to start production? If no, please indicate equipment needed and approximate receiving, installation or modification date:
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Are there enough ingredients to start production? If no, please indicate ingredients needed and approximate receiving date:
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Are there enough packaging material to start production? If no, please indicate packaging material needed and approximate receiving date:
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Has the production line been cleaned/inspected prior to starting?
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Food Safety and Quality Manager Approval:
Report Completion:
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Completed by (Name & Signature)
Incident Review
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Crisis Team Meeting Minutes (date/time):
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Attendance:
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Issues raised as a result of review:
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Decisions made as a result of crisis incident review:
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General conclusion of review:
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Follow-ups:
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Approved by (Name & Signature)
