Recall Log Glutenull Bakery NRM119713

• Glutenull Bakery 112 - 1647 Broadway Street Port Coquitlam, BC V3C 6P8
  Address

• Enter Employee Name

• Enter Date & Time

  Date

• RECALL TYPE

  MOCK RECALL

  PRODUCT WITHDRAWAL

  PRODUCT RECALL

RECALLED RAW INGREDIENTS (SUPPLIER GENERATED RECALL)

• Supplier Issuing Recall

• List Ingredient & Lot Number(s) Recalled

• Reason For Recall

  Select Physical Contamination Chemical Contamination Biological Contamination Allergen Contamination

  • Physical Contamination
  • Chemical Contamination
  • Biological Contamination
  • Allergen Contamination

• Recall Level

  Select Level 1 Level 2 Level 3

  • Level 1
  • Level 2
  • Level 3

• Quantity Received

• Quantity On-Hand

• Lot Numbers Of Affected Final Product

RECALLED FINAL PRODUCT (MANUFACTURER GENERATED)

• Enter Product & Lot Number(s)

• Reason For Recall

  Select Physical Contamination Chemical Contamination Biological Contamination Allergen Contamination

  • Physical Contamination
  • Chemical Contamination
  • Biological Contamination
  • Allergen Contamination

• Recall Level

  Select Level 1 Level 2 Level 3

  • Level 1
  • Level 2
  • Level 3

• Quantity Affected

• Quantity On-Hand

COMMUNICATION

• Recall Team Notified

  Yes

  No

  N/A

• CFIA Notified

  Yes

  No

  N/A

• USFDA Notified

  Yes

  No

  N/A

• Affected Customers Notified

  Yes

  No

  N/A

• Press Release Issued

  Yes

  No

  N/A

DISPOSITION

• Affected Product Segregated

  Yes

  No

  N/A

• Enter Disposition Plan

• PROOF OF DISPOSITION (If Applicable - Requires Photo)

  Media

Signatures

• Name & Signature of Person Completing This Log.

  Sign

• Supervisor Name & Signature

  Sign