VACCP Plan Template

• Establishment name

• Reference number

• Conducted on

  Date

• Prepared by

Step / Process

• Identify step/process

• Take or attach photo of process

  Media

• Description of process

• Select which food fraud type(s) is likely

  Select Adulteration Tampering Over-run Theft Diversion Simulation Counterfeit

  • Adulteration
  • Tampering
  • Over-run
  • Theft
  • Diversion
  • Simulation
  • Counterfeit

• Please specify

• Rate the likelihood and consequence of material below.
  
  NOTE:
  RED responses mean urgent action and regular monitoring is required.
  YELLOW responses require action and occasional monitoring.
  GREEN responses represent low risk.

• Evaluate risk likelihood

  Very Unlikely

  Unlikely

  Fairly Likely

  Likely

  Very Likely

• Evaluate risk consequence

  Negligible

  Minor

  Moderate

  Severe

  Very Severe

• Is there any V-CCP in place?

  Yes

  No

• Indicate V-CCP#

• Please refer to 2nd Page

V-CCP

• Step/Process

• Critical Limits

Monitoring Guide

• What

• How

• Frequency

• Who

• Corrective Action(s)

Completion

• Name & Signature of Person in Charge (PIC)

  Sign