HACCP Plan Form
Reference Number
Establishment Name
Hazard Analysis
Processing Step
Potential Hazards
Does the potential food safety hazard carry considerable significance?
Justification of Decision
Preventive Measures
Is this step considered a CCP?
1.
Chemical
Physical
Biological
Yes
No
Yes
No
2.
Chemical
Physical
Biological
Yes
No
Yes
No
3.
Chemical
Physical
Biological
Yes
No
Yes
No
4.
Chemical
Physical
Biological
Yes
No
Yes
No
5.
Chemical
Physical
Biological
Yes
No
Yes
No
6.
Chemical
Physical
Biological
Yes
No
Yes
No
7.
Chemical
Physical
Biological
Yes
No
Yes
No
Critical Control Points
Assigned Employee Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Signature
Submit
Should be Empty: