Food Safety Program

Template for Evolution

Restaurant
 Table of
Contents

1 INTRODUCTION

2 HACCP PLAN

2.1 HACCP Team

2.2 Scope
2.3 Product Description and Intended Use
2.4 Process Flow Chart
2.5 Hazard Analysis
2.6 Hazard Audit Table
2.6.1 Justification Table
2.6.2 Verification Table

3 SUPPORT PROGRAMS
3.1 Maintenance Program
3.2 Approved Supplier Program
3.3 Good Food Handling Practices
3.4 Cleaning and Sanitation Program
3.5 Pest Control Program
3.6 Personal Hygiene Program
3.7 Product Recall Program
3.8 Staff Training Program
3.9 Calibration Program
3.10 Internal Audit
3.11 Document and Data Control Program

4 APPENDICES

Form 1 Monthly Maintenance

Checklist Form 2 Temperature
Monitoring Sheet Form 3a Supplier
Approval Letter
Form 3b Supplier Approval Application
Form 4 Approved Supplier List
Form 5 Product Receival Sheet
Form 6 Product Monitoring
Sheet Form 7 Product Despatch
Form 8 Pre-operational Checklist
Form 9 Staff Training Matrix
Form 10 Internal Audit Checklist
Form 11 Product testing Schedule

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 The Use of NSW Food Authority Assistance Materials

The NSW Food Authority “General Guidelines for the Development and Implementation of a Food
Safety Program”, “Food Safety Program Template” and “Industry Specific Guides” are guidance
documents only. NSW Food Authority disclaims any liability for any loss or injury directly or
indirectly sustained by any person as a result of reliance upon these documents. Businesses must
not assume that these guidance documents cover all food safety hazards within their business. If using
these document to develop your Food Safety Program then you must adapt these to fit your business,
products, and market requirements, and to ensure that all potential food safety hazards are identified and
controlled. You are advised to seek independent legal advice in relation to any query you may have
regarding the legal obligations imposed under the relevant Food Safety Scheme Regulation.

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1. Introduction

In this Section you should give a general introduction to

your organisation and outline the principle of
management’s commitment to the development and
implementation of a Food Safety Program. This could
include:
 Nature of business
 Scope of products
 Major customers
 Commitment to quality statement
 Organisational chart showing positions within the
organisation responsible for food safety
Refer to:
 the General Guidelines for the Development
and Implementation of a Food Safety Program.

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2. HACCP-based Food Safety Plans
2.1 HACCP Team

In this section record the team that is responsible for

The HACCP team includes: developing and maintaining this food safety plan,
updating the HACCP manual, analysing and
improving procedures and implementing effective
NAME POSITION
controls to manage food safety IN COMPANY
risks.
Refer to:
TEAM LEADER  the General Guidelines for the Development
and Implementation of a Food Safety
TEAM MEMBER

TEAM MEMBER

TEAM MEMBER

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2.2 Scope and Purpose

In this section document the scope and purpose of

the food safety plan.
Refer to:
 the General Guidelines for the Development
and Implementation of a Food Safety
Program.
 your Industry Guide.

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2.3 Product Description and Intended Use

In this section complete details for each product

you produce (the example layout below can be
used as a guide).
Refer to:
 the General Guidelines for the Development
and Implementation of a Food Safety
Program.
Product Name

Ingredients used/composition

Form

Packaging

Shelf Life

Storage and Transport

Intended Use

Consumer

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2.4 Process Flow Chart

In this section construct a flow chart for each

product or like- products by providing a simple,
clear description of the steps involved in your
process.
Refer to:
 the General Guidelines for the Development
and Implementation of a Food Safety
Program.

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2.5 Hazard Analysis

In this section carry out a Hazard Analysis for each product or like products in your
process. Refer to:
 the General Guidelines for the Development and Implementation of a Food Safety Program,
 your Industry Guide, and the CCP Decision Tree (located in
CCP= Critical Control Point SP= Support Program
general guide). Note:
CCP’s should be decided using the CCP decision tree and should assume that the control measures
PROCESS STEP HAZARD are followed. CONTROL MEASURE Q1 Q2 Q3 Q4 Q5 CCP
Copy more pages of the table as needed.

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PROCESS STEP HAZARD CONTROL MEASURE Q1 Q2 Q3 Q4 Q5 CCP

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2.6 Hazard Audit Table

In this section set up the Hazard Audit table for each product or like products in
your process. Refer to:
the General Guidelines for the Development and Implementation of a Food Safety Program
your Industry Guide.
Step Hazard Control Measure Monitoring Procedures Critical Limits Corrective Action Records
Copy more What
pages of the table as needed.
:

How:

When
:

Who:
What
:

How:

When
:

Who:
What
:

How:

When
:

Who:

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Step Hazard Control Measure Monitoring Procedures Critical Limits Corrective Action Records
What
:

How:

When
:

Who:
What
:

How:

When
:

Who:
What
:

How:

When
:

Who:
What
:

How:

When
:

Who:

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2.6.1 Justification Table

Hazard/Control Measure Critical Limit Reference/Justification

2.6.2 Verification Table

CCP or Support Verification Activity Frequency Person Responsible Records Corrective

Program Action/Comments

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 3. SUPPORT PROGRAMS

In the following sections document information on

policies and procedures for each of the Support
3.1 MAINTENANCE PROGRAM Programs established in your organisation.
Refer to:
 the General Guidelines for the development
and
In this implementation
section, documentof ainformation
food safety program
on policies and
 your Industry
procedures Guide.
for the Maintenance Program established
in your organisation.
Ensure that you include the relevant aspects of the
premises, equipment and food transport vehicles as
part of the program. An example of a Monthly
Maintenance Checklist can be found in the Appendix
(Form 1) and Pre-Operational Checklist (Form 8) of
this document.
Refer to:
 the General Guidelines for the Development
and Implementation of a Food Safety

3.2 APPROVED SUPPLIER PROGRAM

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 In this section document your Approved Supplier
Program.
An example guide of an Approved Supplier Program
and documents required is as follows:
 All goods and services are to be sourced from an
approved supplier.
 Suppliers are required to complete the Supplier
Approval Application (Form 3b) which is sent to
each supplier along with the Supplier Approval
Letter (Form 3a).
 It is your responsibility to determine criteria for
approving and maintaining suppliers (eg HACCP
program required for high risk ingredients).
 All suppliers approved are listed on the Approved
Supplier List (Form 4) along with the products
they supply.
 Documents provided by the supplier and the
completed Supplier Approval Application Form
need to be kept.
Refer to:
 the General Guidelines for the Development

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3.3 GOOD FOOD HANDLING PRACTICES

In this section document information on policies and

procedures for Good Handling Practices established
in your organisation.
Refer to:
 the General Guidelines for the Development
and Implementation of a Food Safety
Program.
 Appendix 5 of this document for an example of
good food handling policy.
Ensure that you incorporate all areas relevant to your
business.

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3.4 CLEANING AND SANITATION PROGRAM

In this section, document information on

policies and procedures for the Cleaning and
Sanitation Program established in your
organisation.
Ensure that you incorporate the relevant aspects of
the premises, equipment and food transport vehicles
as part of the program.
A Pre-Operational Checklist is a useful tool. This type
of check can be used at the commencement of each
shift/day to ensure the premises and equipment are
satisfactory for use. Ths can be carried out daily
before processing to ensure that all surfaces are
clean prior to use. An example is found in Form 8 of
the Appendix.
Refer to:

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3.5 PEST CONTROL PROGRAM

In this section document information on policies and

procedures for the Pest Control Program established
in your organisation.
Animals and pests including insects and rodents must
be excluded from the premises. As an example, any
evidence of pests can be recorded on the Pre-
Operational Checklist (Form 8).
Refer to:
 the General Guidelines for the Development
and Implementation of a Food Safety
Program.

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3.6 PERSONAL HYGIENE PROGRAM

In this section document information on policies and

procedures for the Personal Hygiene Program
established in your organisation.
Personal hygiene is a vital part of minimising the risk of
food poisoning or a contamination incident affecting
the business.
Refer to:
 the General Guidelines for the Development
and Implementation of a Food Safety

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3.7 PRODUCT RECALL PROGRAM

In this section document information on policies and

procedures for the Product Recall Program
established in your organisation.
Refer to:
 the General Guidelines for the Development
and Implementation of a Food Safety Program
 your Industry Guide.

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3.8 STAFF TRAINING PROGRAM

In this section document information on policies and

procedures for the Staff Training Program
established in your organisation.
Refer to:
 the General Guidelines for the Development
and Implementation of a Food Safety Program
and
 your Industry Guide.
All staff must be trained to enable them to perform
their job safely and competently. All staff are trained
for their appropriate work activity, which may include
at least:
 Good personal hygiene;
 Food handling procedures; and
 Cleaning and sanitation.
Records of staff training should be kept. An example
of a Staff Training Matrix, where staff training can be
recorded, is shown in Form 9 of the Appendix.

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3.9 CALIBRATION PROGRAM

In this section document information on policies and

procedures for the Calibration Program established in
your organisation.
Refer to:
 the General Guidelines for the Development
and Implementation of a Food Safety Program
and
 your Industry Guide.
All equipment used at the premises must be calibrated
and maintained in working order.
Records must be kept and an example of hand-held
thermometers calibrated monthly on a Monthly
Maintenance Checklist is shown in Form 1 of the
Appendix. If in-house calibration of the temperature
gauges on coolrooms/freezers occurs then this is also
recorded on the same checklist.
Thermometer gauges on coolrooms, freezers and ice
rooms should be calibrated regularly, for example
every 6 months and the calibration result recorded.
 An example of calibration intervals and methods in
shown in Appendix 3 of the General Guidelines for the

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3.10 INTERNAL AUDIT PROGRAM

In this section document information on policies and

procedures for the Internal Audit Program established
in your organisation.
Refer to:
 the General Guidelines for the Development
and Implementation of a Food Safety
Program.
 your Industry Guide.
Internal audits are conducted to ensure that
procedures and practices used at the business are
being controlled adequately according to what is
documented in this manual and in the records
associated with this manual.
An example of an Internal Audit Checklist is shown in
Form 10 of the Appendix. Where non-conformities

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3.11 DOCUMENT AND DATA CONTROL PROGRAM

In this section, document information on policies and

procedures for the Data and Document Control
Program established in your organisation.
Refer to:
 the General Guidelines for the Development
and Implementation of a Food Safety
Program.
 your Industry Guide.

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Appendices

Table of Contents

Form 1 Monthly Maintenance

Checklist Form 2 Temperature
Monitoring Sheet Form 3a
Supplier Approval Letter
Form 3b Supplier Approval
Application Form 4 Approved
Suppliers List
Form 5 Product Receival Sheet
Form 6 Product Monitoring Sheet
Form 7 Product Despatch
Form 8 Pre-operational Checklist
Form 9 Staff Training Matrix
Form 10 Internal Audit
Checklist Form 11 Product Testing
Schedule

Figure 1 CCP Decision Tree

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 Form 1: Monthly Maintenance Checklist

Completed at the end of each month.

Satisfactory (S) Unsatisfactory (U) and complete corrective action/comments column

Completed by: Date:

Item S/U Corrective action/Comment
Processing Area
Ceiling, walls and floors free
from cracks and other signs
of damage
Food processing benches free
from rust, damage and
deterioration
All equipment free from rust,
damage and deterioration – no
exposed wood
present
Lights above processing area
covered
All sinks (including hand washing)
accessible and in working order
Other fitting and fixtures in
good condition and in
working order
Coolrooms/Freezers/Ice Room
Walls, floors and ceiling clean
and in good condition
Shelving free from rust and
kept cleaned
Lights covered

Seals clean and in good condition

Cooling units free from rust

and corrosion
Storage Areas
Chemicals stored separately to
food and packaging material
All food and packaging material
stored in a manner to prevent
contamination
Staff Amenities (eg. toilets, staff rooms)
Staff amenities kept clean and tidy

Hand washing facilities accessible

and
in good order
Pest Control
No sign of pest within processing
area, storage area or staff
amenities
Rodent and insect bait
stations maintained and
correctly situated

Comments/Further Action:

Thermometer/Temperature gauge
Date Thermometer Temperature reading Difference Signed
number/Gauge position
calibration

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 Form 2: Temperature Monitoring Sheet
Temperature for each area is recorded twice daily when
being used Week commencing:_
Temperature (°C)
Area M T W T F S S Corrective action Initials

AM
Coolroom
PM

AM
Freezer
PM

AM

PM

AM

PM

Week commencing:_
Temperature (°C)
Area M T W T F S S Corrective action Initials

AM
Coolroom
PM

AM
Freezer
PM

AM

PM

AM

PM

Week commencing:_
Temperature (°C)
Area M T W T F S S Corrective action Initials

AM
Coolroom
PM

AM
Freezer
PM

AM
PM
AM

PM

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 Form 3a: Supplier Approval Letter

Application to supply goods

Dear supplier,

Our business is committed to providing our customers with product that is of the highest
quality and which complies with the requirements of the Food Production Food Act 2003
and the Food Regulation 2004.

To facilitate this commitment we have implemented a food safety program that complies with
these requirements. This program identifies the potential food safety hazards and, where
necessary, introduces measures to control and correct them.

A critical component of this food safety program requires all suppliers of product to
demonstrate that their goods are produced with due care. We therefore ask that you complete
the attached application to join our Approved Suppliers List. Once completed the form should
be returned to us at the address below.

This business values your past custom and upon receiving details of your commitment to a food
safety program, we look forward to continuing our business relationship and your assistance in
offering our customers the highest possible level of food safety.

Yours sincerely

Name of business
Postal address of
business:
Contact name:
Contact details:

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 Form 3b: Supplier Approval Application

Supplier Details

Registered Name:
Trading As:
Address:

Contact: Phone:
Mobile:
Fax:
Details of product that you will supply

Details of current food safety or quality assurance programs (which may include: HACCP accreditation
or testing program eg. NSW Food Authority licence)

Please complete the above details and return as soon as possible

Note: All details provided to us will be treated as confidential and only used to support the
accredited supplier requirements of our food safety program

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 Form 4: Approved Suppliers List
List of suppliers to our business (including suppliers of product, packaging and ingredients)

Supplier Contact details Goods Supplied Special Instructions

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 Form 5: Product Receival Sheet

Product Visual Correctiv

Date Supplier name Products Signature
Temperatu Inspectio e Action
Supplied
re n

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 Form 6: Product Monitoring Sheet

Date Product Temperature of Chemicals used Other comments Signed

type product

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 Form 7: Product Despatch Sheet

Batch Compan Batch Compan

Date Temperatur Date Temperatur
Numbe y Number y
e e
r Supplied s Supplied
to to

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 Form 8: Pre-Operational Checklist
Complete at the commencement of each shift/day
Satisfactory (S) Unsatisfactory (U) and complete corrective

action/comments column Completed by:

Date Corrective Action

Premises clean and tidy

Processing areas clean

and tidy

No evidence of pests
Hand washing
facilities clean and
accessible with soap
and paper towels
available

Food contact surfaces

clean

All equipment clean

All packaging
material stored
correctly
Coolrooms/Freezers
and/or Ice Rooms clean
and tidy
Food transport
vehicles clean and
tidy

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 Form 9: Staff Training Matrix
Record all food safety training conducted by staff involved in the business

Date Staff member Type of training Trained by Staff signature

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 Form 10: Internal Audit Checklist
Complete every 6
months
Satisfactory (S) Unsatisfactory (U) and complete corrective action/comments column

Completed by: Date: _

Section S/U Corrective Action

1. Management responsibility
Is the food safety statement still
current? Is the scope and purpose
still current?
Are the members of the HACCP team still
current?
2. HACCP Plan
Are the product specifications still
valid? Is the flow chart still
correct?
Is the Risk Analysis still valid?
3. Premises and Equipment
Has the Monthly Maintenance Checklist
been completed?
Have the Temperature Monitoring Sheets
been completed?
4. Supplier Approval Program
Is the Supplier Approval List up to date?

5. Food Handling Procedures

Is the Treatment Register Sheet up to
date? Has the Fish Treatment Diary been
completed?
Have the Product Dispatch Monitoring Sheets
been completed?
6. Testing and Calibration
Have water and ice tests been
completed? Are all results within the
Standards specified?
Have any results which exceed the Standards
been reported to the NSW Food Authority
Have all thermometers and temperature
gauges been
calibrated every six months?
7. Cleaning and Sanitation
Has the Pre-Operational Checklist been
completed? Are the chemicals listed still used?
8. Pest Control
Are procedures still correct?
Are pest company records available?
9. Personal Hygiene
Have all staff been briefed on personal
hygiene?
10. Product Identification and
Traceability Is the list of customers
up to date?
Are invoices for each sale available?
11. Food Recall
Is there a copy of the FSANZ Food Recall
Protocol available?
Are the contact numbers up to date?
12. Staff Training
Is the Staff Training Matrix up to date?
Comments/Further Action:
 Form 11: Product Testing Schedule
As an example of a verification activity, finished product testing can be undertaken to verify that
the practices and procedures in place at this business are achieving safe food. Five samples of
the same product can be sampled (can be pooled) and provided to the laboratory. An example
of schedule of tests follows.

Product Testing frequency Tests Standard

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