Fillable 2020 HACCP Specialized Processes Other Than ROP (Hennepin County)

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2020 HACCP Specialized Processes Other Than ROP (Hennepin County)

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PUBLIC HEALTH
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
2020 HACCP – Specialized Processes Other Than ROP
VALID 2/1/2020 – 1/31/2021
Hazard analysis critical control point (HACCP) is a preventative approach to food safety. It identifies food safety hazards in
the food production process and designs measurements to reduce those hazards to a safe level. HACCP includes having a
written plan that addresses identified critical control points (CCPs) where illness or injury is reasonably likely to occur in the
absence of the hazard’s control.
2020 HACCP PLAN REVIEW FEES*
SUBMISSION CHECKLIST
Initial Plan Review Fee:
$371.00
Application
Annual HACCP Audit Fee:
$185.00
Plan
*Make checks payable to Hennepin County Treasurer
Plan Fee ($371.00) *license fee is separate and will be
assessed upon plan approval
ESTABLISHMENT INFORMATION
Establishment Name*
Phone
MN
Address
State
Zip
OWNER INFORMATION
Owner Name*
Phone
Address (all correspondence will be sent to this address)
State
Zip
RESPONSIBLE AGENT FOR PLAN REVIEW (if other than owner)
Operator
Contractor
Designer
Other: ______________________________________
Responsible Agent Name
Phone
Address
State
Zip
ADDITIONAL INFORMATION
Basic Procedure Info:
New Revised
Do you regard any info in this application/plan as Trade Secrets?
Yes No
HACCP PLAN CONTACT INFORMATION
Signature:
Date:
Please PRINT the following information:
Name:
Phone:
Email:
*This will appear on the license
click to sign
signature
click to edit
Page - 2 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
Non-ROP HACCP Submittal Information
Is new construction or remodeling taking place?
Yes
No
If yes, was this HACCP plan submittal provided along with the construction plan review submittal? Reminder: HACCP
plan review and fee is separate from construction plan review and fee
.
Yes
No
For construction plan review submittal requirements, please contact us at (612) 543-5200 or
https://www.hennepin.us/business/licenses-permits/food-beverage-lodging
What is the reason for this HACCP plan submittal?
New HACCP plan
Modification of existing approved HACCP plan
Have you previously submitted this HACCP plan to a regulatory authority (i.e. MDH, MDA, city or county health
department) in the state of Minnesota?
Yes
No
If yes, please provide the following:
Regulatory Authority
Food Establishment(s)
Activity or Food Category
Please select one of the following processes that this HACCP plan covers (additional processes will require separate
HACCP plan review application). Specialized processing is allowed under Minnesota Rules, part 4626.0415 or Minnesota
Rules, part 4626.0367. Specialized processing includes the activities or food categories listed in this section. If
submitting for reduced oxygen packaging (ROP), do NOT use this submittal form. Use the form HACCP – REDUCED
OXYGEN PACKAGING (ROP).
Smoking food as a method of food preservation, rather than as a method of flavor enhancement.
Curing food (for example, using sodium nitrite or sodium nitrate).
Using ingredients as a method of food preservation, or to produce a food that is not time/temperature control for
safety (TCS) food. This includes food additives or components such as vinegar used to acidify sushi rice or a
fermentation starter culture for yogurt. This does not include using ingredients to enhance flavor.
Operating a molluscan shellfish life-support system display tank used to store or display shellfish including oysters,
clams, mussels and scallops that are offered for human consumption.
Custom processing game animals that are for personal use as food and not for sale or service in a food
establishment and not under USDA or “state equal to” inspections.
Sprouting seeds or beans.
Producing unpackaged juice on premises for highly susceptible populations.
Packaging juice in the food establishment, unless label requirements in Minnesota Rules, part 4626.0367B are met.
Preparing food by any method that is not in compliance with the Minnesota Food Code.
Page - 3 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
Other (describe) :
Variance Request
If you are proposing to implement an operation, procedure, and/or equipment that does not comply with State Rules and
County ordinances, a variance from the regulations may be requested. The variance request process includes the following
(minimum):
1. Complete a Variance Request application (applications at our Hopkins office or website:
www.hennepin.us/business/licenses-permits/food-beverage-lodging
)
2. State regulation from which you are requesting a variance.
3. Reason/need for variance from the regulation (financial reasons will not be accepted).
4. Provide documentation that supports the variance will not negatively impact food safety, public health, or
employee safety. (This must also show that no other accepted operation, practice, technique and/or equipment
can be substituted or is available.)
Page - 4 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
Product Details
Provide product names, ingredient lists, formulations or recipes, and other information to describe the methods that
address the food safety concerns of this HACCP activity. You must include all chemical preservatives, such as cure or “pink
salt” and brand name, in the ingredient lists.
Upon request of the regulatory agency, you must provide additional scientific documentation or other information (e.g.,
source of recipe used, processing authority letter) that demonstrates food safety is not compromised by the proposal.
Activity or Food Category
Name(s) of Product(s)
Page - 5 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
Recipe and Methods Used
Page - 6 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
Materials and Equipment
List all materials and equipment used specifically for this specialized process. Provide manufacturer information specific
and relevant to materials and equipment used to verify, control or meet the critical limits. Materials and equipment
required depend on your process.
Item
Manufacturer
Model Number
Page - 7 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
Food Flow Diagram
Include a food flow diagram for the activity or food category in this HACCP plan. Diagrams may be drawn by hand or
computer generated. You may include diagrams in this document or submit them as attachments. Identify all steps in the
process, all critical control points and add critical limits to all critical control points.
Page - 8 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
Identifying Hazards and Controls
Use the examples in the following table to identify your food safety hazards and controls.
1. List the operational steps that match your food flow. The list is provided as an example. Your list must be based on your food flow.
2. List the potential food safety hazards for each step. Hazards can be:
a. Biologica
l
B
acteria (e.g., Bacillus cereus, Campylobacter jejuni, Clostridium botulinum, Clostridium perfringens, Listeria monocytogenes,
Salmonella, Shiga toxin-producing E. coli, Shigella, Staphylococcus aureus, Vibrio vulnificus)
Yeasts and molds (e.g., Rhodotorula spp., Mucilaginosa glutinis, Mucilaginosa minuta, mycotoxin)
Viruses (e.g., hepatitis A, norovirus)
Parasites
b. Chemical (e.g. poisonous chemicals, histamines, allergens)
c. Physical (e.g. hepatitis A, norovirus)
3. List the preventative measures to control the hazards. Preventative measures may include:
a. Standard Operating Procedures (SOPs) such as: receiving products from approved sources, monitoring temperatures, cooling using
proper methods, date marking, employee training, etc
.
b. S
anitation Standard Operating Procedures (SSOPs) such as: illness policy, handwashing, prohibiting bare hand contact with ready-to-
eat food, cleaning and sanitizing equipment and utensils, etc
4. Identify if this step is a critical control point (CCP). CCPs often include: weighing of cure and other ingredients, testing pH, monitoring
times and temperatures, etc.
Page - 9 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
Operational Step Potential Hazard(s) Preventative Measure(s) to Control the Hazard Is This Step a CCP?
Page - 10 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
CCP Summary
Use the table below to identify key elements of your HACCP plan. Your HACCP plan may be different depending on your process.
Critical
Control
Point
(CCP)
Critical
Limit to
Control the
CCP
What will be
monitored?
How will it be
monitored?
Frequency of
monitoring
Who is
responsible to
monitor?
Corrective
action(s) to be
taken if critical
limit(s) is not met
What type
of records
will be
kept?
How will
this step be
verified?
Page - 11 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
HACCP Training Program
Required Elements
Your food employee and supervisory training program must address the food safety issues of concern. Provide details below
HACCP Training Program Element HACCP Training Program Details
Who is responsible to coordinate and provide the training? (E.g., certified food
protection manager and/or PIC)
Who will be trained? (E.g., food employees, supervisors, managers; include names
and roles if possible)
How will training be delivered? (E.g., in-person, computer-based)
How often will training or re-training take place? (E.g., new hire, annual refresher,
corrective action)
What skills regarding HACCP specialized processes will the trainee master? (E.g.,
sanitary use of equipment, correct method for taking temperatures, proper
record-keeping)
How will the trained employee demonstrate knowledge gained? (E.g., describe
the HACCP process and identify CCPs, perform process under supervision)
Page - 12 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
Required Topics
Your food employee and supervisory training plan must address the food safety issues of concern. Provide details below.
Topic
Objectives
HACCP Training Program Details
Concepts required for
a safe operation
Food employees and supervisors will understand the
parts of the HACCP plan (including the food flow
diagram and CCP summary).
Concepts required for
a safe operation
Food employees and supervisors will understand any
additional supporting documents provided, such as
logs and corrective action forms.
Concepts required for
a safe operation
Food employees and supervisors will understand the
importance of following the HACCP plan.
Other (describe)
Other (describe)
Page - 13 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
Record-Keeping
Attach or include copies of all blank record-keeping forms you will use that are necessary to implement this
HACCP plan. Some examples are included on the following pages. These may include:
• HACCP Training Log
• Thermometer / Thermocouple Accuracy Testing Log / pH Meter Log
• pH Testing Log
• Food Scale Accuracy Testing Log
• Batch Record
• Storage Log
• Other logs specific to your HACCP processes
These records are to be maintained by the designated employee, PIC and manager on duty to demonstrate
that the HACCP plan is properly operated and managed.
*
All records for your approved HACCP plan must be kept on site for at least one year.
Page - 14 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
HACCP Training Log
Name: ____________________________________________________________________________________
The designated employee must be trained before conducting HACCP processes. Record training and any
retraining on this log. Trainer must verify this log when training / retraining is completed.
Training Program Element Date
Was Knowledge
Gained? (Yes/No)
Retrain if No
Were Skills
Mastered? (Yes/No)
Retrain if No
Trainer
Initials
HACCP plan (food flow, CCPs,
critical limits)
Employee health policy and
hygiene
Supporting documentation for
specialized processing
Other (describe)
Other (describe)
Other (describe)
Comments and Corrective Action(s):
Page - 15 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
Thermometer / Thermocouple Accuracy Testing Log
The designated employee must test thermometer / thermocouple accuracy at least once weekly. Record observations and any corrective actions on
this log. PIC or manager on duty must verify this log weekly.
Thermometer / Thermocouple ID: ____________________________________
Date
Method
Used
Thermometer
Reading
Accurate
(Yes/No)
Initials
Ice Slurry
Ice Slurry
Ice Slurry
Ice Slurry
Ice Slurry
Ice Slurry
Ice Slurry
Ver
ified by (PIC or manager on duty initials): ___________________________
Thermometer / Thermocouple ID: ____________________________________
Date
Method
Used
Thermometer
Reading
Accurate
(Yes/No)
Initials
Ice Slurry
Ice Slurry
Ice Slurry
Ice Slurry
Ice Slurry
Ice Slurry
Ice Slurry
V
erified by (PIC or manager on duty initials): ___________________________
Corrective Action(s):
Page - 16 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
When to use this thermometer / thermocouple accuracy-testing log
If you are following an approved HACCP plan for specialized processing for TCS food, you must use this log for
record-keeping. Make records available to the regulatory authority upon request. Keep records for at least one
year.
Thermometers must be:
• Checked for accuracy at least once weekly (or manufacturer requirement)
• Accurate to within 2⁰F (32⁰F for ice slurry testing)
Always follow manufacturer’s instructions for thermometer / thermocouple accuracy checks and calibration.
Page - 17 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
pH Testing Log
The designated employee must calibrate pH meter according to manufacturer’s instructions to ensure accurate
results. Test each batch of finished product to ensure product pH meets your HACCP plan critical limit. Record
observations and any corrective actions on this log. PIC or manager on duty must verify this log weekly.
Date Product Name pH Critical Limit Product pH
Retest Product
pH (as
needed)
Employee Initials
Corrective Action(s):
Ver
ified by (PIC or manager on duty intials): _______________________
Page - 18 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
When to use this pH testing log
If you are following an approved HACCP plan for specialized processing for TCS food, you may use this log for
record-keeping. Make records available to the regulatory authority upon request. Keep records for at least one
year.
Always follow manufacturer’s instructions for pH meter calibration and use.
Page - 19 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
Food Scale Accuracy Testing Log
The designated employee must check accuracy of food scales(s) used for HACCP operations according to
manufacturer’s instructions and your HACCP plan. PIC or manager on duty must verify this log yearly.
Date
(mm/dd/yyyy)
Food Scale ID
Standard
Weight
Scale Reading
Accurate to ± 0.02
oz? (yes/no)
Employee
Initials
Corrective Action(s)
Verified by (PIC or manager on duty initials): _______________________
Page - 20 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
When to use this food scale accuracy-testing log
If you are following an approved HACCP plan for using cure, you may use this log for record-keeping. Make
records available to the regulatory authority upon request. Keep records for at least one year.
Always follow manufacturer’s instructions for food scale accuracy checks and calibration.
Page - 21 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
Batch Record
Specialized Processing – Cure
The designated employee must complete this form for every batch produced according to your curing HACCP
plan. Record observations and any corrective actions on this log. PIC or manager on duty must verify this log
for every batch.
Product: ___________________________________
Production Date: ____________________________
Formulation
Control Point (CP)
OR
Critical Control Point (CCP)
Ingredients Weight or Volume
Limit / Critical
Limit
CP / CCP Met?
(Yes/No)
Employee Initials
Curing Agent
Control Point (CP)
OR
Critical Control Point (CCP)
Cure Lot Number Cure Type Weight
Limit / Critical
Limit
CP / CCP Met?
(Yes/No)
Employee
Initials
Page - 22 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
Tumbling / Mixing
Control Point (CP)
OR
Critical Control Point (CCP)
Vacuum Speed Start Time End Time Total Time
Limit /
Critical Limit
CP / CCP Met?
(yes/no)
Employee
Initials
Smoking / Cooking
Control Point (CP)
OR
Critical Control Point (CCP)
Final Internal
Temperature
Time Limit / Critical Limit
CP / CCP Met?
(yes/no)
Employee Initials
Cooling
Control Point (CP)
OR
Critical Control Point (CCP)
Check temperatures and take needed corrective action(s) BEFORE 2-hour limit AND BEFORE 6-hour limit.
Cooling Started:
Time/Temp
Clock starts when
food is 135⁰F
Less Than 2 Hours:
Time/Temp
Must be 70⁰F or below
before 2 hours
Less Than 6 Hours:
Time/Temp
Must be 41⁰F or below
before 6 hours
CP / CCP Met?
(yes/no)
Monitored By
(Employee Initials)
Corrective Action(s):
Verification of Batch Record
PIC or manager on duty must verify this log for every batch.
Verified by (PIC or manager on duty initials): ____________________ Date: ____________________
Page - 23 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
When to use this batch record
If you are following an approved HACCP plan for using cure, you may use this log for record-keeping. Make
records available to the regulatory authority upon request. Keep records for at least one year.
Always follow manufacturer’s instructions for thermometer/thermocouple accuracy checks and calibration.
Page - 24 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
Cold Holding Log (Option A)
The designated employee must monitor temperatures according to the approved HACCP plan. Record
observations and any corrective actions on this log. PIC or manager on duty must verify this log weekly.
Refrigeration Unit ID: __________________________________
Week of: __________________________
Refrigeration Unit ID Date Temperature Initials
Past Use By Date?
(yes/no)
Initials
Corrective Action(s):
Verified by (PIC or manager on duty initials): ____________________ Date: ____________________
Page - 25 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
Cold Holding Log (Option B)
The designated employee must monitor temperatures according to the approved HACCP plan. Record
observations and any corrective actions on this log. PIC or manager on duty must verify this log weekly.
Refrigeration Unit ID: __________________________________
Week of: __________________________
Day and Date Temperature Initials
Past Use By
Date?
(yes/no)
Initials
Sunday
Date:
Monday
Date:
Tuesday
Date:
Wednesday
Date:
Thursday
Date:
Friday
Date:
Saturday
Date:
Corrective Action(s):
Verified by (PIC or manager on duty initials): ____________________ Date: ____________________
Page - 26 -
Hennepin County Public Health
1011 South First Street, Suite 215, Hopkins, MN 55343
612-543-5200 | Epi-envhlth@hennepin.us
When to use a Cold Holding Log
If you are following an approved HACCP plan for conducting specialized processing, you may be required to
maintain temperature records. You may use this log for record-keeping. Make records available to the
regulatory authority upon request. Keep records for at least one year.
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2020 HACCP Specialized Processes Other Than ROP (Hennepin County)

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Completed 24 December 2020

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