ITEM: Validation Summary – Allergen Control PAGE: 1 of 1

PLANT NAME: Derstine’s Inc. ISSUE DATE: 09/04/2018

SUPERSEDES
ADDRESS: 3245 State Rd. Sellersville, PA. 18960 NEW
:

INTENDED PURPOSE VALIDATION PERIOD

The facility should include methods to prevent potential cross-contact throughout all steps in any January 1, 2018 through
distribution activity (Derived from NSF text, HACCP Manager Version 4.0.) December 31, 2018

NAME DATE

Section 1: Validation Method

VALIDATION METHOD PROGRAM EFFECTIVENESS METRICS FREQUENCY OF VALIDATION
Overall assessment of “Effective” by the Internal Auditor assigned to
Internal Audits
evaluate the “Allergen Management” element.
Annual
Outside Audits
ZERO “Critical” or “Major” nonconformities related to Allergen Control.

Section 2: Assessment of Report Data

VALIDATION METHOD CRITERIA RESULTS TARGET OUTCOME
☐ Effective ☐ Pass
Internal Audits Program Effectiveness Effective
☐ Not Effective ☐ Fail
Enter total #: ☐ Pass
# of CRITICAL nonconformities Zero
☐ Fail
Outside Audits
Enter total #: ☐ Pass
# of MAJOR nonconformities Zero
☐ Fail

Section 3: Summary of Validation Results

Based on the assessment results articulated above, this program has been validated as being effective in achieving its ☐ Yes
intended purpose. ☐ No

Section 4: Proposed Action(s)

Date Started:

Section 5: Results of Proposed Action(s)

Date Completed:

Section 6: Management Notification and Approval

Director of Operation’s signature indicates understanding of all information contained in the Validation Summary report and
demonstrates approval of any proposed action(s).
Signature: Title: Date: