Form C
Form C
List the Raw Material (RM) number. The ingredient list shall include all raw materials, processing aids, rework, packaging materials in direct contact with finished product, or finished product non-contact packaging materials that will become contact packaging materials during consumer use
(i.e. resealable lids for multiple-use containers, drinking straws for RTD pouches, eating utensils built into lidding material). Fully describe the name or type of material, for example, starch is corn starch. List carriers for flavors, for example: lactose; propylene glycol; ethyl alcohol; corn
maltodextrin; salt; refined, bleached, and deodorized cottonseed oil.
List the storage condition, for example, A=ambient, R=refrigerated, F=frozen. Describe the hazards and assess the severity and likelihood of occurrence (significance) for each hazard. Complete the Foreign Material Risk Assessment Matrix (Ref 7.3.2) for determination of potential physical
hazards. Describe the rationale behind the decision for each hazard, and determine the control mechanism(s). List CCP Model name and specific Prerequisite Program name. Determine if the control mechanism(s) shall be a Critical Control Point (CCP) or specific Prerequisite Program (sPP).
If a CCP model does not exist, then the scientific basis must be cited for the critical limit (e.g. regulatory guidelines, experimental studies, scientific publications) and notify a HACCP Systems Team member (Technical Resources Section) to develop a model. If no Hazards exist, describe with
“None”.
DO NOT LEAVE ANY SECTIONS BLANK. List "None" or “NA” (not applicable) if appropriate and avoid the use of acronyms (e.g. CMC is carboxy methyl cellulose).
SIGNIFICANT
POTENTIAL FOOD
HAZARD:
SAFETY HAZARDS
DO ANY
(B) VP=Vegetative
POTENTIAL FOOD
Pathogen HAZARD EVALUATION
SAFETY HAZARDS
(B) SP= Spore forming
REQUIRE A
Pathogen
PREVENTIVE
(C) Chemical
CONTROL?
(P) Physical
4 - 9 = Yes sPP?
CCPs, process, allergen,
O=other, please performed in HACCP
Form E1/E2 and supported sanitation, supply chain, or other
specify Biological:
by allergen checklist preventive controls)
Refer to HACCP (sPP/CCP)
(found in Sanitation team Standard Sections 14
site). Chemical hazard and 7
evaluation performed by Chemical:
Global HACCP team Refer to HACCP
based on information Standard Sections 15
provided in HACCP and 7
Sections 6 and 15 Physical:
(P) Hazard evaluation done Refer to HACCP
by Hazard Calculation Standard Section 7
Matrix HACCP Sections 6
and 7
(P) Associated with sugar processing, however risk of physical hazard from
metal dust from sugar is unlikely as there is a magent in line, supplier is
(P) Metal dust 1 2 2 No apporved and historically, no incidences seen None NA
PP : 30 mesh & 4 mesh Sieve and Magnet are in place
PP : SQA
(C) Milk protein is classified under Global allergen category as per Mondelez
(C) Allergen- Milk protein 3 3 9 Yes Labelling in final finished goods sPP-Labelling
Global HACCP standard Chapter 1
(P) No risk of physical hazard likely as there is are sieve & magnet in line,
supplier is apporved and historically, no incidences seen in IM plant last 3
(P) None 1 1 1 No years None NA
PP : 30 mesh sieve in place
PP : SQA
(B) Inherently low aw of this raw material prevents outgrowth and toxin
(B) SP 1 1 1 No formation by spore forming pathogens of concern. None NA
PP- Material classification, Low water activity<0.85.
(C) Antibiotics (Veterinary
1 2 2 No None NA
residue)
(C) Milk protein is classified under Global allergen category as per Mondelez
(C) Allergen- Milk protein 3 3 9 Yes Labelling in final finished goods sPP-Labelling
Global HACCP standard Chapter 1
(P) No risk of physical hazard likely as there is are sieve & magnet in line,
supplier is apporved and historically, no incidences seen in IM plant last 3
(P) None 1 1 1 No years None NA
PP : 30 mesh sieve in place
PP : SQA
(B) Inherently low aw of this raw material prevents outgrowth and toxin
(B) SP 1 1 1 No formation by spore forming pathogens of concern. None NA
PP- Material classification, Low water activity<0.85.
(C) Pesticide 1 2 2 No (C) As per Chapter 1 of the Mdlz HACCP standard, these contaminants None NA
could result in chronic toxicity (adverse health effects) due to repeated
exposures over a longer time period. They are controlled via prerequisite
programs such as Supplier Quality Assurance (supplier approval process,
(C) Melamine 1 2 2 No None NA
specifications / Certificates of Analysis) control concentration. Parameter
10275979 Whey Permeate powder A levels also controlled thro Regulatory requirements
PP : SQE and Material Monitoring for the ingredients used for
(C) Heavy metals 1 2 2 No manufacturing of WIP None NA
(C) Milk protein is classified under Global allergen category as per Mondelez
(C) Allergen- Milk protein 3 3 9 Yes Labelling in final finished goods sPP-Labelling
Global HACCP standard Chapter 1
(P) No risk of physical hazard likely as there is are sieve & magnet in line,
supplier is apporved and historically, no incidences seen in IM plant last 3
(P) None 1 1 1 No years None NA
PP : 30 mesh sieve & Magnet in place
PP : SQA
(B) Inherently low aw of this raw material prevents outgrowth and toxin
(B) SP 1 1 1 No formation by spore forming pathogens of concern. None NA
PP- Material classification, Low water activity<0.85.
(C) Residual pesticides 1 2 2 No (C) As per Chapter 1 of the Mdlz HACCP standard, these contaminants NA
17020832 Cocoa Mass A
could result in chronic toxicity (adverse health effects) due to repeated
exposures over a longer time period. They are controlled via prerequisite
programs such as Supplier Quality Assurance (supplier approval process,
(C) Heavy metals 1 2 2 No None NA
specifications / Certificates of Analysis) control concentration. Parameter
levels also controlled thro Regulatory requirements
PP : SQE and Material Monitoring for the ingredients used for
(C) Mycotoxin 1 2 2 No manufacturing of WIP NA
(B) Inherently low aw of this raw material prevents outgrowth and toxin
(B) SP 1 1 1 g formation by spore forming pathogens of concern. None NA
PP- Material classification, Low water activity<0.85.
Cocoa - Alkalized Cocoa (C) Residual pesticides 1 2 2 No (C) As per Chapter 1 of the Mdlz HACCP standard, these contaminants NA
101668638 A
Powder (Indo) could result in chronic toxicity (adverse health effects) due to repeated
exposures over a longer time period. They are controlled via prerequisite
programs such as Supplier Quality Assurance (supplier approval process,
None
specifications / Certificates of Analysis) control concentration. Parameter
levels also controlled thro Regulatory requirements
PP : SQE and Material Monitoring for the ingredients used for
manufacturing of WIP
Cocoa - Alkalized Cocoa (C) As per Chapter 1 of the Mdlz HACCP standard, these contaminants
101668638 A
Powder (Indo) could result in chronic toxicity (adverse health effects) due to repeated
exposures over a longer time period. They are controlled via prerequisite
programs such as Supplier Quality Assurance (supplier approval process,
(C) Heavy metals 1 2 2 No None NA
specifications / Certificates of Analysis) control concentration. Parameter
levels also controlled thro Regulatory requirements
PP : SQE and Material Monitoring for the ingredients used for
(C) Mycotoxin 1 2 2 No manufacturing of WIP NA
(B) Inherently low aw of this raw material prevents outgrowth and toxin
(B) SP 1 1 1 No formation by spore forming pathogens of concern. None NA
PP- Material classification, Low water activity<0.85.
SF11HU COCOA (C) Residual pesticides 1 2 2 No (C) As per Chapter 1 of the Mdlz HACCP standard, these contaminants NA
86006813 A
1X25KG EXP could result in chronic toxicity (adverse health effects) due to repeated
exposures over a longer time period. They are controlled via prerequisite
programs such as Supplier Quality Assurance (supplier approval process,
(C) Heavy metals 1 2 2 No None NA
specifications / Certificates of Analysis) control concentration. Parameter
levels also controlled thro Regulatory requirements
PP : SQE and Material Monitoring for the ingredients used for
(C) Mycotoxin 1 2 2 No manufacturing of WIP NA
Pesticides 1 1 1 No NA NA
(C) As per Chapter 1 of the Mdlz HACCP standard, these contaminants
could result in chronic toxicity (adverse health effects) due to repeated
exposures over a longer time period. They are controlled via prerequisite
Mycotoxins 1 1 1 No programs such as Supplier Quality Assurance (supplier approval process, NA NA
specifications / Certificates of Analysis) control concentration. Parameter
levels also controlled thro Regulatory requirements
17020860 Malt Extract R PP- SQA,RM specification & Monitoring
Heavy metals 1 1 1 No NA NA
(B) Inherently low aw of this raw material prevents outgrowth and toxin
(B) SP 1 1 1 No formation by spore forming pathogens of concern. None NA
PP- Material classification, Low water activity<0.85.
(C) Antibiotics (Veterinary
1 2 2 No None NA
residue)
(C) Pesticide 1 2 2 No (C) As per Chapter 1 of the Mdlz HACCP standard, these contaminants None NA
could result in chronic toxicity (adverse health effects) due to repeated
exposures over a longer time period. They are controlled via prerequisite
programs such as Supplier Quality Assurance (supplier approval process,
(C) Melamine 1 2 2 No None NA
specifications / Certificates of Analysis) control concentration. Parameter
17020877 Egg Albumin powder A levels also controlled thro Regulatory requirements
PP : SQE and Material Monitoring for the ingredients used for
(C) Heavy metals 1 2 2 No manufacturing of WIP None NA
(C) Egg protein is classified under Global allergen category as per Mondelez
(C) Egg protein allergen 3 3 9 Yes Labelling in final finished goods sPP-Labelling
Global HACCP standard Chapter 1
(P) No risk of physical hazard likely as there is a magent & sieve in line,
supplier is apporved and historically, no incidences seen in IM plant last 3
(P) None 1 1 1 No years None NA
PP : 30 mesh Sieve is in place
PP : SQA
SALTS
(P) No risk of physical hazard likely as there is a magent & sieve in line,
supplier is apporved and historically, no incidences seen in IM plant last 3
(P) None 1 1 1 No years None NA
PP : 30 mesh Sieve in place
PP : SQA
G.M.S (GlycerylMono
17020874 A
stearates)
Product specifications,Local Regulatory control
Low occurrence potential as per Mondelez HACCP standard, Chapter 1.
Inhearnt to Agricultural based product,
They are controlled via prerequisite programs such as Supplier Quality
(C) Heavy Metals
G.M.S (GlycerylMono 1 1 1 No Assurance (supplier approval process, specifications / Certificates of None NA
17020874 A Analysis) control concentration, regulatory control in place
stearates)
PP- RM Specification
PP- SQA
PP- Material Monitoring Program
(P) No risk of physical hazard likely as there is a magent & sieve in line,
supplier is apporved and historically, no incidences seen in IM plant last 3
(P) None 1 1 1 No years None NA
PP : 30 Sieve in place
PP : SQA
(C) This ingredient has not history of presence of soya protein, it’s exempted
by FARRP and therefore is not a risk to allergenic consumers according
Global/regional allergen list section 15 of the HACCP std
Labelled in case of local regulatory requirements
(C) Soya 3 1 3 No None NA
PP : Labelling only for Rgulatory requirement
PP- RM Specification
PP- SQA
PP- Material Monitoring Program
10186648 Soya Lecithin A (C) As per Chapter 1 of the Mdlz HACCP standard, these contaminants
Heavy Metals 1 2 2 No could result in chronic toxicity (adverse health effects) due to repeated None NA
exposures over a longer time period. They are controlled via prerequisite
programs such as Supplier Quality Assurance (supplier approval process,
specifications / Certificates of Analysis) control concentration.
PP- RM Specification
Pesticides 1 2 2 No PP- SQA None NA
PP- Material Monitoring Program
(P) No risk of physical hazard likely as there is are sieve & magnet in line,
supplier is apporved and historically, no incidences seen in IM plant last 3
(P) None 1 1 1 No years None NA
PP : 30 Sieve in place
PP : SQA
(P) No risk of physical hazard likely as there is are sieve & magnet in line,
supplier is apporved and historically, no incidences seen in IM plant last 3
(P) None 1 1 1 No years None NA
PP : 30 mesh Sieve in place
PP : SQA
(P) No risk of physical hazard likely as there is are sieve & magnet in line,
supplier is apporved and historically, no incidences seen in IM plant last 3
(P) None 1 1 1 No years None NA
PP : 30 mesh Sieve in place
PP : SQA
FLAVOURS
(P) No risk of physical hazard likely as there is are sieve & magnet in line,
supplier is apporved and historically, no incidences seen in IM plant last 3
(P) None 1 1 1 No years None NA
PP : 30 mesh Sieve in place
PP : SQA
(P) No risk of physical hazard likely as there is are sieve & magnet in line,
supplier is apporved and historically, no incidences seen in IM plant last 3
(P) None 1 1 1 No years None NA
PP : 30 mesh Sieve in place
PP : SQA
(P) No risk of physical hazard likely as there is are sieve & magnet in line,
supplier is apporved and historically, no incidences seen in IM plant last 3
(P) None 1 1 1 No years None NA
PP : 30 mesh Sieve in place
PP : SQA
(P) No risk of physical hazard likely as there is are sieve & magnet in line,
supplier is apporved and historically, no incidences seen in IM plant last 3
(P) None 1 1 1 No years None NA
PP : 30 mesh Sieve in place
PP : SQA
(P) No risk of physical hazard likely as there is are sieve & magnet in line,
supplier is apporved and historically, no incidences seen in IM plant last 3
(P) None 1 1 1 No years None NA
PP : 30 Sieve in place
PP : SQA
(P) No risk of physical hazard likely as there is are sieve & magnet in line,
supplier is apporved and historically, no incidences seen in IM plant last 3
(P) None 1 1 1 No years None MA
PP : 30 mesh vibro Sieve in place
PP : SQA
(P) No risk of physical hazard likely as there is are sieve & magnet in line,
supplier is apporved and historically, no incidences seen in IM plant last 3
(P) None 1 1 1 No years None NA
PP : 30 mesh vibro Sieve in place
PP : SQA
REWORK
(B) Inherently low aw of this raw material prevents outgrowth and toxin
(B) SP 1 1 1 No formation by spore forming pathogens of concern. None MA
PP: Material classification ,water activity <0.85
Moro Rework
NA A
(Coated and uncoated) (C) Barley gluten is classified as MSI as per Mondelez Global HACCP
(C) MSI Gluten 2 3 6 Yes Labelling in final finished goods sPP-Labelling
standard Chapter 1
(C) Allergen- Soy 3 3 6 Yes (C) Soy is classified as allergen as per Local Regulatory Labelling in final finished goods sPP-Labelling
PACKING MATERIAL
Microbiologically non-sensitive ingredient as per Mondelez HACCP Manual
Chapter 1
(B) VP/SP - None 1 1 1 No None NA
PP:SQE, Material classification
(C) They are controlled via prerequisite programs such as Supplier Quality
Assurance (supplier approval process, specifications / Certificates of
515000000179.00 Outer (Display Box) A (C) None 1 1 1 None None NA
Analysis.
PP:SQA
UTILITIES
NA Forced room air Not Applicable (C) Chemcial Hazards is controlled through Preventive maintainance plan
(C) Chiller Lubricants 1 1 1 None None NA
PP : preventive maintenance
(P) Dust and Particulate (P) Physical Hazards is control through preventive maintenance plan
1 1 1 None None NA
matter PP :preventive maintenance
The physical risk is unlikely as prefiletr and F7 filter is in place as per the
(B) VP - Salmonella 3 1 3 None Mondelez sanitation standards and preventive maintenance established None NA
PP :F7 filtration and preventive maintenance
Air
(C) The chemical risk is unlikely as Preventive maintenance is established
NA (For RM transferring by Not Applicable (C) AHU Lubricants 1 1 1 None None NA
PP: Preventive maintenance
blower)
The physical risk is unlikely as prefiletr and F7 filter is in place as per the
(P) Dust and Particulate
1 1 1 None Mondelez sanitation standards and preventive maintenance established None NA
matter
PP :F7 filtration and preventive maintenance
The biological hazard is unlikely as air is prefiletr (Air filter 1 micron, oil
filter 10 micron, oil separator 3 micron) as per the Mondelez sanitation
(B) VP - Salmonella 3 1 3 None None NA
standards and preventive maintenance established
PP :F7 filtration and preventive maintenance
The physical risk is unlikely as prefiletr and F7 filter is in place as per the
(P) Dust and Particulate
1 1 1 None Mondelez sanitation standards and preventive maintenance established None NA
matter
PP :F7 filtration and preventive maintenance
As per the water risk assessment the source of water for the plant is borewel
In-house water treatment - sPP-Water
(B) VP - Salmonella 3 3 9 Yes water and used only for wet equipment cleaning
Chlorination treatment
PP: Chlorination, Chemical & microbiological water testing
*Any size differences of RM numbers can be considered to have the same hazard assessment