Recall Exercise Form

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This form is recommended by AIB International and is not sanctioned by any regulatory agency. Each plant can
develop its own form, which may contain more specific requirements. AIB recommends plant-specific forms should
include everything in this form.
RECALL EXERCISE
FORM
Date: _________________________
Time Started: ___________________
Time Finished: __________________
Description of Product: _________________________________________________________
______________________________________________________________________________
Finished Product or Ingredient (circle one)
Date or Lot Code: _________________ Quantity of Suspect Product: __________________
Personnel Involved in Mock Recall:
_____________________________________
____________________________________
_____________________________________
____________________________________
_____________________________________
____________________________________
RECORDS (Check when attached):
_____ Receiving Records (if applicable)
_____ Production Records (if applicable)
_____ Rework Records (if applicable)
_____ Distribution Records
_____ Discarded Material Log (if applicable)
Quantity of Product on Hand (verified): ___________________________________________
Quantity of Product Shipped (first point identified): __________________________________
Quantity of Product Discarded (production loss/spillage or damage): ____________________
Total Quantity Accounted For: ________________________________________
% Recovered: ______________________________________________________
Total Quantity Accounted For
divided by
Quantity of Suspect Product
= % Recovered
IF THIS WERE AN ACTUAL RECALL, the following contacts would be made:
Regulatory Agency Name/Number: _______________________________________________
Customer(s) Name/Phone and Fax Number: _______________________________________
______________________________________________________________________________
Review of
Recall
Exercise:
Signature: __________________________________________ Date: ____________________
Comments: ___________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

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