| I-000-788 |
05/05/2021 |
Allergens |
Multiple Allergens |
Poultry Meat & Poultry Meat Products |
Blank |
Blank |
Blank |
Blank |
Blank |
Source: People - Training.
Lack training: As the Quality Controller was qualified to MSc Food Safety, management assumed the QC had sufficient food labelling knowledge to manage the pack labelling for artworks.
Source: People - Oversight
Insufficient oversight. Final artwork not checked by Head of Technical.
Source: Environment - Distraction
Too much distraction - Difficult for QC to focus on artwork due to distraction with production matters during production time. |
Source: People -Training.
Labelling training for QC: Example:
- FSA online resources allergen labelling for food manufacturers.
- Food Information to Consumers Regulation (EU 1169/2011) (FIC).
Source: People - Oversight
All artworks counter-checked by Head of Technical.
Source: Environment - Distraction
Work on artworks to be carried out after the days production has finished. |
Process: Labelling Verification Checks - failure
Process: Quality Control Checks - inadequate
People: Training incomplete |
| I-000-572 |
12/05/2021 |
Pathogenic Microorganisms |
Listeria Monocytogenes |
Prepared Dishes & Snacks |
The product was tested positive for Listeria Monocytogenes |
This is not known. Product testing flagged the unsatisfactory result. |
Following the flagged result extensive environmental and raw ingredient testing was carried out within the product unit however no source of contamination |
Root Cause not known |
Blank |
Listeria Monocytongenes identified by food lab in the tuna mayo sandwich filling. The root cause was not identified as extensive environmental and raw ingredient testing failed to identify the source of the contamination. |
Monthly swabbing routine followed |
Undetermined |
| I-000-800 |
12/05/2021 |
Foreign Body |
Animal origin |
Prepared Dishes & Snacks |
Blank |
Blank |
Blank |
Blank |
Blank |
A deceased Frog was found in a bag of Seaonal Lettuce by a Restaurant employee. The Frog was intact with the exception of missing back foot which appeared to have been sliced off. The Frog passed through the process, namely the Optical Sorter which product is passed through to identify and remove foreign bodies from the lettuce prior to washing and packing. Seasonal lettuce contaminated by a Frog located France/Spain. Frog entered within the Supplier Raw Material. |
Supplier completed a full review of process and risk assessment at each stage of the process verifying it is only linked to implicated Use By date and no other. This is due to the Line being washed and the Washer Water being dropped as Line 2 changed from running Iceberg to Seasonal leaf. Line 2 ran Seasonal leaf until the Line was stopped, Wash water was then dropped again ready to change back to Iceberg. On line 2 where this product was produced Supplier have an Optical Sorter which is designed to detect and remove foreign body contaminants using air jets set off via Cameras looking at Colour, Infrared looking at Density and Lasers looking at Shine Scatter and Anti-Scatter. The records for the past week were reviewed & the Optical Sorter was working correctly at current settings.
Supplier concludes that the frog was picked up by the sensor but that the issue occurred during the attempted rejection of the frog. As the frog was moving on the belt, either it moved so that it was not in the right place for the ejectors to reject it, or the frog was too heavy for the ejector air blowers to remove the frog, or the speed and mass of the frog meant that when it was ejected off it carried on over the bridge between the Optical Sorter belt and the Washer infeed belt, or lastly the frog jumped across the gap itself (although this latter point is considered the least likely scenario)
External analysis of the Frog - stated that the missing back foot portion, from the end of the fractured bone, was measured as being approximately 3cm in length. It is not believed that the foot reached the final product as the detached foot itself is smaller and less dense compared to the rest of the Frog. Supplier believe that the missing foot has been identified and rejected by the Optical Sorter, transferred via the waste belt into the Waste Bin.
Corrective measures identified to prevent incident reoccurance:
Supplier has contacted the manufacturer of the sensor equipment regarding the issue and requested that they visit the site to look at the current process and programmes on the Optical Sorters which will enhance the machines efficacy on removal of moving objects like this
Additional Subject Matter Experts on optical sorters are to be recruited and trained to ensure Supplier have experts across all shifts ensuring the machines are running optimally
Supplier to retrospectively install software on optical sorters that enables data capture of detections and performance of the machines which will give Supplier visibility of issues and the ability to highlight to growers what we are finding
Site QAS to complete a verification check on optical sorter set up prior to each seasonal lettuce run. Root Cause:
Further DNA analysis by External body confirmed this Frog had originated from France therefore from a French Supplier, which is covered crop grown under Tunnel. Frogs by nature are migratory animals through environmental impacts and influences, therefore during transit the Frog entered the area through the perimeter fencing and came across the Covered Tunnels. The lettuce is grown under cover, with access opportunities via open doors during employee movement and during harvesting, but more importantly the doors are sometimes opened at night to ensure air circulation and manage the temperature increases from the day. Frogs are more active at night, therefore it is likely that the Frog entered the Greenhouse structure during the night whilst the doors were opened to increase the air circulation. The cropping environment was ideal for the Frog as protected in the Leaf and access to food, water and importantly safety within that environment. During the harvest process, the Whole Head was cut and then placed into a Plastic Crate and then transported via Transporter to recipient.
Corrective measures identified to prevent incident reoccurance:
All growers have been notified of this incident asked to increase focus at source with field walks and pre harvest checks further reducing the likelihood of Frogs getting to the processor.
All growers have been asked to implement the shaking and inversion of heads or inspection of each cut lettice prior to palletisation to deter or remove any containment that might have been taking cover in the head of lettuce
Recipient Product Manager working with all Suppliers to identify if there are any frog habitats near the harvested batches.
Supplier have taken the decision not to supply any further seasonal lettuce from this years crop to specific restaurants. |
Material: Ingredient Cross-contamination |
| I-000-819 |
12/05/2021 |
Allergens |
Milk |
Prepared Dishes & Snacks |
The translation label did not state on pack that they may contain traces of mustard/milk |
We sent the English text to the customer and asked them to translate all relevant information. It would appear that a mistake occurred and this led to the problem in step 1. We have now moved to printed film with the foreign language which has been signed off and approved by the foreign importer. |
Root cause has been identified and sorted. |
Blank |
Blank |
Human error. Procedures not followed - one-off operator error - Translation not thoroughly checked |
All labels have been updated and checked. Labels checked and updated |
Process: Labelling Verification Checks - absent / failure |
