Form FDACS-14095 "Application for Specialized Process Alternative for Retail Food Establishment" - Florida

What Is Form FDACS-14095?

This is a legal form that was released by the Florida Department of Agriculture and Consumer Services - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2016;
  • The latest edition provided by the Florida Department of Agriculture and Consumer Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form FDACS-14095 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

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Download Form FDACS-14095 "Application for Specialized Process Alternative for Retail Food Establishment" - Florida

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Florida Department of Agriculture and Consumer Services
Bureau of Food Inspection
Division of Food Safety
Attention: Retail Specialized
Process Alternative
3125 Conner Boulevard C-26
APPLICATION FOR SPECIALIZED PROCESS
Tallahassee, FL 32399-1650
Fax (850) 245-5553
ALTERNATIVE FOR RETAIL FOOD ESTABLISHMENT
NICOLE "NIKKI" FRIED
COMMISSIONER
Chapter 500, Florida Statutes
5K-4, Florida Administrative Code
Specialized Process Alternative (SPA) is a method that allows a food establishment to vary from the FDA Food Code or allows a high risk process to
be performed that requires stringent controls if, in the opinion of the Department, a health hazard or nuisance will not result from the altered provision.
Application must be submitted and accepted before starting the specialized processing. A separate application is required for
each process if there is more than one.
Date:
Business Name:
Food Entity Number:
Location Address:
City:
State:
ZIP:
County:
Business Owner Name:
Owner Contact Phone Number:
Email:
Name of Applicant:
Contact Phone Number:
Email:
TYPE OF SPECIALIZED PROCESS ALTERNATIVE REQUESTED (CHECK ONE):
Reduced Oxygen Packaging*
Shelf Stability at Room Temperature
Bare Hand Contact Alternative
Smoking Food for Preservation
Custom Animal Processing for Personal Consumption
Curing Food
Sprouting Seeds or Beans
Using Food Additives or Adding Components for Preservation
Operating a Molluscan Shellfish Life-Support Tank
Other Specialized Processes
*You may conduct Reduced Oxygen Packaging without having to obtain a Specialized Process Alternative from the Division if at least two barriers (one
barrier in addition to refrigeration or freezing) are in place to control the growth and toxin formation of Clostridium botulinum and the growth of Listeria
monocytogenes and all provisions of § 3-502.12 of the FDA Food Code are followed, however, you must submit a Hazard Analysis Critical Control Point
(HACCP) plan. You may not begin the process until this agency has deemed your HACCP plan acceptable in writing.
What is the specific finished product(s) for which you are requesting a Specialized Process Alternative?
How do you plan to store the final product?
Refrigeration
Freezing
Shelf Stable
How do you plan to display the final product?
Refrigeration
Freezing
Shelf Stable
If you are using a reduced oxygen packaging process, what barrier you are using to prevent Clostridium botulinum and Listeria monocytogenes in your
process (see Annex 6 of the FDA Food Code)?
You will be notified, by email, within 14 days of receipt of your documentation. If there are any deficiencies or additional information is required you will
be notified. After our receipt of all requested information and corrections, you will be notified within 30 days as to whether the Specialized Process
Alternative is granted or denied.
A Specialized Process Alternative is not transferable from person to person or place to place. A Specialized Process Alternative may be rescinded if the
applicant is not following the parameters/conditions as outlined in the acceptance or if the Department receives additional information that would deem
the process a food safety hazard.
I herby certify that the above information is correct. I have provided all relevant material to the best of my ability. I understand until such time as this
Specialized Process Alternative is granted I must cease or not begin operation of any specialized process activity. I understand that by submitting this
application in no way guarantees that my Specialized Process Alternative will be granted. I understand that if this Specialized Process Alternative is
granted it can be rescinded immediately during any official inspection.
Signature of Applicant:
Print Name and Position Title:
FDACS-14095 Rev. 09/16
Page 1 of 2
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Florida Department of Agriculture and Consumer Services
Bureau of Food Inspection
Division of Food Safety
Attention: Retail Specialized
Process Alternative
3125 Conner Boulevard C-26
APPLICATION FOR SPECIALIZED PROCESS
Tallahassee, FL 32399-1650
Fax (850) 245-5553
ALTERNATIVE FOR RETAIL FOOD ESTABLISHMENT
NICOLE "NIKKI" FRIED
COMMISSIONER
Chapter 500, Florida Statutes
5K-4, Florida Administrative Code
Specialized Process Alternative (SPA) is a method that allows a food establishment to vary from the FDA Food Code or allows a high risk process to
be performed that requires stringent controls if, in the opinion of the Department, a health hazard or nuisance will not result from the altered provision.
Application must be submitted and accepted before starting the specialized processing. A separate application is required for
each process if there is more than one.
Date:
Business Name:
Food Entity Number:
Location Address:
City:
State:
ZIP:
County:
Business Owner Name:
Owner Contact Phone Number:
Email:
Name of Applicant:
Contact Phone Number:
Email:
TYPE OF SPECIALIZED PROCESS ALTERNATIVE REQUESTED (CHECK ONE):
Reduced Oxygen Packaging*
Shelf Stability at Room Temperature
Bare Hand Contact Alternative
Smoking Food for Preservation
Custom Animal Processing for Personal Consumption
Curing Food
Sprouting Seeds or Beans
Using Food Additives or Adding Components for Preservation
Operating a Molluscan Shellfish Life-Support Tank
Other Specialized Processes
*You may conduct Reduced Oxygen Packaging without having to obtain a Specialized Process Alternative from the Division if at least two barriers (one
barrier in addition to refrigeration or freezing) are in place to control the growth and toxin formation of Clostridium botulinum and the growth of Listeria
monocytogenes and all provisions of § 3-502.12 of the FDA Food Code are followed, however, you must submit a Hazard Analysis Critical Control Point
(HACCP) plan. You may not begin the process until this agency has deemed your HACCP plan acceptable in writing.
What is the specific finished product(s) for which you are requesting a Specialized Process Alternative?
How do you plan to store the final product?
Refrigeration
Freezing
Shelf Stable
How do you plan to display the final product?
Refrigeration
Freezing
Shelf Stable
If you are using a reduced oxygen packaging process, what barrier you are using to prevent Clostridium botulinum and Listeria monocytogenes in your
process (see Annex 6 of the FDA Food Code)?
You will be notified, by email, within 14 days of receipt of your documentation. If there are any deficiencies or additional information is required you will
be notified. After our receipt of all requested information and corrections, you will be notified within 30 days as to whether the Specialized Process
Alternative is granted or denied.
A Specialized Process Alternative is not transferable from person to person or place to place. A Specialized Process Alternative may be rescinded if the
applicant is not following the parameters/conditions as outlined in the acceptance or if the Department receives additional information that would deem
the process a food safety hazard.
I herby certify that the above information is correct. I have provided all relevant material to the best of my ability. I understand until such time as this
Specialized Process Alternative is granted I must cease or not begin operation of any specialized process activity. I understand that by submitting this
application in no way guarantees that my Specialized Process Alternative will be granted. I understand that if this Specialized Process Alternative is
granted it can be rescinded immediately during any official inspection.
Signature of Applicant:
Print Name and Position Title:
FDACS-14095 Rev. 09/16
Page 1 of 2
Submit the following documentation with the Specialized Process Application-FDACS 14095:
Standard Operating Procedures (SOPs) which include items such as: Step-by-step description of the entire process from start
to the finished food product – include ingredients; preparation steps; method(s) of storage and display for sale; labels (include
use by date, etc.); calibration of applicable instruments; Sanitation Standard Operating Procedures; training of employees on
all aspects of the specialized procedures; etc.
A HACCP plan is required, unless, stated otherwise. Provide a HACCP plan with copies of potential monitoring records. A
HACCP plan must include all the following:
A.
A categorization of the types of Time/temperature Control for Safety (TCS) Foods that are specified in your special
process such as: type of meats and if raw or cooked, soups and sauces, salads, and bulk, solid foods such as meat
roasts, sausages, or of other foods that are specified by the Department;
B.
A flow diagram by specific food or category type identifying critical control points and providing information on the
following:
1.
Ingredients, packaging, and equipment used in the preparation of that food, and
2.
Formulations or recipes that delineate methods and procedural control measures that address the food safety
concerns involved;
C. Food employee and supervisory training plan that addresses the food safety issues of concern—include summary
outline or course content, trainer and designate responsible person;
D. Clearly identify:
1.
Each critical control point,
2.
The critical limits for each critical control point,
3.
The method and frequency for monitoring and controlling each critical control point by the food employee
designated by the person in charge (who, what, when and how),
4.
The method and frequency for the person in charge to routinely verify that the food employee is following
standard operating procedures and monitoring critical control points,
5.
Action to be taken by the person in charge if the critical limits for each critical control point are not met
(corrective actions), and
6.
Records to be maintained by the person in charge to demonstrate that the HACCP plan is properly operated
and managed; and
Additional scientific data or other information, as required by the Department, supporting the determination that the proposal
does not compromise food safety such as lab analysis, letter from a Process Authority, etc.
Lot identification code system—include explanation of code and record keeping system
Layout of the area where the operation will be performed; include storage, preparation/processing, display area, hand washing
sink and three-compartment sink, etc.
There must be physical separation/barrier OR a scheduling separation from other activities to prevent cross contamination
when necessary. A diagram to scale indicating the location of where the processing operation will occur in relation to your
other processing areas or specific processing schedule showing times when specialized processing will take place in relation
to your other processing times to avoid cross contamination.
Any other pertinent, applicable documentation to ensure the safety of the finished product
Submit all required documentation to:
Florida Department of Agriculture and Consumer Services
Division of Food Safety
Attn: Specialized Process Alternative
3125 Conner Boulevard, Room 287 (C-26)
Tallahassee, Florida 32399-1650
OR
FoodInsp@FDACS.gov
*Subject line should state “Specialized Process Alternative Application”
Contact 850-245-5520 for any questions or
concerns regarding these instructions.
FDACS-14095 Rev. 09/16
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