Form FSIS 10,240-1 FSIS 10,240-1 Product Information on Post-Lethality Exposed Ready-To-E

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0583-0132. The time required to complete this information collection
is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed,
and completing and reviewing the collection of information.
1a. ESTABLISHMENT NAME
1b. EST. # (e.g., 00023 P)
U.S. DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE
1c. STREET ADDRESS (P.O. Box alone not acceptable)

PRODUCTION INFORMATION ON
POST-LETHALITY EXPOSED
READY-TO-EAT PRODUCTS

1d. CITY

1e. STATE

1f. ZIP CODE

(See Instructions on Page 4)

ALTERNATIVE 1: Both a post-lethality treatment
and an antimicrobial agent or process are used.

1g. PLANT SIZE CATEGORY (specify very small, small, or large):

-

2. Annual Production Volume (enter actual lbs. )
OTHER THAN DELI PRODUCTS 2

DELI PRODUCTS 1
SLICED &
PACKAGED AT
OFFICIAL EST.

TO BE SLICED
AFTER DISTRIB.
FROM OFFICIAL
EST.

HOT DOG
PRODUCTS

3. (Select applicable letter below):

FULLY COOKED
PRODUCTS

FERMENTED
PRODUCTS (with
or without cooking)

DRIED PRODUCTS SALT-CURED
PRODUCTS

a. more than 2 logs

B. Validated or highest
increase in Listeria
monocytogenes
allowed by your
antimicrobial
agent or process:

a. less than 1 log

C. How often do you
test food contact
surfaces per line
each year?

b. 2 logs
c. 1 log
d. less than 1 log

b. 1 log
c. 2 logs

PATÉ PRODUCTS

OTHER THAN DELI PRODUCTS 2

DELI PRODUCTS 1
TO BE
FULLY
HOT
SLICED AND
SLICED
COOKED
DOG
PACKAGED AFTER DIST.
PRODUCTS PRODUCTS
AT OFFICIAL
FROM
OFFICIAL
EST.
EST.

A. Validated log
reduction of Listeria
monocytogenes by
your post-lethality
treatment:

FROZEN
PRODUCTS

FERMENTED
DRIED
PRODUCTS PRODUCTS
(With or
without
cooking)

SALTCURED
PRODUCTS

FROZEN
PRODUCTS

PATÉ
PRODUCTS

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

d. more than 2 logs

a. more than 4 times
b. 3 or 4 times
c. 2 times
d. less than 2 times

See Footnotes on Page 4

4. PRINT NAME/TITLE OF AUTHORIZED ESTABLISHMENT OFFICIAL

FSIS FORM 10,240-1 (08/19/2009)

5. SIGNATURE OF AUTHORIZED EST. OFFICIAL

PREVIOUS EDITIONS ARE OBSOLETE

6. DATE

PAGE 1 of 4

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0583-0132. The time required to complete this information collection
is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed,
and completing and reviewing the collection of information.
1a. ESTABLISHMENT NAME
1b. EST. # (e.g., 00023 P)
U.S. DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE

PRODUCTION INFORMATION ON
POST-LETHALITY EXPOSED
READY-TO-EAT PRODUCTS

1c. STREET ADDRESS (P.O. Box alone not acceptable)
1d. CITY

1e. STATE

1f. ZIP CODE

(See Instructions on Page 4)

Only a post-lethality treatment
OR only an antimicrobial agent or process is used.

ALTERNATIVE 2:

1g. PLANT SIZE CATEGORY (specify very small, small, or large):

-

2. Annual Production Volume (enter actual lbs. )
OTHER THAN DELI PRODUCTS 2

DELI PRODUCTS 1
SLICED &
PACKAGED AT
OFFICIAL EST.

TO BE SLICED
AFTER DISTRIB.
FROM OFFICIAL
EST.

HOT DOG
PRODUCTS

3. (Select applicable letter below.
Answer either A & B or C & D):

A. Validated or highest
increase in Listeria
monocytogenes
allowed by your
antimicrobial agent
or process:

a. less than 1 log

B. If using antimicrobial
agent or process,
how often do you test
food contact surfaces
per line each year?

a. more than 8 times

FULLY COOKED
PRODUCTS

FERMENTED
PRODUCTS (with
or without cooking)

DELI PRODUCTS

DRIED PRODUCTS

1

SALT-CURED
PRODUCTS

FROZEN
PRODUCTS

PATÉ PRODUCTS

OTHER THAN DELI PRODUCTS 2

TO BE
HOT DOG
SLICED AND
SLICED
PACKAGED AFTER DIST. PRODUCTS
AT OFFICIAL
FROM
OFFICIAL
EST.
EST.

DRIED
FULLY
FERMENTED
PRODUCTS PRODUCTS
COOKED
(With or
PRODUCTS
without
cooking)

SALTCURED
PRODUCTS

FROZEN
PATÉ
PRODUCTS PRODUCTS

b. 1 log
c. 2 logs
d. more than 2 logs

b. 5,6,7or 8 times
c. 4 times
d. less than 4 times

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

OR
C. Validated log
reduction of Listeria
monocytogenes by
your post-lethality
treatment:

a. more than 2 logs
b. 2 logs
c. 1 log

D. If using post-lethality
agent, how often do
you test food contact
surfaces per line
each year?

a. more than 8 times
b. 5,6,7 or 8 times
c. 4 times
d. less than 4 times

d. less than 1 log

See Footnotes on Page 4
4. PRINT NAME/TITLE OF AUTHORIZED ESTABLISHMENT OFFICIAL

FSIS FORM 10,240-1 (08/19/2009)

5. SIGNATURE OF AUTHORIZED EST. OFFICIAL

PREVIOUS EDITIONS ARE OBSOLETE

6. DATE

PAGE 2 of 4

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0583-0132. The time required to complete this information collection
is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed,
and completing and reviewing the collection of information.
1a. ESTABLISHMENT NAME
1b. EST. # (e.g., 00023 P)
U.S. DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE
1c. STREET ADDRESS (P.O. Box alone not acceptable)

PRODUCTION INFORMATION ON
POST-LETHALITY EXPOSED
READY-TO-EAT PRODUCTS

1d. CITY

1e. STATE

1f. ZIP CODE

(See Instructions on Page 4)

ALTERNATIVE 3: Only a sanitation program
with testing is used.

1g. PLANT SIZE CATEGORY (specify very small, small, or large):

-

2. Annual Production Volume (enter actual lbs.)
DELI PRODUCTS
SLICED &
PACKAGED AT
OFFICIAL EST.

1

OTHER THAN DELI PRODUCTS 2

TO BE SLICED
AFTER DISTRIB.
FROM OFFICIAL
EST.

HOT DOG
PRODUCTS

3. (Select applicable letter below):

FULLY COOKED
PRODUCTS

FERMENTED
PRODUCTS (with
or without cooking)

DRIED PRODUCTS SALT-CURED
PRODUCTS

DELI PRODUCTS 1

a. more than 4 times
b. 4 times
c. 3 times
d. 2 times
e. 1 time
f. less than 1 time

-

-

PATÉ PRODUCTS

OTHER THAN DELI PRODUCTS 2

TO BE
FULLY
HOT
SLICED &
SLICED
COOKED
DOG
PACKAGED AFTER DIST.
PRODUCTS PRODUCTS
AT OFFICIAL
FROM
OFFICIAL
EST.
EST.

A. How often do you
test food contact
surfaces per line
each month?

FROZEN
PRODUCTS

-

-

FERMENTED
PRODUCTS
(With or
without
cooking)

-

DRIED
PRODUCTS

-

SALTFROZEN
PATÉ
CURED
PRODUCTS PRODUCTS
PRODUCTS

-

-

-

See Footnotes on Page 4

SUBMIT
4. PRINT NAME/TITLE OF AUTHORIZED ESTABLISHMENT OFFICIAL

FSIS FORM 10,240-1 (08/19/2009)

5. SIGNATURE OF AUTHORIZED EST. OFFICIAL

PREVIOUS EDITIONS ARE OBSOLETE

6. DATE

PAGE 3 of 4

INSTRUCTIONS FOR COMPLETING THE FORM
As stated in 9 CFR 430, FSIS collects annual production volume and
information on post-lethality exposed ready-to-eat (RTE) meat and
poultry products. FSIS uses the information as a basis for directing its
verification activities, including microbiological sampling, at affected
establishments. Establishments must complete this form and submit it
to FSIS at least annually and whenever there is a significant change in
the alternative category or volume of production.
The regulations classify the products by the L. monocytogenes
control alternative used:
ALTERNATIVE 1:

Establishment uses a post-lethality
treatment and an antimicrobial
agent/process

ALTERNATIVE 2:

Establishment uses either a
post-lethality treatment or an
antimicrobial agent/process

ALTERNATIVE 3:

Establishment uses sanitation and a
testing program and uses neither a
post-lethality treatment nor an
antimicrobial agent or process

ITEMS 1a - 1g (Continued)

.

When entering the Establishment Number (Est. No.), follow these
guidelines:
When entering the Est. No., if it is less than 5 digits, for
example 123, complete the Est. No. field by filling in the first
two digits with zeroes, or 00123. The same applies for any
number with less than 5 digits.

.
..

ITEM 1g PLANT SIZE CATEGORY

.

Footnotes for Products:

2 Other than Deli Products:

Hot dog products include a ready-to-eat meat or poultry frank, frankfurter, or
weiner such as a product defined in 9 CFR 319.180 and 319.181 (9 CFR 430.1).
Examples include hot dogs, wieners, frankfurters.

Dried products include include jerky, dried beef, dried duck breast, basturma,
carne seca.
Salt-cured products include country cured ham, prosciutto, dry cured duck,
coppa, cappicola.

A large plant has more than 500 employees.

.

Enter your establishment's annual production volume in
hundreds, thousands, or millions of pounds, as applicable, of
post-lethality exposed RTE meat and poultry products for each
Alternative in each product category column.

ITEM 3 ALTERNATIVE 1 - ALTERNATIVE 3

Fully cooked products include chicken nuggets, chili, fully cooked bacon.
Fermented products include dry salami, Lebanon bologna, cervelat, thuringer,
summer sausage, pepperoni.

A small plant has 10 to 500 employees.

ITEM 2 ANNUAL PRODUCTION VOLUME

1 Deli Products: A ready-to-eat meat or poultry product that typically is sliced,

either in an official establishment or after distribution from an official est., &
typically is assembled in a sandwich for consumption (9 CFR 430.1). Examples
include ham, bologna, chicken roll, turkey breast, olive loaf.

A very small plant has fewer than 10 employees or annual sales
of less than $2.5 million.

.

For Alternative 1 and Alternative 2, in each product category column,
as applicable, select the applicable letter that most nearly corresponds
to your establishment's control of L. monocytogenes (Lm), the log
reduction or growth limitation achieved, and the frequency of
food-contact surface verification testing. Please make sure that you
select the minimum log reduction achieved by the post-lethality
treatment or the highest growth limitation allowed by the
antimicrobial agent or process for each product category.
For products in Alternative 3, select the applicable letter that
corresponds to the establishment's frequency of food contact surface
testing.

Frozen products include frozen chicken breasts, fully cooked and breaded.
Paté products include Paté.

.
.

ITEMS 4-6

.
.
.

ITEMS 1a - 1g
Enter establishment's name, number (See instructions below),
address and size category.

Print Name and Title of Authorized Official
Signature and Date of Authorized Official and Date Signed
(Note: If you re completing and submitting the form electronically,
enter the name of the Authorized Official and the Date completed.)

When entering the Establishment Number (Est. No.), follow these
guidelines:
Enter only one Est. No. on the form. If more than one number
applies, for example if you have a number for both meat (M)
and poultry (P), use the number for the species which is the
most predominantly produced.
Enter the Est. No. using five numeric and up to three alpha
characters for example 00123 M. Enter two blank spaces
between the Est. No and the species indicator (M in this
example). If there is an additional identifier, place it in the
space just preceding the species indicator.

SUBMIT THE COMPLETED FORM ELECTRONICALLY ONLINE,
BY MAIL OR FAX:

.

PROLF\ 2SHUDWLRQV Division (P2D), OPPD, FSIS, USDA
6XQQ\VLGH$YH
GWCC Second Wing Second Floor, Mail Stop 5272
Beltsville, MD 20705
Telephone no.: 1-800-233-3935 or 402-344-5000
Fax no.: 301-504-0886

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