Community Partner Product Quality Report
Purpose of Form
Report of CCFB products delivered that are damaged, spoiled, or expired . This program is not intended to address service problems.
Date
-
Month
-
Day
Year
Date
Time
Hour Minutes
AM
PM
AM/PM Option
Name of Community Partner Organization
Partner Representative Name
First Name
Last Name
Product Category (i.e. SFPP, Purchased, PASS, etc.)
Product Name
Quantity of Product Spoiled/Damaged/Unusable
Was any of the product distributed before the quality issue was identified?
Please Select
All product
Some product
No product
Product Condition
Rows
Yes
No
N/A
Unacceptable Spoilage, odor, etc.
Apparent pest activity (insects, rodents, etc.)
Visible damage (opened package, damaged package, etc.)
Food Quality Concern (other)
Food Safety Concern (other)
Description of Product Condition
Please share additional follow up performed.
Product discarded on site
Product sent back to CCFB with driver
Called or emailed CCFB staff with feedback
Attach photographs of the product
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Receiver Signature
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