This government document is issued by Department of Agriculture for use in Pennsylvania
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https://www.google.com/url?client=internal-element-cse&cx=007572080359491747877:qqxrx9mf39e&q=https://www.agriculture.pa.gov/consumer_protection/FoodSafety/Retail%2520Food/Documents/HACCP%2520Plan%2520Form.pdf&sa=U&ved=2ahUKEwjEhMft9dL8AhVEaqQEHZfWBRk4KBAWegQIBRAB&usg=AOvVaw3bt49Ue6yHTXsCJbRql7WW