SHA/AFDO Seafood HACCP Training Program Registration Form

SUBMIT ONE (1) COMPLETE APPLICATION FOR EACH COURSE DATE

Applications must be submitted 20 business days prior to the course start date. Approval MUST be obtained prior to the start date of the course for Course Completion Certificates to be issued.

Applicant

Name(Required)

First Middle Last

Title

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Fax

Email(Required)

Please enter the applicant’s email address.

Other Email

If you are submitting this application on behalf of the supervisory trainer and would like to receive a copy of the application, please provide your email address here.

Course

Choose course(Required)

Virtual Basic HACCP Course (16.5 contact hours)

Virtual Segment II (6.5 contact hours)

Virtual Sanitation Control Procedures (SCP) (6.5 contact hours)

In-Person Basic HACCP (16 contact hours)

In-Person Sanitation Control Procedures (SCP) (6.5 contact hours)

In-Person Segment II (6.5 contact hours)

Please read the SHA Seafood HACCP Basic Virtual Training Course Protocol prior to submitting your Seafood HACCP Training Course Registration Form. If necessary, AFDO will forward course registrations to the SHA Application Review Committee for review and comment.

Please read the SHA Virtual SCP Training Protocol prior to submitting your Seafood HACCP Training Course Registration Form. If necessary, AFDO will forward course registrations to the SHA Application Review Committee for review and comment.

Please read the SHA Virtual Segment Two Training Protocol prior to submitting your Seafood HACCP Training Course Registration Form. If necessary, AFDO will forward course registrations to the SHA Application Review Committee for review and comment.

Please read the SHA HACCP and SCP Training Protocol prior to submitting your Seafood HACCP Training Course Registration Form. If necessary, AFDO will forward course registrations to the SHA Application Review Committee for review and comment.

I acknowledge that I have completely read and fully understand the policies and guidelines outlined in the Protocol(Required)

Yes

I will ensure that all participants have a CCN Email from Cornell University dated within 9 months of my scheduled Segment Two course date.(Required)

Yes

NOTE: Starting April 1, 2023 the Seafood HACCP Alliance protocol will require completion of a Segment Two training within 9 months of completing the Segment One course. Those enrolled after April 1, 2023 must meet this training requirement. For those enrolled prior to April 1, 2023, the previously recommended 6 months and no more than 2 years policy will be honored.

FAILURE TO ACKNOWLEDGE THAT YOU HAVE READ AND UNDERSTAND THE POLICIES OUTLINED WITHIN THE PROTOCOL WILL PREVENT YOU FROM BEING ABLE TO REGISTER A COURSE USING THIS FORM!

Course Start Date(Required)

Course Time Zone(Required)

Alaska Time (AKT)

Central Time (CT)

Eastern Time (ET)

Hawaii-Aleutian Time (HT)

Mountain Time (MT)

Pacific Time (PT)

Other

Please specify the course time zone (if not listed above):(Required)

Virtual Learning Platform(Required)

Hidden

Course Location (city/state/country)(Required)

Course Location(Required)

City State / Province / Region Country

Expected Number of Students (maximum of 20):(Required)

Expected Number of Students (maximum of 30):(Required)

Expected Number of Students (maximum of 40):(Required)

Explain why you will need to exceed the maximum allowed students?(Required)

If course will be taught in a language other than English, list language:

This Course is (choose one):(Required)

Available to the Public

Closed to the Public

Course registration link (OPTIONAL)

Trainers and Qualifying Credentials

Attach brief vitae for all Assistant Trainers without an AFDO “current” certificate number. Minimum of 1 qualified Trainer for every 8 participants and 1 technical administrator. Note: for classes over 8, the second qualified trainer can serve as technical administrator (list as both below, if applicable).

Attach brief vitae for all Assistant Trainers without an AFDO “current” certificate number. Minimum of 1 qualified Trainer for every 10 participants and 1 technical administrator. Note: for classes over 10, the second qualified trainer can serve as technical administrator (list as both below, if applicable).

Attach brief vitae for all Assistant Trainers without an AFDO “current” certificate number. Required 2 trainers for more than 15 students.

Upload CVs and other qualification documents here

Drop files here or

Max. file size: 64 MB, Max. files: 10.

*Supervisory Trainer must be AFDO “qualified” according to the SHA/AFDO Seafood HACCP and SCP Training Protocol and be present for the duration of the course.

Supervisory Trainer(Required)

Name

Certificate # (completed by AFDO)

Technical Administrator(Required)

Name

Certificate # (completed by AFDO)

Assistant Trainer

Name

Certificate # (completed by AFDO)

I certify that I have taught at least 2 in-person Basic HACCP courses(Required)

Yes

The virtual training option is only available for instructors who have taught at least 2 in-person Basic HACCP courses (Section 3.8.1).

Please provide the following course specific details to verify your eligibility status(Required)

Course #

Training Date

Location

Please provide the following course specific details to verify your eligibility status(Required)

Course #

Training Date

Location

AFDO Liaison (Optional — See Section 8.6 of the HACCP and SCP Training Protocol)

I will be using the appropriate AFDO Affiliate to help facilitate my course(Required)

Yes

(i.e., registration, purchase manuals, and course certificates)

Choose which affiliate

Course Agenda

Attach a copy of the course agenda you will be using for this course. Course agenda must meet the requirements as outlined in the Protocol, Appendix I, II and III. Assure all topics are covered, and minimum contact times are met. Be advised the protocol and training manuals provide example agendas that may include a range of times. You will need to PROVIDE ACTUAL PROPOSED TIMES AND SHOW THAT THE COUSE IS A MINIMUM OF 16 CONTACT HOURS (HACCP) or 6.5 CONTACT HOURS (SCP AND SEGMENT II). NOTE: If you plan to teach the course agenda in less than the specified minimum contact hours you will need to justify your decision in writing before approval can be considered.

Attach a copy of the Agenda you will be using for this course. Course agenda must meet the requirements as outlined in the Protocol for SHA Virtual Basic HACCP Trainings. Assure all topics are covered, and minimum contact times are met by completing and submitting an SHA Hours Verification form. You will need to PROVIDE ACTUAL PROPOSED TIMES AND SHOW THAT THE COURSE IS A MINIMUM 16.5 CONTACT HOURS NOTE: If you plan to teach the course agenda in less than the specified minimum contact hours, you will need to justify your decision in writing before approval can be considered.

Attach a copy of the course agenda you will be using for this course. Course agenda must meet the requirements as outlined in the Protocol for SHA Virtual SCP Trainings. Assure all topics are covered, and minimum contact times are met. You will need to PROVIDE ACTUAL PROPOSED TIMES AND SHOW THAT THE COURSE IS A MINIMUM of 6.5 CONTACT HOURS. NOTE: If you plan to teach the course agenda in less than the specified minimum contact hours you will need to justify your decision in writing before approval can be considered.

Attach a copy of the course agenda you will be using for this course. Course agenda must meet the requirements as outlined in the Protocol for SHA Virtual Segment Two Trainings. Assure all topics are covered, and minimum contact times are met. You will need to PROVIDE ACTUAL PROPOSED TIMES AND SHOW THAT THE COURSE IS A MINIMUM 6.5 CONTACT HOURS. NOTE: If you plan to teach the course agenda in less than the specified minimum contact hours you will need to justify your decision in writing before approval can be considered.

↪ Click here to DOWNLOAD the Virtual Basic HACCP Sample Agenda

↪ Click here to DOWNLOAD the Virtual SCP Sample Agenda

↪ Click here to DOWNLOAD the Virtual Segment Two HACCP Sample Agenda

↪ Click here to DOWNLOAD the Segment Two HACCP Sample Agenda

↪ Click here to DOWNLOAD the SCP Sample Agenda

↪ Click here to DOWNLOAD the Basic HACCP Sample Agenda

Attach a copy of the Virtual Course Agenda(Required)

Drop files here or

Max. file size: 64 MB, Max. files: 6.

Attach a copy of the Course Agenda

Drop files here or

Max. file size: 64 MB, Max. files: 6.

I certify that the Course Agenda meets the topic requirements and satisfies the required Contact Hours(Required)

Yes

Are you planning LESS than the required contact hours?(Required)

Yes

Provide justification for why you are planning less than required contact hours:(Required)

↪ Click here to DOWNLOAD the SHA Hours Verification Excel Sheet (for Virtual 16.5 Hours)

↪ Click here to DOWNLOAD the SHA Hours Verification Excel Sheet

Upload a SHA Hours Verification Excel Sheet to ensure time per topic is being met(Required)

Drop files here or

Max. file size: 64 MB, Max. files: 3.

I certify that both the Course Agenda and SHA Hours Verification Excel Sheet meet the topic requirements and satisfy the required 16.5 Contact Hours(Required)

Yes

I certify that both the Course Agenda and SHA Hours Verification Excel Sheet meet the topic requirements and satisfy the required 16 Contact Hours(Required)

Yes

Are you planning LESS than the required contact hours?(Required)

Yes

Provide justification for why you are planning less than required contact hours:(Required)

Training Models

Which approved Training Model(s) do you plan to use during your course? (Select all that apply)(Required)

Please visit the University of Florida’s Sea Grant Webpage to download a PDF copy of the HACCP Model Plan you will be using.

Training Materials

Visit the University of Florida webpage for the most up-to-date training materials: https://www.flseagrant.org/seafood-safety/seafood-haccp-training-and-education/

I certify that all training materials used are the approved SHA/AFDO Training Materials as outlined by the Protocols(Required)

Yes

(i.e., including guides/manuals, slide sets, and training models)

Explain the answer provided above:(Required)

Course Registration Fee

NOTE: course registration fee is in US Dollars

Registration fee must include:

a) $50 per HACCP student to AFDO for recording and preparing the AFDO Certificates of Course Completion
b) $45 USD for the Fish and Fishery Products Hazards and Controls Guidance (FDA Hazards Guide)
c) $35 USD HACCP: Hazard Analysis and Critical Control Point Training Curriculum

d) $25 USD per student for Regional Affiliate (optional))

Registration fee must include:

a) $50 per HACCP student to AFDO for recording and preparing the AFDO Certificates of Course Completion
b) $45 USD for the Fish and Fishery Products Hazards and Controls Guidance (FDA Hazards Guide)
c) $35 USD HACCP: Hazard Analysis and Critical Control Point Training Curriculum
d) $25 $25 USD per student for Regional Affiliate (optional)

Registration fee must include:

a) $40 per HACCP student to AFDO for recording and preparing the AFDO Certificates of Course Completion
b) $35 USD Sanitation Control Procedures for Processing Fish and Fishery Products
c) $25 USD per student for Regional Affiliate (optional)

Registration fee must include:

a) $50 per HACCP student to AFDO for recording and preparing the AFDO Certificates of Course Completion
b) $45 USD for the Fish and Fishery Products Hazards and Controls Guidance (FDA Hazards Guide)
c) $35 USD HACCP: Hazard Analysis and Critical Control Point Training Curriculum
d) $25 $25 USD per student for Regional Affiliate (optional)

Total cost/student $(Required)

US Dollars

Explain why course is $0:(Required)

NOTE: The total cost per student should be reasonable for necessary Trainer(s), travel, facilities, equipment, and related materials. If the cost per student is over $600.00, please itemize below. The Alliance does not specify any specific limit for the cost per student, but the course approval process can question any apparently excessive costs in order to encourage access to affordable education that advances seafood safety. All approved open courses with the respective costs per student will be posted on Alliance maintained websites.

Itemized costs(Required)

Additional Costs per Student

Specific Justifications

Virtual Course Specific Questions

Section 3.2 & 3.3 of the SHA Virtual Segment Two Training Protocol. Provide ample details for the following questions:

Section 3.2 & 3.3 of the SHA Virtual SCP Training Protocol. Provide ample details for the following questions.

Section 3.2 & 3.3 of the SHA Seafood HACCP Basic Virtual Training Course Protocol. Provide ample details for the following questions:

Explain how you will ensure video and audio is live and functional for all participants during the entire training:(Required)

How will you ensure interactions take place between Trainer and participants?(Required)

How will you ensure interactions take place between Participants and other Participants?(Required)

How will you ensure interactions take place between Participants and Course Materials? (i.e. FDA Hazards Guide)(Required)

Will you ensure active participation through use of knowledge assessments and roll-call?(Required)

Yes

If no, explain how will you ensure active participation and learning are taking place:(Required)

Explain how you will ensure participant attendance and visual contact throughout the training:(Required)

Group Activities

PLEASE PROVIDE DETAILED ANSWERS TO THE FOLLOWING QUESTIONS

Section 3.5 of the SHA Virtual Segment Two Training Protocol

Explain how you will breakout participants for group work:(Required)

Explain how you will ensure all students are participating in group activities:(Required)

Explain how participants will collaborate on developing the product description form, hazard analysis form, and HACCP plans:(Required)

Will a file sharing platform such as Google Documents be used?(Required)

Yes

If no, explain how the product description form, hazard analysis form, and HACCP plans will be shared with participants:(Required)

Explain how group presentations will be conducted:(Required)

Course Evaluation (Section 3.7 of the SHA Seafood HACCP Basic Virtual Training Course Protocol)

↪ Click here to DOWNLOAD the Sample Virtual Training Evaluation

Attach a copy of the course evaluation that will be used:(Required)

Drop files here or

Max. file size: 64 MB, Max. files: 10.

Supervisory Trainers are responsible for developing their own course evaluation. The questions included in 3.7 of the virtual training protocol must be listed in the evaluation.

I certify that the Course Evaluation contains the required questions as outlined in the SHA Seafood HACCP Basic Virtual Training Course Protocol(Required)

Yes

Explain how you will ensure each participant completes an evaluation:(Required)

Explain how you will submit your evaluations to AFDO at the completion of the course:(Required)

Course Evaluation (Section 3.7 of the SHA Virtual Segment Two Training Protocol)

↪ Click here to DOWNLOAD the Sample Virtual Training Evaluation

Attach a copy of the course evaluation that will be used:(Required)

Drop files here or

Max. file size: 64 MB, Max. files: 10.

Supervisory Trainers are responsible for developing their own course evaluation. The questions included in 3.7 of the virtual training protocol must be listed in the evaluation.

I certify that the Course Evaluation contains the required questions as outlined in the SHA Virtual Segment Two Training Protocol.(Required)

Yes

Explain how you will ensure each participant completes an evaluation:(Required)

Explain how you will submit your evaluations to AFDO at the completion of the course:(Required)

Miscellaneous Information

Specify any additional information you would like to be included when the course is posted to the Upcoming Courses on the AFDO website:

(i.e. registration website, any cost differences, etc.)

Signature

Signature of the applicant and/or Supervisory Trainer denotes agreement to conduct the described training in accordance with the SHA/AFDO Seafood HACCP and SCP Training Protocols and to be responsible for all fees.

Hidden

Electronic signature

Type your name here to sign this registration form.

eSignature(Required)

Type your name here to sign this registration form.

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