• Client

  • Location
  • Conducted on

  • Prepared by

Risk Assessment

  • Required Personal Protective Equipment (PPE) for this activity is available and will be used

  • NOTE: Do not undertake this activity if the required PPE is not available for use - Discuss with your supervisor.

  • Risk assessment (JSA) for this activity has been read and understood

  • Are there any specific risks identified with the property?

  • If yes, list the risk/s and what action will be taken to eliminate or control the risk.

  • NOTE: If the risk cannot be eliminated/controlled and/or is unsafe, DO NOT undertake the activity - Discuss with your supervisor.
    If during the activity risks are identified and it is unsafe to continue, abandon the activity - Discuss with your supervisor.


  • Trading name

  • Proprietor/company

  • ABN

  • Email

  • Phone

  • Person interviewed (if available)

  • Food safety supervisor appointed to business

  • Name of FSS, FSS certificate number and expiry date (where applicable)

  • Food business notified to the NSW Food Authority

  • Food Business Notification Number (if notified)

  • Type of inspection



  • Surface is smooth and impervious to moisture

  • Undamaged, free of open joints, cracks and crevices

  • Kitchen ceiling is a light colour and is capable of being easily and effectively cleaned


  • Light fittings recessed or where flush mounted sealed as to prevent pest ingress

  • Light fittings capable of being easily cleaned and fitted with diffuser covers where required

  • Adequate task lighting provided for proposed activities


  • Walls of solid construction and not susceptible to mechanical damage

  • Surface is smooth, impervious to moisture and will not collect dust

  • Capable of being easily and effectively cleaned


  • Provided at floor and wall intersections within kitchen area

  • Minimum radius of 25 mm


  • Surface is smooth and impervious to moisture

  • Capable of being easily and effectively cleaned

  • Graded towards floor waste where applicable

  • Does not permit the ponding of water

  • Appropriate grates provided to floor wastes where applicable

Pipes and conduits

  • Concealed within walls, floors, ceilings, plinths OR

  • Fixed on brackets at 25 mm from adjacent vertical surface and 100 mm from horizontal surface

Fixtures, fittings and equipment

  • Designed, constructed and installed in a manner that allows for easy and effective cleaning

  • All equipment located >150 mm above floor or if fixed item sealed to floor

  • Wash and food preparation sinks fitted with appropriate grated drains

Hand washing facilities

  • Located within 5 metres of all food preparation areas

  • Easily accessible by all staff and will not restrict movement within kitchen

  • Supplied with warm water mixed through hands free tap ware (tempering device installed?)

  • Clearly designated for hand washing only

  • Provide with liquid soap and single use towelling

Wash basins

  • Commercial Dishwasher provided

  • Sinks large enough to allow effective cleaning and sanitising and provided with hot water at temperature of minimum of 43 degree C

  • The number of wash basins installed meets requirements of AS4674-2004 eg food prep sink and cleaners sinks provided etc

  • Appropriate strainers installed in sinks wastes


  • Commercial mechanical exhaust systems located above all cooking equipment

  • Mechanical ventilation system provided over dishwasher where provided

  • Certificate provided certifying exhaust/s installed and operating in accordance with Australian Standards

Storage - away from food & food contact surfaces provided for:

  • Sufficient space for waste facilities away fro food preparation area

  • Sufficient space for storage of chemicals and cleaning equipment away from food preparation area

  • Sufficient space for personal belongings away from food preparation area

Pest control

  • Premises free of cracks and crevices

  • Windows and doors fitted with fly mesh screens as necessary

  • Gaps under doorways does not permit entry of pests

  • Licensed pest controller engaged for regular treatment


  • Toilets provided with an air lock or self closing device with exhaust fan

  • Hand wash basin located adjacent to toilet facilities

  • Hand wash basins provided with warm water mixed through hands free single spout

  • Liquid hand soap and single use towelling provided


  • Approved grease arrestor installed and located away from food preparation and food storage areas

  • Appropriate waste storage receptacles provided with hands free use within kitchen

  • Trade waste approval in place with Bega Valley Shire Council (where applicable)

General Requirements

  • Temperature measuring device such as probe thermometer accurate to +/_ 1 degree C provided

  • Food grade gloves provided of adequate sizing

  • Food grade sanitiser is available within premises

  • Adequately sized and resources up to date first aid kit provided

Information to be be provided to Council prior to commencement of trading

  • Information required

  • If other


  • Premises condition

Sign off

  • Signee's Name and Signature

  • Officer/s name

  • Council Officers signature

  • Note: This assessment report contains findings from date/time of inspection only. For further information about this report please contact Council Officer named in report.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.