BELTON FOODS, INC.

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Building & Grounds

• Litter free?

  Yes

  No

  N/A

• Adequate drainage?

  Yes

  No

  N/A

• No evidence of off odors?

  Yes

  No

  N/A

• All entrances can be secured properly?

  Yes

  No

  N/A

• All doors & windows properly screened?

  Yes

  No

  N/A

• Fence perimeter secured?

  Yes

  No

  N/A

• Grass and weeds controlled?

  Yes

  No

  N/A

• Rodent stations properly working, clean, & in proper locations?

  Yes

  No

  N/A

• Bait stations in their proper place?

  Yes

  No

  N/A

• Outside Cobb tank clean and orderly?

  Yes

  No

  N/A

• Outside storage areas clean, orderly, & secured?

  Yes

  No

  N/A

Receiving & Shipping Area

• Clean & orderly?

  Yes

  No

  N/A

• No evidence of off odors?

  Yes

  No

  N/A

• 18" warehouse buffer zone maintained?

  Yes

  No

  N/A

• All entrances can be secured properly?

  Yes

  No

  N/A

• All doors & windows properly screened?

  Yes

  No

  N/A

• All lights are proper material, screened, & clean?

  Yes

  No

  N/A

• No product spills under any racks?

  Yes

  No

  N/A

• Rodent stations properly working, clean, & in proper locations?

  Yes

  No

  N/A

• All product properly sealed & packaged?

  Yes

  No

  N/A

• Proper product identification is visible?

  Yes

  No

  N/A

• Toilets are clean and orderly?

  Yes

  No

  N/A

• Compliance with GMP for buckets & brushes?

  Yes

  No

  N/A

Phase 3 Warehouse

• Clean & orderly?

  Yes

  No

  N/A

• No evidence of off odors?

  Yes

  No

  N/A

• 18" warehouse buffer zone maintained?

  Yes

  No

  N/A

• All entrances can be secured properly?

  Yes

  No

  N/A

• All doors & windows properly screened?

  Yes

  No

  N/A

• All lights are proper material, screened, & clean?

  Yes

  No

  N/A

• No product spills?

  Yes

  No

  N/A

• Rodent stations properly working, clean, & in proper locations?

  Yes

  No

  N/A

• All product properly sealed & packaged?

  Yes

  No

  N/A

• Proper product identification is visible?

  Yes

  No

  N/A

• Compliance with GMP for buckets & brushes?

  Yes

  No

  N/A

• Maintenance racks orderly and clean?

  Yes

  No

  N/A

Process Area/Raw Material Storage

• Clean & orderly?

  Yes

  No

  N/A

• No evidence of off odors?

  Yes

  No

  N/A

• 18" warehouse buffer zone maintained?

  Yes

  No

  N/A

• All entrances can be secured properly?

  Yes

  No

  N/A

• All doors & windows properly screened?

  Yes

  No

  N/A

• All lights are proper material, screened, & clean?

  Yes

  No

  N/A

• Rodent stations properly working, clean, & in proper locations?

  Yes

  No

  N/A

• All raw materials are properly identified, tagged, & placed in the proper location?

  Yes

  No

  N/A

• First In/First Out ingredient policy compliance?

  Yes

  No

  N/A

• Compliance with GMP for buckets & brushes?

  Yes

  No

  N/A

Maintenance Cage

• Clean & orderly?

  Yes

  No

  N/A

• All food grade material separated, identified, & stored properly?

  Yes

  No

  N/A

• Compliance with GMP for buckets & brushes?

  Yes

  No

  N/A

Break Room

• Clean & orderly?

  Yes

  No

  N/A

• All trash disposed of properly?

  Yes

  No

  N/A

• Employee lockers are orderly and clean?

  Yes

  No

  N/A

• Refrigerator is orderly and clean?

  Yes

  No

  N/A

• Toilets are clean and orderly?

  Yes

  No

  N/A

Mezzanine Area

• Clean & orderly?

  Yes

  No

  N/A

• No evidence of off odors?

  Yes

  No

  N/A

• Adequate drainage & cleanable floor surface?

  Yes

  No

  N/A

• All walls, ceiling, & floor cleanable?

  Yes

  No

  N/A

• No paint peeling or flaking?

  Yes

  No

  N/A

• All lights are proper material, screened, & clean?

  Yes

  No

  N/A

• Processing equipment clean and sanitary?

  Yes

  No

  N/A

• Covers in place over production equipment?

  Yes

  No

  N/A

• Mixing utensils and equipment clean & stored in a sanitary manner?

  Yes

  No

  N/A

• All fittings, spouts, clamps, gaskets, & filters stored in a clean and sanitary manner?

  Yes

  No

  N/A

• Cleaning supplies & equipment properly stored?

  Yes

  No

  N/A

• All raw materials are properly identified, tagged, & placed in the proper location?

  Yes

  No

  N/A

• Compliance with GMP for buckets & brushes?

  Yes

  No

  N/A

Horix Production Area

• Clean & orderly?

  Yes

  No

  N/A

• No evidence of off odors?

  Yes

  No

  N/A

• Adequate drainage & cleanable floor surface?

  Yes

  No

  N/A

• All walls, ceiling, & floor cleanable?

  Yes

  No

  N/A

• No paint peeling or flaking?

  Yes

  No

  N/A

• All doors & windows properly screened?

  Yes

  No

  N/A

• All lights are proper material, screened, & clean?

  Yes

  No

  N/A

• Processing equipment clean and sanitary?

  Yes

  No

  N/A

• Filling equipment clean and sanitary?

  Yes

  No

  N/A

• Covers in place over production equipment?

  Yes

  No

  N/A

• Cleaning supplies & equipment properly stored?

  Yes

  No

  N/A

• Compliance with GMP for buckets & brushes?

  Yes

  No

  N/A

Elf Production Area

• Clean & orderly?

  Yes

  No

  N/A

• No evidence of off odors?

  Yes

  No

  N/A

• Adequate drainage & cleanable floor surface?

  Yes

  No

  N/A

• All walls, ceiling, & floor cleanable?

  Yes

  No

  N/A

• No paint peeling or flaking?

  Yes

  No

  N/A

• All doors & windows properly screened?

  Yes

  No

  N/A

• All lights are proper material, screened, & clean?

  Yes

  No

  N/A

• Rodent stations properly working, clean, & in proper locations?

  Yes

  No

  N/A

• Processing equipment clean and sanitary?

  Yes

  No

  N/A

• Filling equipment clean and sanitary?

  Yes

  No

  N/A

• Covers in place over production equipment?

  Yes

  No

  N/A

• Mixing utensils and equipment clean & stored in a sanitary manner?

  Yes

  No

  N/A

• All raw materials are properly identified, tagged, & placed in the proper location?

  Yes

  No

  N/A

• All fittings, spouts, clamps, gaskets, & filters stored in a clean and sanitary manner?

  Yes

  No

  N/A

• Cleaning supplies & equipment properly stored?

  Yes

  No

  N/A

• Compliance with GMP for buckets & brushes?

  Yes

  No

  N/A

Glass, Brittle Plastic, & Wood Audit

• Sliding glass windows (4) in Horix room?

  Yes

  No

  N/A

• Boiler site glass (1) in Horix room?

  Yes

  No

  N/A

• Condenser site glass (1) in Horix room?

  Yes

  No

  N/A

• Glass panels (4) in West garage door in Elf room?

  Yes

  No

  N/A

• Glass panel (1) in North garage door in Elf room?

  Yes

  No

  N/A

• Sliding glass window (1) in warehouse?

  Yes

  No

  N/A

• Glass computer monitors (2) in warehouse?

  Yes

  No

  N/A

• Fluorescent strip lights (6) in maintenance?

  Yes

  No

  N/A

• Glass mirrors (3) on forklifts?

  Yes

  No

  N/A

• Spare fluorescent tubes in women's restroom?

  Yes

  No

  N/A

• Spare sodium metal halide lights in women's restroom?

  Yes

  No

  N/A

• Glass computer monitor (1) in maintenance?

  Yes

  No

  N/A

• Incandescent light (1) in maintenance?

  Yes

  No

  N/A

• Fluorescent strip light (1) in changing rooms?

  Yes

  No

  N/A

• Spark plugs with ceramic insulator (3) in forklifts?

  Yes

  No

  N/A

• Five (5) bathroom mirrors?

  Yes

  No

  N/A

• Lights in Horix room (11) under plastic?

  Yes

  No

  N/A

• Lights in Elf room (13) under plastic?

  Yes

  No

  N/A

• Lights in Warehouse (19) under plastic?

  Yes

  No

  N/A

• Lights in Mid-warehouse (9) under plastic?

  Yes

  No

  N/A

• Lights in Phase 3 Warehouse (32) with coating?

  Yes

  No

  N/A

GMP Audit

• Hairnets & beard nets worn properly?

  Yes

  No

  N/A

• Uniforms & lab coats are clean & worn properly?

  Yes

  No

  N/A

• Everyone is washing & sanitizing hands?

  Yes

  No

  N/A

• No one is wearing jewelry in plant?

  Yes

  No

  N/A

• Shoes & boots are clean and in good condition?

  Yes

  No

  N/A

• Work areas are relatively clean & orderly?

  Yes

  No

  N/A

• Bucket, brush, & squeegee program is active and working?

  Yes

  No

  N/A

• No injuries or illness are present in personnel in the plant?

  Yes

  No

  N/A

• No tobacco, gum, candy, drinks other than water, false fingernails, fingernail polish, items in shirt pockets, & medications are found in plant?

  Yes

  No

  N/A

Observations & Comments

• Any observations & comments?

Signatures

• Signature of auditor:

  Sign

• Corrective actions completed on:

  Date

• Verification signature corrective actions completed:

  Sign

• Validation signature of system review:

  Sign