BELTON FOODS, INC.

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Date?

  Date

Horix Line

• Power has been turned on to all equipment?

  Yes

  No

  N/A

• Bottles & boxes are ready for start of run?

  Yes

  No

  N/A

• Food contact surfaces (capper/filler) are clean & free of foreign materials?

  Yes

  No

  N/A

• Conveyors, labeler, orienter, & tables are clean & free of foreign materials?

  Yes

  No

  N/A

• Label count verified and setup for day's run?

  Yes

  No

  N/A

• Bottle/box printers are setup & working properly?

  Yes

  No

  N/A

Elf Line

• Power has been turned on to all equipment?

  Yes

  No

  N/A

• Bottles & boxes are ready for start of run?

  Yes

  No

  N/A

• Food contact surfaces (capper/filler) are clean & free of foreign materials?

  Yes

  No

  N/A

• Conveyors, labeler, orienter, & tables are clean & free of foreign materials?

  Yes

  No

  N/A

• Label count verified and setup for day's run?

  Yes

  No

  N/A

• Bottle/box printers are setup & working properly?

  Yes

  No

  N/A

Mezzanine & Ingredient Room

• Power has been turned on to all equipment?

  Yes

  No

  N/A

• Food contact surfaces (tanks/lines/filters) are clean & free of foreign materials?

  Yes

  No

  N/A

• All raw ingredients are ready for day's production run?

  Yes

  No

  N/A

Notes

• Notes?

Verification Signature

• Plant Manager

  Sign

Validation Signature

• Quality Assurance

  Sign