Title Page


  • FSA - 001

  • BU NAME:

  • Conducted on

  • Prepared by :

  • Location
  • Personnel




  • Surrounding areas are cleaned and maintained adequately

  • Walls, floors, edges/junctions and drains are clean and are in good state

  • ceiling & overheads are clean

  • Ventilation holes and drainage holes and lights are covered properly

  • The area is free from any objectionable odors, smoke , dust and other contaminants

  • Hot water facility is available throughout the operation


  • Staffs are following proper receiving procedures

  • Food handling equipment, utensils and food contact surfaces are properly maintained or washed and/or sanitized before every use or as applicable

  • Frozen food is thawed either under refrigeration or or in cold running water

  • Vegetable sanitation procedures are in place and is followed

  • Procedures are in place to prevent cross contamination

  • Food is cooked to the safe internal temperature for an appropriate time.

  • Food is prepared in small batches to limit exposure to Temperature danger zone not more than 90 minutes

  • Hot Food is chilled using the blast chiller/blast freezer before cold storage


  • Food holding areas/units are clean and organized

  • Food is heated to the required safe internal temperature before placing in the hot holding unit

  • Hot holding units are not used to reheat potentially hazardous foods

  • Hot Holding unit is pre-heated before hot food is placed in unit

  • Temperature of cold food being held is at or below 5 degrees


  • Temperature of chillers is maintained at below 5 degrees<br>

  • Thermometers are available

  • Temperature of dry storage areas is between 10° C to 30°C

  • Temperature of chillers is maintained at below -12to-18 degrees

  • Food is stored 6 inches above the floor, walls and ceiling and 12 inches away from cooling fans

  • Storage areas/ units are clean and organized

  • There are no expired items, no bulging or leaking canned goods in all storage

  • Open bags of food are stored in containers with tight-fitting lids and labeled

  • All food is covered and properly labeled (labels contains correct information)

  • Non Food chemicals are clearly labeled and stored away from Food and food related supplies & is in a lockable condition


  • cleaning and sanitizing schedule is in place & followed

  • dishwashing machines is properly set up (such as gauge and chemicals are at a recommended levels)

  • water temperature is correct for wash 50°C to 60°C and rinse at 80°C

  • if using a chemical sanitizer, correct concentrations are used and monitored

  • Floors & Walls are clean


  • Team members wear clean and proper uniform including shoes

  • Effective hair restraints &/or protective clothing are properly worn

  • Fingernails are short, unpolished and clean ( no artificial nails allowed)

  • Jewelry is limited to a plain ring such as a wedding band. NO wrist watch and bracelets ( no jewelry in the BOH )

  • Burns, wounds and sores, scabs and blue water proof colored bandage are covered with a food grade glove while handling food

  • hands are washed as per the hand washing guidelines at every 20 minutes intervals and/or when required

  • Staffs appear to be in good health

  • Employees are using assigned restrooms

  • Hand washing stations are operational, clean, unobstructed and are equipped with soap, disposable towels and guidelines are posted


  • garbage bins are kept covered

  • garbage bins at food handling areas are emptied as necessary or at every 4 hours interval

  • Cardboard boxes, outer wraps are removed and placed in specially designated areas

  • loading dock and area around the bins are cleaned and odorless

  • garbage bins are clean

  • Outside doors have screens, are well sealed, and are equipped with a self-closing device, electrical air curtain or plastic strip curtains.


  • No evidence of pests is present.

  • Pest Control visits are documented

  • Pest sighting is recorded

  • Recommendations fromPest Control Visits are acted upon

  • exhaust hoods and filters are clean , working properly


  • All small equipment and utensils including cutting boards and knives are cleaned and sanitized between uses and when required

  • Small equipment and utensils are washed, sanitized and air dried

  • thermometers are cleaned and sanitized after each use

  • drawers and racks are cleaned

  • clean utensils are handled in a manner to prevent contamination of areas that will be in direct contact with food or food handlers


  • Equipment installed properly and broken items are handled properly

  • All confirmed Food handlers have Valid food handlers permit

  • MSDS is available for all chemicals used in operation

  • Storage Temperatures are monitored and documented

  • Food handlers reports sickness like diarrhea, vomiting, food borne diseases, serious colds/Flu, septic cut/wounds etc. to the concerned person

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.