Title Page

  • Establishment Name:

  • Type of Facility:

  • Physical Address:
  • Person in Charge:

  • Inspection Time In:

  • Date:

  • Person Completing Form:

Cleaning & Sanitation - Food Safety Fundamentals

  • DISCLAIMER:
    The temp/time profiles are for the US - please check local regulations.
    For example these sources can be used for Australia:
    Standard 3.2.2 – Food Safety Practices https://www.foodstandards.gov.au/sites/default/files/publications/SiteAssets/Pages/safefoodaustralia3rd16/Standard%203.2.2%20Food%20Safety%20Practices%20and%20General%20Requirements.pdf

    Appendix 6 - https://www.foodstandards.gov.au/sites/default/files/publications/SiteAssets/Pages/safefoodaustralia3rd16/Appendix%206%20-%20Cleaning%20and%20sanitising%20surfaces%20and%20utensils.pdf

  • Are all surfaces smooth, easily cleanable, and frequently washed?

  • Are all equipment kept clean, in proper working order, and meeting local regulations? e.g. ANSI standards

  • Are eating utensils properly washed after each use using a three-compartment sink or commercial dishwashing machine?

  • Is the high-temp dish machine's minimum washing temperature 151°F and rinse temperature 179°F for 10 seconds?

  • Is the low-temp dish machine's minimum wash and rinse temperature between 130°F and 150°F with chlorine sanitizer solution at a minimum of 100ppm?

  • Is the manual sink ware washing minimum wash, rinse, and sanitizing sink water temperature 113°F/45°C? Is the sanitizing solution at the proper concentration (chlorine 100mg/L; Quat. 200mg/L; or Iodine 12.5 – 25mg/L) and soaked for 2 minutes?

  • Are pocket thermometers and sanitizer test kits readily available to verify temperatures and concentrations?

  • Are wiping cloths clean, sanitized, properly stored, and maintained?

  • Are the water temperatures accurate?

  • If heat sanitizing, are the utensils allowed to remain immersed in 170°F/76°C water for 30 seconds?

  • If using chemical sanitizer, is it at the proper dilution?

  • Is the water clean and free of grease and food particles?

  • Are the utensils allowed to dry?

  • Are utensils covered to protect them from dust and contaminants when stored?

  • Are chemicals and cleaning supplies kept away from food surfaces when in use?

  • Are chemicals properly labeled and stored in a separate area from food storage?

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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.