Title Page
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Site conducted
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Conducted on
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Prepared by
Equipment Cleaning & Inspection
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The equipment should be scrubbed with facility-designated cleaner (Chlorinated Plus, Peroxy Protein Remover & Whitner, Rapide) rinsed with water, sanitized with a chlorinated sanitizer, complete 2nd rinse, then apply facility-designated quat sanitizer (Sani -T 10 Plus, Oasis 146 Multi-- Quat, Smart Power Sink and Surface)
LOG
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Date and Time:
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Shift: AM / PM
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Equipment Name and Equipment # (if applicable)
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Equipment Cleaned By:
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Pass / Fail:
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Equipment Inspected By:
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Reviewed By (Name, Signature, Date):
