Title Page
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Enter Employee Name
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Date and Time Assessment Audit was commenced.
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Supervisor Name
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Supervisor Signature
HACCP
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HACCP System in place
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Is There a HACCP Committee
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List HACCP Committee Members
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Scan Minutes from Last Meeting
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Are Biological Hazards Minimized
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Are Chemical Hazards Minimized
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Are Physical Hazards Minimized
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Are Allergenic Hazards Minimized
INTEGRATED PEST CONTROL
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Written integrated pest control policy in place
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Contracted to Pest Control Company
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Date of last inspection
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Scan the Most Recent Service Report
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No evidence of insects or pests present
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Building restricts access to pests
TRACEABILITY & RECALLS
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Traceability & Recall Program in Place
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Has a Mock Recall or Recall Incident Been Performed During the Past 30-days?
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Scan All Pertinent Documents (Notifications, Logs, etc)
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Is a Recall Team in Place
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List Recall Team Members
REGULATORY INSPECTION
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Health Authority and Other Inspection Agencies
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Date and Time of most recent inspection
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Scan Most Recent Regulatory Inspections
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Have All Infractions Been Corrected?
RECEIVING & SHIPPING
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Food items are received from approved source. (Government Approved)
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Sanitation of Delivery Vehicles Observed and Logged
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Temperature of Received Product Recorded
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Pallets are properly labelled and dated
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Food is inspected before placed into storage
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Observed potential of cross-contamination
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Loading Dock Sanitation Condition
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Pallets are checked for cleanliness and potential for contamination
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Food deliveries are kept 6" off the floor before being stored
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Policy in place for rejection of goods
SHIPPING
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Pallets are properly labeled & dated
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Are slip sheets used correctly?
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Temperatures are recorded with each delivery
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Delivery Vehicle Sanitation is observed and logged
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Evidence of cross contamination
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Food is inspected before being placed in delivery vehicles
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Temperature is checked and logged on shipping truck
STORAGE & REFRIGERATION
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DRY STORAGE
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Temperature is appropriate
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Evidence that temperatures are monitored and recorded
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Adequate air circulation
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All food and paper supplies are 6" off the floor
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Product Rotation Maintained (first in first out)
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Food is stored at least 18" below sprinkler head(s)
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Is storage area well lit
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Protective light shields cover all light sources
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All food is labeled & dated
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No evidence of leaks and moisture
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Bulk foods are labeled with common name if not in original container<br>(Flour, rice, sugar, etc)
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Food is protected from cross contamination
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Floors are clean an free of debris, boxes and hazards
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All surfaces are clean
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Chemicals are stored away from food and other food related supplies
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REFRIGERATION UNIT
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Thermometer is conspicuous and accurate
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Evidence that temperatures are monitored and recorded
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Monitored for cross contamination
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FIFO Maintained (first in first out)
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Food is stored 6" off floor
EQUIPMENT and BUILDING MAINTENANCE
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Building meets local building codes for food hygiene
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Floors, walls and ceiling meets local safety codes
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Food contact surfaces meet local safety codes
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No evidence of peeling or flaking paint
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Water quality meets Local Safety Codes
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Regular maintenance performed on building
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Regular preventative maintenance performed on critical equipment
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No evidence of leaking pipes
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Is there a preventative maintenance program
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Inoperative equipment removed from production areas
CLEANING and SANITIZING
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Cleaning compounds and sanitizers meet standards
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Concentrations meet standards
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Chemicals are all properly labelled
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Chemicals are all properly stored
DAILY CLEANING
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Food contact surface cleaning schedule in place
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Floors and walls cleaned regularly
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Deep cleaning schedule in place
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Delivery Vehicle cleaning schedule in place
GARBAGE STORAGE and DISPOSAL
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Refuse and garbage cans are clean and covered when not in use
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Garbage containers are emptied as necessary
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Boxes and containers are removed from site
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Dumpster is located away from facility access points
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Dumpster area is clean
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Dumpster lid(s) are closed
EMPLOYEE FOOD SAFETY TRAINING
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Scan Certificates
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Plan to achieve 100% training compliance
EMPLOYEE HYGIENE
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Employee health poster available
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Hands are washed or gloves are changed at critical points
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Staff only use wash hands in hand wash sinks
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Employees wear proper uniform including proper shoes
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Fingernails are short, unpolished and clean
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Hair restraint is worn
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Jewelry is limited , no watches, earrings
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Gloves are changed as needed
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Open sores, cuts, or splints and bandages on hands are completely covered while handling food
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Staff beverages are covered with a lid and straw and stored away from food preparation area
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Staff take appropriate action when coughing or sneezing
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Disposable tissues are used and disposed of when coughing/blowing nose
HAND WASHING FACILITIES
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Hand washing signage is displayed
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Hand sinks accessible and stocked with soap and paper towels
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Hand sanitizing solution is available at all hand washing stations and wash rooms
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Staff lockers provided away from food production and storage areas
SIGNATURES
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Signature of Employee
