Title Page

  • Enter Employee Name

  • Date and Time Assessment Audit was commenced.

  • Supervisor Name

  • Supervisor Signature

HACCP

  • HACCP System in place

  • Is There a HACCP Committee

  • List HACCP Committee Members

  • Scan Minutes from Last Meeting

  • Are Biological Hazards Minimized

  • Are Chemical Hazards Minimized

  • Are Physical Hazards Minimized

  • Are Allergenic Hazards Minimized

INTEGRATED PEST CONTROL

  • Written integrated pest control policy in place

  • Contracted to Pest Control Company

  • Date of last inspection

  • Scan the Most Recent Service Report

  • No evidence of insects or pests present

  • Building restricts access to pests

TRACEABILITY & RECALLS

  • Traceability & Recall Program in Place

  • Has a Mock Recall or Recall Incident Been Performed During the Past 30-days?

  • Scan All Pertinent Documents (Notifications, Logs, etc)

  • Is a Recall Team in Place

  • List Recall Team Members

REGULATORY INSPECTION

  • Health Authority and Other Inspection Agencies

  • Date and Time of most recent inspection

  • Scan Most Recent Regulatory Inspections

  • Have All Infractions Been Corrected?

RECEIVING & SHIPPING

  • Food items are received from approved source. (Government Approved)

  • Sanitation of Delivery Vehicles Observed and Logged

  • Temperature of Received Product Recorded

  • Pallets are properly labelled and dated

  • Food is inspected before placed into storage

  • Observed potential of cross-contamination

  • Loading Dock Sanitation Condition

  • Pallets are checked for cleanliness and potential for contamination

  • Food deliveries are kept 6" off the floor before being stored

  • Policy in place for rejection of goods

SHIPPING

  • Pallets are properly labeled & dated

  • Are slip sheets used correctly?

  • Temperatures are recorded with each delivery

  • Delivery Vehicle Sanitation is observed and logged

  • Evidence of cross contamination

  • Food is inspected before being placed in delivery vehicles

  • Temperature is checked and logged on shipping truck

STORAGE & REFRIGERATION

  • DRY STORAGE

  • Temperature is appropriate

  • Record Temperature

  • Evidence that temperatures are monitored and recorded

  • Adequate air circulation

  • All food and paper supplies are 6" off the floor

  • Product Rotation Maintained (first in first out)

  • Food is stored at least 18" below sprinkler head(s)

  • Is storage area well lit

  • Protective light shields cover all light sources

  • All food is labeled & dated

  • No evidence of leaks and moisture

  • Bulk foods are labeled with common name if not in original container<br>(Flour, rice, sugar, etc)

  • Food is protected from cross contamination

  • Floors are clean an free of debris, boxes and hazards

  • All surfaces are clean

  • Chemicals are stored away from food and other food related supplies

  • REFRIGERATION UNIT

  • Thermometer is conspicuous and accurate

  • Evidence that temperatures are monitored and recorded

  • Monitored for cross contamination

  • FIFO Maintained (first in first out)

  • Food is stored 6" off floor

  • Record ambient air temperature (Celsius)

EQUIPMENT and BUILDING MAINTENANCE

  • Building meets local building codes for food hygiene

  • Floors, walls and ceiling meets local safety codes

  • Food contact surfaces meet local safety codes

  • No evidence of peeling or flaking paint

  • Water quality meets Local Safety Codes

  • Regular maintenance performed on building

  • Regular preventative maintenance performed on critical equipment

  • No evidence of leaking pipes

  • Is there a preventative maintenance program

  • Inoperative equipment removed from production areas

CLEANING and SANITIZING

  • Cleaning compounds and sanitizers meet standards

  • Concentrations meet standards

  • Chemicals are all properly labelled

  • Chemicals are all properly stored

DAILY CLEANING

  • Food contact surface cleaning schedule in place

  • Floors and walls cleaned regularly

  • Deep cleaning schedule in place

  • Delivery Vehicle cleaning schedule in place

GARBAGE STORAGE and DISPOSAL

  • Refuse and garbage cans are clean and covered when not in use

  • Garbage containers are emptied as necessary

  • Boxes and containers are removed from site

  • Dumpster is located away from facility access points

  • Dumpster area is clean

  • Dumpster lid(s) are closed

EMPLOYEE FOOD SAFETY TRAINING

  • Total number of staff

  • Number of staff with certified food safety training

  • Scan Certificates

  • Plan to achieve 100% training compliance

EMPLOYEE HYGIENE

  • Employee health poster available

  • Hands are washed or gloves are changed at critical points

  • Staff only use wash hands in hand wash sinks

  • Employees wear proper uniform including proper shoes

  • Fingernails are short, unpolished and clean

  • Hair restraint is worn

  • Jewelry is limited , no watches, earrings

  • Gloves are changed as needed

  • Open sores, cuts, or splints and bandages on hands are completely covered while handling food

  • Staff beverages are covered with a lid and straw and stored away from food preparation area

  • Staff take appropriate action when coughing or sneezing

  • Disposable tissues are used and disposed of when coughing/blowing nose

HAND WASHING FACILITIES

  • Hand washing signage is displayed

  • Hand sinks accessible and stocked with soap and paper towels

  • Hand sanitizing solution is available at all hand washing stations and wash rooms

  • Staff lockers provided away from food production and storage areas

SIGNATURES

  • Signature of Employee

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.