Title Page
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Conducted on
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Conducted by
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Site conducted
Asset
Asset and Location Assessment
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Is this present?
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Asset Condition
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Describe the present asset condition
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Performance
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Clean
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1st Calibration Rating (1-100)
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2nd Calibration Rating (1-100)
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Average Calibration Result
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Picture of the Area where the Asset is Located (make sure that the asset is included in the photo)
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Sample picture of an asset in the area
Temperature of the Area
Hazards Identification
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Is the asset hazardous to use?
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Why do you say so? and How safe?
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Hazards Present
- Physical
- Chemical
- Microbiological
- N/A
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Physical Hazards
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Chemical Hazards
- Food Additives
- Working with Chemicals
- Raw material exposure
- N/A
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Microbiological Hazards
- Fecal microbiota
- Industry water
- N/A
Other Hazards
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Others
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Signature
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Please make sure you sign and print your name
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Before you submit, make sure to double check all the data you placed
