eric 2

• Document No.

• Audit Title

• Client / Site:

• Conducted on

  Date

• Prepared by

• Prepared by

  Tim Feeney

  Charlie Mitchell

  Nick Turkson
• Location
  Address

• Personnel

1.0 SHIPPING / RECEIVING

• 1.1 ROLL-UP DOOR<br>(No gaps underneath)

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 1.2 DOCK LEVELLER CLEAN

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 1.3 FLOOR

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 1.4 DOORS

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 1.5 WALLS

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 1.6 CEILING

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 1.7 OVERHEAD UNIT<br>(No condensation)

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 1.8 DRAIN <br>( Clean, free of meat and fat particles, no odour)

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 1.9 INEDIBLE AREA & WASTE CONTAINERS CLEAN

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 1.10 LIGHTS<br>(In good working order)

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 1.11 CARDBOARD COMPACTOR<br>(Clean and odour free)

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 1.12 GATE KEEPER<br>(On and functioning)

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 1.13 FOOT DIP SANITIZER<br>(Prepared @ 800-1000ppm)

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

2.0 STORAGE ROOM

• 2.1 FLOORS CLEAN & SWEPT

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF PCI SUPERVISOR:

  Sign

• 2.2 CHEMICAL CAGE LOCKED

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 2.3 PACKAGING MATERIAL STORED & COVERED

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 2.4 LIGHTS<br>(In good working order)

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

3.0 HALLWAY

• 3.1 FLOOR

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 3.2 DOORS

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 3.3 WALLS

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 3.4 CEILING

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 3.5 OVERHEAD UNIT<br>(No condensation)

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 3.6 LIGHTS<br>(In good working order)

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

4.0 COOLER #1

• 4.1 FLOOR

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 4.2 DOORS

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 4.3 WALLS

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 4.4 CEILING

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 4.5 CEILING / WALLS / OVERHEAD UNITS<br>(No condensation)

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 4.6 DRAIN COVERS<br>( Clean, free of meat and fat particles, no odour)

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 4.7 LIGHTS<br>(In good working order)

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOR 1.1

• DATE CORRECTED:

  Date

• ISSUES WITH EQUIPMENT:

  Select DIRTY AFTER CLEANING WAS NOT CLEANED REPORT FILLED INCORRECTLY ITEM NOT USED / CLEAN EQUIPMENT FAULTY / BROKEN EQUIPMENT NOT DISMANTLED OTHER - SEE NOTES

  • DIRTY AFTER CLEANING
  • WAS NOT CLEANED
  • REPORT FILLED INCORRECTLY
  • ITEM NOT USED / CLEAN
  • EQUIPMENT FAULTY / BROKEN
  • EQUIPMENT NOT DISMANTLED
  • OTHER - SEE NOTES

• CORRECTIVE ACTION TAKEN:

  Select CLEANER INSTRUCTED IN PROPER PROCEDURES ITEM(S) REWASHED NO ACTION REQUIRED AT THIS TIME ADDRESSED WITH CLEANER STAFF NOTIFIED OF DEFECT STAFF NOTIFIED OF NEW EQUIPMENT EQUIPMENT DISMANTLED RINSED AND SANITIZED SANITIZED ONLY FULL WASH AND SANITIZED CLEANER RETRAINED IN PROCEDURE CLEANED, WASHED AND SANITIZED RELEASED OTHER - SEE NOTES

  • CLEANER INSTRUCTED IN PROPER PROCEDURES
  • ITEM(S) REWASHED
  • NO ACTION REQUIRED AT THIS TIME
  • ADDRESSED WITH CLEANER
  • STAFF NOTIFIED OF DEFECT
  • STAFF NOTIFIED OF NEW EQUIPMENT
  • EQUIPMENT DISMANTLED
  • RINSED AND SANITIZED
  • SANITIZED ONLY
  • FULL WASH AND SANITIZED
  • CLEANER RETRAINED IN PROCEDURE
  • CLEANED, WASHED AND SANITIZED
  • RELEASED
  • OTHER - SEE NOTES

• ADDITIONAL INFORMATION:

• NAME OF CLEANER:

• SIGNATURE OF SUPERVISOR:

  Sign

• 4.8 ANY EQUIPMENT, MACHINE, UTENSILS NEW TO THE AREA?<br>(If yes, is QA informed?)

  Yes

  No

  N/A

• ADDITIONAL NOTES:

• NAME AND SIGNATURE OF SUPERVISOR:

  Sign

• NAME AND SIGNATURE OF OPERATOR:

  Sign

• NAME AND SIGNATURE OF PCI SUPERVISOR:

  Sign