eric pci

• Document No.

• Audit Title

• Client / Site:

• Conducted on

  Date

• Prepared by

• Prepared by

  Eric Duchesne

  Tim Feeney

  Nick Turkson
• Location
  Address

• Personnel

1.0 PROCESS ROOM 1

• 1.1 BASKETS (BROWN, GREY, BLUE) <br>WHITE TRAYS / STAINLESS STEEL DOLLIES

  Yes

  No

  N/A

• CORRECTIVE ACTION

BASKETS / TRAYS / SS DOLLIES

• 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 FLOOR SCALE / SMALL SCALES

  Yes

  No

  N/A

• CORRECTIVE ACTION

FLOOR SCALE / SMALL SCALES

• 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 SHRINK PACKAGING EQUIPMENT<br>(OUTER SURFACES)

  Yes

  No

  N/A

• CORRECTIVE ACTION

SHRINK PACKAGING EQUIPMENT

• 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 WHITE CONVEYORS

  Yes

  No

  N/A

• CORRECTIVE ACTION

WHITE CONVEYORS

• 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 CUTTING BOARDS

  Yes

  No

  N/A

• CORRECTIVE ACTION

CUTTING BOARDS

• 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 METAL DETECTORS #1<br>LABELLING CONVEYORS

  Yes

  No

  N/A

• CORRECTIVE ACTION

METAL DETECTORS #2 - LABELLING CONVEYORS

• 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 METAL DETECTORS #2<br>LABELLING CONVEYORS

  Yes

  No

  N/A

• CORRECTIVE ACTION

METAL DETECTORS #3 - LABELLING CONVEYORS

• 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 MAREL PORTION CUTTERS #1

  Yes

  No

  N/A

• CORRECTIVE ACTION

MAREL PORTION CUTTERS #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 MAREL PORTION CUTTERS l-CUT 55

  Yes

  No

  N/A

• CORRECTIVE ACTION

MAREL PORTION CUTTERS l-CUT 55

• 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 REPAK MACHINE #1

  Yes

  No

  N/A

• CORRECTIVE ACTION

REPAK MACHINE #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 REPAK MACHINE #5

  Yes

  No

  N/A

• CORRECTIVE ACTION

REPAK MACHINE #5

• 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 XTRA VAC MACHINE

  Yes

  No

  N/A

• CORRECTIVE ACTION

XTRA VAC MACHINE

• 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 TRIM TABLE / CONVEOYR #1

  Yes

  No

  N/A

• CORRECTIVE ACTION

TRIM TABLE / CONVEYOR #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

• 1.14 TRIM TABLE / CONVEYOR #2

  Yes

  No

  N/A

• CORRECTIVE ACTION

TRIM TABLE / CONVEYOR #2

• 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

• 1.15 SS TABLES

  Yes

  No

  N/A

• CORRECTIVE ACTION

SS TABLES

• 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

• 1.16 BEL 252 PACKAGING MACHINE<br>(Box & tape)

  Yes

  No

  N/A

• CORRECTIVE ACTION

BEL 252 PACKAGING MACHINE (Box & tape)

• 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

• 1.17 SUPPLY RACK<br>(Gloves, aprons, sleeves etc.)

  Yes

  No

  N/A

• CORRECTIVE ACTION

SUPPLY RACK

• 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

• 1.18 AIR / WATER HOSES CLEANED AND PROPERLY WRAPPED AND STORED ABOVE FLOOR

  Yes

  No

  N/A

• CORRECTIVE ACTION

AIR / WATER HOSES

• 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

• 1.19 FLOORS

  Yes

  No

  N/A

• CORRECTIVE ACTION

FLOORS

• 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

• 1.20 DOORS

  Yes

  No

  N/A

• CORRECTIVE ACTION

DOORS

• 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

• 1.21 WALLS

  Yes

  No

  N/A

• CORRECTIVE ACTION

WALLS

• 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

• 1.22 CEILING

  Yes

  No

  N/A

• CORRECTIVE ACTION

CEILING

• 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

• 1.23 CEILING / WALLS / OVERHEAD UNITS<br>(No Condensation)

  Yes

  No

  N/A

• CORRECTIVE ACTION

OVERHEAD UNITS

• 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

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

  Yes

  No

  N/A

• CORRECTIVE ACTION

LIGHTS

• 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

• 1.25 RUBBER FLOOR MATS

  Yes

  No

  N/A

• CORRECTIVE ACTION

RUBBER FLOOR MATS

• 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

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

  Yes

  No

  N/A

• CORRECTIVE ACTION

DRAIN COVERS

• 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

• 1.27 ICE MACHINE<br>(Inner chamber, outside surfaces)

  Yes

  No

  N/A

• CORRECTIVE ACTION

ICE MACHINE

• 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

• 1.28 METAL PADDLE

  Yes

  No

  N/A

• CORRECTIVE ACTION

METAL PADDLE

• 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

• 1.29 PLASTIC SHOVEL

  Yes

  No

  N/A

• CORRECTIVE ACTION

PLASTIC SHOVEL

• 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

• 1.30 GREY ICE BINS / LIDS

  Yes

  No

  N/A

• CORRECTIVE ACTION

GREY ICE BINS / LIDS

• 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

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

  Yes

  No

  N/A

• CORRECTIVE ACTION

GATEKEEPER

• 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

• 1.32 FOOT DIP SANITIZER<br>(Sanitizer @ 800-1000ppm)

  Yes

  No

  N/A

• CORRECTIVE ACTION

FOOT DIP SANITIZER

• 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

• 1.33 HAND WASH SINKS<br>(Stocked with soap / sanitizer)

  Yes

  No

  N/A

• CORRECTIVE ACTION

HAND WASH SINKS

• 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

• 1.34 PAPER TOWEL DISPENSER<br>(Good working order and stocked)

  Yes

  No

  N/A

• CORRECTIVE ACTION

PAPER TOWEL DISPENSER

• 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 SPICE ROOM

• 2.1 SCALES

  Yes

  No

  N/A

• CORRECTIVE ACTION

SCALES

• 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

• 2.2 SCOOPS

  Yes

  No

  N/A

• CORRECTIVE ACTION

SCOOPS

• 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 SPICE CONTAINERS

  Yes

  No

  N/A

• CORRECTIVE ACTION

SPICE CONTAINERS

• 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 SPICE CONTAINER LIDS

  Yes

  No

  N/A

• CORRECTIVE ACTION

SPICE CONTAINER LIDS

• 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

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

  Yes

  No

  N/A

• CORRECTIVE ACTION

LIGHTS

• 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

• 2.6 GARBAGE BINS

  Yes

  No

  N/A

• CORRECTIVE ACTION

GARBAGE BINS

• 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

• 2.7 FLOOR

  Yes

  No

  N/A

• CORRECTIVE ACTION

FLOOR

• 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

• 2.8 WIRE RACKING

  Yes

  No

  N/A

• CORRECTIVE ACTION

WIRE RACKING

• 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 TUMBLER ROOM

• 3.1 TUMBLER #1

  Yes

  No

  N/A

• CORRECTIVE ACTION

TUMBLER #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 TUMBLER #1 LID

  Yes

  No

  N/A

• CORRECTIVE ACTION

TUMBLER #1 LID

• 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 TUMBLER #2

  Yes

  No

  N/A

• CORRECTIVE ACTION

TUMBLER #2

• 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 TUMBLER #2 LID

  Yes

  No

  N/A

• CORRECTIVE ACTION

TUMBLER #2 LID

• 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 DOLLY LIFTER

  Yes

  No

  N/A

• CORRECTIVE ACTION

DOLLY LIFTER

• 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 PLASTIC / METAL SCOOPS

  Yes

  No

  N/A

• CORRECTIVE ACTION

PLASTIC / METAL SCOOPS

• 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

• 3.7 FLOOR SCALE

  Yes

  No

  N/A

• CORRECTIVE ACTION

FLOOR SCALE

• 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

• 3.8 KNIVES / STEELS

  Yes

  No

  N/A

• CORRECTIVE ACTION

KNIVES / STEELS

• 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

• 3.9 SS WORKING TABLES

  Yes

  No

  N/A

• CORRECTIVE ACTION

SS WORKING TABLES

• 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

• 3.9 GARBAGE BIN

  Yes

  No

  N/A

• CORRECTIVE ACTION

GARBAGE BIN

• 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

• 3.10 FLOOR

  Yes

  No

  N/A

• CORRECTIVE ACTION

FLOOR

• 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

• 3.11 DOORS

  Yes

  No

  N/A

• CORRECTIVE ACTION

DOORS

• 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

• 3.12 WALLS

  Yes

  No

  N/A

• CORRECTIVE ACTION

WALLS

• 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

• 3.13 CEILING

  Yes

  No

  N/A

• CORRECTIVE ACTION

CEILING

• 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

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

  Yes

  No

  N/A

• CORRECTIVE ACTION

OVERHEAD UNITS

• 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

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

  Yes

  No

  N/A

• CORRECTIVE ACTION

LIGHTS

• 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

• 3.16 HAND WASH SINKS<br>(Stocked with soap / sanitizer)

  Yes

  No

  N/A

• CORRECTIVE ACTION

HAND WASH SINKS

• 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

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

  Yes

  No

  N/A

• CORRECTIVE ACTION

DRAIN COVERS

• 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

• 3.18 RACK FOR STEAKS

  Yes

  No

  N/A

• CORRECTIVE ACTION

RACK FOR STEAKS

• 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

• 3.19 GARBAGE BINS

  Yes

  No

  N/A

• CORRECTIVE ACTION

GARBAGE BINS

• 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

• 3.20 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 ON DUTY:

  Sign

• NAME AND SIGNATURE OF OPERATOR:

  Sign

• NAME AND SIGNATURE OF PCI SUPERVISOR:

  Sign