Title Page
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Conducted on
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Prepared by
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Location
Inspected By:
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Date & Time Inspected
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Inspected for the month of
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Assessor's Name & Signature
HOUSEKEEPING/GENERAL CONDITIONS
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Coats & Aprons (Clean), clean and dirty coats stored separately
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Back Shipping/Receiving Area (Clean, Doors Closed)
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Front Shipping/Receiving Area (Clean, Doors Closed)
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Gabage Cans (Clean)
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Doors throughout facility (clean and in good condition)
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Facility is adequately clean (i.e. no areas with excessive dust, spider webs, etc)
PRODUCTION ROOM
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Walls (clean and in good condition)
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Ceilings, Vents & Exhaust Fans (clean and in good condition)
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Lights Covered & In Good Condition
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Floors (clean and in good condition, no large cracks or damaged areas)
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Drains (clean and in good condition), no pooling water
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Garbage Cans (Clean and in good condition)
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Racks (Portion cart, and other racking, clean and in good condition)
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Sinks (Clean, warm water available, stocked with soap and paper towels)
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Hoses off the Floor
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Equipment clean & in good condition
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Product containers clean and in good condition
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No temporary repairs observed
PERSONNEL PRACTICES
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Hairnets & Beardnets Properly Worn
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No Jewelry, Watches, fingernail polish observed
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Handwashing & Glove Policies Followed
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No Evidence of Illness, Open Wounds, or Leisons on Employees
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Employees wearing clean clothes/uniforms
FREEZER
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Floor, walls, ceiling, chilling units clean and in good condition
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Racking clean and in good condition
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Items stored in proper areas (raw materials, finished product, allergens)
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Items stored properly (covered, labelled, etc.)
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Freezer at correct temperature:
COOLER
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Floor, walls, ceiling, chilling units clean and in good condition
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Racking clean and in good condition
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Items stored in proper areas (raw materials, allergens)
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Items stored properly (covered, labelled, etc.)
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Thawing procedures being followed
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Cooler at correct temperature:
PACK OUT ROOM
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Floor, walls, ceiling clean and in good condition
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Packaging supplies stored properly
DISH ROOMS
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Proper segregation between clean and dirty dishes
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Clean dishes stored properly
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Floors, walls, ceilings clean and in good condition
CHEMICAL STORAGE ROOM
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Restricted access
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Chemicals stored properly (correct location, properly labelled)
ELECTRICAL/MAINTENANCE AREAS
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Areas are neat and tidy
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Food grade grease/lubricants stored properly
DRY STORAGE
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Food Ingredients Properly Covered
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Packaging (incl. part used packaging) properly covered
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Items are properly labelled
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Racking clean and in good condition
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Items stored in proper areas (packaging, ingredients, allergens)
WASHROOM
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Floors, walls, ceilings clean and in good condition
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Sinks clean and have warm water, soap and paper towels
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Garbage cans clean
LUNCHROOM
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Floors, walls, ceilings clean and in good condition
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Sink clean and has warm water, soap and paper towels
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Food and personal items stored properly
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Fridge clean
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Microwave clean
PEST CONTROL VERIFICATION
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Service Reports (Up To Date, Legible)
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Documention (Activity Noted, Necessary Corrective Actions Taken)
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Traps, Bait Stations (In Place, In Good Condition)
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No evidence of pest infestation
EXTERIOR PREMISES
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Dumpster Area (Clean, no excessive garbage buildup, dumpsters covered)
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Grass/ weeds near building trimmed
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Parking lot/walkways (no litter, in good condition)
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No pooling water observed
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Shipping/Receiving areas (no litter, in good condition, bumper pads at back dock in good condition)
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Exterior doors locked (except retail entrance)
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Exterior of building in good condition
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No evidence of pests
Verification
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Verified by:
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Date & Time of Verification:
