Title Page

  • Establishment Name:

  • Type of Facility:

  • Physical Address:
  • Person in Charge:

  • Inspection Time In:

  • Date:

  • Person Completing Form:

Facility Setup

  • Does the facility contain separate hand sinks, mop sinks, and three-compartment dishwashing sinks?

  • Are wash hand basins clean and equipped with hot water, soap, and hygienic hand drying facilities?

  • Is hot water available at 100°F/37°C at hand sinks and 110°F/43°C at three-compartment sinks?

  • Is the building material around the splash area of sinks waterproof?

  • Are faucets installed at an adequate height above the sink to prevent backflow?

  • Does water drain properly in each sink, and is the plumbing in good working order, free of leaks?

  • Are sanitizer lines equipped with an anti-backflow mechanism?

  • Is adequate lighting available for food preparation and service?

  • Are light fixtures covered to prevent hazards in case of shattering?

  • Does the facility contain adequate bathrooms in working order to support maximum occupancy, and are they used solely as bathrooms (with no storage)?

  • Do bathroom stalls have self-closing, lockable doors in proper working order?

  • Are bathrooms well stocked with toilet paper, soap, and disposable hand towels or air dryers?

  • Are hand washing signs posted in the restrooms and at sanitation stations for employees?

  • Is there adequate ventilation throughout the facility?

  • Are carbon monoxide and smoke detectors properly installed throughout the establishment?

  • Does industrial equipment have adequate space underneath for cleaning or is it sealed to the ground?

  • Are employee break and eating areas located separately from food preparation areas?

  • Is the flooring constructed of durable, impervious, and non-absorbent material suitable for food production or handling areas?

  • Are floors smooth, free of cracks, chips, or other damage that could trap dirt, bacteria, or hinder cleaning?

  • Are floors properly sloped to allow for adequate drainage, especially in wet areas, and are drains free of debris and functioning correctly?

  • Is the flooring designed or treated to reduce the risk of slips and falls without compromising cleanability?

  • Are routine cleaning and maintenance schedules in place, and are they effectively removing dirt, food residues, or other contaminants?

  • Does the flooring comply with relevant food safety regulations and standards for the type of operation (e.g., restaurant, distributor, or manufacturer)?

Equipment & Utensils

  • Are food rooms and equipment in good condition and well maintained?

  • Are food rooms clean and tidy, with staff cleaning as they go, including difficult areas?

  • Are non-food contact surfaces visibly clean and in good repair?

  • Is all equipment (e.g., stoves, grills, refrigerators, tables, sinks) kept clean and well maintained?

  • Has inoperable equipment been repaired, replaced, or removed from the facility?

  • Are all food and hand contact surfaces (e.g., work surfaces, slicers, fridge handles, probe thermometers) in good condition and cleaned/disinfected regularly?

  • Are single-service utensils properly stored and dispensed?

  • Are multi-service utensils being washed and sanitized by one of the following methods:

  • Hand washed in a two or three compartment sink (wash-rinse-sanitize)?

  • Dishwashing machine warewashing (low temp rinse water) with chemical sanitizer in solution?

  • Dishwashing machine warewashing (high temp rinse water) reaching at least 179°F / 82°C for 10 seconds?

  • Have damaged or unapproved utensils been repaired or replaced?

  • Are suitable cleaning chemicals available, stored correctly, and are proper cleaning methods used?

  • Are separate cleaning cloths used in clean areas?

  • If cleaning cloths are re-used, are they laundered in a boil wash?

  • Are utensils/small equipment covered to protect them from dust and contaminants when stored?

  • Are thermometers washed and sanitized between each use?

  • Is the can opener clean to sight and touch?

  • Are drawers and racks clean?

Sign-off

  • Inspection Time Out:

  • Name & Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.