Title Page
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Establishment Name:
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Type of Facility:
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Physical Address:
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Person in Charge:
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Inspection Time In:
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Date:
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Person Completing Form:
Facility Setup
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Does the facility contain separate hand sinks, mop sinks, and three-compartment dishwashing sinks?
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Are wash hand basins clean and equipped with hot water, soap, and hygienic hand drying facilities?
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Is hot water available at 100°F/37°C at hand sinks and 110°F/43°C at three-compartment sinks?
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Is the building material around the splash area of sinks waterproof?
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Are faucets installed at an adequate height above the sink to prevent backflow?
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Does water drain properly in each sink, and is the plumbing in good working order, free of leaks?
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Are sanitizer lines equipped with an anti-backflow mechanism?
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Is adequate lighting available for food preparation and service?
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Are light fixtures covered to prevent hazards in case of shattering?
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Does the facility contain adequate bathrooms in working order to support maximum occupancy, and are they used solely as bathrooms (with no storage)?
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Do bathroom stalls have self-closing, lockable doors in proper working order?
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Are bathrooms well stocked with toilet paper, soap, and disposable hand towels or air dryers?
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Are hand washing signs posted in the restrooms and at sanitation stations for employees?
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Is there adequate ventilation throughout the facility?
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Are carbon monoxide and smoke detectors properly installed throughout the establishment?
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Does industrial equipment have adequate space underneath for cleaning or is it sealed to the ground?
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Are employee break and eating areas located separately from food preparation areas?
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Is the flooring constructed of durable, impervious, and non-absorbent material suitable for food production or handling areas?
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Are floors smooth, free of cracks, chips, or other damage that could trap dirt, bacteria, or hinder cleaning?
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Are floors properly sloped to allow for adequate drainage, especially in wet areas, and are drains free of debris and functioning correctly?
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Is the flooring designed or treated to reduce the risk of slips and falls without compromising cleanability?
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Are routine cleaning and maintenance schedules in place, and are they effectively removing dirt, food residues, or other contaminants?
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Does the flooring comply with relevant food safety regulations and standards for the type of operation (e.g., restaurant, distributor, or manufacturer)?
Equipment & Utensils
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Are food rooms and equipment in good condition and well maintained?
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Are food rooms clean and tidy, with staff cleaning as they go, including difficult areas?
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Are non-food contact surfaces visibly clean and in good repair?
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Is all equipment (e.g., stoves, grills, refrigerators, tables, sinks) kept clean and well maintained?
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Has inoperable equipment been repaired, replaced, or removed from the facility?
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Are all food and hand contact surfaces (e.g., work surfaces, slicers, fridge handles, probe thermometers) in good condition and cleaned/disinfected regularly?
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Are single-service utensils properly stored and dispensed?
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Are multi-service utensils being washed and sanitized by one of the following methods:
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Hand washed in a two or three compartment sink (wash-rinse-sanitize)?
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Dishwashing machine warewashing (low temp rinse water) with chemical sanitizer in solution?
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Dishwashing machine warewashing (high temp rinse water) reaching at least 179°F / 82°C for 10 seconds?
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Have damaged or unapproved utensils been repaired or replaced?
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Are suitable cleaning chemicals available, stored correctly, and are proper cleaning methods used?
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Are separate cleaning cloths used in clean areas?
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If cleaning cloths are re-used, are they laundered in a boil wash?
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Are utensils/small equipment covered to protect them from dust and contaminants when stored?
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Are thermometers washed and sanitized between each use?
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Is the can opener clean to sight and touch?
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Are drawers and racks clean?
Sign-off
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Inspection Time Out:
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Name & Signature