FCRC Food Premises Assessment Form

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Details

• Food Premises

• Reference

• Address

• Manager/Proprietor

• Nominated Food Safety Supervisor

• Officer

• Date/Time Inspection Started

  Date

• Type of Inspection

  Routine

  Complaint

  Other

• Current Certificate Sighted?

  Yes

  No

  N/A

Inspection Details

TEMPERATURE OF PHF

• 1.1 - Storage - Hot

  Yes

  No

  N/A

• 1.2 - Storage - Cold

  Yes

  No

  N/A

• 1.3 - Display - Hot

  Yes

  No

  N/A

• 1.4 - Display - Cold

  Yes

  No

  N/A

• 1.5 - Time Control

  Yes

  No

  N/A

• 1.6 - Process - Defrosting

  Yes

  No

  N/A

• 1.7 - Process - Cooking

  Yes

  No

  N/A

• 1.8 - Process - Reheating

  Yes

  No

  N/A

• 1.9 - Process - Cooling

  Yes

  No

  N/A

• 1.10 - Probe Thermometer

  Yes

  No

  N/A

• Assisted By:

  Select Temp Log Time Log Cooking Log Calibration Checks

  • Temp Log
  • Time Log
  • Cooking Log
  • Calibration Checks

• Training/Knowledge

  Select FCRC Quiz Accredited Training Knowledge 1 2 3 4 5

  • FCRC Quiz
  • Accredited Training
  • Knowledge 1 2 3 4 5

• Temperature Rating

CLEANING & SANITISING

• 2.2 - Food Prep - Floors

  Yes

  No

  N/A

• 2.3 - Food Prep - Ceiling

  Yes

  No

  N/A

• 2.4 - Food Prep - Fixtures/Fittings

  Yes

  No

  N/A

• 2.5 - Food Prep - Equipment

  Yes

  No

  N/A

• 2.6 - Food Prep - Utensils

  Yes

  No

  N/A

• 2.7 - Dry Storage

  Yes

  No

  N/A

• 2.8 - Refrigerated Storage Units

  Yes

  No

  N/A

• 2.9 - Waste Collection Areas

  Yes

  No

  N/A

• 2.10 - Sanitising Processes

  Yes

  No

  N/A

• Assisted By:

  Select Cleaning Log

  • Cleaning Log

• Training/Knowledge

  Select FCRC Quiz Accredited Training Knowledge 1 2 3 4 5

  • FCRC Quiz
  • Accredited Training
  • Knowledge 1 2 3 4 5

• Cleaning Rating

Personal Hygiene

• 3.1 - Hand Wash Basin - Supply

  Yes

  No

  N/A

• 3.2 - Hand Wash Basin - Access

  Yes

  No

  N/A

• 3.3 - Hand Wash Basin - Use

  Yes

  No

  N/A

• 3.4 - Glove Use

  Yes

  No

  N/A

• 3.5 - Staff - Clothing

  Yes

  No

  N/A

• 3.6 - Staff - Hair

  Yes

  No

  N/A

• 3.7 - Staff - Jewellery

  Yes

  No

  N/A

• 3.8 - Staff - Habits

  Yes

  No

  N/A

• 3.9 - Staff - App. use of HWB

  Yes

  No

  N/A

• Assisted By:

  Select Staff Work Attire Policy Sickness Policy Personal Hygiene Work Practices Policy

  • Staff Work Attire Policy
  • Sickness Policy
  • Personal Hygiene Work Practices Policy

• Training/Knowledge

  Select FCRC Quiz Accredited Training Knowledge 1 2 3 4 5

  • FCRC Quiz
  • Accredited Training
  • Knowledge 1 2 3 4 5

• Personal Hygiene

Storage & Delivery

• 4.1 - Delivery - Temperature

  Yes

  No

  N/A

• 4.2 - Delivery - Condition

  Yes

  No

  N/A

• 4.3 - Delivery - Supplier

  Yes

  No

  N/A

• 4.4 - PHF Storage - Covered

  Yes

  No

  N/A

• 4.5 - PHF Storage - Seperated

  Yes

  No

  N/A

• 4.6 - Dry Food Storage - Covered

  Yes

  No

  N/A

• 4.7 - Use of Food Grade Container

  Yes

  No

  N/A

• 4.8 - Non Food Storage

  Yes

  No

  N/A

• Assisted By:

  Select Delivery Records Approved Suppliers Date Coding

  • Delivery Records
  • Approved Suppliers
  • Date Coding

• Training/Knowledge

  Select FCRC Quiz Accredited Training Knowledge 1 2 3 4 5

  • FCRC Quiz
  • Accredited Training
  • Knowledge 1 2 3 4 5

• Storage & Delivery Rating

Maintenance/Fit Out

• 5.1 - Fit Out - Approved/Approp.

  Yes

  No

  N/A

• 5.2 - Premises Cond. - Walls

  Yes

  No

  N/A

• 5.3 - Premises Cond. - Floors

  Yes

  No

  N/A

• 5.4 - Premises Cond. - Openings

  Yes

  No

  N/A

• 5.5 - Fixtures/Fittings Condition

  Yes

  No

  N/A

• 5.6 - Equip & Utensils Condition

  Yes

  No

  N/A

• 5.7 - Cold Storage Seals

  Yes

  No

  N/A

• 5.8 - Other

  Yes

  No

  N/A

• Assisted By:

  Select Maintenance Schedule

  • Maintenance Schedule

• Training/Knowledge

  Select FCRC Quiz Accredited Training Knowledge 1 2 3 4 5

  • FCRC Quiz
  • Accredited Training
  • Knowledge 1 2 3 4 5

• Maintenance/Fit Out Rating

Pest Control

• 6.1 - Treatment Schedule

  Yes

  No

  N/A

• 6.2 - Treatment Method

  Yes

  No

  N/A

• 6.3 - Monitoring

  Yes

  No

  N/A

• 6.4 - Evidence of Pests

  Yes

  No

  N/A

• Assisted By:

  Select Staff Sighting Treatment Record Monitoring

  • Staff Sighting
  • Treatment Record
  • Monitoring

• Training/Knowledge

  Select FCRC Quiz Accredited Training Knowledge 1 2 3 4 5

  • FCRC Quiz
  • Accredited Training
  • Knowledge 1 2 3 4 5

• Pest Control Rating

Results

• OVERALL RATING

• Time Inspection Completed

  Date

• Other Comments

Sign Off

• I agree that the above items have been fully explained to me and that the ratings given are an accurate reflection of the outcomes of today's inspection.

• Name

• Position

• Signature

  Sign