• Food Business Name

  • Proprietor's name

  • Document No.

  • Pathway reference

  • Address
  • Business email

  • Business phone number

  • Date of inspection

  • Officer

  • Officer contact number

Food Safety Practices & General Requirements

Food Receipt

  • Food protected from contamination

  • Identification / traceability of food<br>

  • Temperature control of potentially hazardous foods

Food Storage

  • Food protected from contamination

  • Temperature control of potentially hazardous food

Food Processing

  • Safe and Suitable Food

  • Protection from contamination

  • Adequate cooking / processing

  • Potentially hazardous food out of temperature control for minimum time

  • Cooling of potentially hazardous food- two hours 60-21 & four hours 21-5

  • Reheating potentially hazardous food to greater than 60

Food Display

  • Protection from contamination

  • Temperature below 5 or above 60; or hard frozen

Food Packaging

  • Protection from contamination

Food Transportation

  • Protection from contamination

  • Temperature control of potentially hazardous foods

Food Disposal / Food Recall

  • Food disposal separation / recall process

Health and Hygiene Requirements

  • Food handlers knowledge commensurate with duties

  • Health of food handlers

  • Hygiene of food handlers

  • Food business responsibilities

Cleaning, Sanitising & Maintenance

  • Cleanliness of food premises

  • Cleaning / sanitising equipment

  • Maintenance of premises, fixtures and equipment


  • Temperature measuring device +/- 1 degree

  • Single use items

  • Control of animals and pests

Food Premises & Equipment

Food Premises and Equipment

  • Suitable design and construction

  • Water supply adequate and potable

  • Sewage, waste water and refuse disposal

  • Adequate ventilation and lighting

  • Adequate hand washing facilities

  • Storage facilities (personal, chemicals etc.)

  • Adequate staff toilet facilities

Management & Control Procedures

  • Track record

  • Management approach to food safety

  • Hygiene and food safety knowledge available

  • Documented food safety procedures

  • Is it implemented

  • Training arrangements for food handlers

Smoking & Tobacco Products Control

Smoking / Tobacco Products Control

  • Point of sale requirements

  • Smoking in public places

  • Is an outdoor eating area provided?

  • Is it on Council property

  • Does it have a valid permit

  • Additional comments

Actions and Scores

  • Follow up action required

  • Is the inspection part of the Health Application process?

  • Scores on the Doors

  • Has the proprietor already entered the scores on the doors scheme?

  • Is the proprietor interested in joining the scheme?

  • Terms and Conditions for Scores on the Doors
    1. Rating the Food Business
    1.1 The business will be rated under the scheme at each unannounced inspection carried out by the City's environmental health officers (EHOs) as part of existing food safety inspection functions.
    1.2 Officers will not carry out any additional inspections solely for the purposes of this scheme, however a charge may apply upon a request for a re-inspection.
    1.3 If the City investigates a complaint and that complaint is proven, or if the food safety standards have dropped the certificate may be removed or reissued.

    2. Understanding your Rating
    2.1 The business rating is based on the level of compliance with the Food Standards Code at the date of the unannounced inspection, as assessed and scored by the City's EHOs using a standard inspection checklist.
    2.2 For the purposes of the scheme after an unannounced inspection, you may be awarded as: five stars (excellent), four stars (very good) or three stars (good).

    3. Certificate
    Following an unannounced food safety inspection the City will issue the business a Scores on the Doors rating certificate. The certificate remains the property of the City of Melville.

    4. Displaying Certificate on Premises
    4.1 You agree to display the certificate in a prominent position.
    4.2 You must not display a false or expired certificate.

    5. Publication of Rating
    5.1 The City may identify you and publish your most recently issued rating on its website, but will not publish a rating if a review is underway and not concluded.
    5.2 We will stop publishing your most recently issued rating on the website if you opt out of the scheme.

    6. Review of Rating
    6.1 If you are dissatisfied with a Scores on the Doors rating you may, within seven days of receipt of your certificate, write asking for a review of the rating.

    6.2 The City will review your rating and advise you of its determination within 14 days of receipt of your request. The review will be an internal desk review by an EHO other than the inspector who conducted the initial assessment. It will not involve a further inspection of your premises.
    6.3 If this review results in an amended rating we will issue you with a revised certificate. Otherwise, we will notify you that your certificate remains unchanged.

    7. Term and Termination
    7.1 This Agreement continues until it is terminated in accordance with this clause.
    7.2 This Agreement automatically terminates if:
    (i) You are a company and your majority shareholding changes hands;
    (ii) Your business is sold to someone else; or
    (iii) The Scheme is terminated.
    7.3 The City may terminate this agreement at any time by notice to you if you breach any of the terms or conditions.
    7.4 You may terminate this agreement by writing to the City.

  • I wish to participate in the scores on the doors scheme. I have read and agree to the terms and conditions. I realise that the scheme is voluntary and free to enter.

  • I do not wish to participate at this time because

  • I do not wish to participate in the scores on the doors scheme at this time. I realise that it is voluntary and free to enter.

  • I have read and understood the contents of this assessment

  • Proprietor / Staff Name

  • Officer Name:

  • Environmental Health Officer

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.