Title Page

  • Premise Name

  • Location
  • Conducted on

  • Inspected by


  • Employees wash their hands with soap and warm water before starting work, immediately after using washroom, any time needed to prevent cross-contamination

  • Employees wearing clean outer garments

  • Hair of employees is properly confined

  • Employees in good health with no open cuts or sores

  • Clothing and personal effects stored away from products in a proper manner

Sanitary Facilities

  • Toilet facilities, both public and staff are clean, well maintained and in proper working order

  • Self closing doors for toilet and dressing room working properly

  • Toilet tissue dispensers full. Sanitary napkin disposal unit available.

  • Single service soap and towel dispensers operable and full

  • Ventilation provided and in proper working order

  • Separate hand washing basin in each area with required supplies

Water and Sewage

  • All sinks are fully operable with hot and cold water at each faucet

  • All sinks drain properly. Floor drains and sink in good order

  • Plumbing in good repair

Floors, Wall, Ceilings, Lighting and Ventilation

  • Floors clean, well maintained and in good repair

  • Walls, ceilings and windows clean. Well maintained and in good repair

  • Adequate lighting and ventilation provided throughout the facility

  • Light fixtures have approved safety covers

  • Exhaust ventilation filters are clean and well maintained

Equipment and Utensils

  • Food contact surfaces washed, rinsed and sanitised before using, at least every 4 hours when not in use

  • Non-Food contact surfaces visibly clean and in good repair

  • All equipment (i.e.) stoves, grilld, refrigerators, tables, sinks, ect. cleaned and well maintained

  • Inoperable equipment has been repaired, replaced, or removed from facility

  • Multi- service utensils are being washed and sanitised by one of the following methods:

  • Single service utensils are properly stored and dispensed

  • All multi-service utensils are clean, properly stored, maintained and dispensed

  • Damaged or unapproved utensils have been repaired or replaced

Ware Washing

  • High-temp dish machines minimum washing temp of 151°F/66°C rinse temp 179°F/82°C for 10 seconds

  • Low-temp dish machine minimum wash and rinse temp of 130°F to 150°F/50°C to - 66°C. with chlorine sanitizer solution at a Minimum 100ppm.

  • Manual sink ware washing minimum wash, rinse, sanitizing sink water temp 11 3°F/45°C.<br>Sanitizing solution minimum chlorine 1 00mg/L; Quat. 200mg/L; or Iodine 12.5 – 25mg/L (ppm) Soak for 2 minutes

  • Pocket thermometers and sanitizer test kit readily available to verify temperatures and concentrations.

  • Wiping clothes clean, sanitized, stored and maintained properly

Garbage and Waste

  • Trash containers are lined with insect and vermin-proof disposable plastic bag at all times.

  • Plastic bags are tied before being placed in outside trash bin. Bin lids are kept closed.

  • Outside premises and refuse areas are clean, sanitized, illuminated by light and well maintained.

  • Frequency of garbage removal adequate to maintain premises in a sanitary condition.

Pest Control

  • Adequate protection against the entrance of insects, vermin, rodents, dust and fumes.

  • Outside doors and screen doors are self-closing and closures are in acceptable working order.

  • Keep all areas free of debris, moisture, and visable soil and well lit.

  • Working with a licensed pest control company.

Items Critical to Food Safety

  • Food is purchased ONLY from approved sources

  • Food is inspected when received and found to be free from contamination, adulteration, and spoilage.

  • Frozen food is received and stored at -18°C/0°F or colder

  • Refrigerated food is received and stored at 4°C/40°F or colder

  • All food is stored a minimum 6” off the floor and 2”away from the walls

  • All food is labeled, dated and stored in leak proof packaging or food grade containers

  • All food is protected from dirt, unnecessary handling, over-head leakage and other forms of contamination

  • Prepared and ready to eat food are stored above and away from raw foods

  • A thermometer, accurate to 1 °C/2°F, is provided either as an integral part of the refrigerator / freezer (outside dial) or is located inside each unit at its warmest spot (usually at the point of access)

  • An accurate thermometer, approved for measuring food temperatures, is readily available and is being used to verify internal food temperature on a daily basis

  • Restrooms are not used for storage of food, equipment or non-washroom supplies

  • All paper products are stored in a manner so as to protect them from contamination

  • Thawing of food using one or more of the following acceptable methods:

  • Thawed food items must not be refrozen. Cooked or processed foods may be refrozen

  • Separate raw foods from ready-to-eat foods during storage and handling

  • Maintain separation of ready-to-eat foods from raw foods during preparation and from surfaces and utensils

  • Food handlers use proper utensils to minimize direct hand contact with raw, cooked or prepared foods

  • Hands are properly washed before and after handling food

  • Foods are cooked to minimum internal temperatures:

  • Holding hot foods at a minimum 140°F/60°C and cold foods at a maximum 5°C/40°F

  • Cool from 60°C to 20°C or less in 2 hours and from 20°C to 4°C or less in 4 hours for a total of 6 hours

  • Reheat food to a minimum 74°C/165°F within 2 hours. Hold at minimum 60°C/140°F

  • Unpackaged food, which have been served or returned are discarded

  • All food is protected from potential contamination

  • Foods are dispensed and/or disposed in an approved manner

  • High acid food are prepared and stored in corrosion resistant containers and equipment

  • Signed off by

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