• Proprietor (seller)

  • Business name & address

  • Proprietor email:

  • Council Food Registration No.

  • Purchaser or Purchaser's Solicitor email:

  • Conducted on

  • Prepared by

  • Location
  • Personnel


  • 1. Floors smooth, impervious, undamaged and clean

  • 2. Walls and ceilings - smooth, free from cracks/crevices, clean and finished in a light colour

  • 3. Walls durable and impervious where there is potential to get splashed.

  • 4. Lighting sufficient, globes enclosed with diffusers or plastic sleeves.

  • 5. Harbourage / entry of pests prevented- fly screens on windows, no gaps under doors, holes in walls / air curtains working strips in good condition.

  • 6. Gaps between equipment/fittings/fixtures and walls effectively sealed, seals in good condition.

  • 7. All equipment/shelves etc raised 150mm from the floor to allow easy cleaning underneath

  • 8. Equipment/utensils clean and stored properly

  • 9. Equipment clean, in good working order, correct temp, no rust, suitable/approved material

  • 10. Mechanical exhaust hood and filters clean and in good working order

  • It is recommended that confirmation be sought from the out-going proprietor as to when the premises' mechanical exhaust system was last serviced and frequency of servicing required including grease arresting filters, fan, ducts etc.

  • 11. Hand washing facilities provided in food preparation area, supplied with hot water, liquid soap, paper towels

  • 12. Food contact surfaces smooth, impervious and undamaged

  • 13. Food on display appropriately protected from contamination

  • 14. Food storage areas clean, appropriate shelving (smooth, impervious)

  • 15. Fridges/freezers maintaining appropriate temperatures, seals, shelving in good condition

  • 16. Waste storage area appropriate, clean and paved, adequate waste storage facilities provided

  • 17. Staff/customers toilets clean, hand basin supplied with hot & cold water/liquid soap/paper towel

  • 18. Premise in an appropriate state of cleanliness/no evidence of pests

  • 19. Premises constructed so as not to provide harbourage/entry of pests where practicable

  • 20. Adequate supply of hot water

  • 21. Storage areas supplied for chemicals and personal items

  • 22. Grease trap installed (as required)

  • It is recommended that confirmation be sought from the out-going proprietor as to when the premise's food & oil interceptor (grease trap) was pumped out and frequency of servicing required.

  • 23. Other




  • Overall Food Safety Assessment result:


  • Is a follow-up inspection required?

  • Follow-up Inspection due on:


  • Add media


  • On site representative

  • Auditor's signature

  • Public Health Unit ph: 9518 3539

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.