Information
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Personnel
1 - Personal Hygiene facilities
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A - All wash hand basins stocked with hand soap and paper towels ?
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B - Personal Hygiene Dispensers functioning properly ?
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Any additional information ?
2-Food Preparation area - Cleaning & Sanitation
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A - Detergent & Sanitiser dispensers functioning Properly ?
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B - Correct products in Dispenser ?
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C- Clean As You Go cleaning observed ?
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C - Satisfactory levels of cleaning of Preparation Equipments ( slicers, <br>Knives, weighing scales) ?
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D - Satisfactory levels of cleaning of Food Contact Surfaces ( Cutting Boards & Serving Counters) ?
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E - Vanoquat Sanitiser in use ?
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F - Evidence of recent cleaning to hand<br>contact surfaces ?
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G - Boards, utensils, temp. probes sanitized between different products ?
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H- Fresh produce being washed and sanitized before use ?
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I - Adequate separation between raw and<br>cooked/ready to eat foods ?
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Additional Information
3- Customer Restaurant Area
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A - Floors Clean ?
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B- Tables ?
4 - Pest control.
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A - Flying Insect Pest Control Devices Functioning ?
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B - No signs of pests seen during audit ?
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C - External refuse area kept clean ?
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Additional Information
5 - Training of Staff ?
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A - Training Required ?
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B - STAFF QUESTION - Where would you<br>find information on how to clean ?
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Additional Information
6 - Cleaning & Hygiene Signage
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A - Product use guides in place for each department?
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B - Dispenser Signage for Product in place ?
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B - Hygiene Tip guides in place ?
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C - Hand Hygiene Signage in place over Hand Wash Sinks ?
Sign Off
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Reza Hygiene Signatory - Write Name!
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Customer On Site Signatory - - Write Name!