Title Page
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Premise Name
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Location
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Conducted on
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Inspected by
Hygiene
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Employees wash their hands with soap and warm water before start of shift, immediately after using washroom, changing gloves, and any time needed to prevent cross-contamination
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Employees are wearing clean uniforms/street clothes and aprons
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Hair/Beard of employees is properly confined in provided nets
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Blue latex or white cotton gloves are worn properly, with no rips or holes
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Employees are in good health with no open cuts, sores, or flu like symptoms
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Clothing/Jewelry and personal effects stored away from products in a proper manner
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No food or open containers stored in locker rooms, or lockers (including break room)
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No food, candy, gum or beverages on the production floor. (Except from bubbler or provided water jugs)
Facility Sanitation
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Toilet facilities, both public and staff are clean, well maintained and in proper working order
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Self closing doors for toilet and locker room working properly
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Toilet tissue dispensers full
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Sanitary napkin disposal, and Sharps Containers provided
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Single service soap and towel dispensers operable and full
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Ventilation provided and in proper working order
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Separate hand washing station in each department with required supplies
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No Cigarette butts or garbage found around the grounds of the facility
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All chemicals are securely stored and properly labeled
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Blue brooms, squeegees, and dust pans in bakery/packaging are hung up and being used on the floor only
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Red brooms, squeegees, and dust pans in pizza are hung up and being used on the floor only
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Black brushes, and buckets are being used for drains only
Water and Sewage
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All sinks are fully operable with hot and cold water at each faucet
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All sinks drain properly, Floor drains and sink in good order
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Plumbing in good repair
Floors, Wall, Ceilings, Lighting and Ventilation
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Floors clean, well maintained and in good repair
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Walls, ceilings and windows clean, well maintained and in good repair
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Adequate lighting and ventilation provided throughout the facility
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Light fixtures have approved safety covers and plastic coated bulbs
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Exhaust ventilation filters are clean and well maintained
Equipment and Utensils
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Food contact surfaces washed, rinsed and sanitized before using.
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Non-Food contact surfaces visibly clean and in good repair
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All equipment (i.e.) ovens, mixers, freezers/coolers, tables, cutters, conveyor belts, ect. cleaned and well maintained
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Inoperable equipment has been repaired, replaced, covered, or removed from facility
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Multi- service utensils are being washed and sanitized by one of the following methods:
- hand washed in a two or three compartment sink (wash-rinse-sanitize)
- dish washing machine warewashing (high temp rinse water) reaches at least 179F/82 degrees for 10 seconds
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Single service utensils are properly stored and dispensed
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All multi-service utensils are clean, properly stored, maintained and dispensed
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Damaged or unapproved utensils have been repaired, replaced, or removed
Washing
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High-temp dish machine is clean and in working order
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Manual wash, rinse, sanitize sink is clean and in working order<br>
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All white food contact rags are clean, sanitized, stored and maintained properly
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Uniforms are properly washed and stored outside the locker rooms
Garbage and Waste
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Trash containers are lined with insect proof disposable plastic bags at all times
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Plastic bags are tied before being placed in outside trash bin. Bin lids are kept closed
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Outside premises and refuse areas are clean, sanitized, illuminated by light and well maintained
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Frequency of garbage removal adequate to maintain premises in a sanitary condition
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All trash cans are labeled for the specific department that they're located in.
Pest Control
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Adequate protection against the entrance of insects, vermin, rodents, dust and fumes
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Overhead doors are closed all the way down, unless in use
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Outside doors and screen doors are self-closing and closures are in acceptable working order
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All areas are free of debris, moisture, and visible soil
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Working with a licensed pest control company.
Items Critical to Food Safety
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Ingredients are purchased ONLY from approved suppliers
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Ingredients are inspected when received, and found to be free from contamination, adulteration, and spoilage
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FIFO is being followed
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Refrigerated ingredients are received and stored at 4°C/40°F or colder
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All Ingredients are stored a minimum 6” off the floor and 18” away from the walls
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Black bread racks are on the bottom of the stacks
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All Ingredients are labeled, dated and stored in original packaging or food grade containers (white - Bakery) (yellow - pizza)
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White (bakery, packaging) and yellow (pizza) hand brushes are being used on food and food-contact surfaces only
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All Ingredients/RTE foods are protected from dirt, unnecessary handling, over-head leakage and other forms of contamination
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All film rolls, boxes, and bags are stored in a manner so as to protect them from contamination
Good Manufacturing & Housekeeping
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Allergens Segregated in the warehouse
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All knives are properly stored, inspected and signed out daily
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Metal detectors are in proper working order
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No hose nozzles on the floor in any department
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Hoses coiled when not in use
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No Storage on electrical boxes, control panels, ledges
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No glass, wood, or brittle plastics brought into the plant
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Pallets in good condition and stored properly
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Signed off by
