Title Page

  • Client / Site

  • Location
  • Conducted on

  • Prepared by


  • Traps and bug lights properly positioned & in good condition

  • No evidence of animals waste (dogs, etc) structural infestation (insects), or pests in the area or around the equipment

  • 18" space around the walls & space is clear

  • Ingredients stored off the floor in closed bags

  • No presence of mold or decomposition

  • Openings in doors, floors, & walls are sealed

  • Perimeter control for rodent/insect/bird is in place


  • Equipment, cleaning utensils & chemicals are clean and stored in correct location

  • Cabinets are free of debris, clean and in good condition

  • Cleaning supplies/tools/ lubricants are stored properly ( ex: food grade stored separately from non-food grade lubricants)

  • No evidence of food, drink, tobacco in any area other than designated areas

  • No jewelry (earrings, necklaces, watches, rings, etc) worn in production areas

  • No evidence of spitting or foul personal habits

  • No chemicals stored near exposed product

  • No usage of raw or finished product packaging for trash or scrap

  • Hand washing practices are being followed

  • Uniforms are worn correctly and in good condition

  • No food containers are used for nonfood use

  • Doors are left closed when not in use


  • Footbath stations in acceptable condition

  • Cleaning tool stations are in acceptable condition


  • Hearing protection is being used

  • Bump caps/hard hats are being used

  • Safety glasses are being worn

  • Safety shoes are worn and in good condition

  • Goggles & face shields used when appropriate

  • Gloves, goggles & chemical safety suits in use while foaming

  • No unsafe behavior observed


  • Only site-issued knives are used


  • No areas in need of painting

  • No cupped channel supports or other dust catchers

  • No equipment rusting out or leaking product ( creates additional cleaning required)

  • No badly stained equipment, floor, etc

  • No solid bottom guards or supports not accessible for cleaning

  • No damaged insulation or insulation covers

  • No oil or grease leaking into the product zone

  • There is proper maintenance of associates facilities (restroom, break room, locker room, etc)

  • No evidence of water leakage/oil leakage

  • No temporary repairs using tape, burlap or other materials

  • No water condensate in contact with product

  • No presence of broken glass

  • No equipment open to contaminants


  • Proper waste-handling systems are installed (storage, etc)

  • Weed control is used

  • Ceilings are protected against potential for harborage

  • No standing water present

  • All exterior doors are locked

  • Perimeter fence is in good condition

  • Exterior walls are in good condition

  • Light fixtures are protected

  • Lighting is adequate in area


  • All containers are clearly labeled

  • Storage locations/cabinets are clean and in good condition


  • Wearing correct PPE

  • No unsafe behavior observed


  • Hazardous waste are in good condition

  • Oil and petroleum sources in good condition (All labeled, no leaks, upright, and spill kits available)

  • No co-mingled trash/recyclable


  • Full Name and Signature of Inspector

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.