Title Page

  • Comm Uniform Ref

  • Conducted on

  • Officer

  • Premises Name/ Trading as

  • Contact Number

  • Premises Address
  • Email address

  • Registered Address
  • Food Business Operator

  • Registration details correct

  • Opening Times

  • Type, size, nature and scale of business

  • Changes in activities

  • Approval necessary:

  • No. of employees

  • Primary Authority

  • Inspection Plan

  • Number of Covers/ Customer Base

  • Type of Intervention

  • Vulnerable groups

  • Person seen

  • Local/ National/International

  • Language

  • Area Inspected

Main Inspection Form

Article 5 – Procedures based on the HACCP principles

  • Satisfactory

CHAPTER I - General requirements for food premises (other than those specified in chapter iii)

  • Satisfactory

CHAPTER II - Specific requirements in rooms where foodstuffs are prepared, treated or processed (excluding dining areas and those premises specified in chapter III)

  • Satisfactory

CHAPTER III - Requirements for movable and/or temporary premises (such as marquees, market stalls, mobile sales vehicles), premises used primarily as a private dwelling-house but where foods are regularly prepared for placing on the market and vending machines

  • Satisfactory

CHAPTER IV – Transport

  • Satisfactory

CHAPTER V - Equipment requirements

  • Satisfactory

CHAPTER VI - Food waste

  • Satisfactory

CHAPTER VII - Water supply

  • Satisfactory

CHAPTER VIII - Personal hygiene

  • Satisfactory

CHAPTER IX - Provisions applicable to foodstuffs

  • Satisfactory


  • Satisfactory


  • Satisfactory


  • Satisfactory

Storage / Stock control

  • Satisfactory

Temperature Control

  • Satisfactory

Pest Control

  • Satisfactory

Compliance with FSA E.coli guidance assessed

  • Assessment


  • Sampling undertaken

CHAPTER X - Provisions applicable to the wrapping and packaging of foodstuffs

  • Satisfactory

CHAPTER XI - Heat treatment – food in hermetically sealed containers

  • Satisfactory

CHAPTER XII - Training

  • Satisfactory

Food Information Regulations

  • Customer notification

  • Allergen Matrix/Equivalent System

  • Cross Contamination/Allergen Issues

Additonal Information

  • Referrals

  • Documents seen

  • Information Provided

  • Further Notes

  • H+S Hazard Spotting


  • Category A or B

  • Category C - Broadly compliant

  • Category C – Not broadly complaint:

  • Category D - Alternate between official controls and other interventions

  • Category E

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.