Initial Inspection Report

• Audit Title

• Conducted on

  Date

• Prepared by

• Personnel

DISEASE REPORTING

• 01. Disease Reporting

  Yes

  No

  N/A

• 02. Medical Logs Maintenance

  Yes

  No

  N/A

POTABLE WATER

• 03. Bunker / Production Source; Halogen Residual

  Yes

  No

  N/A

• 04. Distribution System Halogen Residual

  Yes

  No

  N/A

• 05. Distribution System Halogen Analyzer Calibrated

  Yes

  No

  N/A

• 06. Halogen Analyzer Chart Recorder Maintenance, Operation, Records; Micro Sampling, Records.

  Yes

  No

  N/A

• 07. System Protection Cross Connections, Back Flow; Disinfection

  Yes

  No

  N/A

• 08. Filling Hoses, Caps, Connections, Procedures; Sample Records, Valves; System Construction, Maintenance

  Yes

  No

  N/A

RECREATIONAL WATER FACILITIES

• 09. RWF Halogen Residuals

  Yes

  No

  N/A

• 10. RWF Maintenance, Safety Equipment

  Yes

  No

  N/A

FOOD SAFETY

PERSONNEL

• 11. Food Handlers Infections, Communicable Diseases

  Yes

  No

  N/A

• 12. Hands Washed; Hygienic Practices

  Yes

  No

  N/A

• 13. Management, Knowledge, Montoring

  Yes

  No

  N/A

• 14. Outer Clothing Clean; Jewelry, Hair, Hand Sanitizers

  Yes

  No

  N/A

FOOD

• 15. Food source, sound condition; Food reservice

  Yes

  No

  N/A

• 16. Potentially hazardous food temperatures

  Yes

  No

  N/A

• 17. Temperature practices; Thawing

  Yes

  No

  N/A

• 18. Cross contamination

  Yes

  No

  N/A

• 19. Food protection, Original containers; Labelling; In-use food dispensing

  Yes

  No

  N/A

EQUIPMENT

• 20. PHF temperature maintenance facilities; Food contact surfaces; Food temperature measuring devices

  Yes

  No

  N/A

• 21.Non food contact surfaces; Ambient temperature measuring devices

  Yes

  No

  N/A

• 22. Ware washing facilities; Temperature measuring devices; Test kits

  Yes

  No

  N/A

• 23. Prewash; Wash and rinse solutions

  Yes

  No

  N/A

• 24. Sanitizing rinse

  Yes

  No

  N/A

• 25. Wiping cloths / chef's towels

  Yes

  No

  N/A

• 26. Food contact surfaces equipment / utensils clean; Safe materials

  Yes

  No

  N/A

• 27. Non food contact surfaces equipment / utensils clean

  Yes

  No

  N/A

• 28. Equipment / utensil / linen / single service storage handling, dispensing; Cleaning frequency

  Yes

  No

  N/A

TOILET AND HANDWASHING FACILITIES

• 29. Facilities convenient, accessible, design, installation

  Yes

  No

  N/A

• 30. Hand cleanser, sanitary towels, waste receptacles; Handwashing signs; Maintanence

  Yes

  No

  N/A

TOXIC SUBSTANCES

• 31. Toxic items

  Yes

  No

  N/A

FACILITIES

• 32. Solid waste collection

  Yes

  No

  N/A

• 33. Decks / bulkheads / deckheads

  Yes

  No

  N/A

• 34. Plumbing fixtures / supply lines / drain lines / drains

  Yes

  No

  N/A

• 35. Liquid waste disposal

  Yes

  No

  N/A

• 36. Lighting

  Yes

  No

  N/A

• 37. Rooms / equipment venting

  Yes

  No

  N/A

• 38. Unnecessary articles, cleaning equipment; Unauthorized personnel

  Yes

  No

  N/A

ENVIRONMENTAL HEALTH

• 39. IPM program effective; Approved pesticide application

  Yes

  No

  N/A

• 40. IPM procedures; Outer openings protection

  Yes

  No

  N/A

• 41. Housekeeping

  Yes

  No

  N/A

• 42. Child activity centers

  Yes

  No

  N/A

• 43. Ventilation

  Yes

  No

  N/A

KNOWLEDGE

• 44. Person in charge; Knowledge

  Yes

  No

  N/A