Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
- Sanitation Assessment
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Select date
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Swab #
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APC Micro
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Other Micro Results?
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Description of swab site/area
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Swab Zone
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Swab Site Image (take a picture)
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Current PM
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Current PM Frequency
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Date PM was last completed?
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PM Owner
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Corrective Action
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Priority Rating: <br>Priority 1 = Potential Food Safety/Regulatory Implications - Immediate Short Term Action Plan is required within 24-72 w/Long Term Action Plan within 1-2 weeks <br><br>Priority 2 = Low or no Potential Food Safety Implications but item of higher concern: Short Term Action Plan is required within 1-2 weeks and Long Term Action Plan within 1-2 months <br><br>Priority 3 = No obvious or potential likelihood for Food Safety Implications but item needs corrective action plans and follow up to maintain continuous improvement within 1-3 months
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Status Guideline: <br>1 = Owner assigned and 1-25% initiated towards completion<br>2 = In process with 25-75% completed<br>3 = ≥75%, or completed but not yet verified <br>4 = 100% COMPLETE & VERIFIED
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Completion Date
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Assigned Owner or Person Verifying CA
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If applicable, take a picture of the Corrective Action
