Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

    Sanitation Assessment
  • Select date

  • Swab #

  • APC Micro

  • Other Micro Results?

  • Description of swab site/area

  • Swab Zone

  • Swab Site Image (take a picture)

  • Current PM

  • Current PM Frequency

  • Date PM was last completed?

  • PM Owner

  • Corrective Action

  • 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

  • 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

  • Completion Date

  • Assigned Owner or Person Verifying CA

  • If applicable, take a picture of the Corrective Action

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