Licensing & Approvals Unit - incomplete draft -updated 15 April

• Document No.

• Audit Title / Trading Name

• Client / Site / Licensee

• Licence Number

• Inspected by

  Select Eric Wang Mark O'Dwyer Julie Heidenreich Nathan Mills James Masselos Jo van Gorp Sharon Murray Alex Skubij Paul Jansen

  • Eric Wang
  • Mark O'Dwyer
  • Julie Heidenreich
  • Nathan Mills
  • James Masselos
  • Jo van Gorp
  • Sharon Murray
  • Alex Skubij
  • Paul Jansen
• Location / Address
  Address

• Personnel / Contact Person

• Contact Phone Number

• Email

• Inspection Type

  Select Routine Follow-up Complaint Sale search Final / Pre-opening New Licensee Progress Other

  • Routine
  • Follow-up
  • Complaint
  • Sale search
  • Final / Pre-opening
  • New Licensee
  • Progress
  • Other

• Conducted on

  Date

consent of entry

• Check if a signed acknowledgement required under s176(5) of Food Act 2006?

• Hello, I am an authorised person with X Regional Council. I am here to carry out an inspection on the food premises. I must advise you that anything or information I obtain during my inspection may be used as evidence in court, and I am further required to advise you that before I can enter I need your consent which you are not obliged to give me. Do I have your consent?

• Agreed to give consent to enter?

  Consent

  Not consent

• By providing the signature you acknowledge that:
  1 you were told the purpose of the entry; and
  2 you were told that you are not required to consent.

• Acknowledge of consent

  Sign

• This inspection report may include legal obligations and lawful directions from an Authorised Person under the Food Act 2006 (the Act). Failure to comply with an obligation or direction may constitute and offence under the Act. Please contact the Environmental Health Officer listed above if you require any clarification on this report.

Suitability of Premises - Plan Approval

• Have Plans been approved?

  Yes

  No

  N/A

• Recent copy on record?

  Yes

  No

  N/A

Food Business Construction or Refit Assessment

General design - FSS 3.2.3 C4

• Adequate Space?

  Yes

  No

  N/A

• Prevent entry/harbourage of pests?

  Yes

  No

  N/A

• Exclude dirt/dust, able to be effectively cleaned?

  Yes

  No

  N/A

Water Supply - FSS 3.2.3 C4

• Adequate supply of potable water?

  Yes

  No

  N/A

• Adequate supply of hot water for cleaning and sanitising?

  Yes

  No

  N/A

Waste Water - FSS 3.2.3 C5

• Cleaners sink, floor waste drain, grease trap/ permit?

  Yes

  No

  N/A

Waste Storage - FSS 3.2.3 C5

• Adequate, easily/effectively cleaned, prevent pests, sealed lids?

  Yes

  No

  N/A

Ventilation - FSS 3.2.3 C6

• Certification to AS 1668.2?

  Yes

  No

  N/A

• Sufficient natural or mechanical ( >29 MJ or 8kw).

  Yes

  No

  N/A

Lighting - FSS 3.2.3 C7

• Sufficient natural or artificial?

  Yes

  No

  N/A

• Light fittings able to be easily/ effectively cleaned to prevent food contamination?

  Yes

  No

  N/A

Floors - FSS 3.2.3 C10

• Able to be effectively cleaned?

  Yes

  No

  N/A

• Impervious, durable, coved & evenly graded to floor waste where applicable?

  Yes

  No

  N/A

Walls & Ceilings - FSS 3.2.3 C11

• Sealed, impervious, able to be easily and effectively cleaned?

  Yes

  No

  N/A

Fixtures, Fittings & Equipment - FSS C12

• Unable to contaminate food, able to be easily and effectively cleaned, no pest harbourage?

  Yes

  No

  N/A

• Can adjacent surfaces be easily and effectively cleaned?

  Yes

  No

  N/A

• Are food contact surfaces durable and impervious?

  Yes

  No

  N/A

• Can food contact surfaces be cleaned and sanitised?

  Yes

  No

  N/A

Hand Washing Facilities - FSS 3.2.3 C14

• Adequate size ( min 11 litres) within 5m of food preparation areas?

  Yes

  No

  N/A

• Hands free/common outlet/flick mixer?

  Yes

  No

  N/A

• Soap, paper towels, bin provided?

  Yes

  No

  N/A

Storage Facilities - FSS 3.2.3 C15

• Adequate facilities for chemicals, cleaning equipment, personal belongings, office equipment?

  Yes

  No

  N/A

Toilet Facilities -FSS 3.2.3 C16

• Access for food handlers?

  Yes

  No

  N/A

• Hand washing facilities, soap and paper towels provided?

  Yes

  No

  N/A

Food Transport Vehicles - FSS 3.2.3 C17

• Able to protect food from contamination, easily and effectively cleaned?

  Yes

  No

  N/A

Cleaning & Sanitising - FSS 3.2.3 C12

• Double/triple bowl sink, pot wash, hot & cold water, food grade sanitiser, sanitising dishwasher, canopy, adequate size?

  Yes

  No

  N/A

Dry Storage - FSS 3.2.2 C6

• Adequate space, shelving?

  Yes

  No

  N/A

Cold Storage - FSS 3.2.2 C6, FSS 3.2.3 C12

• Adequate refrigeration space, equal to or less than 5 deg C?

  Yes

  No

  N/A

• Food protected from contamination?

  Yes

  No

  N/A

• Raw and RTE food separated?

  Yes

  No

  N/A

Frozen Storage - FSS 3.2.2 C6, FSS 3.2.3 C12

• Adequate freezer space?

  Yes

  No

  N/A

• Capable of keeping food frozen?

  Yes

  No

  N/A

• Capable of keeping food protected from contamination?

  Yes

  No

  N/A

Cold Display - FSS 3.2.2 C8

• Food protected from contamination <5 deg C?

  Yes

  No

  N/A

• Separate utensils?

  Yes

  No

  N/A

Self Service - FSS 3.2.2 C8

• Barriers to protect food from contamination?

  Yes

  No

  N/A

• Separate utensils?

  Yes

  No

  N/A

• Supervised?

  Yes

  No

  N/A

Shelving - FSS 3.2.2 C 6, FSS 3.2.3 C 12

• Bottom shelf raised 150mm above floor?

  Yes

  No

  N/A

• Able to be easily and effectively cleaned?

  Yes

  No

  N/A

• No pest harbourage?

  Yes

  No

  N/A

Food Preparation Sink - FSS 3.2.2 C 7

• Clearly designated veg, meat, seafood?

  Yes

  No

  N/A

• Separated from cleaning & hand washing facilities?

  Yes

  No

  N/A

Thermometer - FSS 3.2.2 C22

• Readily accessible, accurate to plus or minus 1 deg C?

  Yes

  No

  N/A

Approved Food Types/Processing Activities

• Approved food types: Approved Processing Activities:

Approved Fit-Out?

• Premises fitted out in accordance with approved plans?

Food Safety Supervisor

• Yes

  No

  N/A

• Food safety supervisor/s

• Is the Food Safety Supervisor details up to date?

  Yes

  No

Food Safety Program

• Food safety program required?

  Required

  Not required

• Type of FSP

  Onsite Caterer

  Offsite Caterer

  Private Hospital

  Vulnerable Population

• Has the premises a compliant FSP?

  Yes

  No

  N/A

• Due date

  Date

• Is the FSP implemented?

  Yes

  No

  N/A

• Due date

  Date

Food Handling Processes and General Requirements

• Comments:

Cleaning & Sanitising

• Comments:

Structure / Maintenance

• Comments:

• Food transport vehicles

  Compliant

  Not Compliant

  Not Applicable

• Due date

  Date

Other comments

• Other comments

• Inspection outcome

  Satisfactory

  Unsatisfactory

• Follow-up date (All required actions must be completed by the due date.)

  Date

• Improvement Notice to be issued?

  Yes

  No

• Name and signature of the person to receive this report or accompanying the inspection

  Sign

• Signature of EHO

  Sign