• Document No.

  • Audit Title / Trading Name

  • Client / Site / Licensee

  • Licence Number

  • Inspected by

  • Location / Address
  • Personnel / Contact Person

  • Contact Phone Number

  • Email

  • Inspection Type

  • Conducted on


    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?

  • 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

  • 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?

  • Recent copy on record?

Food Business Construction or Refit Assessment

General design - FSS 3.2.3 C4

  • Adequate Space?

  • Prevent entry/harbourage of pests?

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

Water Supply - FSS 3.2.3 C4

  • Adequate supply of potable water?

  • Adequate supply of hot water for cleaning and sanitising?

Waste Water - FSS 3.2.3 C5

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

Waste Storage - FSS 3.2.3 C5

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

Ventilation - FSS 3.2.3 C6

  • Certification to AS 1668.2?

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

Lighting - FSS 3.2.3 C7

  • Sufficient natural or artificial?

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

Floors - FSS 3.2.3 C10

  • Able to be effectively cleaned?

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

Walls & Ceilings - FSS 3.2.3 C11

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

Fixtures, Fittings & Equipment - FSS C12

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

  • Can adjacent surfaces be easily and effectively cleaned?

  • Are food contact surfaces durable and impervious?

  • Can food contact surfaces be cleaned and sanitised?

Hand Washing Facilities - FSS 3.2.3 C14

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

  • Hands free/common outlet/flick mixer?

  • Soap, paper towels, bin provided?

Storage Facilities - FSS 3.2.3 C15

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

Toilet Facilities -FSS 3.2.3 C16

  • Access for food handlers?

  • Hand washing facilities, soap and paper towels provided?

Food Transport Vehicles - FSS 3.2.3 C17

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

Cleaning & Sanitising - FSS 3.2.3 C12

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

Dry Storage - FSS 3.2.2 C6

  • Adequate space, shelving?

Cold Storage - FSS 3.2.2 C6, FSS 3.2.3 C12

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

  • Food protected from contamination?

  • Raw and RTE food separated?

Frozen Storage - FSS 3.2.2 C6, FSS 3.2.3 C12

  • Adequate freezer space?

  • Capable of keeping food frozen?

  • Capable of keeping food protected from contamination?

Cold Display - FSS 3.2.2 C8

  • Food protected from contamination <5 deg C?

  • Separate utensils?

Self Service - FSS 3.2.2 C8

  • Barriers to protect food from contamination?

  • Separate utensils?

  • Supervised?

Shelving - FSS 3.2.2 C 6, FSS 3.2.3 C 12

  • Bottom shelf raised 150mm above floor?

  • Able to be easily and effectively cleaned?

  • No pest harbourage?

Food Preparation Sink - FSS 3.2.2 C 7

  • Clearly designated veg, meat, seafood?

  • Separated from cleaning & hand washing facilities?

Thermometer - FSS 3.2.2 C22

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

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

  • Food safety supervisor/s

  • Is the Food Safety Supervisor details up to date?

Food Safety Program

  • Food safety program required?

  • Type of FSP

  • Has the premises a compliant FSP?

  • Due date

  • Is the FSP implemented?

  • Due date

Food Handling Processes and General Requirements

  • Comments:

Cleaning & Sanitising

  • Comments:

Structure / Maintenance

  • Comments:

  • Food transport vehicles

  • Due date

Other comments

  • Other comments

Outcome & Acknowledgement

  • Inspection outcome

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

  • Improvement Notice to be issued?

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

  • Signature of EHO

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.