Premises details

  • Inspection type

  • Registration number

  • Address
  • Trading name

  • Proprietor

  • Class

  • Food safety supervisor

  • Inspection time & date

  • Date of next inspection

  • Additional comments

  • Inspection result

  • Officer Name

  • Add signature

Food Safety Program Records

  • Copy of Food Safety Program on-site?

  • Food safety knowledge of the Food Safety Supervisor?

  • Approved Food Suppliers List

  • Goods Receiving Form

  • Storage Unit Temperature Log

  • Activity Log (Internal Process Log)

  • Time Log

  • Cleaning record

  • Equipment Calibration Log

  • Other records (eg sushi, Chinese chicken supplement)

Purchasing and Receiving

  • Foods sourced from approved suppliers

  • Correct labelling/use by dates on foods

  • Potentially hazardous foods <5oC or >60oC<br>

  • Suitable receival area and delivery vehicles

Dry storage

  • Foods protected from pests and contaminants

  • Food storage areas - suitable, clean and maintained

Cold and frozen storage

  • Temperature of high risk foods <5oC or -15oC

  • Foods packaged and protected

  • Foods stored with date marking and within use-by-date

  • Cold storage units


  • Potentially hazardous food kept below 5oC

  • Foods protected from contamination during thawing


  • Potentially hazardous foods kept at room temperature <2 hours or 2 hour / 4 hour rule being followed

  • Potable water supply provided

  • Sanitising of utensils and food contact surfaces

  • Safe food handling practices being followed

  • Suitable hand washing facilities provided

  • Potentially hazardous foods cooked to 75oC

  • Foods protected from contamination

  • Potentially hazardous foods cooled correctly

Display and service

  • Cold potentially hazardous foods <5oC

  • Hot potentially hazardous foods kept at or >60oC

  • Sanitising of utensils and food contact surfaces

  • Safe food handling practices being followed

  • Foods protected during display and service


  • Potentially hazardous foods maintained <5oC or >60oC or 2 hour / 4 hour rule being followed

  • Suitable delivery vehicle/s

  • Foods protected from contamination

National Food Safety Standards

  • Allergy and intolerance - cross contamination and labelling

  • Illness Register/Health of Food Handlers

  • Food handler skills and knowledge

  • Pest control

  • Thermometer

  • Wastewater disposal

  • Refuse disposal

  • Ventilation and lighting

  • Storage of chemicals/personal items

Cleaning and Maintenance

  • Floors

  • Walls

  • Ceiling

  • Fittings, flashings and services

  • Exhaust Ventilation

  • Toilets

Tobacco Act Compliance

  • Tobacco warning signs for retailers

  • Suitable advertising by retailers

  • No smoking signs

  • Suitable outdoor dining and drinking areas

  • Suitable vending machine location

  • The intent of this inspection is to determine whether the Food Safety Program for the food business is being complied with, and to assess whether the premises is fully addressing its food safety risks under the Food Act 1984.

    Critical non-conformances must be completed within 1 day.
    Major non-conformances must be completed within 7 days.
    Minor non-conformances must be completed within 30 days.

Council's Contact Details

  • Mornington Peninsula Shire Telephone: 1300 850 600 Email:

  • Private Bag 1000 Fax: (03) 5950 1883 Web:

  • Rosebud 3931

  • Environmental Health Unit - 2 Queen Street Mornington 3931

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.