Title Page

  • Site conducted

  • Business name

  • Manager/proprietor

  • Telephone number

  • Email address

  • Premises address
  • Conducted on

  • Prepared by


    1. Answer the questions below by selecting the most appropriate response.
    2. Add photos and notes as necessary evidences
    3. To add a corrective measure, click ""Add Action"", provide a description, assign to a member, set priority, and due date
    4. Complete the audit by providing a digital signature

General Provisions

  • 1 Cleanliness of premises, outbuildings, fixtures, fittings and equipment including grease traps and drains

  • 2 Control of animals and pests

  • 3 Adequate toilet facilities clean with hot/cold water

  • 4 Suitability and maintenance of premises, fittings and equipment

  • 5 Prevention of emissions – odour/liquid/other

  • 6 Appliances capable of destroying/rendering harmless effluvia, vapours and gases

Offensive Material

  • 7 Receptacle impervious, sufficient capacity with air tight cover

  • 8 Material placed in receptacle as soon as practical

  • 9 Receptacle emptied once per day

  • 10 Receptacle cleaned and sanitised once emptied

Specified Offensive Trades

  • 11 Floor – smooth, impervious, drained, coving

  • 12 Bucket trap/spoon drain

  • 13 Liquid refuse treatment – screened, cooled 26°C before discharge

  • Other comments

  • Please attend to any outstanding items by the due date. For enquiries contact the officer on the number below.

  • Reinspection date

  • I have read and I understand the contents of this assessment. Proprietor/staff name and signature

  • Officer name and signature

  • Officer contact name

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.