Title Page
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Site conducted
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Business name
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Manager/proprietor
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Telephone number
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Email address
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Premises address
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Conducted on
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Prepared by
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INSTRUCTIONS
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
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1 Cleanliness of premises, outbuildings, fixtures, fittings and equipment including grease traps and drains
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2 Control of animals and pests
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3 Adequate toilet facilities clean with hot/cold water
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4 Suitability and maintenance of premises, fittings and equipment
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5 Prevention of emissions – odour/liquid/other
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6 Appliances capable of destroying/rendering harmless effluvia, vapours and gases
Offensive Material
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7 Receptacle impervious, sufficient capacity with air tight cover
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8 Material placed in receptacle as soon as practical
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9 Receptacle emptied once per day
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10 Receptacle cleaned and sanitised once emptied
Specified Offensive Trades
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11 Floor – smooth, impervious, drained, coving
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12 Bucket trap/spoon drain
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13 Liquid refuse treatment – screened, cooled 26°C before discharge
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Other comments
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Please attend to any outstanding items by the due date. For enquiries contact the officer on the number below.
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Reinspection date
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I have read and I understand the contents of this assessment. Proprietor/staff name and signature
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Officer name and signature
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Officer contact name
