Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Mix Room
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DATE:
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AM or PM
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Floors
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Trash
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Tables
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Ingredients Labeled and Covered
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Ceiling Condensation
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Mixer Condition
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No Ingredients / Product Touching Floor
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Fly Lights
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Hand Wash Station
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Brooms / Squeegees
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Are Raw and RTE Employees Segregated?
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Sanitizer Concentration
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Personnel GMPs
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Time
Cook Room
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DATE:
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AM or PM
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Floors
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Tables
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Trash
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Ceiling Condensation
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Food Contact Surfaces
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Hoods / Vents
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Sinks
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Ice Machine
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Electrical Drops
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Ovens / Oven Hoods
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Species Segregation (Raw Materials)
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Hand Wash Station
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Booms / Squeegees
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Are Raw and RTE Employees Segregated?
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Sanitizer Concentration
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Personnel GMPs
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Time
IFK Processing Area
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DATE:
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AM or PM
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Floors
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Trash
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Tables
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Ceiling Condensation
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Cutting Boards
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Electrical Boxes
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Dicing Machine
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No Ingredients / Finished Product Touching the Floor
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Food Contact Surfaces
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Fly Lights
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Hand Wash Station
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Brooms / Squeegees
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Are Raw and RTE Employees Segregated?
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Sanitizer Concentration
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Personnel GMPs
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Time
Mainline Processing Area
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DATE:
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AM or PM
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Floors
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Trash
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Tables
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Ceiling Condensation
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Cutting Boards
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Electrical Boxes
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Hobart Mixers
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Vegetable Wash Sink
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No Ingredients / Finished Product Touching Floor
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Food Contact Surfaces
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Fly Lights
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Hand Wash Station
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Brooms / Squeegees
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Are Raw and RTE Employees Segregated?
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Sanitizer Concentration
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Personnel GMPs
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Time
Dish Room / Dish Storage Room
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DATE:
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AM or PM
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Floors
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Trash
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Smallwares
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Cutting Boards
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Ceiling Condensation
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Peg Boards
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3 Compartment Sink
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Dish Machine
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Drains
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Hand Wash Station
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No Food Contact Items Touching the Floor
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Personnel GMPs
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Time
Packaging Area
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DATE:
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AM or PM
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Floors
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Trash
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Tables
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Ceiling Condensation
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Metal Detector
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Foot Sealers
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Food Contact Areas
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Brooms / Squeegees
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No Ingredients / Product Touching the Floor
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Are Raw and RTE Employees Segregated?
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Sanitizer Concentration
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Personnel GMPs
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Time
