Outlet Visit Acknowledgement Form

• Franchise Outlet

• Conducted on

  Date

• Prepared by

• Designation

Summary of Visit:

• What are the non compliances found during your visit?

• Non Compliance 1

• Non Compliance 2

• Non Compliance 3

• Non Compliance 4

• Non Compliance 5

• Non Compliance 6

• Non Compliance 7

• Non Compliance 8

• Non Compliance 9

• Non Compliance 10

Documentation

• Checklist of Halal Documentation

• Business License

• Fosim Slip

• Halal Executive Appointment Letter

• Employee Master List

• Copy of IC

• Appointment Letter

• Typhoid Injection

• Food Handling Certificate

• Halal Awareness Training Certificate

• Attendance Record

• Menu Graphic

• QR Code for Raw Mat Certificate

• Previous Audit Report & ACR

• Maintenance Report ( inc. refrigeration, cleaning record )

• Halal Logo & Certificate Placement

• Raw Material Master List

• HAS SOP(inc. Internal Halal Commitee Chart, SOP, Minutes of Meeting)

Actions Required by the Outlet:

• Did the employee(s) acknowledge that they received and understood the details of the task that was required?

  Yes

  No

  N/A

• Timeline given to complete these non compliances (Reference: 3 days)

  Date

• Additional Information(If applicable)

Staff Acknowledgement

• Staff have been briefed and trained on all these non compliances

• I hereby acknowledge that this report has been carried out in a fair and reasonable manner. I acknowledge that this report may be used for disciplinary action and I acknowledge that all information is accurate to the best of my knowledge.

  Sign

Review

• Is any further action required?

  Yes

  No

  N/A

• Timeline of 3 working days for the corrective report once this report has been sent out

• I hereby sign off the acknowledgement that the corrective action that was requested has been carried out to a satisfactory level and no further action is required

  Sign