Title Page

  • Conducted on

  • Room Location

  • Previous Order Item Number

  • Previous Order Clean Type

  • Item Number

  • Description

  • Clean Type

  • Top Mezzanine Condition

  • Enter Corrective Actions taken

  • Is Hopper Lid Closed?

  • Enter Corrective Actions taken

  • Hopper Condition

  • Enter Corrective Actions taken

  • Rotary Valve Condition

  • Enter Corrective Actions taken

  • Auger Condition

  • Enter Corrective Actions taken

  • Magnets Condition

  • Enter Corrective Actions taken

  • Are Magnets in the right slots?

  • Enter Corrective Actions taken

  • Check Weigher Condition

  • Enter Corrective Actions taken

  • Conveyor Condition

  • Enter Corrective Actions taken

  • Tape Machine Condition

  • Enter Corrective Actions taken

  • Comments

  • Photo Evidence

  • Area Photos
  • Photo

  • Done by - Signature

  • Verified by - Signature

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.