Information
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Conducted on
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Prepared by
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Verification:
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Date/Time:
Glass, Brittle, and Hard Plastic Verification
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INITIALS:
Rollstock Edge Winder
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Rollstock Label Printer
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Rollstock Control Screen
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Rollstock Waterfilter
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Rollstock E-Stop (1)
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Rollstock E-Stop (2)
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Rollstock E-Stop (3)
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:DATE/TIME:
Tumbler Screen
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Tumbler Screen Trap Separator (2)
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Tumbler E-Stop (1)
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
PVC Under Sink
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Urschel Control Drop Cover
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Door Drop Flaps
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Switch Cover
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Plug Cover
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Lights
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Soap Dispenser
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Urschel E-Stop
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Camera Cover
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
Rack Scale Controls
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Pre-Shift:
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ACCEPTABLE?
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DATE/TIME:
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Post-Shift:
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ACCEPTABLE?
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DATE/TIME:
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COMMENTS:
Operational Sanitation Report
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Complete an operational sanitation report for each time that production is running: start up to lunch, lunch to pm break, pm break to end. 10-fully compliant, 7=minor deficiency, 5=prevalent deficiency, 3=numerous deficiency, 0=total failure. Scores of 5 or below require documented corrective action on the Operational Sanitation Corrective Action Report.
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Employee GMPs (5 team members)
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DATE/TIME:
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DATE/TIME:
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DATE/TIME:
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PERSONAL ITEMS OFF OF THE FLOOR
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DATE/TIME:
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DATE/TIME:
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DATE/TIME:
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HAND-WASH STATIONS STOCKED
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DATE/TIME:
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DATE/TIME:
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DATE/TIME:
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HOUSEKEEPING, INCLUDING TRASH
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DATE/TIME:
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DATE/TIME:
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DATE/TIME:
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PACKAGING MATERIAL STORED APPROPRIATELY
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DATE/TIME:
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DATE/TIME:
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DATE/TIME:
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PRODUCT SAFETY (covered or protected)
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DATE/TIME:
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DATE/TIME:
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DATE/TIME:
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PACKAGING MATERIAL STORED APPROPRIATELY
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CONDENSATION (Clean and Chemical Concentration)
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DATE/TIME:
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DATE/TIME:
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DATE/TIME:
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TOOLS, DETERGENTS, CHEMICALS, & LUBRICANTS
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DATE/TIME:
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DATE/TIME:
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DATE/TIME:
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DRAINS
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DATE/TIME:
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DATE/TIME:
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DATE/TIME:
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DATE/TIME:
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DATE/TIME:
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FOOTBATH
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DATE/TIME:
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DATE/TIME:
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DATE/TIME:
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SHARP IMPLEMENTS, WEAR/BREAKAGE OF EQUIPMENT
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Acceptable?
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SIGN:
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DATE/TIME:
CORRECTIVE ACTION REPORT:
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Identify and Eliminate the Cause of the Deviation:
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Actions to bring the Area back under control:
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Preventative Measures:
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Product Affected: Y or N
