Title Page

  • Premises

  • Address
  • Registered address if different

  • Date of visit

  • Food hygiene visit

  • Workplace health and safety visit

  • Reason for visit

  • Details:

  • Officer

  • Contact details

  • Buckinghamshire Council, Regulatory Services, Walton Street Offices, Walton Street, Aylesbury, HP20 1UA

Business details

Contact details

  • Contact name

  • Email address

  • Head office email address (for multi-site businesses)

  • Telephone number

  • Type of business:

  • Business operator/proprietor:

  • Areas inspected:

  • Please specify:

  • Records/documents examined:

  • Details:

  • Food or environmental samples taken?

  • Details of food sample(s) taken

  • Click to add swab detail

  • Swab
  • Swab description

  • Date/time of swab

  • undefined

  • ATP is the energy molecule found in all living cells, such as bacteria, making it a good indicator to determine if a surface is clean or not. The higher the score, the dirtier the surface.

  • Score

  • Food contact surface (e.g. chopping board, food prep. surface, food utensil): 0-20=Pass, 21-49=Borderline, >50=Fail.
    Hand contact surface (e.g. tap handle, fridge handle): 0-50=Pass, 51-99=Borderline, >100=Fail.

  • Advice - A borderline score can show a surface is trending towards unclean and may require additional attention during the next cleaning.

  • Legal - You need to review your cleaning procedures to ensure surfaces are cleaned and disinfected using a two stage process. The manufacturers' instructions must be followed for the dilution, contact time, and drying method (SR).

  • Protein is more difficult to remove from surfaces than other residues so it is a good indicator of cleanliness.

  • Legal - You need to review your cleaning procedures to ensure surfaces are cleaned and disinfected using a two stage process. The manufacturers' instructions must be followed for the dilution, contact time, and drying method (SR).

  • Persons interviewed:

  • Details:

  • Names of persons interviewed:

Summary of action taken by officer

  • Summary of action to be taken by the officer:

  • Key Points Discussed

  • Add media

  • Revisit required:

  • Date and time of revisit:

  • Officer signature:

  • Signature of person report discussed with:

Further information

Understanding your report and rating

  • Understanding Your Inspection Report

    Items are listed as either Legal Requirements – these are considered to be breaches of the legislation and require action. The period of time allowed to comply is detailed against each item, or Advice – these are items which you are strongly advised to implement as they constitute good practice. Failure to action the legal requirements is a breach of the relevant legislation which may result in enforcement action in line with the Regulatory Services Enforcement Policy. Details of this policy can be viewed at :

    https://tinyurl.com/495xp8vj

  • This report gives you information about the inspection of your premises. It only covers areas inspected at the time; and summarises matters discussed during the inspection. The information provided by you in respect of your business will be held on our database and may be used for the purposes authorised in the Council’s registration under the Data Protection Act 2018.

  • This report, including photographs, may be disclosed in response to a Freedom of Information request apart from information of a personal or commercially confidential nature. If the food business operator has any concerns regarding this then they should contact Mr Ian Snudden, Environmental Health Manager at ian.snudden@buckinghamshire.gov.uk with the reasons why they would not want the information disclosed.

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.