Maintenance Department/Contractor This document details the work being carried out followed by a hand back to production.

  • Plant and area affected.

  • Choose your site

  • Task Description

  • Risk Rating

  • Using the risk matrix calculate the risk rating.

  • Date and Time work undertaken

  • Permit/SOP Number

  • Will production continue on lines either side of the work area ?

  • If yes above, specify the production being carried out and the proximity. Less than 5 Metres requires controls put in place.

  • What type of work is being carried out ?

  • What type of foreign matter will be /is expected to be generated ?

  • List all controls put in place: eg.physical barriers, suppression,cloth drops,screens,extraction, cleaners in attendance.

  • What actions will be taken after completion of work and prior to hand back to Production ?

  • Have you completed a foreign matter inspection ?

  • List any items found - on food stream,above food stream, in 10m radius of work area.

  • Is the area clean ?

  • Engineering/Contract Representative I am satisfied that the area has been left in a clean and food safe condition. List name and sign.

  • Production/QA Representative I am satisfied that the area has been left in a clean and food safe condition. list name and sign.

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. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.