Maintenance Department/Contractor

  • Date

  • Choose your site

  • Time started

  • Time Finished work

  • Risk Rating

  • Capture.JPG
  • Work performed by : Name and Signature

  • If Contractor GF contact to sign as well

  • Location work was done

  • Equipment that was worked on - be specific

  • Description of work

  • Have all tools been counted and reconciled and put back in Toolbox or appropriate location ?

  • Has all equipment and surrounding areas been cleaned ?

  • Have you physically checked equipment and surrounding area for Foreign Matter ?

  • Has a temporary repair been made ?

  • If yes to temporary repair was done has it been logged ?

  • I am satisfied that the area has been left in a clean and food safe condition.

  • I have handed over to -

Cleaner to complete if applicable.

  • Has cleaning been completed and line inspected ?
    Cleanliness, loose items, foreign matter.

  • I am satisfied that the area has been left in a clean and food safe condition Name and Signature

Production Department

  • Has line been inspected ?

  • I am satisfied that the area is clean, no loose items, no foreign matter.

  • If unacceptable state what further action is required and record any further work done before signing off.

  • Line was handed to me and all work and cleaning is complete ? Enter name and sign that production is ready to start.

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