• Enter Date & Time.


  • Daily Cleaning Plan In Place.

  • Food Contact Surface Clean And In Good Repair.

  • Racks are Clean And In Good Repair.

  • Storage Drawers Are Clean.

  • Floors & Walls Are Clean And In Good Repair.

  • Pallets, if used, Are Clean And In Good Repair.

  • Utensils, Small Wares & Mixers Are Cleaned And Sanitized.

  • Deep Cleaning Plan In Place.

  • Record Dish Cleaning Sanitizer Concentration (Dish Machine and/or Three-Sink).


  • Building meets local building codes.

  • All Entry Points Prohibit Pest Entrance.

  • Water Quality meets Safety Standards.

  • Regular Maintenance on building evident.

  • Regular Maintenance on equipment evident.

  • Inoperative equipment has been removed from Production Areas.

  • No evidence of flaking paint.


  • Chemicals are properly labeled.

  • Only Authorized Cleaning compounds and sanitizers are in use.

  • Chemicals are properly stored.

  • Wiping Cloths are kept in a sanitizing solution.

  • Record sanitizing concentration ph.


  • Only approved equipment is in use.

  • Power Equipment is clean and maintained.

  • Power equipment shows no signs of fluid leaks.

  • Equipment is covered when clean and not in use.


  • Garbage containers are clean and covered when not in use.

  • Garbage containers are emptied as necessary.

  • Boxes and containers are removed as necessary.

  • Dumpster is located away from facility entryways.

  • Dumpster area is clean.

  • Dumpster lids are closed.


  • Enter Employee Name & Signature.

  • Supervisor Name & Signature.

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