Title Page
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Client / Site
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Conducted on (Date and Time)
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Performed by
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Location
Sanitizing food contact surfaces (Utensils)
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1. Wash surface with detergent solution
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2. Rinse surface with clean water<br>
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3. Sanitize surface using a sanitizing solution mixed at a concentration specified on the manufacturer’s label.
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4. Place wet items in a manner to allow airdrying.
Sanitizing food contact surfaces (Cooking Equipment)
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1. Wash surface with detergent solution
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2. Rinse surface with clean water<br>
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3. Sanitize surface using a sanitizing solution mixed at a concentration specified on the manufacturer’s label.
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4. Place wet items in a manner to allow airdrying.
When using 3-compartment sink:
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1. In the first compartment, wash with a clean detergent solution at or above 110 degrees F.
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2. In the second compartment, rinse with clean water.
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3. In the third compartment, sanitize with a sanitizing solution mixed at a concentration specified on the manufacturer’s label for 30 seconds.
When using the dish machine:
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1. Refer to the information on the data plate for determining wash, rinse, and sanitization rinse temperatures; sanitizing solution concentrations; and water pressure if applicable.
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2. Follow manufacturer’s instructions for use.
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3. Ensure that food contact surfaces reach a surface temperature of 160 degrees F or above.
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Signature of worker/cleaner