• Select date

  • Employee/Assessor Name & Signature

  • Supervisor Name & Signature


Pest Control Program

  • Written Pest Control Policy In Place.

  • Contracted to Pest Control Company

  • Add Photo of Most Recent Service Report.

  • Evidence of Pests.

  • Building Restricts Access To Pests.

Traceability & Recall Program

  • Traceability & Recall Programs In Place.

  • List Recall Team (Name & Responsibility).

  • Has a Product Withdrawal,Product Recall, or Mock Recall Occurred In The Past 30 Days?

  • Add Photo of Recall Log Documenting Each Occurrence in the Past 30 Days.

Documentation & Inspections

  • % Of Production Staff With Food Safety Training (Goal Is 100% After 90 Days Employment).

  • Inspection Report from Regulatory Authority In The Past 30 Days.

  • Add photo of Inspection Report.

  • Have All Infractions Been Addressed And Corrected (Corrective Action Plan Created And Implemented).

  • Organic, Kosher, Gluten-Free or other Certification

  • Add photo of most recent Certifications.

  • Have All Infractions Been Addressed And Corrected (Corrective Action Plan Created And Implemented).



  • Loading Dock Clean, Well-Lit And Free of Debris.

  • Food items are from Approved Source.

  • Deliveries Received At Non-Peak Times, Not Left On The Dock.

  • Sanitation of Trucks Checked and Logged.

  • Deliveries Are Kept At Least 15cm/6in Off Floor.

  • Pallets are Clean, Properly Labelled and Dated.

  • Pallets Observed for Cleanliness & Potential Of Cross-Contamination.

  • Food is Inspected Before Being Placed In Storage.

  • Evidence of Cross Contamination.

  • Policy In Place For Rejection Of Goods.


  • Pallets are Clean, Properly Labelled and Dated.

  • Are Slip Sheets (or Similar) Used With Pallets (Should Cover Entire Pallet)?

  • Sanitation of Trucks Checked and Logged.

  • Is the Loading Dock Clean, Well-Lit and Free of Debris.

  • Is there Evidence of Cross Contamination?

  • Food is Inspected before being placed into Vehicle.


Dry Storage

  • Enter Ambient Air Temperature.

  • Evidence temperatures are monitored and recorded.

  • Adequate Air Cirulation

  • Food And Supplies Are Maintained At 15cm/6in Off Floor.

  • FIFO Product Rotation Maintained

  • Food & Supplies Are Stored At Least 45cm/18in From Sprinkler Heads.

  • Are storage areas well lit?

  • Are protective light shields cover all light sources?

  • Is all food is labelled and dated?

  • Bulk Food Products Are Labeled & Dated If Not In Original Containers.

  • Evidence of leaks and moisture.

  • Is food protected from cross-contamination?

  • Floors are clear of debris, boxes and hazards.

  • All surfaces are clean.

  • Chemicals are stored away from food products & supplies.



  • Drying/Storage Areas For Small Wares Kept Clean And Organized.

  • Only Clean & Sanitized Utensils Are Used For Production.

  • List Sanitizing Method and Concentration.


  • Sanitation Log Maintained.

Equipment And Building Maintenance

  • Building meets local building codes.

  • Floors, walls and ceiling meets local safety codes.

  • Building, Storage Shelves, Counters and Work Surfaces In Good Repair
    (No evidence of flaking paint).

  • Food contact surfaces meet safety standards.

  • Regular Maintenance on building.

  • Water Quality meets Safety Standards.

  • Regular Preventative Maintenance Performed.

  • Inoperative equipment removed from production areas.


  • Only Authorized Cleaning Compounds and Sanitizers In Use.

  • Sanitizer Concentrations meet standards.

  • Chemicals are properly labeled.

  • Chemicals are properly stored.

Power Equipment

  • Only approved equipment is used.

  • Power Equipment is clean and maintained.

  • Power equipment shows no signs of fluid leaks.

Utensils And Equipment

  • Utensils are clean & sanitized.

  • Drawers Are Clean & Sanitized.

  • Racks are clean.

  • Equipment is covered when clean and not in use.

  • Pallets are maintained and clean.


  • Daily Cleaning Schedule In Place.

  • Floor and walls cleaned regularly.

  • Deep cleaning schedule in place.


  • Garbage containers are clean and covered.

  • Garbage containers are emptied as necessary.

  • Boxes and containers are removed.

  • Dumpster is located Away From Points of Facility Entry.

  • Dumpster area is clean.

  • Dumpster lids are closed.



  • Employee Health Poster available.

  • Proper Hand Washing Observed.

  • Staff only wash hands in designated handwash sink.

  • Employees wear appropriate uniform including proper shoes.

  • Hair restraints worn.

  • Fingernails are trimmed.

  • Jewelry is restricted.

  • Disposable Glove Policy Maintained (minimized bare hand contact, cover cuts & sores, changed frequently).

  • Open sores, cuts, or bandages on hands are completely covered while handling food.

  • Staff beverages are covered with a lid and stored away from food prep areas.

  • Eating, drinking or gum Allowed only in designated areas.

  • Appropriate action when coughing or sneezing.

  • Disposable tissues are used and disposed of when coughing or blowing nose.


  • Hand Washing signage displayed.

  • Adequate hand wash stations available and are fully stocked (anti-microbial hand soap, disposable towels and hand sanitizer)

  • Sanitizing solution available in critical areas.

  • Staff lockers available away from food prep area.

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.