Self Assessment RJT Blueberry Park Inc. Certification #NRM235122

• RJT Blueberry Park Inc. 25990 48th Ave Aldergrove, BC V4W 1J2
  Address
• Add location
  Address

• Select date

  Date

• Employee/Assessor Name & Signature

  Sign

• Supervisor Name & Signature

  Sign

Pest Control Program

• Written Pest Control Policy In Place.

  Yes

  No

  N/A

• Contracted to Pest Control Company

  Yes

  No

  N/A

• Add Photo of Most Recent Service Report.

  Media

• Evidence of Pests.

  no

  yes

• Building Restricts Access To Pests.

  Yes

  No

  N/A

Traceability & Recall Program

• Traceability & Recall Programs In Place.

  Yes

  No

  N/A

• List Recall Team (Name & Responsibility).

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

  Yes

  No

  N/A

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

  Media

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.

  Yes

  No

  N/A

• Add photo of Inspection Report.

  Media

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

  Yes

  No

  N/A

• Organic, Kosher, Gluten-Free or other Certification

  Yes

  No

  N/A

• Add photo of most recent Certifications.

  Media

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

  Yes

  No

  N/A

RECEIVING

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

  Yes

  No

  N/A

• Food items are from Approved Source.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Sanitation of Trucks Checked and Logged.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Pallets are Clean, Properly Labelled and Dated.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Food is Inspected Before Being Placed In Storage.

  Yes

  No

  N/A

• Evidence of Cross Contamination.

  Safe

  At Risk

  N/A

• Policy In Place For Rejection Of Goods.

  Yes

  No

  N/A

SHIPPING

• Pallets are Clean, Properly Labelled and Dated.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Sanitation of Trucks Checked and Logged.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is there Evidence of Cross Contamination?

  Safe

  At Risk

  N/A

• Food is Inspected before being placed into Vehicle.

  Yes

  No

  N/A

Dry Storage

• Enter Ambient Air Temperature.

• Evidence temperatures are monitored and recorded.

  Yes

  No

  N/A

• Adequate Air Cirulation

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• FIFO Product Rotation Maintained

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are storage areas well lit?

  Yes

  No

  N/A

• Are protective light shields cover all light sources?

  Yes

  No

  N/A

• Is all food is labelled and dated?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Evidence of leaks and moisture.

  Safe

  At Risk

  N/A

• Is food protected from cross-contamination?

  Yes

  No

  N/A

• Floors are clear of debris, boxes and hazards.

  Yes

  No

  N/A

• All surfaces are clean.

  Safe

  At Risk

  N/A

• Chemicals are stored away from food products & supplies.

  Yes

  No

  N/A

Warewashing

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

  Yes

  No

  N/A

• Only Clean & Sanitized Utensils Are Used For Production.

  Yes

  No

  N/A

• List Sanitizing Method and Concentration.

• Sanitation Log Maintained.

  Yes

  No

  N/A

Equipment And Building Maintenance

• Building meets local building codes.

  Yes

  No

  N/A

• Floors, walls and ceiling meets local safety codes.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Food contact surfaces meet safety standards.

  Yes

  No

  N/A

• Regular Maintenance on building.

  Yes

  No

  N/A

• Water Quality meets Safety Standards.

  Municipal

  Non-Municipal, Tested

  Non-Municipal, Untestes

• Regular Preventative Maintenance Performed.

  Yes

  No

  N/A

• Inoperative equipment removed from production areas.

  Yes

  No

  N/A

CHEMICALS

• Only Authorized Cleaning Compounds and Sanitizers In Use.

  Yes

  No

  N/A

• Sanitizer Concentrations meet standards.

  Yes

  No

  N/A

• Chemicals are properly labeled.

  Yes

  No

  N/A

• Chemicals are properly stored.

  Yes

  No

  N/A

Power Equipment

• Only approved equipment is used.

  Yes

  No

  N/A

• Power Equipment is clean and maintained.

  Yes

  No

  N/A

• Power equipment shows no signs of fluid leaks.

  Yes

  No

  N/A

Utensils And Equipment

• Utensils are clean & sanitized.

  Yes

  No

  N/A

• Drawers Are Clean & Sanitized.

  Yes

  No

  N/A

• Racks are clean.

  Yes

  No

  N/A

• Equipment is covered when clean and not in use.

  Yes

  No

  N/A

• Pallets are maintained and clean.

  Yes

  No

  N/A

DAILY CLEANING

• Daily Cleaning Schedule In Place.

  Yes

  No

  N/A

• Floor and walls cleaned regularly.

  Yes

  No

  N/A

• Deep cleaning schedule in place.

  Yes

  No

  N/A

GARBAGE STORAGE and DISPOSAL

• Garbage containers are clean and covered.

  Yes

  No

  N/A

• Garbage containers are emptied as necessary.

  Yes

  No

  N/A

• Boxes and containers are removed.

  Yes

  No

  N/A

• Dumpster is located Away From Points of Facility Entry.

  Yes

  No

  N/A

• Dumpster area is clean.

  Yes

  No

  N/A

• Dumpster lids are closed.

  Yes

  No

  N/A

EMPLOYEE HYGIENE

• Employee Health Poster available.

  Yes

  No

  N/A

• Proper Hand Washing Observed.

  Yes

  No

  N/A

• Staff only wash hands in designated handwash sink.

  Yes

  No

  N/A

• Employees wear appropriate uniform including proper shoes.

  Yes

  No

  N/A

• Hair restraints worn.

  Yes

  No

  N/A

• Fingernails are trimmed.

  Yes

  No

  N/A

• Jewelry is restricted.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Appropriate action when coughing or sneezing.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

FACILITIES

• Hand Washing signage displayed.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Sanitizing solution available in critical areas.

  Yes

  No

  N/A

• Staff lockers available away from food prep area.

  Yes

  No

  N/A