Water X Industries Ltd. Self-Assessment Certification #SAN1681115

• Enter date & time.

  Date

• Employee/Assessor name & signature.

  Sign

• Supervisor name & signature.

  Sign

HACCP System

• List HACCP Committee Members.

• When was the last HACCP Committee Meeting?

  Date

• Scan a copy of the meeting minutes.

  Media

Pest Control

• Is a written Integrated Pest Control Policy in place?

  Yes

  No

  N/A

• Is there evidence of pests?

  Yes

  No

  N/A

Traceability & Recall

• Is a Traceability & Recall Program in place?

  Yes

  No

  N/A

• Is there a Recall Team in place to administer recall event protocols?

  Yes

  No

  N/A

• List the Recall Team.

• Has a Recall Event occurred in the past 30 days?

  Yes

  No

  N/A

• Check if a Mock Recall (be sure HACCPCanada has received all pertinent documents).

• Check if an actual Recall (be sure HACCPCanada has received all pertinent documents).

Receiving Supplies

• Supplies are received clean, dry and undamaged.

  Yes

  No

  N/A

• Damaged product is not received (Rejection Policy).

  Yes

  No

  N/A

• All supplies are immediately stored.

  Yes

  No

  N/A

Mobile Unit & Warehouse Maintenance

• Facility meets local building codes.

  Yes

  No

  N/A

• Floors, walls and ceilings meet safety requirements.

  Yes

  No

  N/A

• Floors and walls cleaned regularly.

  Yes

  No

  N/A

• No evidence of flaking paint.

  Yes

  No

  N/A

• Facility cleaning schedule in place.

  Yes

  No

  N/A

• Regular maintenance is performed on building and equipment (Preventative Maintenance Program).

  Yes

  No

  N/A

Chemical Use & Storage

• Only approved cleaning compounds and sanitizers are used.

  Yes

  No

  N/A

• MSDS Sheets on file as required by WHMIS.

  Yes

  No

  N/A

• Concentrations meet standards.

  Yes

  No

  N/A

• Chemicals are properly labeled and stored.

  Yes

  No

  N/A

Garbage Storage & Disposal

• Refuse and garbage containers are clean and covered when not in use.

  Yes

  No

  N/A

• Garbage containers are emptied as necessary.

  Yes

  No

  N/A

Personal Hygiene

• Employee Health Poster is available.

  Yes

  No

  N/A

• Staff only wash hands in designated hand sinks.

  Yes

  No

  N/A

• Employee Uniform Policy adhered to.

  Yes

  No

  N/A

• Fingernails are trimmed and clean.

  Yes

  No

  N/A

• Hair restraints are worn.

  Yes

  No

  N/A

• Jewelry is restricted.

  Yes

  No

  N/A

• Open sores, cuts, or bandages on hands are completely covered (Glove Use Policy).

  Yes

  No

  N/A

• Staff beverages are covered and kept away from storage areas.

  Yes

  No

  N/A

• Staff take appropriate action when coughing or sneezing.

  Yes

  No

  N/A

• Hand washing signage is displayed at all hand sinks.

  Yes

  No

  N/A

• All hand sink areas are stocked with anti-microbial soaps, sanitizer, and disposable handtowels.

  Yes

  No

  N/A

• Hand sanitizing solution is available in all mobile units and warehouse washrooms.

  Yes

  No

  N/A

• Staff lockers are located away from storage areas and wash bays.

  Yes

  No

  N/A