Title Page

  • Conducted on

  • Prepared by

  • Location

Food Premises Information / Inspection Details

  • Proprietors/Directors

  • E-mail address

  • Phone Number

  • Person Interviewed

  • Food Safety Supervisor

  • Food Safety Supervisor Certificate Number

  • FSS Certificate Valid until

  • Number of Staff FTE

  • Type of Inspection

General Requirements

  • 1. Food Business has notified current details to Wentworth Shire Council 3.2.2 Clause 4

  • 2. Food business has notified current Food Safety Supervisor to Wentworth Shire Council Food Act s106

  • 3. FSS Certificate is on the Premises Food Act s106

Hand Washing Facilities

  • 4. Hand wash facility correctly located and adequately sized

  • 5. Hand wash facility accessible

  • 6. Hand wash facility clearly designated

  • 7. Warm running water provided to hand washing facility

  • 8. Single use towels provided near hand wash facility

Food Handler Health Hygiene

  • 9. Hands are washed when they are likely to be a source of contamination

  • 10. Hands, wrists, forearms & fingernails clean

  • 11. Bandages/dressings completely covered with water proof dressings

  • 12. Food handler displaying any signs of illness restricted from food areas

  • 13. Food handlers with long hair tied up

  • 14. Food handlers have skills and knowledge to handle food safely

  • Provide food handlers with the skills and knowledge to handle food safely

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  • 15. Hands are washed before commencing/recommencing work, after using the toilet, coughing, sneezing, smoking, handling raw meat, cleaning etc.

4.0 Food Receival

  • 16. List of suppliers and manufacturers available

  • 17. Food is sourced from licensed businesses and is traceable (meat, seafood, plant and dairy products)

  • 18. Food is received from a licensed vehicle where required (current NSW Food Authority Sticker observed on vehicle)

  • 19. All food received is in good condition, with no damage to packaging and no signs of contamination

  • 20. Temperature checks are carried out upon receival and recorded

  • 21. Dry goods, chemicals, packaging are delivered at room temperature

  • 22. Unpackaged Ready to Eat (RTE) food separate from raw foods.

  • 23. No food is in direct contact with floor

Food Handling Controls

  • 24. Food protected from the possibility of contamination; food receipt, storage, preparation, display and transport

  • 25. Potentially hazardous food (PHF) is under temperature control: food receipt, storage, display and transport; less than 5 degrees or above 60 degrees. Frozen food is hard frozen

  • 26. Processing of foods; take all practicable measures to process only safe and suitable food, prevent liklihood of contamination, use process steps if necessary

  • 27. Cooked PHF is cooled rapidly (2+4 hr rule); items thawed correctly and processed quickly

  • 28. Reheating PHF is rapid - oven, stove top or microwave but not bain marie

  • 29. Self serve food bar is supervised, has separate utensils and sneeze guard clause

  • 30. Food wraps and containers will not cause contamination

  • 31. Food for disposal is identified and separated from normal stock

Cleaning and Sanitising & Maintenance

  • 32. All food contact surfaces are clean and serviceable

  • 33. All food contact surfaces are subject to a cleaning and maintenance program

  • 34. Eating and drinking utensils clean

  • 35. Premises, fixtures, fittings and equipment maintained to an appropriate standard of cleanliness

Design and Construction

  • 36. General design and construction of premise appropriate

  • 37. Adequate supply of potable water available

  • 38. Effective sewage and waste water disposal system

  • 39. Adequate storage facilities for garbage & recyclables

  • 40. Premises has sufficient lighting

  • 41. Floors are able to be effectively cleaned, are appropriately designed and constructed and do not permit harbourage of pests

  • 42. Walls, ceilings are sealed and able to be effectively cleaned, are appropriately designed and constructed and do not permit harbourage of pests

  • 43. Sufficient ventilation provided within the premises

  • 44. Premises has adequate storage facilities (personal items, food, chemicals)


  • 45. Food labelling complies with the Food Standards Code 1.2

  • 46. For 'Standard Food Outlet', nutritional information displayed

  • 47. Food business is aware of the Raw Egg Guideline

  • 48. Food business is aware of its obligations regarding allergens

Animals and Pests

  • 49. Animals not permitted in areas where food is handled

  • 50. Practical pest exclusion measures used (screens)

  • 51. Practical measures to eradicate and prevent harbourage of pests (housekeeping, stock rotation, pest control)

  • 52. No signs of infestation or rodent activity in premises

Further Action

  • Further action required

  • Comments

Fees to be Charges

  • Inspection Fee

  • Administration Fee

Acknowledgement of Report - I have read this report and understand the contents

  • Owner/employee signature

  • Officers Name

  • Wentworth Shire Council

  • Officers Signature

  • NB: Assessment report contains findings from date/time of inspection only

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. You should independently determine whether the template is suitable for your circumstances.