Zone Self Assessment Inspection

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

Zone 1-Employees Locker Room

• Is the Floor Clean?

  Yes

  No

  N/A

• Are the Lockers Clean?

  Yes

  No

  N/A

• Is there evidence of Pest activity?

  Yes

  No

  N/A

• Is all Lighting in order?

  Yes

  No

  N/A

Zone 2 Employee Lunch Area

• Are Floors Clean?

  Yes

  No

  N/A

• Yes

  No

  N/A

• Are the Walls Clean?

  Yes

  No

  N/A

• Are the Applicances and Cooler Clean?

  Yes

  No

  N/A

• Are the tables Clean?

  Yes

  No

  N/A

• Is the Area Free of Pest activity?

  Yes

  No

  N/A

Zone 3- Office

• Are the Floors Clean?

  Yes

  No

  N/A

• Are there Enough Hairnets?

  Yes

  No

  N/A

• Is the area free of Pest Activity?

  Yes

  No

  N/A

• Is All Lighting in order?

  Yes

  No

  N/A

• Is Men's Rooms Properly Cleaned?

  Yes

  No

  N/A

• Is Ladies Room Properly Cleaned?

  Yes

  No

  N/A

• Does Handwash Sink Have proper Soap and Towels?

  Yes

  No

  N/A

Zone 4- Small Mixing Area

• Are Floors Clean?

  Yes

  No

  N/A

• Are Walls Clean?

  Yes

  No

  N/A

• Are Tables Clean?

  Yes

  No

  N/A

• Are the machines Free of Cobwebs or pest activity?

  Yes

  No

  N/A

• Is equipment clean and in working order?

  Yes

  No

  N/A

• Are GMPS being followed?

  Yes

  No

  N/A

• Any Notes?

Zone 5-Large Mixing Area

• Are the Walls Clean?

  Yes

  No

  N/A

• Are the floors Clean?

  Yes

  No

  N/A

• Is the equipment functioning properly?

  Yes

  No

  N/A

• Are all Fly Lights on and Working?

  Yes

  No

  N/A

• Are All GMPS Being Followed?

  Yes

  No

  N/A

• Observations?

Section 6- Three Compartment Sink and Ice Machines

• Is there Area Clean?

  Yes

  No

  N/A

• Are all Chemical Stations working properly?

  Yes

  No

  N/A

• Are the Ice Machines free of Mold and Mildew?

  Yes

  No

  N/A

• Is the Area Free of Pest Activity?

  Yes

  No

  N/A

Section 7-Large Rolling Area

• Is the machine clean and properly functioning?

  Yes

  No

  N/A

• Are all employees following GMPS?

  Yes

  No

  N/A

• Observations?

• Is all lighting in Working Order?

  Yes

  No

  N/A

• Is the are Free of Pest Activity?

  Yes

  No

  N/A

Zone 8-Retarder

• Are Floors Clean?

  Yes

  No

  N/A

• Are all Fans Clean and Working?

  Yes

  No

  N/A

• Is Temperature being monitored properly?

  Yes

  No

  N/A

• Are all racks properly covered?

  Yes

  No

  N/A

• Are all allergens segregated?

  Yes

  No

  N/A

Zone-9 Oven Areas

• Are the Floors Clean?

  Yes

  No

  N/A

• Are the walls Clean?

  Yes

  No

  N/A

• Are all seed Containers labeled?

  Yes

  No

  N/A

• Are all planks being checked?

  Yes

  No

  N/A

• Is the area free of Pest Activity?

  Yes

  No

  N/A

• Are the fly lights on and working?

  Yes

  No

  N/A

• Are all GMPS being followed?

  Yes

  No

  N/A

• Observations?

Zone 10-Packing Area

• Are the floors Clean?

  Yes

  No

  N/A

• Is the Netting Separating the Ingredient Area Clean?

  Yes

  No

  N/A

• Is metal detector in use?

  Yes

  No

  N/A

• Are all packing areas off the floor?

  Yes

  No

  N/A

• Are the table clean and neat?

  Yes

  No

  N/A

• Are All GMPS Being Followed?

  Yes

  No

  N/A

• Observations?

Zone 11-Slicing and Storage

• Is the area clean?

  Yes

  No

  N/A

• Are the Slicers Clean and working?

  Yes

  No

  N/A

• Are all ingredients properly labeled?

  Yes

  No

  N/A

• Observations

Zone 12- Silo Side Storage

• Is all Flooring Clean?

  Yes

  No

  N/A

• Is All Lighting in Working order?

  Yes

  No

  N/A

• Is the Rolling Gate Fully Closed and functioning?

  Yes

  No

  N/A

• Is the Food Defense Gate Closed?

  Yes

  No

  N/A

• Are All Ingredients Properly Stored and Labeled?

  Yes

  No

  N/A

• Are there any Mops or Cleaning Chemicals Stored Properly?

  Yes

  No

  N/A

• Is the area Free of Pest Activity?

  Yes

  No

  N/A

• Are All GMPS Being Followed?

  Yes

  No

  N/A

• Is the Silo Surface Clean and free of Leaks?

  Yes

  No

  N/A

Zone 13- Freezer Side Storage

• Is all Lighting in Working order?

  Yes

  No

  N/A

• Are the Floors Clean?

  Yes

  No

  N/A

• Are the Plastic Strips Cleaned?

  Yes

  No

  N/A

• Is the Rolling Gate Closed and Functioning?

  Yes

  No

  N/A

• Is tools and storage areas neat and safe?

  Yes

  No

  N/A

• Is Freezer Properly functioning?

  Yes

  No

  N/A

• Are All GMPS Being Followed?

  Yes

  No

  N/A

• Are all Chemicals locked in Maintenance Cage?

  Yes

  No

  N/A

• Observations?

Zone 14- Frontage

• Are the waste Containers neat and orderly?

  Yes

  No

  N/A

• Are all Weeds and debris removed?

  Yes

  No

  N/A

• Are Bait Stations UnDamaged?

  Yes

  No

  N/A

• Are Rolling Gates Down and Functioning?

  Yes

  No

  N/A

• General Observations

Conclusions

• General Summary

Date

• Select date

  Date

• Signature

  Sign