July 2000	Sanitation Audit Form	Page 1 of 2

Form used for both daily and monthly sanitation activities

Firm Name:____________________________ Address:__________________________________________

Date:_________________________________ Supervisor/Technician:_______________________________

Sanitation Conditions & Practices	Time	Time	Time	Time	Comments
Pre-Op

Pass/Fail

Pass/Fail

Pass/Fail	Monthly

Pass/Fail
1.	Safety of water
A.	City water: annual verification (on file)
B.	No cross-connections between potable and wastewater systems
2.	Condition and cleanliness of food-contact surface
A.	Processing equipment and utensils in suitable condition
B.	Equipment cleaned and sanitized before start-
up
1.	Concentration of chlorine used for sanitizing equipment (ppm)
C.	Product residue removed from equipment during breaks
D.	Ready-to-eat-product equipment cleaned and sanitized during breaks
E.	Gloves and aprons in good repair
3.	Cross contamination
A.	Physical condition of plant and layout of equipment suitable to minimize risk of contamination
B.	Employees' hands, gloves, equipment and utensils that contact unsanitary objects are washed and sanitized before contacting product
C.	Employee in raw-product area wash and sanitize hands, gloves and aprons before moving to cooked-product area

July 2000	Sanitation Audit Form	Page 2 of 2

Sanitation Conditions & Practices	Time	Time	Time	Time	Comments
Pre-Op

Pass/Fail

Pass/Fail

Pass/Fail	Monthly

Pass/Fail
4.	Maintenance of hand-washing, hand-sanitizing and toilet facilities
A.	Adequate supplies
B.	Concentration of iodine in hand dips (ppm)
1.	Front entrance
2.	Rear entrance
3.	Side entrance
4.	Start of line 1
5.	End of line 1
6.	Start of line 2
7.	End of line 2
C.	Toilets are clean and properly functioning
5.	Protection from adulterants (lubricants, fuel, pesticides, cleaning and sanitizing agents, condensates, floor splash, etc.)
A.	Food product
B.	Food-packaging material
C.	Food-contact surfaces
6.	Labeling, storage and use of toxic compounds
A.	Cleaning compounds labeled and stored properly
B.	Lubricants labeled and stored properly
C.	Pesticides labeled and stored properly
7.	Employee health condition
A.	Employees show no signs of medical problems that could compromise product safety
8.	Exclusion of pests
A.	No evidence of pests in plant