Food Safety Control Plan Form
Complete this form to document and monitor your facility's food safety procedures and compliance.
Facility Name
*
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Person Responsible
*
First Name
Last Name
Food Safety Training Completed
*
Yes
No
Handwashing and Hygiene Practices Observed
*
Satisfactory
Needs Improvement
Unsatisfactory
Food Storage Temperatures (°C)
*
Rows
Temperature Recorded
Within Safe Range?
Refrigerator
1
Freezer
2
Hot Holding
3
Allergen Management Procedures in Place
*
Yes
No
Partially
Pest Control Measures in Place
*
Yes
No
Cleaning and Sanitizing Schedule Followed
*
Always
Sometimes
Rarely
Corrective Actions Taken (if any)
Additional Comments or Observations
Inspector/Manager Signature
*
Submit Food Safety Plan
Submit Food Safety Plan
Should be Empty: