Food Pantry Inspection Form
Use this form to document a food pantry inspection, including safety, sanitation, storage, inventory, accessibility, and follow-up actions.
Pantry Identification
Pantry Name
*
Pantry Location / Address
*
Contact Person or Manager Name
Inspection Date
*
-
Month
-
Day
Year
Date
Inspection Time
Hour Minutes
AM
PM
AM/PM Option
Inspector Name
*
Inspection Scope and Operational Status
Type of Inspection
*
Routine Inspection
Follow-up Inspection
Complaint-based Inspection
Opening Readiness Check
Other
Pantry Operating Status at Time of Inspection
*
Open
Closed
Partially Operating
Notes on Special Circumstances
Food Safety and Storage Conditions
Refrigeration Working Properly
*
Compliant
Non-compliant
Not applicable
Freezer Working Properly
*
Compliant
Non-compliant
Not applicable
Dry Goods Stored Off the Floor
*
Compliant
Non-compliant
Not applicable
Temperature Monitoring Present
*
Compliant
Non-compliant
Not applicable
Cold Items Separated from Room-Temperature Items
*
Compliant
Non-compliant
Not applicable
Food Sealed and Undamaged
*
Compliant
Non-compliant
Not applicable
Spoiled or Expired Food Present
*
No
Yes
Not applicable
Sanitation and Pest Control
Floors clean and free of debris
*
Yes
No
Not Applicable
Shelves and storage surfaces clean
*
Yes
No
Not Applicable
Trash and waste are properly managed
*
Yes
No
Not Applicable
Handwashing sink area available, if applicable
Yes
No
Not Applicable
Pest evidence observed
*
Rodent droppings
Insects
Gnaw marks
Nests
None observed
Other
Sanitation and pest control comments
Inventory and Expiration Check
Are expiration dates checked regularly?
*
Yes
No
Not Observed
Were any expired items found?
*
Yes
No
Not Observed
Was any damaged packaging found?
*
Yes
No
Not Observed
How is inventory organized?
By category
First-in, first-out (FIFO)
By expiration date
Other
Items needing removal or review
Accessibility and Client Service Readiness
Entrance and access path usable
*
Adequate
Needs improvement
Not applicable
Signage visible and clear
*
Adequate
Needs improvement
Not applicable
Waiting or distribution area organized
*
Adequate
Needs improvement
Not applicable
Hours of operation posted
*
Adequate
Needs improvement
Not applicable
Accommodations for mobility needs
Adequate
Needs improvement
Not applicable
Accommodations for language needs
Adequate
Needs improvement
Not applicable
Notes on access barriers
Staffing, Training, and Documentation
Do staff and volunteers on site understand basic pantry procedures?
*
Yes
Partially
No
Not observed
Are required logs and checklists available and in use?
*
Yes
No
Not applicable
Are incident and maintenance records up to date?
*
Yes
Partially
No
Not available
Number of staff and volunteers present during inspection
Findings, Corrective Actions, and Sign-off
Overall Inspection Result
*
Pass
Pass with Corrections
Fail
Needs Follow-up
Priority Issues Found
Corrective Actions Required
Recommended Follow-up Date
-
Month
-
Day
Year
Date
Inspector Signature
Submit Inspection
Submit Inspection
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