Sanitation Test Verification Checklist Form
Complete this checklist to verify sanitation test results and ensure compliance with established hygiene standards.
Date of Verification
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location/Area Tested
*
Name of Person Conducting Verification
*
Sanitation Checklist
*
Rows
Pass
Fail
N/A
Cleanliness of surfaces
1
2
3
Proper chemical usage
4
5
6
Equipment sanitized
7
8
9
Waste disposal practices
10
11
12
Personal protective equipment used
13
14
15
Overall cleanliness rating
*
1
2
3
4
5
Were all required sanitation procedures followed?
*
Yes
No
Partially
If any procedures were not followed, specify which ones:
Corrective actions taken (if any):
Additional comments or observations
Verification status
*
Pass
Fail
Submit Verification
Should be Empty: