Dairy Equipment Cleaning Checklist Form
Complete this form to record and verify all required dairy equipment cleaning tasks.
Date of Cleaning
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Person Completing Checklist
*
First Name
Last Name
Equipment ID or Description
*
Pre-rinse completed
*
Yes
Detergent wash performed
*
Yes
Rinse after detergent
*
Yes
Sanitizer applied
*
Yes
Final rinse completed
*
Yes
Visual inspection for cleanliness
*
Passed
Additional Comments or Notes
Submit Checklist
Should be Empty: