Food Contact Surface Inspection Checklist Form
Document inspections of food contact surfaces in food-service and food-handling environments.
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Time
*
Hour Minutes
AM
PM
AM/PM Option
Location/Area
*
Inspector Name
*
First Name
Last Name
Surface/Equipment Inspected
*
Surface Cleanliness Status (check all that apply)
*
Clean
Dirty
Needs Attention
Visible Contamination or Presence of Residue
*
No visible contamination
Residue present
Other (describe in notes)
Sanitizing or Disinfecting Status
*
Sanitized/Disinfected
Not Sanitized
Needs Re-sanitizing
Corrective Action Needed
*
No action needed
Immediate cleaning required
Re-sanitizing required
Other (describe in notes)
Inspection Outcome / Notes
Submit Inspection
Should be Empty: