Food premises inspection form

1Initial details

2Food establishment details

3Food hygiene rating score

4Food standards scoring

5Follow-up actions as required/Referrals

6Physical inspection

7Structure & cleaning requirements

8Confidence In management

9Food standards

10Records examined on site

11Health & safety

Name of the officer(Required)

Civica reference number

Date(Required)

Day

Month

Year

Time (24hr)(Required)

Hours

Minutes

Type of Intervention(Required)

Full inspection

Partial inspection

Revisit

FHRS re-rating

Complaint

Sampling

Other

Please specify(Required)

Food establishment details

Trading name

Premises address

Find addressSelected address

Registered Business name

Registered address

Address Line 1 Address Line 2 City County Postcode

Company type

Ltd Co

Plc

Partnership

Sole trader

Charity

Other

Please specify

Name(s) of FBO

Contact number

Establishment type

Does FBO prepare foods on premises and sold to other businesses?

Yes

Do other FBOs use this premises for commercial catering purposes?

Yes

Description of business operation

Approved premises?

Yes

Specify: processor of POAO, etc

PA agreement

New business

New ownership

New trading name

New operation

Please specify

Opening times

Service times

Number of staff

Responsible food safety staff

Person interviewed

Customers vulnerable group?

Yes

Please specify

Number of meals daily

Does the food business undertake any of the following

Cook/Chill

Rare cooked meats/steak

Handling Raw Meats

Raw eggs dishes

Ready To Eat Foods

Pre-packed For Direct Sale

Sushi (all raw seafoods)

Open high risk foods

Sashimi/Tatare/Raw Meats

Sou-vide/Low Temp

Vacuum Packing/MAP

Other

Please specify

Brief description, summary or notes about food establishment

Food hygiene rating score

Food hygiene

Previous Risk Category FHRS

Type and method of food handling(Required)

Method of processing high risk foods(Required)

Consumers at risk(Required)

Vulnerable Group(Required)

Food Hygiene and Safety(Required)

Structure including cleaning(Required)

Confidence in management(Required)

Significance of risk(Required)

Total

FHRS(Required)

Food standards

Inherent Risk Factors

Scale of supply(Required)

Ease of compliance(Required)

Complexity of supply chain(Required)

Responsible for information(Required)

Potential for product harm(Required)

Average score

Compliance Risk Factors

Management system and procedures(Required)

Allergen Information(Required)

Current level of compliance(Required)

Confidence in management(Required)

Average score

Follow-up Actions as required/Referrals

Revisit

HEPN

HIN

Warning letter

Verbal advice

AES

NFA

Fire Authority referral

Trading Standards referral

Health & Safety referral

Other referral

Revisit date(Required)

Please specify

FHRS rating decided on site?

Yes

FHRS sticker left on site?

Yes

Comments/notes

Physical inspection

Food Hygiene & Safety Requirements

Personal hygiene practices

Hygienic use of hand gloves

Clean protective clothing/apron

Regular hand wash

Jewellery off

Staff Fit to work policy

Hairnet/hat

Finger nails clean?

Beard net

Other

Please specify

Managing cross contamination

Clear separation of raw meats and other foods

Batch prep/cooking

Preparation zones

Designated food washing sink

Dual equipment (with RTE)

Use of colour coded utensils, knives, boards etc.

Use of (BSEN1276 compliant sanitiser & contact time)

Multi-use tea towels

Disposable paper towel

Are Food handling practices satisfactory (if applicable)

Defrosting practices

Food protection practices

Food storage practices

Food service practices

Notes

Temperature Control

Refrigerator / Walk-in chiller

Yes

Temperature

Deep freezer / Walk-in freezer

Yes

Temperature

Cold display

Yes

Temperature

Cold display - 4hr rule applied?

Yes

Hot holding

Yes

Temperature

Hot holding - 2hr rule?

Yes

Cook/Cool

Yes

Temperature

Cook/Cool - 90 min rule?

Yes

Suitable/satisfactory space & technique for cooling?

Yes

Blast chiller in place

Yes

Re-heating method

Yes

Method

Thermometer in place & good working order?

Yes

Are there (non-expired) probe wipes in place?

Yes

Is device calibrated (hot/ice-cold water test)?

Yes

Notes

Physical inspection

Structure & cleaning requirements

Cleaning standards

including equipment: dual usage utensils, mincers, vacuum packer etc., 2 stage cleaning and sanitising where applicable

Structural repair

walls, floors, ceiling

Design & layout

flow, space, access restrictions, zone/separation

Lighting

Ventilation

[mechanical/natural], effective for type of premises?

Water supply/drainage

Waste disposal arrangement

General waste

Waste oil

Animal waste

Waste notes seen

Pest control

Contract

Self-monitoring

Details of pest contractor and latest pest control report

Evidence of Pest Activity seen

Yes

Detail

Mice

Rats

Cockroaches

Ants

Fruit flies

Bottle flies

Pigeons

Other

Please specify

Location found

Dedicated WHB?

Yes

Satisfactory Alternative?

Easy to access?

Yes

Wash hand basin

Hot water

Soap

Hand dryer

Connected to main drain

Staff toilet / changing facility

Hot water

Soap

Hygienic hand dryer

Good repair

Clean

Changing facility

Locker

Lobby

Vent

Notes

Washing facilities

Kitchen sink

Food only sink

Other cleaning facility

Dry Storage facilities

Sound structure

Food stored on shelves/pallets

Cleanliness

Vent

Lidded container

Easy accessibility for cleaning & pest monitoring

Sufficient storage space

Separate

Confidence In Management

(assess food safety management system, documentation, records etc.)

Food Safety Management System

In-house system

SFBB

Documented HACCP

None

Pre-requisite Programs

Other

Primary Authority

NCASS

FSMS Consultancy

Established Internal/External Audits

Pre-requisite programs: are these sufficient to control all hazards?

Yes

Other: please specify

Article 5

Are all potential hazards identified

Yes

Comments

CCPs identified

Yes

Comments

Monitoring of CCPs

Yes

Comments

Corrective Actions established

Yes

Comments

Verification procedures in place

Yes

Comments

Food Safety System Review process in place

Yes

Comments

Traceability

Reputable/vetted suppliers

Yes

Supplier Ordering System in place

Yes

Invoices/delivery notes documented

Yes

Batch Coding system in place

Yes

Product recall/withdrawal procedure in place

Yes

Able to contact customers

Yes

Staff training

Food /Hygiene Level 2

Training in SFBB

HACCP training

Employee supervision

In-house training

Allergy awareness training

Other

Please specify

Stock control

Date coding practices seen

FIFO practices seen

Use-by dates checks

Records

Fit-for-purpose

Up-to-date (within 4 weeks)

In one place

Easy to access

Food standards

Please select

Loose food sold

Pre-packed food sold

Pre-Packed food sold

GMO ingredients used [customer notification required]

Allergen awareness

Allergen signage

Allergen matrix

Online

Leaflets

Staff

Natasha’s Law compliance

Food made to dietary requirements (e.g. care establishments)

Name & allergen sticker on takeaway packs

Food claims

Homemade

Organic

Fresh

Vegan

Vegetarian

Gluten free

Kosher/Halal

Health claims

Proof of claim

Food labelling (fbo own pre-packed for direct sale products)

Name of food

Yes

Description of food

Yes

List of full ingredients

Yes

Allergens highlighted in bold

Yes

Date/shelf life

Yes

Other info

nutrition info, QUID, storage, instructions of use, weight

Retailer

Does fbo sell food from outside the UK

Yes

Is the labelling in English

Yes

Are alternative English labels stickers used

Yes

Distance selling

Allergen sticker

Tamper proof

Online platform

Own website

Telephone

Comments/Notes

Records examined on site (not older than 4 weeks records)

Records examined on site

Fridge/Freezer temperatures

Cooking temperatures

Hot holding food temperatures

Probe calibration records

Cleaning schedule

Delivery checks

Waste Management

Supplier list

Staff Fit to Work Policy

Training records

Pest control records

Opening/Closing checks

Waste oil

Allergen Information

Invoices

Related Food Stds Records

Health & safety

Matters of immediate concern

Notes