Monthly and Daily Sanitation Monitoring Record Examples

Following are example sanitation monitoring forms based on frequency of monitoring the 8 key areas of sanitation. These example forms are only one way to record sanitation monitoring and may not apply to every situation.

"FOR EXAMPLE ONLY"
DAILY SANITATION REPORT

Report Date:____________________

Firm Name:________________________________

Line 1: (Name of product being processed)

Firm Address:______________________________

Line 2: (Name of another product being processed)

_________________________________________

Sanitation Area and Goal		Pre-Op Time:	Start Time:	4 Hour Time:	8 Hour Time:	Post-Op Time:
1) Safety of Water (See Monthly Sanitation Report)
Back Siphonage - Hoses		(circle one) S / U
2) Condition and cleanliness of food contact surfaces (See Monthly Sanitation Report)
Equipment cleaned and sanitized	Line 1:	(circle one) S / U
Equipment cleaned and sanitized	Line 2:	(circle one) S / U
Sanitizer Strength Sanitizer Type:_______________ Minimum Strength: ___ ppm	Line 1:	___ ppm
	Line 2:	___ ppm
Gloves and aprons clean and in good repair	Line 1:	(circle one) S / U
Gloves and aprons clean and in good repair	Line 2:	(circle one) S / U
3) Prevention of cross-contamination (See Monthly Sanitation Report)
Hands, gloves, equipment, and utensils washed / sanitized after contact with unsanitary objects			(circle one) S / U	(circle one) S / U	(circle one) S / U
Employees working on raw products, wash and sanitize hands / gloves / outerwear before working with cooked products				(circle one) S / U	(circle one) S / U
Unpackaged cooked products separated from raw products				(circle one) S / U	(circle one) S / U	(circle one) S / U
4) Maintenance of hand-washing, hand-sanitizing, and toilet facilities
Hand-wash and hand-sanitizing stations adequate
Hand-wash station	Line 1:	(circle one) S / U
Hand-wash station	Line 2:	(circle one) S / U
Hand-sanitizing station Sanitizer Type:_______________ Minimum Strength: ___ ppm	Line 1:	___ ppm		___ ppm	___ ppm
	Line 2:	___ ppm		___ ppm	___ ppm
Toilets clean, properly functioning, and adequately supplied		(circle one) S / U
5) Protection from adulterants and 6) Labeling, storage, and use of toxic compounds
Product protected from contamination			(circle one) S / U	(circle one) S / U	(circle one) S / U
Cleaning compounds, lubricants, and pesticides labeled and stored properly		(circle one) S / U
7) Employee health conditions
Employees do not show signs of medical problems		(circle one) S / U
8) Exclusion of Pests
Pests excluded from processing area		(circle one) S / U
Other area(s)

Additional Comments:
S = Satisfactory
U = Unsatisfactory

Signature (or Initials): ________________________________________________

"FOR EXAMPLE ONLY"
MONTHLY SANITATION REPORT

Report Date:____________________

Firm Name:________________________________

Line 1: Apple juice

Firm Address:______________________________

Line 2: Grape Juice

_________________________________________

Sanitation Area and Goal	Decision	Comments / Corrections
1) Safety of Water
Safe and sanitary source (semi-annual)	(circle one) S / U
No cross-contamination - Hard Plumbing	(circle one) S / U
2) Condition and cleanliness of food contact surfaces
Processing equipment and utensils in suitable condition	(circle one) S / U
3) Prevention of cross-contamination
Physical conditions of plant and layout of equipment	(circle one) S / U

Additional Comments:
S = Satisfactory
U = Unsatisfactory

Signature (or Initials): ________________________________________________

Source: U.S. FDA/CFSAN Office of Field Programs. 2002. Juice HACCP Regulator Training. Cited April 9, 2005. http://www.cfsan.fda.gov/~comm/juiceman.html

Updated: 07/19/07

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Pamela D. Tom, SeafoodNIC Director
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Sea Grant Extension Program
Food Science & Technology Department
University of California
One Shields Avenue, Davis, CA 95616

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