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1、HEALTH AND HYGIENE REPORT FORMMESS / KITCHEN / FOOD STORAGE / / Site/ : Date/ : GENERAL SANITATION总体卫生情况是或否 COMMENTS备注1a. Are there adequate supplies of hot (82 degrees centigrade) and cold water?凉水和热水（82 摄氏度）供应是否充足？b. Has this water been certified as fit for human consumption? (date of the last tes
2、t)水质是否经过检测证明适合生活用水？（上次水质监测的时间）2. Are there adequate cleaning supplies?是否有足够的清洁用具？3a. Are there suitable (and clean) receptacles for the disposal of waste food and debris?有无合适和干净的容器用于收集剩饭和食物残渣？b. Inside 厨房内c. Outside厨房外d. Are waste receptacles areas clean, free from insects, rodents and vermin and cl
3、ose to where will be required残渣容器是否干净，有无招来虫子和啮齿动物现象，是否摆放在合适位置？4. Are all drinking dispensers cleaned once a week?是否对所有饮用器皿每周清洁一次？5. Are all ice machines completely cleaned once a week?是否对所有冰冻设备每周清洁一次？B PERSONEL HYGIENE人员卫生情况Y / N / N.A / /.COMMENTS备注1. Are food handlers with skin infections, sores,
4、heavy colds, eye or ear discharge, diarrhea, vomiting, or other illnesses refraining from handling food until they have recovered?食品加工人员是否在患有皮肤传染病、疼痛症、重度感冒、眼睛或耳朵分泌异物、腹泻、呕吐、或其他不适宜工作的病症期间从事食品加工操作？2. Are all food handlers wearing clean, washable, light- colored protective clothing?食品加工人员是否穿戴清洁、可洗和浅色的工作
5、服？3. Are all food handlers wearing hair nets/caps?食品加工人员是否穿戴发套和帽子？4. Are all food handlers refraining from smoking or chewing gum?食品加工人员有无吸烟和嚼口香糖的行为？5. Are all food handlers refraining from wearing earrings, watches or jeweled rings?食品加工人员有无佩戴耳环、手表和首饰的现象？6. Are all food handlers wearing closed shoes
6、? (No sandals or bare feet?)是否所有的食品加工人员都穿紧口鞋？（不穿凉鞋或赤脚）7.a.Hand washing facilities (with towel) are available and used: 是否配有洗手用品（包括毛巾）及在下列时候是否使用洗手用品：After visiting toilet? 上过卫生间后？b. Upon entering the kitchen and before handling any food or food preparation equipment?进入厨房后在加工食品或操作食品加工设备前？c. In between
7、 handling raw food and cooked food?在生熟食品倒换加工过程中？d. After combing there hair?在梳理头发之后？e. After eating, smoking or blowing their nose?在进食、吸烟或清理鼻子之后？f. After handling waste food or refuse?在处理剩饭或废弃物之后？ KITCHEN AND EQUIPMENT操作间和设备Y / N / N.A / /.COMMENTS备注1. Is the kitchen generally clean and in good orde
8、r?操作间总体卫生是否良好，物品摆放是否有序？2. Is the oven and stove in proper working order?烤箱和炉灶是否工作正常？3. Are all drains covered with metal grates?所有排水渠是否加盖金属网？4. Are the drip pans cleared daily?是否每日清洗沥油罩？5. Is the water in the food heaters changed every week and the containers cleaned with detergent?食品加热设备用水是否每周更换，是否
9、用清洁剂清洗食品加热设备？6. Are the filters for the exhaust fan cleaned daily?是否每日清洁排气扇网罩？7. Is the ice machine clean and in proper working order?冰冻设备是否清洁和正常工作？8. Are all dishes, plates and glasses clean and free from cracks and chips?是否所有的碗、碟、盘子、玻璃杯清洁且无缺损、裂缝现象？9. Is a hand washing sink with soap dispensers rea
10、dily available?厨房是否配备洗手池和肥皂？10. Is the kitchen and dining area are well-lighted?操作间和餐厅照明是否充足？11. Are there any items needing repair (leaking, faucets, bad electrical cables)?厨房有无修缮需要（漏水、接线不良）？12a. Is all shelving made from stainless steel and in good condition?所有盖罩是否为不锈钢材质，并且状况良好？b. Are the tables a
11、nd chairs in good condition?所有桌椅状况是否良好？13 Are there suitable food processors for each stage of food preparation?每一阶段的食品加工是否都有适宜的加工设备？14 Are fire extinguishers installed in the dining area and kitchen?操作间和餐厅是否配备灭火器？15 Is there a first aid kit in the kitchen (including a burns kit)?厨房是否配备急救箱（包括烧伤急救药）？
12、16 Is all food prepared on stainless steel surfaces?是否所有食品都在不锈钢面上烹饪？17 Are all cutting boards clean and made from white plastic? 是否所有的切案板都清洁卫生且用白塑料制成？D REFRIGERATED FOOD冷藏食品Y / N / N.A / /.COMMENTS备注1 Is the refrigerator temperature between one and four degrees centigrade?冰箱的温度是否设置在 1-4 摄氏度？2 Are th
13、e refrigerators thoroughly clean?冰箱是否彻底干净卫生？3 Are the refrigerator overloaded?冰箱工作负荷是否过大？4 Is stored food properly stored (either wrapped or placed in covered containers) and stored on metal or plastic shelving?需存放的食品是否正确储藏（带包装的食品或罐装食品），且采用金属或塑料盖罩？5 Are there any open cans (fruit, juice, tomatoes)?
14、有无打开的罐装食品（水果、果汁、番茄）？E FROZEN FOOD冷冻食品Y / N / N.A / /.COMMENTS备注1 Is the freezer temperature minus eighteen degrees centigrade?冷冻箱的温度是否为-18 摄氏度？2 Are frozen foods defrosted in dedicated chiller units?有无专用的食品解冻设备？3 Is raw meat kept in a different area to that used for cooked meats?生熟肉制品是否分开存放？F HIGH-R
15、ISK FOOD高危食品Y / N / N.A / /.COMMENTS备注They are normally consumed without further cooling which would destroy bacteria. Because most of them content big amount of protein they readily support the multiplication of bacteria. They should be kept apart from new foods.高危食品通常不经过可以杀菌的降温措施而直接被食用。因为这类食品通常含有大量的蛋白质，蛋白质为易滋生细菌的食物，受细菌污染的食物应该和新食物分开存放。Avoid handling these foods after they are cooked.以下食品一经烹饪就要避免再次加工这些食品 All cooked meat and poultry 所有熟肉和家禽肉 Cooked meat products including gravy 熟肉制品，包括肉汁 Milk, cream, artificial cream, custards and dairy products 牛奶、
