Free FDA-3623a.p65 - Federal

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

FOOD AND DRUG ADMINISTRATION

BAKERY INSPECTION REPORT
1. ESTABLISHMENT NAME AND ADDRESS (Include ZIP code) 2. DATE INSPECTED

3. STATE LICENSE OR PERMIT NUMBER

4. NAME OF OWNER

5. TELEPHONE NUMBER (Include Area Code)

6. NAME OF MANAGER

7. TELEPHONE NUMBER (Include Area Code)

INSTRUCTIONS:

Answer the following questions by checking the appropriate box. Explain "No", answer on continuation sheet(s). Precede each explanation with the item number. Use "N/A" where questions are Not Applicable.

NO.
1. 2. 3. 4. 5. 6. 7. 8.

RAW MATERIAL STORAGE - REFRIGERATED AND NON-REFRIGERATED
Are raw materials stored off the floor and away from walls Are raw materials free of insect infestation Are raw materials free of rodent infestation or adulteration Are raw materials free of contamination from other sources, e.g., birds, moisture, mold, etc. Are raw materials, in other than original containers, clean and contents protected Is plant free from evidence of domestic pets, rodent, insect or bird activity Are refrigerated items stored at proper temperatures If bulk flour handling and storage system is in use: a. Are hose couplings, inside and outside plant, adequately protected from rodents, clean, and in good repair b. Are dust collector or ventilation bags at top of bulk tank clean and insect free c. If system contains inspection ports, were they found free from contamination d. Were tailings from sifting operation free from contamination

YES

NO

MANUFACTURING AREA
9. 10. 11.
Are pieces of food contact equipment (e.g., mixers, conveyors, tables, rounders, racks, pan, etc.) clean and in good repair Is such equipment and its surroundings free from eivdence of rodent or insect activity Are inspection cleaning ports on flour conveyor systems accessible and easy to open PAGE 1 OF 3
PSC Graphics (301) 443-1090

FORM FDA 2681 (2/02)

EF

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INSPECTION CRITERIA NO.
12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.

MANUFACTURING AREA
Are such conveyor systems free from evidence of insect activity Are cloth connecting sleeves clean, tight fitting and insect free Is tailings box on sifter free from evidence of insects Is proofing equipment free from evidence of insects or rodents If baking pans or storage bins are nested, are bottom surfaces clean Is equipment cleaned before use Are miscellaneous utensils, (e.g., pans, spoons, beaters. bowls, etc.,) clean and free from adulterants Are utensils and equipment washing facilities clean and adequate Are cleaning compounds kept in original containers and separate from raw materials Are food/color additives or pesticides used properly Do labels of products covered during inspection comply with the Fair Packaging and Labeling Act Are weighing practices adequate to insure the declared quantity of contents would be achieved

YES

NO

BUILDING AND GROUNDS
24. 25. 26. 27. 28. 29. 30.
Are outside premises free from spillage, trash, etc.. which may attract or harbor rodents or other pests Is the building of suitable construction and generally in good physical repair Are doors and windows leading to outside in good repair, tight-fitting, and closed or screened adequately Are processing and storage areas adequately lighted, ventilated, and reasonably free of odors and condensation Are floors, walls, and ceilings clean and in good repair Does firm maintain a regular cleaning schedule covering both processing and storage areas Are insecticides and rodenticides properly used and stored

TRANSPORTATION FACILITIES
31. 32.
Are vehicles used to transport finished products clean and in good repair Are products properly protected from adulteration during transport

TOILETS, DRESSING ROOMS AND EMPLOYEES
33. 34. 35. 36.
Are toilets and dressing rooms in good repair, clean, properly ventilated, and adequately separated from storage areas Are handwashing facilities clean and supplied with soap, hot water, and sanitary towels Are employees clean and properly clothed, including head covers Do employee practices appear to be satisfactory PAGE 2 OF 3

FORM FDA 2681 (2/02)

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CORRECTIONS AND SAMPLES
37. 38.
If any corrections were made during this inspection or made as a result of a previous inspection (including voluntary destructions, capital improvements, etc.), complete Voluntary Correction section of cover sheet Form FDA 481 (E) - CG. If any samples were collected, list sample numbers and briefly describe samples.

DISCUSSION WITH MANAGEMENT
Indicate individual with whom inspection was discussed. Identify official (name and title) having authority to authorize corrections. Record any recommendations and / or warnings given, and managements responses.

CONTINUATION SHEET
(Use additional sheets as appropriate.)

Need additional space for "Continuation Sheet"?
SIGNATURE OF INSPECTOR DATE

FORM FDA 2681 (2/02)

PAGE 3 OF 3