Appendix D
Establishment Inspection Report

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Application for consideration as an Establishment under the Canadian Partners in Quality Program (C-PIQ)

Establishment Name:

Address:

Establishment Number (Renewal):

C-PIQ #:

RPW #:

Date of inspection:

Date of previous visit:

Inspector:

Purpose of
Inspection:

For Renewal:

New Application:

RPW Frequency of Inspection Level (for information purposes only):

Reduced

Normal

Tightened

Note: This Registered Establishment Inspection Report is for use for new or renewing C-PIQ establishments. This report may also be used for C-PIQ establishments which are Registered Produce Warehouses (RPW's).

For New and/or Renewal Application Satisfactory Unsatisfactory Comments Correction Dates
Has application been properly completed?        
Has competent, responsible supervisor been identified by the applicant?        
Name of supervisor designated by applicant:        

 

Renewal Only Satisfactory Unsatisfactory Comments Correction Dates
Is certificate posted in conspicuous place?        
Is proper Registered Establishment logo on packaging inventory?
(Note: Applicable to RPW's only. N/A if applied solely at pallet level)		        
Has there been any change in operations or personnel that might affect the registration of the establishment?        

 

Records Renewal Only Satisfactory Unsatisfactory Comments Correction Dates
Accurate records are maintained of produce shipments from the establishment by kind and grade of produce, size of container, date of shipment and number of containers shipped.        
Records are retained for two years.        
A file of all establishment labels is available for inspection.
(Note: Applicable to RPW's only)		        
Annual water test records are maintained and available.        
Pest control records are maintained and available.
(Note: Only applicable if pest control program is referenced in the Company C-PIQ QA Manual).		        

 

Surroundings Satisfactory Unsatisfactory Comments Correction Dates
Land free of debris and refuse.        
Land permits good drainage.        
Not close to any source of pollution.        

 

Establishment Satisfactory Unsatisfactory Comments Correction Dates
Separate from and no direct access to areas where operations are carried out which are incompatible with the handling of food.        
Protected against entrance of insects, birds, rodents etc.        
No room in the establishment used for storage or manufacture of anything that is likely to emit an odour that could affect flavour of the produce.        
Of sound construction, in good repair.        
All construction materials durable and free of noxious constituents.        
Areas with temperature, light and ventilation are suitable for the preservation of produce.        
Adequate means of drainage, waste removal and waste disposal.        
Physical facilities are maintained in a sanitary manner.        
Shatter proof light bulbs and fixtures where produce or packaging material is exposed.        
Adequate supply of potable hot and cold water to serve the water needs of the establishment.        
No connection between the non potable and potable water systems.        

 

Chemical Storage Satisfactory Unsatisfactory Comments Correction Dates
Detergent, sanitizer, food contact lubricant or other chemical agent is properly labelled, stored and used in a manner that prevents contamination of produce or a surface with which produce comes in contact.        

 

Lavatories Satisfactory Unsatisfactory Comments Correction Dates
Able to be kept clean and sanitary.        
Adequate in size and equipment for the number of people.        
Well lighted and ventilated.        
Not leading directly into any room used to handle produce.        
"Wash Hands" sign is clearly posted.        

 

Product Handling Satisfactory Unsatisfactory Comments Correction Dates
Lighting over the grading equipment provides minimum 550 lux.        
No stagnant or polluted water used in the washing or fluming of the product.        
Final rinse water is potable.        
If final rinse water is reused, it is only used for initial washing or fluming of the produce.        
Produce is handled with equipment that is cleaned regularly and maintained in a sanitary condition.        
Adequate facilities and means for cleaning of equipment.        
Operations in relation to the preparation of produce are carried out in a sanitary manner.        

 

Inspection Facilities Satisfactory Unsatisfactory Comments Correction Dates
There is at least 550 lux of light at inspector's point of produce inspection.        
The location is free from vehicular traffic or other hazards.        
There is a suitable grading table.        
An electrical outlet is available to facilitate the use of electronic equipment necessary to carry out a full inspection.        
The inspection room or area has a draft free environment with temperatures maintained between 10 and 20º Celsius.        
Establishment is willing to provide assistance as required to obtain samples and open and close containers and provide other assistance as the inspector requires.        
Waste disposal is provided for the inspector.        

Registration (New or Renewal):

image of checkbox Recommended

image of checkbox Recommendation pending correction of non-compliances

image of checkbox Denied

Inspector's Comments / Observations:

Inspector's Name:

Signature: 

Date:

Name of Establishment
Representative:

Signature: 

Date:

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