1-Sanitation Verification (if in contact w/ product complete verification; if not fill in with N/A)

Verify if tools and parts are sanitized before use

• Yes
• No
• N / A

Enter the count of Tools & Parts IN

Enter the count of Tools & Parts OUT

Verify if equipment is sanitized and ready for production

• Yes
• No
• N / A

Inspected By (Quality Assurance, Operator, or Supervisor on duty)

Production Sign (Operator or Supervisor on Duty)

Maintenance Sign (Mechanic on Duty)

Maintenance Manager Sign (if applicable, if not, sign N/A)

Completion Date