FORMULIR LAPORAN KESEHATAN DAN KEBERSIHAN

RUANG MAKAN / DAPUR / TEMPAT TINGGAL / BINATU

HEALTH AND HYGIENE REPORT FORM
MESS / KITCHEN / QUARTERS / LOUNDRY

Site : Date:

COMMENT & RECCOMENDATION

KONDISI
CONDITION COMMENT RECCOMENDATION FOLLOW UP BY

A SANITASI UMUM
GENERAL SANITATION
- Generally sanitation at camp/living quarter clean
enough, but some mess need additional waste
bin, because the waste always full and the
removed process of waste not have regularly
schedule.
- Please provide additional waste
receptacles
- Please always remove waste
maximize 24 hours
- Motivate all employee to elide waste
in the suitable places ( waste
receptacles)

B KEBERSIHAN PERORANGAN
PERSONAL HYGIENE
C DAPUR DAN PERALATAN
KITCHEN AND EQUIPMENT
Kitchen crew
- No one food handlers have medical
certificate which indicate they fit to work
as food handlers.
- All food handlers not wore hair net, and
they wore ring and wrist watch when
handling foods.
- The Kitchen room was not standard,
because it was not closed enough, flies
and dust free come and out.
- There was adequate supply of water for
cooked, but the water not tested yet.
- Please all food handlers have Medical
check up, to make sure they do not
have infection diseases
- Please use hair nets to prevent food
contamination from the food
- Please take off wrist watch and ring
when handling food
- Please did hand washing in all
situation as follow:
1. After visiting the Toilet.
2. Upon entering the kitchen and
before handling food
3. In between handling raw food and
cooked food
4. After eating, smoking or blowing
their nose
5. After handling waste food
- Please always cover all cooked foods
to minimize food contamination
- Plan to water test at kitchen Mayataka
to make sure is fit for human
consumption
 - No water heater facilities to clean up
dishes and other food prepared
equipment
- Cutting board look dirty and only have
one
- Kitchen do not have Refrigerator
- Please provide new cutting boards
and use it separate between meat and
vegetables.
- Please provide Refrigerator

D MAKANAN YANG DIBEKUKAN - The cover sheet some of frozen food - Please routinely clean up Freezer
FROZEN FOOD looks dirty and not packed well. - Please use FIFO system (first in first
- out)

E GUDANG MAKANAN KERING
DRY FOOD STORAGE
- Dry food storage looks dirty and not tidy
enough
- Found sugar and wheat at sack put direct
on the floor and opened.
- All canned food in good condition and
have expiry date
- Please regularly clean up dry food
storage
- Sugar, wheat and rice in the sack
must put on rack, not directly on the
floor, and always close.
- Please use FIFO system

G PENCEGAHAN UMUM - Found some cooked food not well-cover, it will - To prevent cooked food from contamination, Mayataka
KERACUNAN MAKANAN Contaminate with Flies and dust please make sure all cooked food cover well.
GENERAL FOOD POISONING
PREVENTION

Inspected by : Date :

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