| Date of Inspection: |
| Name of Business: |
| Distribution of Product: |
| | Only local | | Locally and Overseas |
| Treated Capacity of Plant: |
| Design Actual |
| Year Started Operation: |
| Security of Plant |
| Fenced | Yes | | | No | | |
| | | | | | |
| Security Guard | Yes | | | No | | |
| Person in Charged: |
| Payment of public Health License for Year |
| Yes | | | No | | |
| No. of Employees: Male Female |
| I | PERSONNEL |
| 5 | Workers with infections restricted/valid Health certificate All employee properly clad with: |
| 1 | • Hair Restraint |
| 1 | • Apron |
| 1 | • Face mask |
| 1 | Hand washed and clean, good hygiene, practices |
| II | EQUIPMENT AND UTENSILS |
| 2 | Proper handling and storage of sterilized container and closures. |
| 2 | Bottle area completely separated from other areas of the plant and has self-closing doors. |
| 2 | Equipment, containers and closure are sanitized with steam or chemical agent |
| 2 | Residue of chemical sanitizing agents thoroughly rinsed from equipment and containers. |
| II | EQUIPMENT AND UTENSILS – continued |
| 5 | Surfaces of all equipment, utensils, pipes-lines and valves that come into contact with treated water clean and sanitized |
| 2 | Reusable retail plastic container and closure thoroughly cleaned and sanitized prior to reuse |
| III | TREATMENT PROCESS |
| 5 | Filtration, activated carbon, ultraviolet disinfection, reverse osmosis, ozonation, storage. |
| 1 | Schematic - site (facility) diagram |
| 1 | Schematic - water treatment diagram/process |
| 1 | Schematic - bottling process diagram |
| 1 | Equipment specifications |
| 5 | Recall plan |
| 5 | Storage tank holding the product before, during and after processing clean, adequately protected from contamination |
| IV | TOILET FACILITIES |
| 2 | Number, Convenient, Accessible, Designed and Installed |
| 2 | Toilet rooms enclosed, Self – Closing doors, fixtures good repair, clean hand cleanser, hand drying device provided, proper waste receptacles. |
| V | GARBAGE/REFUSE DISPOSAL |
| 1 | Containers covered and adequate number |
| 1 | Outside storage are enclosed, properly constructed, clean |
| VI | PEST CONTROL |
| 4 | Presence of insects/rodents: outer openings protected, pest control measures applied |
| VII | PHYSICAL PLANT |
| 2 | Bottling room and plant constructed and design |
| 2 | Floors constructed, drained, clean, good repair, covering installed, dustless cleaning methods walls, ceiling, attached equipment constructed, good repair, clean surfaces, dustless cleaning methods |
| Lighting |
| 1 | Fixtures shielded |
| 1 | Lighting provided as required |
| Ventilation |
| 1 | Ventilation in plant sufficient to prevent condensation |
| Dressing Room |
| 1 | Room clean, lockers provided |
| 1 | Facilities clean |
| VIII | QUALITY ASSURANCE |
| 5 | Regular performance of bacteriological and chemical analysis: |
| (a) In house |
| (b) Third party laboratory |
| 2 | Preventive Maintenance |
| 1 | Record keeping |
| 2 | Source and product water quality test results and records |
| 2 | Batch number and expiration date indicated on each container |
| IX | STORAGE FACILITIES |
| 1 | Faulty Tanks/Reservoir |
| 2 | Leaks in the pipe line |
| 2 | Site(s) adequately secured |
| 2 | Surface coating in contact with water acceptable |
| 2 | Tanks/Reservoir protected against corrosion |
| 2 | Tanks/reservoir are cleaned frequently |
| 1 | Air vents and overflow protected by screen |
| 2 | Are tanks disinfected after repairs |
| X | SOURCES |
| 2 | Springs: Source protected by masonry box to reduce contamination |
| Municipal: No other appurtenances connected to taps used for filling storage tanks |
| X | SOURCES |
| 2 | Spring: Masonry protecting the spring source faulty |
| Municipal: Tap head free of leaks |
| 1 | Spring: Air vented and overflow on masonry box |
| Municipal: Tank vents and overflow protected |
| 2 | Spring: Limited animal access to within 30ft./(10m) radius of the spring source |
| Municipal: Limited access to tank filling area. (Only authorized individuals) |
| 3 | Spring: Absence of pollution source above the spring |
| Municipal: The extraction or collection of water conducted safely hence preventing other than the intended water from entering the tank |
| XI | TRANSPORTATION |
| 2 | Vehicles used to transport finished products adequate, clean, and in good repair |
|
| *Critical items requiring immediate action | Rating score (“100”) Less weight of items violated | |
| |
| ENVIRONMENTAL HEALTH OFFICER |