If premises includes outlets such as fish shops, butchers ...€¦ · Self-Assessment for Greengrocer Circle the correct answer(s) or fill in the blanks. (Do not leave anything out)

For Office Use

FPR No: ________

Section A: General Information according to the Food Premises Register

Identity Card: Contact Number:

Email Address:

Self-Assessment for Greengrocer

Circle the correct answer(s) or fill in the blanks. (Do not leave

anything out)

If premises includes outlets such as fish shops, butchers etc a separate self-assessment form

specific to that trade is to be completed.

Company Name

Company Registration

Number

Name & Surname of person

responsible of the premises:

Name of Premises:

Address of Premises:

Locality:

In Annex 1 Enter the details of all employees including their identity card number and job

description. Food Handlers Category (A or B) and the date of expiry. Mark not applicable if employee

is not a food handler.

Section B according to CAP. 343 Act of Employment and Training Services & Chapter

449 Food Safety Act

Write down the total number of workers working in your business below:

Full Time: Casual Workers:

Part Time: Other: (Please Specify)

1.1

1.4

1.5

1.6

2.1

2.2

2.3

NO

For office use only:

NO


Section C according to Chapter 449 Food Safety Act

1.3

Is sink for washing of equipment provided? Note: Only applicable if you are

selling open foods such as delicatessens, confectioneries, hot snacks or

slicing/trimming of fruits/vegetables.

YES NO

Not Applicable

Go to 1.5


1.2

Do you have a Cleaning Schedule showing frequency, method of cleaning and

personnel responsible for cleaning? Note: Cleaning Schedules and records

are to be available during the inspection.

YES NO

Not Applicable


Part 1: Cleaning

Are your premises clean? YES

Is sink for washing of equipment provided with hot and cold water? YES NO


Are walls in good state of repair? Note: Smooth, impervious, not cracked and

no flaky paint. YES NO

Part 2: Design and Layout

Is the design, size and layout adequate to prevent risk of contamination? YES NO


Are cleaning materials being stored separately from food items? YES NO


Are cleaning materials clearly labelled? YES


Is floor in sound condition? Note: Smooth, impervious and not cracked. YES NO


2.4

2.5

2.6

2.7

2.8

2.9

2.11

2.12

2.13

2.14


Is ceiling in good state of repair? Note: No mould and no flaky paint. YES NO


Is all lighting covered with shatterproof material including that in display

counters? Note: Only applicable where open food is stored or handled.YES NO

Are all windows, doors and other openings which lead to the outside

environment, excluding service doors/windows, provided with clean/un-torn

insect screens which can be easily removed for cleaning?

YES NO


Are all rooms properly ventilated? Note: Either windows/doors or

mechanically ventilated.YES NO


Is the height of your premises adequate? YES NO



Is all lighting working and adequate in all areas of your premises including

that in storage areas and bathrooms? YES NO


2.10

Is a wash hand basin provided in close proximity where open food is handled?

Note: Only applicable if you are selling open foods such as delicatessens,

confectioneries, hot snacks or slicing/trimming of fruits/vegetables.

YES NO

Not Applicable

Go to 2.13


Are “No Smoking Signs” provided? YES NO


Is a “Wash your hands” sign provided above all wash hand basins? YES NO


Are all wash hand basins supplied with cold and hot water at a suitably

controlled temperature, hand washing and hand drying facilities?YES NO

Are premises provided with a toilet room? YES NO


2.15

2.16

2.18

2.19

2.20

2.21

2.22

2.23

If you answered No to the previous question go to Part 2.20

Is toilet including flushing apparatus being kept in sound condition? YES NO


Are all drains working properly? Note: No leakages or blockages. YES NO

Are all toilet rooms provided with a regularly drained wash hand basin

supplied with cold and hot water at a suitably controlled temperature, hand

washing and hand drying facilities?

YES NO


Is the drainage system properly designed so as to prevent any risk of

contamination? YES NO


Is toilet room provided with a window or an extractor fan that works? YES NO


Is anteroom provided with a window or an extractor fan that works? YES NO


2.17

Is toilet room provided with an adequately sized anteroom (Area before

entering toilet room)? Note: Do not store food items or food contact material

in this space. If toilet is located in yard no anteroom is required thus mark Not

applicable

YES NO

Not Applicable

Go to 2.19


If you answered No to the previous question go to Part 3

Is loading/unloading area provided with a ventilated and well lighted

anteroom?YES NO



Do delivery vehicles enter the premises for loading/unloading? YES NO


3.1

3.4

3.7

Do you keep temperature records? Note: Temperature records are to be

available for inspection.YES NO

3.2 Is clean equipment stored in a safe place to avoid contamination? YES NO

Not Applicable


Part 3: (Equipment, Fridges, Freezers etc)

Is all equipment such as fridges/freezers, chopping boards, slicers etc. being

kept in good working order and in a good state of cleanliness?YES NO


Not Applicable



3.3

Is each fridge, freezer, cold room or any display counter (excluding beverages

which do not require specific temperature control such as soft drinks)

provided with a thermometer?

YES NO

Not Applicable

Go to 3.5


3.5 Are all cold storage facilities being cleaned and defrosted regularly?YES NO

Not Applicable


Is shelving in a good state of repair and clean? Note: Surfaces to be smooth,

impervious, non-toxic and easily cleaned material including edges.YES NO


3.6

Is all food contact material used, certified as food grade or bears said symbol?

Note: This applies also to food storage containers and packing material. You

may be requested to provide data sheets with specifications of food grade

material being used and it`s intended use.

YES NO

4.1

4.2

4.3

4.4

4.5

4.7

Do you keep records of incoming goods? Note: You are requested to provide

traceability records such as copies of delivery notes or invoices.YES NO

Part 4: Purchasing, Storage and Selling.

Are all food items including beverages being purchased from licensed

suppliers accompanied with receipts or delivery documents? Note: Do not

purchase anything from unlicensed suppliers and without documentation.

YES NO


Are all incoming deliveries (Food and beverages) properly labelled, in sound

condition, within their date of minimum durability and in the correct

temperature?

YES NO


Is all food elevated from the floor? YES NO



Are all foods being stored at the correct temperature? Note: Abide by the

storage conditions marked on label.YES NO


4.9Are food items being stored separately from soaps and detergents so as to

avoid contamination by odour?

YES NO

Not Applicable

Do you have a First in First Out system? Stock Rotation. Note: Keep an area

clearly marked designated for storing expired or damaged foods.YES NO


4.6Are hot cupboards provided with a temperature gauge? Note : Hot foods to be

kept above 63⁰C.

YES NO

Not Applicable



4.8Are food items being stored separately? Note: Example ice cream separate

from raw foods.

YES NO

Not Applicable


4.11

4.12

5.1

5.2

5.3

5.4

6.1


Do you keep records of traceability? Note: You are requested to provide

traceability records.YES NO

Part 5: Packing

Do you pack food products such as cheeses and delicatessens? YES NO



Are products packed inside premises properly labelled according to current

Regulations? Note: These are to be sold only from the same premises.YES NO


4.10Are all open foods in display counters properly labelled? The label should at

least include the name of the food and allergen.

YES NO

Not Applicable



Is area where food supplements are displayed, monitored by personnel who

have successfully completed a Health Food Stores' Personnel course?YES NO


Do you sell food supplements? YES NO

Do you sell open food? YES NO



Are you sure that the date of durability of your products truly reflects the shelf

life of the products?YES NO


Part 6: Allergen Control

6.2

6.3

6.3.1

6.3.2

6.3.3

6.3.4

6.3.5

6.3.6

6.3.7

6.3.8

Crustaceans and products thereof. (e.g. Prawns, crabs, lobsters and cray fish)

and products thereof.YES NO

Which substances or products causing allergies or intolerances do you handle in your premises?

Please mark accordingly from the list below:

Note: You have to check also for substances or products causing allergies or intolerances in the

ingredients you use. Including checking the labels of prepared food, sauces and seasoning mixes

Cereals containing gluten: wheat, (such as spelt and khorasan wheat) rye,

barley, oats or their hybridised strains and products thereof.YES NO



Do you retain the original label of the food until the product is exhausted? YES NO




Molluscs and products thereof. (e.g. Clams, mussels, whelks, oysters, snails

and squid) YES NO


Eggs and products thereof. YES NO


Soybeans and products thereof. YES NO


Peanuts and products thereof. YES NO


Fish and products thereof. YES NO

Milk and products thereof. YES NO


6.3.9

6.3.10

6.3.11

6.3.12

6.3.13

6.3.14

6.4

6.5

Nuts including almonds, hazelnuts, walnuts, cashews, pecan nuts, Brazil nuts,

pistachio nuts, macadamia or Queensland nuts and products thereof.YES NO



Celery and products thereof. YES NO


Do you have a sign clearly informing customers to tell you if they suffer from

allergies or intolerances? Note: Wording of said sign could be as follows:

“Food Allergies and Intolerances. Please speak to our staff if you suffer from

allergies/intolerances. Thank you”

YES NO

Sesame seeds and products thereof. YES NO


Lupin and products thereof. YES NO


Mustard and products thereof. YES NO


Sulphur dioxide and sulphites often expressed as:

E220 Sulphur dioxide ;

E221 Sodium sulphite ;

E222 Sodium hydrogen sulphite;

E223 Sodium metabisulphite;

E224 Potassium metabisulphite;

E226 Calcium sulphite;

E227 Calcium hydrogen sulphite;

E228 Potassium hydrogen sulphite;

E150b Caustic sulphite caramel;

YES NO


Are you taking all precautions to prevent contaminating food with allergens? YES NO


7.2

7.3

7.4

7.6

7.7

8.1

8.2

YES NO

Not Applicable



Do you have a cupboard / designated area for storing personal belongings? YES NO


Do you have a well-stocked First Aid Box? YES NO

Part 7: Personal Hygiene

7.1Are all food handlers wearing clean/protective clothing including head-gear?

Note: Only applicable if open food is sold

NO

7.5If disposable gloves are being used, are these food grade? Note: Blue gloves

are recommended.

YES NO

Not Applicable


Are all food hygiene practices being observed? Note: No smoking, no eating,

cuts covered with colour water-proof dressing, no jewellery etc.YES NO


Do you carry out Pest control? YES NO



Are all food handlers registered with the Food Safety Commission? Note: All

staff including cleaners and delivery personnel are to be registered. Food

Handler card to be available during inspection.

YES NO


Part 8: Pest Control

Are your premises free from any pests, such as mice, cockroaches, flies etc.? YES NO


Are all food handlers returning from sick, certified fit for work as a food

handler?YES

8.3

8.4

9.1


Do you keep documentation related to Pest Control? Note: Whether it is

carried in-house or by contractor, you will be requested to provide

documentation when and where pest control is being carried out and data-

sheets of products being used.

YES NO


Part 9: Deliveries

Do you carry out food deliveries? YES NO

Do you have any devices such as insectocutors, mice repellents, rodent bait

boxes or other devices that prevent pest infestation? Note: You need to keep

documentation of maintenance of such devices, example replacement of UV

tubes for insectocutors. These are to be kept switched on at all times.

YES NO


Temperature Controlled Temperature Controlled Temperature Controlled Temperature Controlled

Yes c N o c Yes c N o c Yes c N o c Yes c N o c

FPR: FPR: FPR: FPR:


8.5

Are all devices kept clean and positioned in such a way to avoid risk of food

contamination? Note: Insectocutors and spray repellent devices not located

above where opened food is stored or prepared.

YES NO

Not Applicable


If you answered No to the previous question go to Part 10, if yes, list vehicle registration number of each

delivery vehicle below. If you have more than four Delivery Vehicles please continue to fill on Annex 2. Also for

each delivery Vehicle the Self-Assessment for Delivery Vehicle has to be filled in.

Vehicle Registration No: Vehicle Registration No: Vehicle Registration No: Vehicle Registration No:

10.1

10.2

11.1

11.2

11.3

Is the refuse storage area separated from the food areas?YES NO

Not Applicable

Part 10: Waste Management

Is an adequate number of covered waste bins provided? YES NO



Part 11: Smoking and sale of tobacco

Do you ensure smoking is not carried out in the enclosed areas of your

premises? Note: Enclosed area means any space covered by a roof and

enclosed by more than one wall or side, regardless of the material used for

the roof, wall or sides, and regardless of whether the structure is permanent

or not.

YES NO


Do you ensure that your premises is free from any tobacco advertisement?

Note: Ash trays/umbrellas or canopies with cigarette brands are not allowed.YES NO


Are waste receptacles / skips / refuse rooms being kept clean and in sound

condition?YES NO


10.4 Is refuse storage area well ventilated? YES NO

Not Applicable


10.3

Do you sell cigarettes, cigars, tobacco or tobacco products or smoking

requisites?YES NO



11.4

12.1

13.1

13.2


11.5Are cigarette vending machines located in a place that they can be supervised

at all times?

YES NO

Not Applicable

Do you have a clear warning displayed in a prominent position stating the

dangers to health of smoking?YES NO

Is water supply in your premises from an approved source? Circle if direct from mains or else please

specify other source.

Government Mains If from another source please specify:


If you answered No to the previous question go to Part 13. If you answered Yes, please write down the address

of the store. A Self-Assessment for Store of the unsold is to be completed for each store.

Address of Store/s

Part 13: Water Supply


Part 12: Food stores not interconnecting with premises

Do premises have a separate food store/s not inter-connecting with the

premises?YES NO


Do you have a supply of water? YES NO


13.3

13.4

14.1

15.1

YES NO


If you answered from another source kindly insert DEH

Registration Number and attach copy of certificate and copy of

receipt if from third party.


Part 15: Price Indication as per Regulation 5(5) in Subsidiary Legislation 378.09 -

Consumer Affairs Act (Price Indication) Regulations

Are prices indicated on or near all products? Note: This includes bread price list (including product

item, the actual price and actual weight of each product and the price per kilo of each product), shelve

products, display products and frozen products? Circle where applicable

15.1.1 Foods in display counters:YES NO

Not Applicable


15.1.2 Frozen / refrigerated foods:YES NO

Not Applicable


Do you have water storage tanks/reservoirs placed below and/or above ground

level for the storage of water?YES NO


Part 14: Registration of Premises

Is food premises registered with the Food Safety Commission in terms of

L.N.180 of 2001 as amended by L.N. 136 of 2007?YES NO



Are these water storage tanks/reservoirs adequately disinfected and treated

accordingly to the volume of water being stored and water turnover?

15.1.3 Shelved foods:YES NO

Not Applicable


16.1

To be filled in by EHO carrying out inspection

Officer Reg No:_________________ Date and time of inspection:_______________________

Name & Surname of person during inspection: ____________________________________________

Details of Person managing the premises: ______________________ Contact Number: ___________

If you answered YES to the previous question, do you have a valid

encroachment permit?

YES NO

Not Applicable

Part 16: Lands Authority- as per Chapter 573 Government Lands Act, 31 (H)

Have any items been placed on or under the pathway? YES NO

For more detailed information kindly refer to:

Section D: Details of person filling up this form

If form is filled by EHO Section D is to be left empty

Name & Surname: Position:


If you answered YES to the previous question, please provide copies of;

- the encroachment permit,

- the site plan issued by the Lands Authority indicating the area in question,

- the invoice showing that the permit is paid.



16.2

http://deputyprimeminister.gov.mt/en/environmental/Legislation/Pages/Legislation.aspx

http://deputyprimeminister.gov.mt/en/environmental/Pages/Home-Page.aspx

Signature: Date:

Section E: For office use only

http://deputyprimeminister.gov.mt/en/environmental/Legislation/Pages/Legislation.aspx

http://deputyprimeminister.gov.mt/en/environmental/Pages/Home-Page.aspx

A B N/A

A B N/A

A B N/A

A B N/A

A B N/A

A B N/A

A B N/A

A B N/A

A B N/A

A B N/A

A B N/A

A B N/A

A B N/A

A B N/A

A B N/A

A B N/A

A B N/A

A B N/A

Annex 1: Details of all employees

Enter the details of all employees including their identity card number and job description. Food

Handlers Category (A or B) and the date of expiry. Mark not applicable if employee is not a food

handler.

Name & SurnameID Card

NumberCourse Category Date of Expiry Job Description


Annex 2: Food delivery vehicles


FPR: FPR: FPR: FPR:







FPR: FPR: FPR: FPR:


FPR: FPR: FPR: FPR:




Documents

If premises includes outlets such as fish shops, butchers ...€¦ · Self-Assessment for Greengrocer Circle the correct answer(s) or fill in the blanks. (Do not leave anything out)