DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration
FOOD GMP INSPECTION REPORT
2. Date Inspected
1. Establishment Name and Address (Include ZIP code)
3. Product(s) Inspected
5. State License or Permit Number
6. Name and Title of Responsible Plant Official
7. Telephone Number (Include Area Code)
8. Name and Title of Responsible Corporate Official
9. Telephone Number (Include Area Code)
Answer the following questions by checking the appropriate box. Explain “No”, answers on continuation sheet(s).
Precede each explanation with the item number. Use “N/A” where questions are Not Applicable.
Plants and Grounds
Are premises free of harborages and/or breeding places for rodents, insects and other pests?
Is adequate drainage provided to avoid contamination of facilities and products?
Is sufficient space provided for placement of equipment, storage of materials and for production
Are floors, walls and ceilings constructed of easily cleanable materials and kept clean and in good repair?
Are food and food contact surfaces protected from contamination from pipes, etc., over working areas?
Are food processing areas effectively separated from other operations which may cause contamination
of food being processed?
Are food products and processing areas protected against contamination from breakage of light bulbs
and other glass fixtures?
Is air quality and ventilation adequate to prevent contamination by dust and/or other airborne substances?
Are doors, windows and other openings protected to eliminate entry by insects, rodents and other pests?
Equipment and Utensils
Are all utensils and equipment constructed of adequately cleanable materials and suitable for their
Is the equipment designed and used in a manner that precludes contamination with lubricants,
contaminated water, metal fragments, etc.?
Is the equipment installed and maintained so as to facilitate the cleaning of equipment
and adjacent areas?
FORM FDA 2966 (3/13)
Page 1 of 4
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