EQUIPMENT REINSTATEMENT CHECKLIST

Date: ______________________

Equipment Manufacturer: ____________________________ Model #: ___________________

I. PRIOR APPROVAL/PERMITS Y N N/A

1.1 Was proper notice given to department manager prior to taking equipment out of service?

1.2 Is equipment regarded as a food safety critical control point (CCP)?

1.3 Were all lockout/tag-out procedures followed prior to working on equipment?

Comments:

II. INSPECTION AND CLEANUP Y N N/A

Was equipment or new parts that will replace existing parts inspected and cleaned by washing
2.1
with potable water? Note: Items must be free of dust residues, insects or other foreign material.
Was all evidence of maintenance work removed once repairs and/or replacement of equipment
2.2
was complete?

2.3 Was oil/grease residues wiped off all equipment surfaces with a clean, disposable towel?

2.4 Were metal shavings and welding slag removed from the work area?
Were excess materials, such as welding rods, nuts, bolts, etc. collected and removed from the
2.5
area, making sure that none were inadvertently left inside the equipment?
Were all food contact surfaces in/on the equipment washed or flushed with potable water and
2.6
then inspected for foreign material and chemical residues?
Comments:

III. FINAL INSPECTION AND RELEASE Y N N/A

After inspecting the entire work area and all food contact surfaces, do any hazards remain that
3.1
jeapardize the safety of the product?

3.2 Should this equipment be released/re-instated?

Comments:

I have inspected the work area and verify that proper procedure was followed and hearby authorize the release/reinstatement of
this equipment.

Signature Title Date

*Send a copy of completed report to the QA Manager, Maintenance Manager, and Plant Manager.

CONFIDENTIAL
(Uncontrolled document, if printed)