Supervision on Food Safety

Supervised on Supervisor

Date: DD / MM / YYYY Name:

Time Started: HM : MM am/pm Designation:

1. General Information
1.1. RDHS area
1.2. MOH area
1.3. Name of the local authority
(Pradeshiya Sabha/Municipality area/Urban Council)
1.4. PHI area
1.5. Name of the PHI
1.6. Date appointed to this station DD / MM / YYYY
1.7. Date of first appointment DD / MM / YYYY

2. Transport facilities

Yes Personal Departmental

2.1. Available
No Date obtained

2.2. Is it in working condition (if applicable) Yes No

3. Uniform (dressed according to circular) Yes No
Reason/Explanation, if 'NO':

4. Food safety charts (each in A‐4 size papers) Maintained Well Any Remarks
Yes No

i. Bar Charts (2) for Food handling Current Yr

Establishments Previous Yr
ii. Bar Charts for Food sampling (by month)

5. Registers (on Food Safety) Satisfactory

Available Remarks If any
(Up to date)
Yes No Yes No
5.1 Food Analysis Register

5.2 Meat Inspection Register

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 6. Files (on Food Safety) Satisfactory
Available Remarks If any
(Up to date)
Yes No Yes No

6.1 Food Handling Establishments (H‐800)

6.2 Food Safety and Hygiene Programmes

7. Food establishments inspected for the previous six months (at least one routine inspection)

Total Expected %
Grade of Establishment Minimum Frequency no. of inspections Remarks if any
No inspections done
i. Grade‐A Once in 6 months
ii. Grade‐B Once in 3 months
iii. Grade‐C Once a month
iv. Grade‐D Once in two weeks

8. Change of grade of the food establishments at the last inspection (according to previous two
inspection results)

Type of food Total Improvements Deteriorations

establishment Number No. % No. %
8.1 Food Factories
8.2 Bakeries
8.3 Hotels/Restaurants
8.4 Snack Bars
8.5 Tea/ Coffee Kiosks
8.6 Groceries
8.7 Super Markets
8.8 Mid‐day meal Kitchens
8.9 School Canteens
8.10 Institutional Canteens
8.11 Others

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 9. Food Sampling (during Last Quarter) Formal Informal Remarks if any
No % No %
a. Number targeted
b. Samples taken
c. Reports received Unsatisfactory

Unfit for human consumption

Poor quality

Adulterated

d. No of prosecutions
e. No convicted

10. Action taken by the PHI to improve sanitary conditions of food establishments?

No. of raids done

11. Food Raids No. of items seized
(during fast year) No. of items destroyed
No. of prosecutions done

Conducted
12. Health Education programmes No. Planned
No %
(during last six months)

Number of
13. Water Number of Samples bacteriologically Action taken for unsatisfactory
Sampling tested unsatisfactory samples samples
(during last reported
year)

14. Other Inspections

(during last one month) * Look for Pocket Note Book

Number Number Inspected

(according to Pocket Note Book)

i. Weekly Fair

ii. Slaughter Houses

iii. Others;(Meat Stalls,
Fish Stalls)

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 15. Attention on food handlers

No %
i. Estimated no. of food handlers in the area
ii. No. of food handlers screened during the previous year
iii. No. of food handlers vaccinated for Typhoid during the
previous year

FIELD SUPERVISION

Instructions to the Supervisor:

Randomly select two (2) Food establishments visited by the Public Health Inspector during the
previous six months.

Institution Canteens
Hotel/Restaurants

Tea/Coffee Kiosks

School Canteens
Food Factories

Supermarkets
Mld‐day Meal
Snack Bars

Groceries
Bakeries

Kitchens
16. Food Handling establishments

Date of visit tallies with the Yes

Register /Packet Note Book No
Health education carried out for Yes
food handlers No
Yes
Grading done at the inspection
No
Yes
Food sampling done
No
Yes
Notices issued
No
Yes
Follow‐up visits done
No
Remarks on Food Handling Establishments inspected

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 17. What was the feedback of the PHI about the supervisions?

18. Problems identified by the PHI?

19. Suggestions made by the PHI for more effective service delivery?

20. Details of Previous supervisions

a. Date of previous supervision
b. Designation of the supervisor
c. Recommendations made were
Yes No
implemented

d. Reasons/Details on unimplemented recommendations

e. Action taken by the Medical Officer of Health (MOH) for non implementation

21. Recommendations of this supervision

A. Strengths B. To be Strengthened

i. i.

ii. ii.

iii. iii.

iv. iv.

v. v.

C. Tentative Date for next supervision DD / MM / YYYY

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 22. Action Plan for problem solving
Identified Underlying Suggestive
Responsibility Time frame
problem/deficiency cause/causes solutions

Signature of the Supervisor : .................................................. Completed at: HM : MM am/pm

Signature of the PHI : ............................................................

23. Recommendations of the Head of the Institution

Signature of the Head

of the Institution ...........................................................

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