Template for Cleaning Schedule

Week Commencing: ________________________________________

(Example)
Items/Surface/Area Cleaning Person Cleaning Product Cleaning Method Time Completed Checked by Comments
frequency Responsible /Equipment
Floor As you go Bob Smith Detergent Sweep first Various times Mr Brown More thorough cleaning needed within
Broom, mop, bucket, hot throughout the the preparation area B re-clean
water, detergent day immediately
Meat Slicer Before & after use Brenda Jones Sanitisers Dismantle, trigger spray Mr Brown
sanitiser, scrub, wipe 11.00am

Items/Surface/Area Cleaning Person Cleaning Product Cleaning Method Time Completed Checked by Comments
frequency Responsible /Equipment

To be displayed in a prominent location such as the notice board in the kitchen

 Confidential Staff Health Questionnaire

Position Applied For:

Surname First Name

Dr/Mr./Mrs./ Home Address
Miss/Ms
Date of Birth
Contact Number
Doctors Name
Contact Number

1. Have you suffered from any of the following? Please provide details continuing on a separate
sheet if necessary.
a) Any skin disease(s) Yes  No 
b) Discharge or infection of the ears or hearing defect Yes  No 
c) Asthma or hay fever of sufficient severity to require time off work Yes  No 
d) Any allergies (including sensitive to antibiotics or other drugs Yes  No 
e) Recurrent sore throats or sinusitis Yes  No 
f) Bronchitis or pneumonia Yes  No 
g) Tuberculosis Yes  No 
h) Heart disease or high blood pressure Yes  No 
i) Headache or migraine requiring time off work Yes  No 
j) Fits, blackouts or epilepsy Yes  No 
k) Depression, nervous, breakdown or mental illness, psychiatric Yes  No 
treatment including anorexia
l) Backache or sciatica requiring time off work Yes  No 
m) Indigestion or stomach pains Yes  No 
n) Kidney or bladder infection Yes  No 
o) Eye disease, injury or significant defect of vision not corrected by Yes  No 
glasses
p) Diabetes Yes  No 
q) Serious injury or operation. Have you ever been admitted to Yes  No 
hospital, please give details
2. Do you suffer from any defect or disability not included in the above, Yes  No 
please give details
3.How many days have you been off work for illness in the past two
years?
4. Are you receiving injections, pills, tablets or medicines from a doctor
(other that contraceptives)? Please give details
5. What is your height?
6. What is your weight?
I understand and acknowledge that should I knowingly make a false statement
regarding my medical history, either in answering the above questions or to any
medical examiner, or should I willfully conceal any material facts, I will, if engaged be
liable to have my contract terminated. In the event of any health queries, I will
consent to my doctor supplying relevant information to the professional medical
advisor.
Signed: ____________________________Date:____________________________
Agreement to report infections

The document should be completed at the commencement of

employment. One copy should be issued to the employee and the
hotelier should retain one copy.

I will report to my manager or supervisor as soon as possible and make

myself available for medical examination, if required, should I suffer any
illness involving.

13. a) Vomiting
b) Diarrhoea
c) Septic skin lesions (boils, infected cuts, etc however small)
d) Discharge from the ear, nose or other orifice

14. After returning, and before commencing work following an illness

or any of the above conditions

15. If ant member of my household is suffering from diarrhoea

and/or vomiting

16. After returning from holiday during which I suffered from sickness
or diarrhoea

17. After returning from holidays during which any member of my

party suffered from sickness or diarrhoea.

Signed: __________________________ Print Name: _____________________

Date: ____________________________
 Illness Report Form

Camp Safety
Camp Name & Dates Covered Coordinator
Location

Number of Employees Total Employees

Completed By affected in camo

Customer Onset Symptoms Duration Doctor Diagnosis Any additional comments or

Name Date of (use code) of Seen information regarding
illness Symptoms Yes /No investigations being carried out
locally or the source of the illness

Symptoms Code: D = Diarrhoea V = Vomiting S = Stomach Cramps F = Fever O + Other (Please specify)

Comments from the Camp QHSE Coordinator

Food Poisoning Summary
This is not intended to be authoritative document B further information should be obtained from a medical practitioner

Bacteria Onset period Symptoms & duration of illness Possible Sources

Allergy Immediately or Symptoms vary considerably. Amy include The allergen is usually a protein
up to 48 hours vomiting, diarrhoea, bronchitis, rash and migraine
Bacillus Cereus 1 to 5 hours Vomiting, abdominal pains and some diarrhoea. Cereals, especially rice, dust and soil
Duration 12 to 14 hours
Campylobacter 2 to 5 days Headaches, fever, diarrhoea (often blood stained), Raw poultry, raw milk and sewage, contamination
persistent colicky abdominal pain and nausea. by birds and small animals
Duration 1 to 7 days
Clostridium 8 to 22 hours Abdominal pain, fever, diarrhoea. Vomiting is rare. Animal and human excreta, soil, dust, insects and
Perfringens usually 12 to 18 Duration 12 to 48 hours raw meat
hours
Escerichia Coli 12 to 24 hours Abdominal pain, fever, diarrhoea, vomiting and Human sewage, water, raw meat
(E-Coli 0157) fever. Duration 1 to 7 days
Salmonella 6 to 72 hours Abdominal pain, diarrhoea, vomiting and fever. Raw meat, milk, eggs, poultry, carriers, pets, birds,
usually 12 to 36 Duration 1 to 7 days rodents, terrapins, sewage and water
hours
Scrombrotoxic Fish 10 minutes to 2 Allergic reaction B tingling and burning around the Where fish have undergone bacterial
Poisoning hours mouth, facial flushing, sweating, nausea, vomiting, decomposition after capture
headache, palpitations, dizziness and possibly a
rash
Staphylococcus 1 to 6 hours Abdominal pain, vomiting, prostration and sub Human nose, mouth, skin, boils and cuts, raw milk
Aureus normal temperatures from cows and goats with mastitis
Vibrio 2 to 48 hours Diarrhoea, vomiting, fever, prostration and sub Sewage, polluted water
Parahaemolyticus usually 12 to 18 normal temperatures. Duration 6 to 24 hours
hours
Viruses 24 to 48 hours Diarrhoea, abdominal pain, fever, nausea and Raw foods, especially shellfish such as oysters and
vomiting. Duration 24 hours cockles
 Delivery Temperature Monitoring Records

Delivery Time Product Description Product Temperature Supplier Comments Signature

Date Condition Receipt

Always check & record the temperature of chilled, refrigerated and frozen foods
Where checks on deliveries show that food or packaging is damaged, infested or contaminated at too high temperatures, foods should be rejected.
Any rejected food should be logged in the comment section

Temperatures: Chilled / refrigerated foods should not be accepted if the temperature is above 81C (46 1F)
Frozen Foods should not be accepted if the temperature is above -181C (0 1F)
 Supplier Assessment
Can be utilized by camps to audit the food providers and suppliers in their food
chain. If used, a copy of the completed audit and the subsequent
recommendations issued to the suppliers concerned should be retained on file and
be available for inspection by the tour operators on request.

Company Name
Managers Name
Address of the premises
Telephone Number
Description of activities carried out at the
above address
Person responsible for food safety
Position in the organization
Date Completed
Question Yes No Question Yes No
1. Is there a documented 2. Do they operate a hazard
food safety policy? analysis scheme?
3. Do they evaluate their 4. Do they have a
Suppliers? documented product
recall procedure?
5. Do they have a formal 6. Do they provide food-
complaint procedure? handling training for staff
on induction?
7. Within 3 months of 8. Are internal audits
commencing conducted to verify food
employment are staff safety and hygiene
trained in food hygiene? standards are being
maintained?
9. Are written reports 10 Have any organisation or
produced of these audits customers externally
audited the company?
If Yes attach copies of
audits
11 Does the company 12 Provide the details of the
belong to an association, association and the
which has accredited accreditation they have
them? issued the company
13 Is a >goods in’ control 14 Is there a stock rotation
procedure in place? 16 system in place?
15 Are ready to eat products 16 Is the temperature of the
kept separate from raw storage areas for chilled
product? and frozen products
monitored and recorded?
17 Has the company been 18 Have all of the
inspected by a legal requirements been
enforcement agency in completed from this
the last 12 months? inspection?

Completed By: _____________________________ Signed _________________________

Job Title ___________________________________ Date: __________________________

Received By: ______________________________ Signed _________________________

 Temperature Log- Fridges & Freezer

Week commencing: ___________________________________

Day Time Fridges Freezers

Name of Checked
Staff By Manager 1 2 3 4 5 1 2 3 4
Member

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Freezer temperatures must reach Temperatures: -181C (0 1F)

Fridges must never exceed 81C (46 1F)

All fridge’s and freezers to be checked at least three times daily

The record sheet to be displayed in a prominent location and completed at the time
of the check
If the temperature of a fridge or freezer is not within the stated guidelines, the staff
member must report it to a supervisor immediately and an engineer called to rectify
the problem
At the end of the week the completed record sheet to be submitted to the hotel
manager for file and reference
 Temperature Monitoring Log- Defrosting

Week commencing: ___________________________________

Day Name of
Staff Time Dish Temperature Signature of
Member Manager

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

The temperature of food must not exceed 81C (461F)

The record sheet to be displayed in a placed in a prominent location and completed

at the time of the check

At the end of the week the completed record sheet to be submitted to the hotel
manager for file and reference
 Temperature Monitoring Log- Cooking

Week commencing: ___________________________________

Day Name of
Staff Time Dish Temperature Signature of
Member Manager

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

The core temperature of food must exceed 751C (1671F)

The record sheet to be displayed in a placed in a prominent location and completed

at the time of the check

At the end of the week the completed record sheet to be submitted to the hotel
manager for file and reference
 Temperature Monitoring Log- Reheating

Week commencing: ___________________________________

Day Name of
Staff Time Dish Temperature Signature of
Member Manager

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

The core temperature of food must exceed 751C (1671F)

Food must only be reheated once B all leftovers should e discarded

The record sheet to be displayed in a placed in a prominent location and completed

at the time of the check
 Temperature Log- Chilled Buffet

Week commencing: _________________

Restaurant Name: ___________________ Verified by: _______________

Day Meal Dish Time Temp Time Temp Time Temp Time Temp Signed

Breakfast

Monday
Lunch

Evening

Breakfast

Tuesday
Lunch

Evening

Breakfast

Wednesday
Lunch

Evening

Breakfast

Thursday
Lunch

Evening
 Breakfast

Friday
Lunch

Evening

Breakfast

Saturday
Lunch

Evening

Breakfast

Sunday
Lunch

Evening

The temperature of chilled foods must not exceed 81C (46 1F)

Foods should not be kept within display units for more than 4 hours

Temperatures to be taken at the beginning, middle and towards the end of each
meal sitting

The record sheet is to be displayed in a prominent location and completed at the

time of the check.

If the temperature of the foods is not within the stated guidelines, the food should be
removed from display and discarded.

At the end of the week the completed record sheet to be submitted to

the hotel manager for file and reference
 Temperature Log- Hot Buffet

Week commencing: _________________

Restaurant Name: ___________________ Verified by: _______________

Day Meal Dish Time Temp Time Temp Time Temp Time Temp Signed

Breakfast

Monday
Lunch

Evening

Breakfast

Tuesday
Lunch

Evening

Breakfast

Wednesday
Lunch

Evening

Breakfast

Thursday
Lunch

Evening
 Breakfast

Friday
Lunch

Evening

Breakfast

Saturday
Lunch

Evening

Breakfast

Sunday
Lunch

Evening

The temperature of hot foods must be 631C (145 1F) or above

Hot foods should not be kept for more than 2 hours

Temperatures to be taken at the beginning, middle and towards the end of each
meal sitting

The record sheet is to be displayed in a prominent location and completed at the

time of the check.

If the temperature of the foods is not within the stated guidelines, the food should be
removed from display and discarded.

At the end of the week the completed record sheet to be submitted to the hotel
manager for file and reference
 Pest Identification Report Form
Can be utilised by staff to report pest sightings. If used, a copy of the completed report form
and the subsequent action taken should be retained on file and be available for inspection by
Saudi Aramco on request.

Location Identified

Pests Sighted

Approximate Number Sighted

Pests Signs

Date & Time

Reported by

Date reported to contractor

Action Taken

By whom

Signed

Date