Company XYZ Form B01
Page 1 of 1
Issued on: Version: 1 Revised:
Issued by: Supersedes:
†Check the temperature of a product from the middle of the pallet by using the laser thermometer. Take the temperature of the truck using the laser thermometer.
Temperatures must be ≤ 4°C.
*S- Satisfactory, U- UnSatisfactory (Inform QA Department; may compromize food safety, place on HOLD). Unsatisfactory condition is when...: Carrier is not clean. OR There
is evidence of contamination. OR There is evidence of pests.
†Temperature ˚C (If Condition of
Description (Please attach a copy of the Receiving Slip)
Date Ingredients / Returned Products / Packaging and/or Receiver Comments /
Received Materials (pails, plastic bags, boxes) Packaging Carrier PO# Product Truck Product Truck Initial Action Taken
QA Department ONLY Verified By: Date Verified:
LIST all ingredients