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 CCDEH Model CFO Self‐Certification Checklist                                                                                     Page 2 of 2  <br />  <br />Sanitation Requirements: Yes No <br />9. Kitchen equipment and utensils used to produce CFO products are clean and maintained in <br />a good state of repair. <br />10. All food contact surfaces, equipment, and utensils used for the preparation, packaging, or <br />handling of any CFO products shall be washed, rinsed, and sanitized before each use. <br />11. All food preparation and food and equipment storage areas shall be maintained free of <br />rodents and insects. <br /> <br />Food Preparation Requirements (includes packaging and handling): Yes No <br />12. Hand washing is required immediately prior to handling foods and after engaging in any <br />activity that contaminates the hands such as after using the toilet, coughing or sneezing, <br />eating or smoking. <br /> <br />13. Warm water, hand soap and clean towels are available for hand washing. <br />14. All food ingredients used in the CFO products are from an approved source. <br />15. Potable water shall be used for hand washing, ware washing and as an ingredient. <br />16. Is your water source a private water supply (well, spring, surface)? <br />a. If YES, have you completed testing for bacteria, nitrate & nitrite? <br />17. Is your water source a public water system or community services district? <br />a. If YES, what is the name of the system or district? <br />During the preparation, packaging or handling of CFO products: Yes No  <br />18. Domestic activities such as family meal preparation, dishwashing, clothes washing or <br />ironing, kitchen cleaning or guest entertainment are excluded from the kitchen. <br />19. Infants, small children (younger than 12 yr. old), or pets are excluded from the kitchen. <br />20. Smoking is excluded. <br />21. Any person with a contagious illness shall refrain from work in the CFO. <br /> <br /> Labeling Requirements: Yes No <br />22. A copy of the label has been submitted to this Department for review and approval. <br />23. I have attached a sample label. <br /> <br />By signing below you are certifying that you meet the requirements of the California Homemade Food Act, AB 1616 <br />(Gatto), as it pertains to a “Class A” Cottage Food Operation. Prior to making any changes, I acknowledge that I must <br />notify the Alameda County Department of Environmental Health Jurisdiction of any intended changes to the above <br />statement. <br /> <br />Cottage Food Operator Checklist completed and submitted by: <br /> <br />Owner’s Signature Print Name Date <br />