Received by: _______________________________________ Date: ___________ Page #: _____ of ____ ITEM ITEM
MATCHES P.O.
ACTUAL TEMP1
PACKAGING INTACT?
Yes No
USE-BY DATE VALID?
Yes No ACCEPTED REJECTED2 STORED3
1 Receive refrigerated food at 41˚F or below. Receive frozen food at 0˚F. Ice cream may be received at 6˚F - 10˚F. 2 If rejected, write comments on the back of this form. 3 Check to confirm that the item was stored.