1. Full Kitchen Audit

• Site conducted

  Select

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• Yes

  No

  N/A

• Conducted on

  Date

• Prepared by

• Location
  Address

• Yes

  No

  N/A

• Please fill out the audit below:

• * 1. Email address:

• * 2. Date of audit:

  Date

• * 3. Your name:

• * 4. Your position:

• * 5. Facility Name:

• 6. Menus and Logs compliant and all temperatures are logged: INSRUCTIONS: Hot foods need to be held at >135°F and cold foods need to be held at <41°F. You can use the production sheet from Dining RD or a standard form to record your logs

  Yes

  No

  N/A

INSTRUCTIONS

• 7. Substitutions are recorded with correct nutritional value and RD has signed off: INSTRUCTIONS: If menu item is not available, a substitution needs to be added and sign off by an RD. The substitution needs to be the same nutritional value as the base item (ie protein can only be substituted with protein):

  Yes

  No

  N/A

INSTRUCTIONS

• 8. All cooked potentially hazardous foods not served within 4 hours after being cooked or

  Yes

  No

  N/A

• are left over from being served, have been cooled down correctly and are logged accordingly:

  Yes

  No

  N/A

• Food that reaches 135° F must be cooled down to 70°F within 2 hours; 70°F - 40°F from the 3rd to the 5th hour

  Yes

  No

  N/A

• INSTRUCTIONS: and 41°F within the 6th hour

  Yes

  No

  N/A

• * 10. Menus are posted in dining room and in an area assessable to residents:

  Yes

  No

  N/A

• 11. Please upload a copy of each log (food temp, cool down and substitution):

  Yes

  No

  N/A

• No file chosen

• 3. Dry Storage Area plastic) with correct date received, labels and Use By date (expiration date):

  Yes

  No

  N/A

NOTE:

• Items removed from boxes need to be dated, even if on box and other items are near it are dated. Additionally, items that are opened need to be dated with the new opened date. These include plastic containers

• * 15. Are there signs of pests or insect infestation?

  Yes

  No

  N/A

• * 16. Dented cans are stored in a separate area and not with the rest of the cans:

  Yes

  No

  N/A

• * 17. Floors are clean and free of debris, including in the isles and under shelving:

  Yes

  No

  N/A

• 4. Janitorial Closet mop bucket:

  Yes

  No

  N/A

• * 22. All chemicals are correctly labeled:

  Yes

  No

  N/A

• * 24. Janitor closet is free of musty odor:

  Yes

  No

  N/A

• 25. Comments: * 23. Janitor’s closet is clean and free of debris; as are the shelves, walls, floor and trash:

  Yes

  No

  N/A

• 5. Coolers/Refrigerators and Freezer below; FREEZER - 0 ̊ F or below. All thermometers are close to their doors and visible without

  Yes

  No

  N/A

• 27. Please upload a copy of each log:

  Media

• * 28. All food is in proper containers and stored 6 inches off of floor. All raw food, including

  Compliant

  Non-Compliant

• eggs, are in proper containers stored below cooked food and not stored in the same container

  Yes

  No

  N/A

• All raw food must be stored on the bottom to avoid cross contamination with cooked food. THIS IS ESPECIALY

  Yes

  No

  N/A

• TRUE FOR THAWING FOOD. THAWING FOOD MAY NOT BE STORED WITH OR ON TOP OF OTHER RAW FOOD

  Yes

  No

  N/A

• * 29. All foods are covered and stored securely, properly identified, dated and labeled, and no

  Yes

  No

  N/A

• expired food are present:

  Yes

  No

  N/A

• Left over food must include a UB (use by) date. Vegetables need to be covered as well. Employee and resident food must be labled and date as well

  Yes

  No

  N/A

• * 30. No mold is present in fridge, on any carts, on fruits or vegetables:

  Yes

  No

  N/A

• * 31. All refrigerators are and freezers are clean on the inside as well as outside. This

  Yes

  No

  N/A

• includes floors, fans, shelves, walls and ceilings:

  Yes

  No

  N/A

• searching

  Yes

  No

  N/A

• No as cooked food:

  Yes

  No

  N/A

NOTE:

NOTE:

• * 32. Fridges and freezers are in good working order (including lights):

  Yes

  No

  N/A

• 33. No ice build up or leaks are present (including on the pipes, fans, walls and ceiling):

  Yes

  No

  N/A

• Often times if ice buildup is present it is due to hot air entering from the outside and creating humidity freezing over. Check if there plastic strps present. Strips are very helpful

  Yes

  No

  N/A

• LEAKAGE ON FOOD MUST BE ADDRESSED ASAP

NOTE:

• 6. Dish Room and Dish Washer Area should be logged twice (AM and PM) daily and sanitizer should be logged after each meal:

  Yes

  No

  N/A

INSTRUCTIONS:

• LOW TEMP DISHWASHER - Between 50 and 150 ppm. Take a strp test and dip it into the drain on the side of measurement on the log for the proper day and time

  Yes

  No

  N/A

• HIGH TEMP DISHWAHER - Wash Temp - 160°F and Rinse Temp - 180°F. You need to log both temps

• Temperatures can be found on the side or bottom of the machine. You should also temp the water with the proper temp strip to confirm that the machine is working properly

  Yes

  No

  N/A

• SANITIZER SINK SOLUTION - Chlorine Sanitizer - between 50 and 100 ppm; Ammonium Sanitizer - 200 strip's container. Record the PPM measurement on the log for the proper day and meal

  Yes

  No

  N/A

• 36. Please upload a copy of each log:

  Media

• No file chosen

• * 37. Solid/liquid chemicals for the dishwasher and sinks dispense properly:

  Yes

  No

  N/A

• * 38. Pot washing procedures are posted in designated area:

  Yes

  No

  N/A

• * 39. Hands are washed, clean, and properly sanitized before handling clean dishes and

  Yes

  No

  N/A

• flatware to prevent contamination and aprons and gloves are changed before handling clean

  Yes

  No

  N/A

• dishes and flatware to prevent contamination:

  Yes

  No

  N/A

• * 40. Dishes (dishes, cups, pots, pans, etc ) and flatware are free of food particles, debris,

  Yes

  No

  N/A

• grease and carbon. No cracks are present in dishes, all dishes are air dried and clean dishes

  Yes

  No

  N/A

• are not stored next to dirty dishes:

  Yes

  No

  N/A

• Dishes must be left to dry openly and dishes may not be stacked

  Yes

  No

  N/A

NOTE:

• 7. Preparation Areas/Service dish towels placed in solution, ppm is logged and solution in changed every meal:

  Yes

  No

  N/A

• 43. Please upload a copy of each log:

  Media

• No file chosen

• * 44. Tables, shelves, and bottoms/underneath tables are clean:

  Yes

  No

  N/A

• * 45. All utensils are clean, dry, and stored in proper areas. Utensils are stored in proper

  Yes

  No

  N/A

• drawers and drawers are clean:

  Yes

  No

  N/A

• * 46. All cutting boards are clean, sanitized, and stored in proper areas and without chips and

  Yes

  No

  N/A

• cracks:

  Yes

  No

  N/A

• * 47. Is Nesting Water observed?

  Yes

  No

  N/A

• * 48. Hand sinks have adequate soap, paper towels and properly working trash cans:

  Yes

  No

  N/A

NOTE:

• Sink must have warm water to sanitize correctly

  Yes

  No

  N/A

• 8. Equipment service is not over due (sticker with service date is present):

  Yes

  No

  N/A

• * 55. Is there any equipment requiring repair:

  Yes

  No

  N/A

• If yes, which equipment:

• 9. Beverage Area ground coffee makes more sense)?

  Yes

  No

  N/A

• 59. Comments and company of coffee and juice machine:

• 10. Overall Area * 60. Floor is clean and free of grease, and no food debris/particles are on floor:

  Yes

  No

  N/A

• 61. Trash cans are kept covered while not in use: * 63. Staff are following proper sanitation and operational policies

  Yes

  No

  N/A

• NOTES:

• Staff are wearing jewelry that meets facility guidelines (no dangle earrings, loops over dime size, rings other than 79. Are there items being ordered and produced that should be changed based on budget, staff, )?

  Yes

  No

  N/A

• 80. Does the menu and order guide meet the needs of faciity (and menu for OG)?

  Yes

  No

  N/A

• If no, please details the concers and changes needed:

• 12. Dietary Manager

  Yes

  No

  N/A

• 81. Is the DM/FSD CDM certfied?

  Yes

  No

  N/A

• 82. Please upload a copy of the DM's CDM certficate:

  Media

• No file chosen

• 13. Overall Staffing and Operations * 83. Is there a need for training and /or POC?

  Yes

  No

  N/A

• If yes, please detail the necessary actions:

• If no, please deatail:

• * 84. Has the necessary trainig/POC from last visit been corrected?

  Yes

  No

  N/A

14. Survey Completion

• 85. Overall comments and conce