Title Page
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Food Safety Visit
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Store Number/Name
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Store Representative
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Prepared by
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Conducted on
Handwashing and Glove Use
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Are handwash sinks properly supplied and accessible (identify departments with issues)?
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Are employees washing hands when required and following correct technique (identify departments with issues)?
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Are gloves being worn and used correctly (identify departments with issues)?
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Other observations
Protection From Contamination
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Are foods protected from contamination during storeage, production and display (Identify departments with issues)?
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Are chemicals stored and used in a manner that prevents contamination (identify departments with issues)?
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Are food contact surfaces clean (Identify departments with issues)?
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Are food contact surfaces and utensils able to be cleaned appropriately (identify departments wth issues)?
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Is there evidence or actual observation of pest (identify pest type, department and location)?
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Other Observations
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Temperature Control
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Is the department supplied with a minimum water temperature of 120'F at the 3-Comp sink (provide temp, and identify departments with issues)
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Are TCS foods held at or below 40'F (Identify product and list temperature) ?
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Are TCS foods found out of temperature during stocking or preparation (list product, temperature and department)?
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Are the internal temperatures of TCS foods in hot holding at or above 140'F (list product, temperature and department)?
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Are TCS foods cooked/reheated to the appropriate internal temperature (list product, temperature and department)?
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Are TCS foods thawed properly using approved methods (list product and department)?
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Are hot foods cooled with the appropriate time and temperature (list product, time/temp, department)?
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Have all cooked/hot held TCS foods been documented in a log (identify product and department)?
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Other Observations
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Code Dating and Labeling
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Are store opened, processed and packaged foods properly labeled and/or date market as required (identify product and department)?
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Are foods held beyond the manufactures date code (identify product and department)?
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Other Observations
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Facilities, Front End & General Safety
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Are customer restrooms clean, supplied and in good repair?
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Are employee restrooms clean, supplied and in good repair?
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Is janitorial area properly stocked, maintained clean and in good repair?
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Is store exterior/entryway maintained clean and in good repair?
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Fire exits are not blocked?
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Other observations
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Records, Documentation and Knowledge
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Is department maintaining the required records (list missing records and department)?
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Workers compensation and general liability logs in use and up to date?
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Safety board is up to date?
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Hazardous waste log in use and up to date?
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Other observations
Notes and Reminders
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Pest Control Service, Support and Training: Call 1-800-325-1671
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Chemical Dispenser Servicve, Support and Training: Call 1-800-529-5458
