Title Page
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Food Safety Visit
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Store #/Name
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Store Director/PIC
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Conducted on
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Prepared by
GENERAL (Exterior & Front End)
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Front entry doors (in good repair, properly functioning)
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Restrooms clean and properly stocked (identify customer/employee)
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Workers Comp/General Liability Logs available and up to date
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Safety Board is up to date
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Other Observations
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FRESH DEPARTMENTS (Produce, Meat, Seafood, Deli, Bakery)
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C.O.O.L. in place where required (list department/product not labeled)
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HANDSINKS (Properly stocked, hot water, not obstructed, etc.)
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HAND HYGIENE (Proper handwashing and glove use in place)
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THERMOMETER (Calibrated thermometer available, properly stored, in good condition)
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LABELING & DATE MARKING (Ingredients & date codes in place)
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FOOD HANDLING/STORAGE (Foods being properly prepared and stored)
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TEMPERATURE CONTROL (Hot/Cold foods properly stored under temperature control)
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RECORD KEEPING (Food Safety Log Books, Grinder logs. Shellfish Tags)
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FOOD PROTECTED FROM CONTAMINATION (No physical, biological and chemical hazards)
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FOOD CONTACT SURFACES (Clean, free of clutter & physical hazards)
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PRODUCTION/STORAGE EQUIPMENT (Approved for commercial use, in good repair, etc.)
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GENERAL CLEANLINESS (Department is clean, organized, free of broken/out of use equipment)
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CLEANING & SANITIZING (3-Comp sink in good repair, used properly, chemicals and test strips available, dispensing equipment properly functioning)
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CUT GLOVES (Being used properly)
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OTHER OBSERVATIONS
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PEST CONTROL
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FLYING PEST PROGRAM (Pest lights in place, properly functioning, at least 4 in store, not above food prep surface)
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LOG BOOK (available, most recent report visit & trap map available, sighting log in use)
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STORE FREE OF FROM SIGNS OF PESTS, HARBORAGE AREAS, STANDING WATER, EXCESS FOOD DEBRIS
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OTHER OBSERVATIONS
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STORAGE, DELIVERY & JANITORIAL
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CLEANING CENTER (Clean, organized, well maintained)
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DELIVERY DOORS (In good repair including sweeps)
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EXTERIOR DOORS (In good repair including sweeps)
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FIRE EXITS (Are maintained free of all obstructions)
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KEY CONTROLS (Controls in place for baler, fork lift and compactor)
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HAZARDOUS WASTE (Waste center in place & being used, inventory log in use)
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OTHER OBSERVATIONS
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