12 Critical check

• Conducted on

  Date

• Prepared by

AUTOMATIC FAIL

• No running water

  Yes

  No

  N/A

• Back up drains

  Yes

  No

  N/A

• Cooler temp verified 34F-40F

  Yes

  No

  N/A

• Freezer temp verified 10F-or below

  Yes

  No

  N/A

• Broiler unable to reach minimum internal temp of product and still in use

  Yes

  No

  N/A

• No working restroom

  Yes

  No

  N/A

• No sanitizer available

  Yes

  No

  N/A

• Serious gas or electrical issue

  Yes

  No

  N/A

• Only 1 person in the store

  Yes

  No

  N/A

FS101. Required Hand-Washing Procedures are Followed

• Paper towel dispensers are stocked and easily dispensed.

  Yes

  No

  N/A

• Approved Antibacterial soap and sanitizer dispensers are stocked and functioning

  Yes

  No

  N/A

• Antibacterial soap within date?

  Yes

  No

  N/A

• Hand sanitizer within date?

  Yes

  No

  N/A

• Hand Washing sink is not obstructed?

  Yes

  No

  N/A

• Hand Washing procedure executed properly

  Yes

  No

  N/A

• Employee #1

• Employee #2

• Manager #1

• Hands washed when required?

  Yes

  No

  N/A

FS102. Health Department Inspection are Available and Violations Have Been Corrected

• Report is available and violations corrected?

  Yes

  No

  N/A

FS103. Hot Water is Available.

• Hand Washing sink must meet minimum of 100.F

  Yes

  No

  N/A

• Non Hand Washing sinks must meet a minimum of 110. F

  Yes

  No

  N/A

• All Hand Washing sinks are functioning

  Yes

  No

  N/A

• Hot water makes temperature in 20 seconds

  Yes

  No

  N/A

FS104. Quality Checks, Potentially Hazardous Foods Meet Temperature Standards

• Hot PHF’s meet minimum of 140. F

  Yes

  No

  N/A

• Cold PHF’s meet minimum of 40.F

  Yes

  No

  N/A

• Daily planner

  Yes

  No

  N/A

• Calibrated Thermometer

  Yes

  No

  N/A

FS105. Sanitizer Solution are Properly stored/labeled/used

• Manager able to demonstrate proper use of test strips

  Yes

  No

  N/A

• Test strips within date

  Yes

  No

  N/A

• 3-compartment sink meets 50-200 ppm

  Yes

  No

  N/A

• Sanitizer buckets and sanitize spray bottles meet 50-200 ppm

  Yes

  No

  N/A

• Towels are completely submerged in the containers

  Yes

  No

  N/A

• Sanitizer solutions are in properly labeled approved containers

  Yes

  No

  N/A

FS106. Shake, Soft Serve Machine, Smoothie Pitchers Sanitized Properly

• Build up not evident in carburetor tube

  Yes

  No

  N/A

• All required brushes are present, clean, and in good condition

  Yes

  No

  N/A

• Green pack sanitizer (Kay 5) is available

  Yes

  No

  N/A

• Brushes are stored in a clean and approved storage unit or cabinet

  Yes

  No

  N/A

• Shake Spindle clean and free of all build up

  Yes

  No

  N/A

FS107. Restaurant is only using Approved Product

• Approved gloves in use

  Yes

  No

  N/A

• All chemicals are found on approved brand list

  Yes

  No

  N/A

• Only have red, blue, yellow, and green wipe clothes

  Yes

  No

  N/A

• Approved black, elbow length disposable gloves are present

  Yes

  No

  N/A

• Inspect pans-remove cracked items

  Yes

  No

  N/A

• Inspect knives-tongs-melted replaced

  Yes

  No

  N/A

FS108. Prepped items are Marked with hold Time and not Expired (PHF’s)

• Hold Times for PHF’s on boards

  Yes

  No

  N/A

• Pies

• Shake syrups

• Iced coffee

• Bulk creamer

• Lettuce

• Tomatoes

• Cheese

• Eggs

• Onions

• Iced tea

• Cookies

• Ham

FS109. Cross contamination is not Observed

• Proper use of tongs

  Yes

  No

  N/A

• Using tongs for nuggets

• Using tongs to drop meat

• Cooked and raw product are kept seperate

  Yes

  No

  N/A

• New product is not placed on top of in-use product

  Yes

  No

  N/A

• Ice scoop is not touching ice

  Yes

  No

  N/A

• Employee is using ice scoop and not using cup to scoop ice

  Yes

  No

  N/A

• No mold is in ice machine

  Yes

  No

  N/A

• No mold on pop nozzles

  Yes

  No

  N/A

• Employee food is stored properly

  Yes

  No

  N/A

FS110 Effective Pest Elimination is in Place

• Rodent, insect and pest activity is not present

  Yes

  No

  N/A

• Visit within last month

• Monthly pest control report is on file and in the restaurant

  Yes

  No

  N/A

FS111 product Cook-Out Procedures/Temperature Meets Standards

• No day part cookout are missed in a 30 day window

  Yes

  No

  N/A

• Any temperatures under the minimal 155F are corrected

  Yes

  No

  N/A

• Manager knows how to change broiler time to adjust the temp

  Yes

  No

  N/A

• Manager able to perform proper cook out procedures

  Yes

  No

  N/A

• Beef cook out tray is required

  Yes

  No

  N/A

• Meat cook out poster is posted

  Yes

  No

  N/A

• Manager does not miss any steps in meat cookout

  Yes

  No

  N/A

• Review procedure with manager during visit

  Yes

  No

  N/A

• Yes

  No

  N/A

FS112. No other food safety violations are present

• No drainage back-up observed

  Yes

  No

  N/A

• Food prep area is free from roof leaks

  Yes

  No

  N/A

• Chemicals are labeled and stored properly

  Yes

  No

  N/A

• No evidence of team members working while ill

  Yes

  No

  N/A

• No crew drinks cup observed

  Yes

  No

  N/A

• Onion slicer and tomato slicer stored dirty on 3-comp sink

  Yes

  No

  N/A

Other Things to Check

• Frozen drinks

• Free Style on shelf

• Lettuce

• Milk

• Eggs

• Uniforms up to standards

  Yes

  No

  N/A