Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Hand washing

  • Hand washing sink working properly

  • Hand washing sink clean

  • Soap available and spare

  • Sanitizer available and spare

  • Paper towel available and spare

  • Gloves available

  • Instructions poster available

  • Employees washing hands when required

  • Hand washing sink within correct temperature range

  • Employees following correct hand washing procedure

Sanitizing solution

  • W/R/S process properly followed (small wares sanitised for 1 min)

  • Approved sanitizing test strips available and within date

  • Sanitizer buckets approved and properly labelled

  • Sanitizer buckets within tolerance

  • All open stations have designated bucket

  • All buckets have cloths and are fully submerged

Cross contamination

  • Onion/ tomato/ lettuce slicer clean

  • No tongs burnt or cracked

  • Soft drink machine nozzle and bib connectors clean in direct contact with food

  • Interior of ice machine is clean and not used as storage for other items

  • Ice scoop is clean and stored correctly in a pan

  • Correct tongs in use at correct stations : frozen vs cooked

  • No tongs in contact with food inside fridges or freezers

  • No evidence of old and new products are mixed

  • Allergens disclaimer and content poster available in front counter

  • Allergens disclaimer available in at least 1 door. DT menu board

  • Allergens BOH training poster completed <br>Hospital map <br>List of products <br>And all employees signatures

  • Minimum of 1 POS sticker for cashier reference in case of guest doubts

  • Small wares used for allergens product identified as per ops alerts

  • No other evidence of cross contamination

Soft serve machine

  • Correct number of brushes and properly stored, cleaned and maintained

  • KAY5 sanitizer available and in date

  • Food grade lube available and in date

  • In Taylor machine, agitator is clean and properly maintained

Hot water

  • Hand washing sink temperature reaching a min

  • 3 compartment sink is reaching a minimum of 49c

Beef cook out

  • Beef cook out log fully completed

  • No registered temperatures out of range

  • Cookout is performed every 3 hours, prior to open and prior to peak hour

  • MIC able to demonstrate and verbalise C/O procedure

Temperature control

  • All hot PHF's above minimum temperature ( products in MPHU)

  • All cold PHF below maximum temperature (products in fridges)

  • Calibrated probes available

  • Quality checks log complete

Time control

  • All PHF's products on boards are marked with PTD labels and have not expired

Unapproved items

  • No unapproved food found in the restaurant

  • No unapproved chemicals found in the restaurant

  • No unapproved equipment found in the restaurant

  • No unapproved smallwares or tools found in the restaurant

Pest control

  • No evidence of pest infestation

Health inspection report

  • No health department failures not amended within 10 days or specific dates

Other FSC

  • No evidence of water back up in the kitchen

  • No evidence of employees working in sick conditions

  • No cleaning chemicals stored near food

  • No yellow cleaning equipment near or touching other equipment

  • Serve safe certificate in use and available for manager on duty

  • Roof in good condition in all preparation and storage areas

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.