2019 Food Safety Verification (1-3-19)

• Restaurant Number:

• Prepared by

• Conducted on

  Date

• Manager on Duty:

CRITICAL FOOD SAFETY

• Critical Food Safety questions are FS1-US through FS6-US.
  
  If any one or more are not compliant, it results in automatic failure and must be corrected immediately with auditor/inspector to remove the risk before leaving the premises.
  
  A follow up visit is required within 14 days.

• FS1-US Is the restaurant infested or does it have signs of active pest infestation? Is the restaurant building, adjoining coral, and any area within 10 feet (3m) from the building (i.e. inside the drive thru lane) clear from animal or insect infestation?

  Safe

  At Risk

  N/A

• Inside the restaurant has visible infestation

• Provide Photo:

  Media

• Inside the restaurant shows signs of infestation

• Provide Photo:

  Media

• Outside the restaurant has visible infestation

• Provide Photo:

  Media

• Outside the restaurant shows signs of infestation

• Provide Photo:

  Media

• Other

• Explain:

• Provide Photo:

  Media

• FS2-US Are the internal temperatures of beef patties after cooking at or above 155°F and fresh beef patties at or above 175°F?

  Yes

  No

  N/A

• Frozen 10:1 (below 155°F)

• Highest temperature obtained:

• Frozen 4:1 (below 155°F)

• Highest temperature obtained:

• Fresh 4:1 (below 175°F)

• Explain:

• Other:

• Explain:

• FS3-US Are the internal temperatures of raw chicken products after cooking at or above 165°F?

  Yes

  No

  N/A

• Chicken Tenders

• Highest temperature obtained::

• Chicken McNuggets

• Highest temperature obtained::

• Crispy Chicken

• Highest temperature obtained::

• Grilled Chicken

• Highest temperature obtained::

• McChicken/Spicy McChicken

• Highest temperature obtained::

• Other:

• Explain:

• FS4-US Are the internal temperatures of breakfast steak and breakfast sausage after cooking at or above 155°F for sausage made from beef or pork and 165°F for sausage made from poultry?

  Yes

  No

  N/A

• Breakfast Steak (below 155°)

• Highest temperature obtained::

• Breakfast Sausage -beef/pork (below 155°)

• Highest temperature obtained::

• Breakfast Sausage -poultry (below 165°)

• Highest temperature obtained::

• Other:

• Explain:

• FS5-US Do cooked round eggs have gelled yolks (are not runny)? Are internal temperatures at or above 155°F?

  Yes

  No

  N/A

• FS6-US Can managers (or staff assigned to complete the checklist) demonstrate they have been trained on properly completing the procedures on the Food Safety Daily Checklist and can take corrective action? Assess through observation, questioning, and demonstration of knowledge (key is completed training, knowing and demonstrating food safety checks and corrective actions are done appropriately).

  Yes

  No

  N/A

• Manager does not know how to correctly meet Non-Critical question's requirements

• Explain the deficiency:

• Manager does not know how to correctly meet Critical question's requirements

• Explain the deficiency:

• Other. (List areas of manager's lack of knowledge)

• Explain the deficiency:

• If the overall score is BELOW 80%, the visit results in a failure and follow up is required between 30-90 days. Food Safety Review Guide is available for this section.

• Food Safety Review Guide is Available for this section.
  https://dmc.accessmcd.com/content/mcmac/storagearea/wa1/ea3639be10a5d4b9b9518b3e0e83d6fb/2949050.AssetPar.Single.File.0.tmp.x.pdf

• FS7-US Is there warm running water and required supplies at all handwashing sinks? Are hand wash sinks easily accessed by employees and only used for hand washing, not preparing food, or storing equipment?

  Yes

  No

  N/A

• Hand washing sink knobs/automatic tap not working well

• Soap dispenser empty / not working

• No warm running water

• No paper towel/working hand dryer

• Soap dispenser does not contain Ecolab approved hand soap

• Hand washing sink/tap obstructed and not accessible

• Hand washing sink used for other purposes

• Other:

• Explain:

• FS8-US Are hands properly washed following hand washing procedures at the appropriate times and is a system in place to ensure hourly hand washing by all employees?

  Yes

  No

  N/A

• Hands not washed on hourly basis

• Hand washing clock / timer not working / not in use / system not in place

• Hand washing activity not monitored

• Hands not washed after using restroom / taking a break

• Hands not washed after handling raw products and working on other station, e.g., prop table

• Hands not washed after tasks (i.e. handling waste, touching face, hair, picking items off floor, etc.)

• Other:

• Explain:

• FS9-US Do sanitized towel buckets contain towels and sanitizer solution at the correct concentration checked with a chlorine test strip?

  Yes

  No

  N/A

• Fresh bucket with sanitized towels not prepared

• Buckets not labeled

• No towels in fresh bucket

• Used towels mixed with fresh towels

• Bucket is soiled

• Sanitizer level is not at correct concentration

• Test strips not available / damaged / expired / not in usable condition

• Other:

• Explain:

• FS10-US Are sanitizer-soaked towels and grill cloths used at food, beverage preparation, and service areas placed into the soiled towel bucket after using and not left sitting out on surfaces?

  Yes

  No

  N/A

• Grill towels left out on kitchen surfaces

• Cloth towels left out on kitchen surfaces

• Cloth towels left out on beverage/service areas

• Other:

• Explain:

• FS11-US Are all UHC trays, grill utensils, prep table utensils, and utensil holders clean (no build up), washed, and sanitized at least every 4 hours as per approved procedure? Do the back sink and soap/sanitizer dispensers or dishwashers function (hot water 110°F or higher) with all required supplies? Does the sanitizer solution have the right concentration when checked with an appropriate test strip?

  Yes

  No

  N/A

• UHC trays, utensils, and utensil holders are not clean

• Items are not being cleaned and sanitized every 4 hours

• Back sink dispenser/ware washer not operating properly

• Sanitizer solution not at the correct concentration

• Water at back sink is not 110°F or hotter

• Test strips not available or damaged / expired / not in usable condition

• Other:

• Explain:

• FS11-US-01 All soiled raw wares that came into contact with raw proteins (such as fresh beef and raw chicken) are washed and sanitized last (unless a ware washer is used). Soiled blue raw beef trays and lids are kept in blue bus box until cleaned. Back sink is properly sanitized after washing wares that came into contact with raw proteins.

  Yes

  No

  N/A

• Raw ware equipment not cleaned last

• Raw ware equipment not washed separately

• Soiled raw beef tray(s) / lid(s) are not stored in blue bus box

• Back sink / Powersoak sink not cleaned after washing raw ware equipment

• Raw ware equipment is soaking in Powersoak sink

• Other:

• Explain:

• FS12-US Are floors, walls, ceilings and equipment in good repair (not cracked or damaged) and clean (free of excessive soil, grease, or food debris build-up)? Are floor drains functioning (not clogged)? Are the floors free of standing or puddling water?

  Yes

  No

  N/A

• Floors/walls/ceiling not in good repair

• Equipment cracked or damaged

• Build up of dirt/grease on floors/walls/ceiling

• Build up of dirt/grease on equipment

• Floor drains not functioning

• Standing/puddling water on the floor

• Other:

• Explain:

• FS13-US Are appropriate measures taken to protect water and ice from foreign material, chemicals, and/or bacterial contamination? Are water filters in date and ice machines free from mold or build up?

  Yes

  No

  N/A

• Water filter not in date

• Water filters bypassed

• Ice transfer bucket not clean

• Water / ice not protected from possible contamination

• Ice machine has visible mold or build up

• Other:

• Explain:

• FS14-US Are opened packages of food in storage, (including dry storage, refrigerators, and freezers) covered/wrapped, labeled, off the floor and away from walls and stored according to proper procedures? If no, mark what product is not stored properly:

  Yes

  No

  N/A

• Frozen beef

• Fresh beef

• Frozen chicken

• Thawed chicken

• Fish

• Breakfast meats

• Potato products

• Bakery / Buns

• Produce / Salad ingredients

• Cheese / Eggs / Dairy

• Other:

• Discribe:

• FS15-US Are blue disposable glove procedures or dedicated tongs used to prevent cross-contamination when handling all raw meat or poultry products (including shell eggs) at the grill station and fryer station? Are dedicated utensils used for raw products (e.g. the yellow yolk breaking tool is only used to break egg yolks)?

  Yes

  No

  N/A

• Gloves not discarded when removed/are being reused

• Double set of gloves being worn

• Proper blue gloves procedures not being followed

• Yellow yolk breaking tool not available

• Yellow yolk breaking tool used for items other than raw eggs

• Utensils other than yellow yolk breaking tool used to break raw egg yolks

• Bare hand used with raw product at grill / fryer

• Other:

• Explain:

• FS16-US Are clear/white disposable gloves worn for food preparation of ready to eat foods at the sandwich prep table and salad prep table to prevent bare hand contact with any cooked or ready-to-eat foods?

  Yes

  No

  N/A

• Gloves not worn when preparing sandwiches, salads, or burritos

• Gloves not replaced when damaged / contaminated

• Gloves not discarded when removed or being reused

• Gloves not changed and hands not washed if they become contaminated

• Clear gloves are used for handling raw products

• Double set of gloves being worn

• Other:

• Explain:

• FS17-US Are chemicals stored away from food and packaging?

  Yes

  No

  N/A

• Chemical spray bottles / containers stored in the kitchen

• Chemical spray bottles / containers stored in the service area

• Chemicals are stored in dry storage near to food and packaging

• Chemicals stored in food containers

• Other:

• Explain:

• FS18-US Is a pest management program and pest prevention steps and behaviors in place and being managed effectively? Is the restaurant properly pest proofed to prevent entry of pests (e.g. gaps under doors are sealed)? <br><br>Review the most recent pest control report, ensuring all recommendations have been corrected. If the pest management program and pest prevention steps and behaviors are not in place or are not complete, then mark this question as no. Include in the comments specifics on what you observed.

  Yes

  No

  N/A

• Pest management program is not in place

• Pest management program is not working effectively

• Restaurant is not pest proofed

• Most recent pest control report recommendations not corrected

• Other:

• Explain:

• FS19-US Are non-food spill clean-up procedures in place?

  Yes

  No

  N/A

• 3-n-1 cleaner / disinfectant not availble

• Staff not trained in the use of the non-food spill procedures

• Non-food spill procedures not available

• Non-food spill procedures not followed

• Other:

• Explain:

• FS20-US Are walk-in freezers and any other primary storage freezers operating at 0°F or below? Are secondary storage freezers keeping all products solidly frozen? If no, check which units are not at proper temperature:

  Yes

  No

  N/A

• Walk-in freezer

• Reach-in freezer

• Kitchen wall freezer

• Grill side freezer

• Frozen fry dispenser

• Other

• Describe:

• FS21-US Are refrigerated products inside all refrigerated units at or below 40°F (including shake/sundae reservoir)? If no, check which units do not meet the temperature standard:

  Yes

  No

  N/A

• Walk-in cooler

• Reach-in cooler

• Prep line

• Grill side refrigerator

• McCafé

• Shake/Sundae reservoir

• Milk/Beverage coolers

• Salad displays

• Other

• Describe:

• FS22-US Are all refrigerated products in code (within primary shelf life)? If no, mark what product is not in code:

  Yes

  No

  N/A

• Fresh beef

• Produce

• Cheese / Eggs / Dairy

• Sauces

• Milk

• Shake / Sundae mix

• Other

• Product:

• FS23-US Are secondary shelf lives of all refrigerated products held in refrigerators and at room temperature marked and are the products being used within their secondary shelf lives? If no, mark what product is not in code:

  Yes

  No

  N/A

• Produce

• Cheese / Eggs / Dairy

• Sauces

• Raw poultry

• Fresh beef

• Canadian bacon

• Other

• Product:

• FS24-US Are leftover heated foods discarded (including any shake/sundae mix removed from heat treatment shake/sundae machines)? If no, mark what product

  Yes

  No

  N/A

• Shake / Sundae mix

• Sauces / Soups / Gravies

• Food donation products not stored in freezer

• Other

• Describe:

• FS25-US Is the Pyrometer calibrated, working correctly, and is the probe clean?

  Yes

  No

  N/A

• Probe not complete/missing

• Pyrometer not in calibration

• Pyrometer / probes damaged

• Probe not clean

• Other:

• Explain:

• FS26-US Is the internal temperature of Filet-O-Fish portions after cooking at or above 150°F?

  Yes

  No

  N/A

• FS27 Are all food, food packaging, equipment (including utensils), and cleaning chemicals from approved sources?

  Yes

  No

  N/A

• Food not from approved sources

• Packaging not from approved sources

• Equipment not from approved sources

• Cleaning chemicals not from approved sources

• Other:

• Explain:

• FS28-US Do managers understand employee illness symptoms and reportable illness causes for when an employee cannot be working? Do managers also understand when an employee can return work after illness?

  Yes

  No

  N/A

• Manager does not know what symptoms would result in employees not being allowed to work

• Manager does not know the procedures to follow when presented with an ill employee

• Manager does not know when an ill employees would be allowed to return to work

• Manager does not know the reportable illness causes

• Other:

• Explain:

• FS29-US Are all managers (including shift managers) trained and currently certified in food safety through ServSafe (or an equivalent and accredited food safety training course)? Are all employees trained and verified on food safety and sanitation per McDonald's current training program in accordance with local regulations?

  Yes

  No

  N/A

• Proof of employee food safety training not available

• Certification is overdue and needs to be reissued

• Not all managers have been trained and certified

• Not all employees have been trained and verified

• Food safety certificate not available

• Other:

• Explain:

• FS30-US Are at least the last 60 days of correctly completed Food Safety Daily Checklists available? Are the last two correctly completed Monthly Food Safety Procedure Verifications available? (For Digital Food Safety please reference the Food Safety Guide)

  Yes

  No

  N/A

• Last 60 days of completed Daily Food Safety Book (records) not available

• Incorrect completion of last 60 days of completed Daily Food Safety Book (records)

• Last two completed Monthly Food Safety Procedure Verifications are not available

• Incorrect completion of last two Monthly Food Safety Procedure Verifications

• Digital Food Safety acceptance criteria not met

• Other:

• Explain:

• FS31-US When reviewing the most recent health department inspection report, have all food safety violations noted by the health department been corrected or a plan in place to correct issues?

  Yes

  No

  N/A

• Health Department inspection report not available

• Violations noted by Health Department have not been corrected

• Plan not in place to correct issues

• Other:

• Explain:

• FS32-US Are nut containing McFlurry mix-ins kept in the orange container with lid and a dedicated scoop?

  Yes

  No

  N/A

• Orange container not utilized for nut containing mix-ins

• Dedicated scoop not utilized

• Nut-free mix-ins kept in the orange container

• Other:

• Explain: