2020 - Food Safety Verification - v2

• Conducted on

  Date

• Prepared by

• Location
  Address

Critical Food Safety

• FS1-US<br><br>Is the restaurant free of infestation and free from signs of an active pest infestation? Is the restaurant building, adjoining corral, and any area within 10 feet (3m) from the building (i.e. inside the drive thru lane) clear from animal or insect infestation?

  Yes

  No

  N/A

• Select Inside the restaurant has visible infestation Inside the restaurant shows signs of infestation Outside the restaurant has visible infestation Outside the restaurant shows signs of infestation Un-trapped live rodent(s) Live cockroach(es) Unmanaged or excessive presence of other pests (e.g. greater than 5 small flies congregating in one area) Rodent droppings Other

  • Inside the restaurant has visible infestation
  • Inside the restaurant shows signs of infestation
  • Outside the restaurant has visible infestation
  • Outside the restaurant shows signs of infestation
  • Un-trapped live rodent(s)
  • Live cockroach(es)
  • Unmanaged or excessive presence of other pests (e.g. greater than 5 small flies congregating in one area)
  • Rodent droppings
  • Other

• Please specify

• FS2-US<br><br>Are the internal temperatures of beef patties after cooking at or above 155°F and fresh beef patties at or above 175°F (for quality)?

  Yes

  No

  N/A

• Select Temperature settings and cooking timers are not set correctly Maximum run size exceeded Patties not laid and removed in the proper sequence Release sheets are not in good condition or not tightly placed on platen Release sheets are not squeegeed between every run and wiped off with a grill cloth at least four times every hour Patties not solidly frozen or shows signs of thawing Grill is not in good repair Other

  • Temperature settings and cooking timers are not set correctly
  • Maximum run size exceeded
  • Patties not laid and removed in the proper sequence
  • Release sheets are not in good condition or not tightly placed on platen
  • Release sheets are not squeegeed between every run and wiped off with a grill cloth at least four times every hour
  • Patties not solidly frozen or shows signs of thawing
  • Grill is not in good repair
  • Other

• Please specify

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

  Yes

  No

  N/A

• Select Temperature settings and cooking timers are not set correctly Maximum run size exceeded Proper fryer baskets not being used or are overfilled Oil levels in fryers are not correct Portions not solidly frozen or shows signs of thawing Fryer is not in good repair Other

  • Temperature settings and cooking timers are not set correctly
  • Maximum run size exceeded
  • Proper fryer baskets not being used or are overfilled
  • Oil levels in fryers are not correct
  • Portions not solidly frozen or shows signs of thawing
  • Fryer is not in good repair
  • Other

• Please specify

• FS4-US<br><br>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

• Select Temperature settings and cooking timers are not set correctly Maximum run size exceeded Patties not laid and removed in the proper sequence Release sheets are not in good condition or not tightly placed on platen Release sheets are not squeegeed between every run and wiped off with a grill cloth at least four times every hour Patties not solidly frozen or shows signs of thawing ⃝ Grill is not in good repair Other

  • Temperature settings and cooking timers are not set correctly
  • Maximum run size exceeded
  • Patties not laid and removed in the proper sequence
  • Release sheets are not in good condition or not tightly placed on platen
  • Release sheets are not squeegeed between every run and wiped off with a grill cloth at least four times every hour
  • Patties not solidly frozen or shows signs of thawing ⃝ Grill is not in good repair
  • Other

• Please specify

• FS5-US<br><br>Are the internal temperatures of round eggs after cooking at or above 155°F?

  Yes

  No

  N/A

• Select Temperature settings and cooking timers are not set correctly Eggs not laid and removed in the proper sequence Egg ring not positioned properly on the grill surface or egg cooker not level on the floor Improper amount of water is poured into the center of the egg ring or timer is not started immediately after pouring the water Egg ring or egg cooker is not in good repair Grill is not in good repair Other

  • Temperature settings and cooking timers are not set correctly
  • Eggs not laid and removed in the proper sequence
  • Egg ring not positioned properly on the grill surface or egg cooker not level on the floor
  • Improper amount of water is poured into the center of the egg ring or timer is not started immediately after pouring the water
  • Egg ring or egg cooker is not in good repair
  • Grill is not in good repair
  • Other

• Please specify

• FS6-US<br><br>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

• Select Pyrometer is not being properly placed in the center of the patties Not all the 4:1 patties cooked are checked The manager does not know the correct minimum cooking temperature requirement The manager does not state to wash, rinse, and sanitize the probe, utensils, and tray after discarding product that did not meet minimum temperatures The manager does not take proper corrective action when a product is undercooked Other (List areas of manager lack of knowledge)

  • Pyrometer is not being properly placed in the center of the patties
  • Not all the 4:1 patties cooked are checked
  • The manager does not know the correct minimum cooking temperature requirement
  • The manager does not state to wash, rinse, and sanitize the probe, utensils, and tray after discarding product that did not meet minimum temperatures
  • The manager does not take proper corrective action when a product is undercooked
  • Other (List areas of manager lack of knowledge)

• Other

  Yes

  No

  N/A

• (List areas of manager lack of knowledge)

Hygiene & Sanitation

• FS7-US<br><br>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

• Select Hand washing sink knobs/automatic tap not working well Soap dispenser empty / not working No warm running water No paper towel/working hand dryer Hand washing sink/tap obstructed and not accessible Hand washing sink used for other purposes Other

  • Hand washing sink knobs/automatic tap not working well
  • Soap dispenser empty / not working
  • No warm running water
  • No paper towel/working hand dryer
  • Hand washing sink/tap obstructed and not accessible
  • Hand washing sink used for other purposes
  • Other

• Please specify

• FS8-US<br><br>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

• Select 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., prep table Hands not washed after tasks (i.e. handling waste, cell phone usage, touching face, hair, picking items off floor, etc.) Proper hand washing procedure not followed Other

  • 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., prep table
  • Hands not washed after tasks (i.e. handling waste, cell phone usage, touching face, hair, picking items off floor, etc.)
  • Proper hand washing procedure not followed
  • Other

• Please specify

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

  Yes

  No

  N/A

• Select Fresh bucket with sanitized towels not prepared Buckets not labeled No towels in fresh bucket Bucket is soiled Sanitizer level is not at correct concentration Test strips not available / damaged / expired / not in usable condition Other

  • Fresh bucket with sanitized towels not prepared
  • Buckets not labeled
  • No towels in fresh bucket
  • Bucket is soiled
  • Sanitizer level is not at correct concentration
  • Test strips not available / damaged / expired / not in usable condition
  • Other

• Please specify

• FS10-US<br><br>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

• Select Grill towels left out on kitchen surfaces Cloth towels left out on kitchen surfaces Cloth towels left out on beverage/service areas Used towels mixed with fresh towels in the clean towel bucket Other

  • Grill towels left out on kitchen surfaces
  • Cloth towels left out on kitchen surfaces
  • Cloth towels left out on beverage/service areas
  • Used towels mixed with fresh towels in the clean towel bucket
  • Other

• Please specify

• FS11-US<br><br>Are all in-use 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

• Select UHC trays, utensils, and utensil holders have excessive grease or build-up 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

  • UHC trays, utensils, and utensil holders have excessive grease or build-up
  • 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

• Please specify

• FS11-US-01<br><br>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 warewasher 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

• Select 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

  • 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

• Please specify

Contamination Prevention

• FS12-US<br><br>Are floors, walls, ceilings, and equipment in good repair (not cracked or damaged) and 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

• Select Floors/walls/ceiling not in good repair In-use food contact equipment cracked or damaged Excessive build up of dirt/grease/mold on floors/walls/ceiling Excessive build up of dirt/grease/mold on equipment Floor drains not functioning Standing/Puddling water on the floor Other

  • Floors/walls/ceiling not in good repair
  • In-use food contact equipment cracked or damaged
  • Excessive build up of dirt/grease/mold on floors/walls/ceiling
  • Excessive build up of dirt/grease/mold on equipment
  • Floor drains not functioning
  • Standing/Puddling water on the floor
  • Other

• Please specify

• FS13-US<br><br>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

• Select Water filter(s) not dated (if not serviced by Coke) Water filter(s) bypassed Ice transfer bucket not clean Ice scoop not stored in holder Water / ice not protected from possible contamination Ice machine, bin, or ice chute has visible mold or build up Other

  • Water filter(s) not dated (if not serviced by Coke)
  • Water filter(s) bypassed
  • Ice transfer bucket not clean
  • Ice scoop not stored in holder
  • Water / ice not protected from possible contamination
  • Ice machine, bin, or ice chute has visible mold or build up
  • Other

• Please specify

• FS14-US<br><br>Are opened packages of food in storage, (including dry storage, refrigerators, and freezers) covered/wrapped, 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

• Select Frozen beef Fresh beef Frozen chicken Thawed chicken Fish Breakfast meats Potato products Produce / Salad ingredients Cheese / Eggs / Dairy Raw products are not stored separately from ready-to-eat foods Packages of food stored touching the wall Packages of food are not covered/wrapped Other

  • Frozen beef
  • Fresh beef
  • Frozen chicken
  • Thawed chicken
  • Fish
  • Breakfast meats
  • Potato products
  • Produce / Salad ingredients
  • Cheese / Eggs / Dairy
  • Raw products are not stored separately from ready-to-eat foods
  • Packages of food stored touching the wall
  • Packages of food are not covered/wrapped
  • Other

• Please specify

• FS15-US<br><br>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

• Select Gloves not discarded when removed/are being reused Double set of gloves being worn Proper blue glove procedures for use/removal are not being followed Yellow yolk breaking tool not available Yellow yolk breaking tool used for items other than raw eggs Yellow yolk breaking tool is improperly stored in contact with food or utensils used for cooking food Utensils other than yellow yolk breaking tool used to break raw egg yolks Bare hands used with raw product at grill / fryer Other

  • Gloves not discarded when removed/are being reused
  • Double set of gloves being worn
  • Proper blue glove procedures for use/removal are not being followed Yellow yolk breaking tool not available
  • Yellow yolk breaking tool used for items other than raw eggs
  • Yellow yolk breaking tool is improperly stored in contact with food or utensils used for cooking food
  • Utensils other than yellow yolk breaking tool used to break raw egg yolks
  • Bare hands used with raw product at grill / fryer
  • Other

• Please specify

• FS16-US<br><br>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

• Select 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 if they become contaminated Clear gloves are used for handling raw products Double set of gloves being worn Other

  • 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 if they become contaminated
  • Clear gloves are used for handling raw products
  • Double set of gloves being worn
  • Other

• Please specify

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

  Yes

  No

  N/A

• Select 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 Chemicals improperly used (ex. spraying around open food or packaging) Other

  • 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
  • Chemicals improperly used (ex. spraying around open food or packaging)
  • Other

• Please specify

• FS18-US<br><br>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)?

  Yes

  No

  N/A

• Select Pest management program is not in place Pest management program is not working effectively Restaurant is not pest proofed Report is older than 60 days or no pest service report is available for review. Most recent pest control report recommendations not corrected or there is no action plan to correct Dead cockroach(es) Trapped rodent(s) Trailing ant activity in one area High large fly activity greater than 5 in one area Other

  • Pest management program is not in place
  • Pest management program is not working effectively
  • Restaurant is not pest proofed
  • Report is older than 60 days or no pest service report is available for review.
  • Most recent pest control report recommendations not corrected or there is no action plan to correct
  • Dead cockroach(es)
  • Trapped rodent(s)
  • Trailing ant activity in one area
  • High large fly activity greater than 5 in one area
  • Other

• Please specify

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

  Yes

  No

  N/A

• Select 3N1 cleaner / disinfectant not available 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

  • 3N1 cleaner / disinfectant not available
  • 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

• Please specify

Storage

• FS20-US <br><br>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

• Select Walk-in freezer or other primary storage freezer is above 10°F Product in the primary or secondary freezers are not solidly frozen Other

  • Walk-in freezer or other primary storage freezer is above 10°F
  • Product in the primary or secondary freezers are not solidly frozen
  • Other

• Please specify

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

  Yes

  No

  N/A

• Select Refrigerated products held in walk-in refrigerators are over 40°F Refrigerated products held in secondary/reach-in refrigerators are over 40°F Other

  • Refrigerated products held in walk-in refrigerators are over 40°F
  • Refrigerated products held in secondary/reach-in refrigerators are over 40°F
  • Other

• Please specify

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

  Yes

  No

  N/A

• Select Fresh beef Produce Cheese / Eggs / Dairy Apple slices Milk Shake/Sundae mix Other

  • Fresh beef
  • Produce
  • Cheese / Eggs / Dairy
  • Apple slices
  • Milk
  • Shake/Sundae mix
  • Other

• Please specify

• FS23-US-01<br><br>Are secondary shelf lives of all items held at room temperature (Time as a Public Health Control) properly marked and within their secondary shelf lives? If no, mark what product is not in code.

  Yes

  No

  N/A

• Select Produce held at the prep table or chilled rail Cheese / Eggs / Dairy Canadian bacon Apple slices/butter pats at room temperature or chill pans Other

  • Produce held at the prep table or chilled rail
  • Cheese / Eggs / Dairy
  • Canadian bacon
  • Apple slices/butter pats at room temperature or chill pans
  • Other

• Please specify

• FS23-US-02<br><br>Are secondary shelf lives of all refrigerated products held in refrigerators properly marked and being used within their secondary shelf lives? If no, mark what product is not in code

  Yes

  No

  N/A

• Select Product held in refrigerators are not properly marked Product held in refrigerators not within proper secondary shelf life Other

  • Product held in refrigerators are not properly marked
  • Product held in refrigerators not within proper secondary shelf life
  • Other

• Please specify

• FS24-US<br><br>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

• Select Shake / Sundae mix Sauces / Soups / Gravies Food donation products not stored in freezer Other

  • Shake / Sundae mix
  • Sauces / Soups / Gravies
  • Food donation products not stored in freezer
  • Other

• Please specify

Cooking

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

  Yes

  No

  N/A

• Select Probe not complete/missing Pyrometer not in calibration Pyrometer / probes damaged Probe has excessive, encrusted food residue Other

  • Probe not complete/missing
  • Pyrometer not in calibration
  • Pyrometer / probes damaged
  • Probe has excessive, encrusted food residue
  • Other

• Please specify

General

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

  Yes

  No

  N/A

• Select Food not from approved sources Packaging not from approved sources Equipment not from approved sources Cleaning chemicals not from approved sources Other

  • Food not from approved sources
  • Packaging not from approved sources
  • Equipment not from approved sources
  • Cleaning chemicals not from approved sources
  • Other

• Please specify

• FS28-US<br><br>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 to work after illness?

  Yes

  No

  N/A

• Select Manager does not know what symptoms (at a minimum, vomiting, diarrhea and jaundice) 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 employee would be allowed to return to work Manager does not know the reportable illness causes Employee(s) are observed exhibiting any of the reportable illness symptoms Other

  • Manager does not know what symptoms (at a minimum, vomiting, diarrhea and jaundice) 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 employee would be allowed to return to work
  • Manager does not know the reportable illness causes
  • Employee(s) are observed exhibiting any of the reportable illness symptoms
  • Other

• Please specify

• FS29-US<br><br>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?

  Yes

  No

  N/A

• Select Certification date is not current Certification for managers not issued by ServSafe or equivalent/accredited organization Employee training tracking document not available for review during the visit Not all employees have been trained and verified Other

  • Certification date is not current
  • Certification for managers not issued by ServSafe or equivalent/accredited organization
  • Employee training tracking document not available for review during the visit
  • Not all employees have been trained and verified
  • Other

• Please specify

• FS30-US<br><br>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

• Select 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 less than 80% completion for the last 60 days of Food Safety Daily Checklists Other

  • 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 less than 80% completion for the last 60 days of Food Safety Daily Checklists
  • Other

• Please specify

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

  Yes

  No

  N/A

• Select Health department inspection report not available Critical violations noted by Health Department have not been corrected Plan not in place to correct issues Other

  • Health department inspection report not available
  • Critical violations noted by Health Department have not been corrected
  • Plan not in place to correct issues
  • Other

• Please specify

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

  Yes

  No

  N/A

• Select Orange container not utilized for nut containing mix-ins Dedicated scoop not utilized or available Nut-free mix-ins kept in the orange container Other

  • Orange container not utilized for nut containing mix-ins
  • Dedicated scoop not utilized or available
  • Nut-free mix-ins kept in the orange container
  • Other

• Please specify

Completion

• Overall Comments

• Inspected by: (Name and Signature)

  Sign