Title Page
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Conducted on
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Prepared by
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Location
Critical Food Safety
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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?
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- 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
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Please specify
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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)?
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- 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
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Please specify
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FS3-US<br><br>Are the internal temperatures of raw chicken products after cooking at or above 165°F?
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- 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
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Please specify
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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?
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- 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
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Please specify
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FS5-US<br><br>Are the internal temperatures of round eggs after cooking at or above 155°F?
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- 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
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Please specify
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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).
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- 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)
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Other
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(List areas of manager lack of knowledge)
Hygiene & Sanitation
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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?
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- 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
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Please specify
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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?
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- 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
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Please specify
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FS9-US<br><br>Do sanitized towel buckets contain towels and chlorine sanitizer solution at the correct concentration checked with a chlorine test strip?
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- 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
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Please specify
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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?
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Please specify
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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?
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- 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
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Please specify
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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.
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- 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
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Please specify
Contamination Prevention
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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?
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- 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
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Please specify
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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?
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- 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
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Please specify
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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:
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- 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
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Please specify
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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)?
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- 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
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Please specify
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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?
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- 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
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Please specify
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FS17-US<br><br>Are chemicals stored away from food and packaging?
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- 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
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Please specify
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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)?
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- 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
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Please specify
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FS19-US<br><br>Are non-food spill clean-up procedures in place?
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Please specify
Storage
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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
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Please specify
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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:
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Please specify
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FS22-US<br><br>Are all refrigerated products in code (within primary shelf life)? If no, mark what product is not in code:
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- Fresh beef
- Produce
- Cheese / Eggs / Dairy
- Apple slices
- Milk
- Shake/Sundae mix
- Other
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Please specify
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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.
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Please specify
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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
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Please specify
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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:
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Please specify
Cooking
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FS25-US<br><br>Is the Pyrometer calibrated, working correctly, and is the probe clean?
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Please specify
General
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FS27<br><br>Are all food, food packaging, equipment (including utensils), and cleaning chemicals from approved sources?
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Please specify
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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?
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- 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
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Please specify
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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?
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Please specify
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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)
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- 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
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Please specify
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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?
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Please specify
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FS32-US<br><br>Are nut containing McFlurry mix-ins kept in the orange container with lid and a dedicated scoop?
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Please specify
Completion
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Overall Comments
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Inspected by: (Name and Signature)