Title Page

  • Conducted on

  • Prepared by

  • Location

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?

  • 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)?

  • Please specify

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

  • 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?

  • Please specify

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

  • 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).

  • Other

  • (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?

  • 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?

  • 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?

  • 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?

  • 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?

  • 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.

  • 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?

  • 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?

  • 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:

  • 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)?

  • 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?

  • Please specify

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

  • 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)?

  • Please specify

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

  • 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

  • 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:

  • 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:

  • 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.

  • 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

  • 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:

  • Please specify

Cooking

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

  • Please specify

General

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

  • 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?

  • 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?

  • 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)

  • 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?

  • Please specify

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

  • Please specify

Completion

  • Overall Comments

  • Inspected by: (Name and Signature)

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