Title Page
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Conducted on
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Prepared by
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Location
- 8201 Dillingham
- 8203 Umi
- 8204 McCully
- 8205 Kam IV
- 8206 Waipahu
- 8207 Waimanalo
- 8208 Kapiolani
- 8209 Wahiawa
- 8210 Kapahulu
- 8211 Kaneohe
- 8212 Kahului
- 8213 Stadium
- 8217 Waipio
- 8219 Kailua
- 8222 Kihei
- 8223 Hilo
- 8227 Bishop
- 8230 Moanalua
- 8233 Waimalu
- 8237 King/Kalakaua
- 8244 Piikoi
- 8245 Wailuku
- 8246 Kapolei
- 8249 Kunia
- 8251 Kona
- 8252 Waianae
- 8253 Lihue
- 8254 Ala Moana
- 8255 Tamuning
- 8256 Niu Vlley
- 8259 Mililani
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PIC Name
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FINAL SCORE (With any applicable bonus points included)
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This will be entered at the end of the audit.
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Instructions for each question will be underneath the question. Once an answer is selected, the instructions will be hidden. To view the instructions again, deselect the answer. Bonus points will be evaluated at the end of the audit.
1. GENERAL
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1-1 Manager Certification
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Check that Restaurant Manager has a current ServSafe Managers certification. (For Guam, also assess that all Team Leaders have a current ServSafe Certification.)
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1-4 Food Permit
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Valid food permit posted.
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1-5 Health Department Inspection
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Most recent health inspection report is at the restaurant, and all deficiencies have been addressed.
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1-6 Food Safety Standards Validated Throughout Day
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Daily food safety checklist, thermometer calibration, and corrective actions taken.
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1-7 Corrective Action Plan: NSF Previous Failure
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For previously failed assessments, a copy of corrective action plan is available for all 'Priority' standards and/or improvement on previously missed standards is observed.
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1-9 Immediate Corrective Action
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All items observed unacceptable during today's Food Safety Assessment are corrected during the assessment.
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1-10 PIC Knowledge of Health Inspections: Failed, Downgraded, Samples Taken
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PIC can demonstrate they understand the requirements if a failed health department inspection occurs.
2. EMPLOYEE HEALTH & HYGIENE
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2-1 Illness
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Food handlers have no obvious signs of illness/not working when sick.
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2-2 Eating, Drinking, Smoking, Gum-Chewing, and Personal Items
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Eating, drinking, smoking, gum-chewing, and personal items are not allowed at workstations and are kept separate from food and beverage areas.
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2-3 Team Appearance
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All restaurant employees follow dress code requirements.
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2-4 PIC Knowledge of Illness Policy
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PIC can explain the employee illness policy and when to restrict or exclude ill Team Members.
3. Pest Control
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3-1 Pest Prevention
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RM effectively controlling pests.
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3-2 Pest Activity
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The facility is free of signs of pest activity
4. HANDWASHING/HAND SINKS
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4-1 Handwashing Sink Availability
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Handwashing sinks in kitchen areas are available, accessible, working, and properly set up.
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4-2 Handwashing Sink Usage
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Handwashing sinks are used only for handwashing.
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4-3 Handwashing
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All employees are observed washing hands properly and only in designated handwashing sinks.
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4-4 Glove Usage
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Employees are properly using disposable gloves
5. FOOD RECEIVING AND STORAGE
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5-1 Food Receiving
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Evidence of food receiving to standard- Temperatures, condition, receiving and storage procedures to standard
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5-2 Expired Products/Ingredients
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No expired products/ingredients are noted.
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5-3 PIC Knowledge of Purchasing Food
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PIC can describe the correct procedures to purchase foods.
6. FOOD CONTAMINATION PREVENTION & PROTECTION
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6-1 Food and Packaging Are Stored Properly and Protected From Contamination
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Adequately covered, RTE foods stores over raw foods.
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6-2 No Food or Packaging Contamination Observed
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6-3 Proper Washing
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Fruits and vegetables are properly washed before use.
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6-4 Lighting
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Lighting is adequate and all lights are clean and properly shielded or shatterproof.
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6-5 8 Major Food Allergens Job Aid
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8 Major Food Allergens job aid (TDC #1273) is displayed to be viewed by Team Members.
7. TEMPERATURE CONTROL/STORAGE
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7-1 Food Thermometers
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Food thermometers are available, operational and accurate; employees can demonstrate the proper procedure to calibrate and use the instrument.
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7-2 Equipment Thermometers
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Equipment dial thermometers are present, functional and located in the warmest part of the refrigerator or freezer unit.
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7-3 Refrigerator and Freezer Equipment (Walk-Ins and POUs)
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Walk-ins and POUs are maintaining proper temperatures: 41F or below for coolers; 20F or below for freezers
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7-4 Walk-In and Freezer Product Temperatures (document temps taken in notes)
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TCS foods are at a temperature of 41F or below and frozen foods are at a temperature of 20F or below.
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7-5 Point of Use (POU) Refrigerated and Freezer Product Temperatures (document temps taken in notes)
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Cold, TCS foods are maintained at a temperature of 41F or below, and frozen foods are maintained at a temperature of 20F or below.
8. TEMPERATURE CONTROL/PREPARATION/STAGING
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8-1 Thawing
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Foods are thawed under refrigeration.
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8-2 Hold Times
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Time and temperature of TCS foods are effectively managed during prep.
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8-3 Time as a Control
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Approved time as a public health control (TPHC) procedures are followed.
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8-4 Hot, Staged Product Temperatures
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TCS foods are held at a temperature of 135F or above.
9. COOKING TEMPERATURES
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9-1 Internal Temperature Preparation/Cooking
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Required cooking time procedures for TCS foods are followed.
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9-2 Final Flip and Check
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JIB final flip and visual check followed.
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9-3 Temperature Evaluation
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Employee can independently and without coaching demonstrate the correct procedure to take the temperature of a food item and grill.
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9-4 PIC Knowledge of Internal Cooking Temperatures
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PIC has knowledge of proper internal cooking temperatures.
10. MAINTENANCE & REPAIR: NON-FOOD CONTACT, FACILITIES/EQUIPMENT
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10-1 Non-Food Contact Surfaces Condition
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Floors, walls, ceilings and other non-food contact surfaces are properly constructed and in good condition.
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10-2 Restrooms
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Restrooms are clean, stocked, and in good repair. Sinks, toilets, soap dispensers and paper towel holders are functioning properly, and hot and cold running water is available at the sink.
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10-3 Doors and Windows
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All doors and drive thru windows to the outside are self-closing and/or maintained closed and tightly fitting with no gaps greater than 1/4".
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10-4 Drains
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All drains working properly, clean, and free of standing water.
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10-5 Cleaning Tools
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Mops, brooms and cleaning tools are properly stored.
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10-6 Back Flow Devices
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All devices (e.g. air gap, vacuum breaker, etc.) are installed and working properly to prevent back siphonage where necessary.
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10-7 Refrigerator and Freezer Condition
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Walk-In and POU refrigerators and freezers are in good repair and condition. Observe water/leaks/condensation, and check gasket condition, shelving, fan, and fan guards.
11. CLEANLINESS: NON-FOOD CONTACT, FACILITIES & EQUIPMENT
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11-1 Clean Refrigerators and Freezers
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Walk-In and POU refrigerators and freezers are clean, dry, and free of odor. Fans and gaskets clean.
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11-2 Waste Receptacles
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Waste receptacles indoors and outdoors are present, durable, insect/rodent resistant, leak proof, lined, maintained clean and kept covered.
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11-3 Non-Food Contact Surfaces Clean
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Floors, walls, ceilings, and other non-food contact surfaces are clean and kept free of accumulation of dust, dirt, food residue, and other debris.
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11-4 Dumpster Area
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Dumpsters, trash compactors and grease bins/containers are maintained, clean, closed, and in good repair. Surrounding areas are maintained and clean.
12. CONDITION AND SANITATION: FOOD CONTACT, EQUIPMENT AND UTENSILS
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12-1 Smallwares/Utensils Condition
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Tools, utensils, smallwares and equipment are commercial grade and in good condition to ensure clean-ability and minimize risk of physical contamination.
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12-2 Smallwares/Utensils Clean
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Tools, utensils, smallwares, and food-contact surfaces are cleaned at an appropriate frequency and are clean to sight and touch to prevent cross contamination.
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12-3 Equipment and Food Contact Surfaces Clean
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All equipment and food-contact surfaces are cleaned at an appropriate frequency and are clean to sight and touch.
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12-4 Equipment and Utensils Air Dried
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Equipment and utensils are properly stored and air dried.
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12-5 Ice Machines
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Ice machines are clean inside and out, in good repair; buckets and scoops are properly stored in a sanitary manner.
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12-6 Beverage Dispensers
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Beverage dispensers are clean and free of soil and mold buildup.
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12-7 PIC Knowledge of Water Outage
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PIC has knowledge and can explain proper procedure(s) to ensure ice and water are safe.
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12-8 Team Knowledge of Allergen Awareness
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Guest Service Team Member can answer Allergen Awareness question or refer to 8 Major Food Allergen job aid (TDC#1273) and then answer correctly.
13. SANITIZER/CHEMICALS
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13-1 Chemicals Labeled
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All chemical containers labeled.
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13-2 3-Compartment Sinks
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3-Compartment sinks and dish washing machines are properly maintained, with appropriate soap/sanitizing agents and adequate hot and cold running water. Test strips are available to test sanitizer concentration.
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13-3 Sanitizer Containers and Wiping Towels
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Sanitizer containers and wiping towels are properly used and stored, sanitizer at proper concentration.
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13-4 Approved Chemicals
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Only approved chemicals are present, stored, and used properly in the restaurant.
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13-5 PIC Knowledge of Proper Dishwashing
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PIC and back of house Team Members correctly wash, rinse, and sanitize dishes at the three-compartment sink.
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13-6 PIC Knowledge of Bodily Fluids Cleanup
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PIC can describe correct procedures or show written procedure and respond to properly clean areas exposed to vomit, blood or diarrheal events in the restaurant.
14. FOOD SECURITY
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14-1 Exterior of Facility
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Exterior of facility is secure; doors are closed and locked when not in use. The parking lot is properly illuminated at night.
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14-2 Unauthorized Personnel
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Unauthorized personnel, including off-duty personnel, are restricted from back areas, food preparation areas and storage areas.
15. IMMINENT HEALTH HAZARDS
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15-1 Imminent Health Hazards
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Restaurant is free of any imminent health hazards while operating.
16. APPEAL
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16-1 Assessment Appeal
BONUS POINTS
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iAuditor does not allow bonus points to be calculated. Please follow the instructions below to calculate the actual final score, which will be inputted on the title page.
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How many Priority (10pt) questions failed during this audit?
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Awesome, they are eligible for bonus points! Answer the following questions to determine the final score.
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1-2 PIC Certification Bonus
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Select the number of employees, other than the restaurant manager, that have a valid ServSafe Certificate available. Bonus points are capped at 5.
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1-3 Team Leader Food Safety Certification Bonus
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Select the number of team leaders that have a Team Leader Food Safety Certification (from the ipad training) completed and available. Bonus points are capped at 5.
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1-8 Corrective Action Improvement Bonus
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Previous Assessment was a "Pass"- most recent 'passed' food safety assessment is available and all previous deficiencies (within manager control) addressed.
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Total Bonus Points
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Add up the bonus points from question 1-2, 1-3, and 1-8.
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Now, add the total bonus points to the score and divide by 376. This will give you their actual final score. Enter the score on the title page.
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Unfortunately, the restaurant is not eligible for bonus points. The score will remain as is. Enter the score on the title page.
