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PACE Food Safety Form

Critical Food Safety

  • FS1-US Restaurant is free of infestation and/or signs of active pest (animal/insect) infestation in<br>the restaurant building, adjoining corral, and any area within 10 feet (3m) of the building.

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  • Other

  • FS2-US The internal temperatures of beef patties after cooking are at or above 155°F (69°C).

  • Select all applicable

  • Other

  • FS3-US The internal temperatures of raw plant based and chicken products after cooking are at or above 165°F (74°C).

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  • Other

  • FS4-US The internal temperature of Filet-O-Fish portions after cooking are at or above 155°F (69°C).

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  • Other

  • FS5-US The internal temperatures of breakfast sausage made from raw pork and breakfast steak are at or above 155°F (69°C).

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  • Other

  • FS6-US Cooked McMuffin raw round eggs have gelled yolks (are not runny). Internal temperatures are at or above 155°F (69°C).

  • Select all applicable

  • Other

  • FS7-US The on-duty manager (or staff assigned to complete the checklist) can demonstrate they have been trained on properly completing the Food Safety Daily Checklist including the ability to take corrective action.

  • Select all applicable

  • Other

TCS for Refrigerated Products

  • FS8-US All Time-Temperature Control for Safety (TCS) refrigerated products in code (within primary shelf life)

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  • Other

Hygiene & Sanitation

  • FS9-US Handwashing sinks: There is running warm water and required supplies at all handwashing sinks. Handwashing sinks are easily accessed by employees and only used for hand washing, not preparing food or storing equipment.

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  • Other

  • FS10-US Handwashing procedure: Hands are properly washed following hand washing procedures. A system is in place to ensure hourly and activity based hand washing by all employees.

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  • Other

  • FS11-US Sanitized towel/cloth buckets: Sanitized towel buckets contain towels and chlorine sanitizer solution at the correct concentration checked with a chlorine test strip.

  • Select all applicable

  • Other

  • FS12-US Sanitizer-soaked towels/cloths: 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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  • Other

  • FS13-US Utensil and trays sanitizing: All in-use UHC trays, grill utensils, prep table utensils, and utensil holders are clean (no build-up), washed, and sanitized at least every 4 hours as per approved procedure. The back sink and soap/sanitizer dispensers or dishwashers function (hot water 110˚F or higher in the wash bin/sink) with all required supplies. The sanitizer solution has the right concentration when checked with an appropriate test strip.

  • Select all applicable

  • Other

Contamination Prevention

  • FS14-US State of cleanliness: The restaurant (all areas) in a good state of cleanliness. In all areas, the floors/walls/ceiling and equipment do not have dust/dirt/food build-up. There should not be a pool of standing water in the restaurant.

  • Select all applicable

  • Other

  • FS15-US State of repair: The building and equipment is functioning properly and in a good state of repair (not cracked or damaged). The freezers should not have an excess build-up of ice that would prohibit the unit to function properly.

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  • Other

  • FS16-US Water and ice: Appropriate measures taken to protect water and ice from foreign material, chemicals and/or microbial contamination. Water filters in date and ice machines free from mold.

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  • Other

  • FS17-US Food product opened: Opened packages of food in storage, (including dry storage, refrigerators and freezers) covered/ wrapped, labeled, off the floor and away from walls. Product stored according to proper procedures.

  • Select all applicable

  • Other

  • FS18-US Raw food product handling: Blue or colored disposable glove procedures (or other globally approved procedures) used to prevent cross-contamination when handling all raw meat or poultry products (including shell eggs) at the grill station. Dedicated utensils used for raw products (e.g., the yellow hutzler spatula or egg yolk breaking tool is only used to break egg yolks).

  • Select all applicable

  • Other

  • FS19-US Good hygiene practices: Disposable gloves and other personal hygiene procedures followed.

  • Select all applicable

  • Other

  • FS20-US Chemical management: All chemicals are clearly labeled and stored away from food and packaging.

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  • Other

  • FS21-US Pest management: Pest management program is in place and working effectively. Restaurant is pest proofed to prevent entry of pests (e.g., gaps under doors are sealed, <br>drive-thru window closed when not in use).

  • Select all applicable

  • Other

  • FS22-US Non-food/biohazard spill procedures are in place.

  • Select all applicable

  • Other

Storage

  • FS23-US Frozen products: Walk-in freezers and any other primary storage freezers keeping products at 0°F (-18° C) or below. Secondary storage freezers keeping products solidly

  • Select all applicable

  • Other

  • FS24-US Refrigerated products: All products in walk-in refrigerator and any other primary storage refrigerator at or below 40° F (4° C) (including shake/sundae in reservoir). All products in secondary storage refrigerators keeping at correct temperature.

  • Select all applicable

  • Other

  • FS25-US Shelf lives: All in-use refrigerated products held in refrigerators or at room temperature marked and being used within their secondary shelf lives.

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  • Other

  • FS26-US Leftover heated foods: All leftover heated foods are discarded (including expired food in the UHC and any shake/sundae mix removed from heat treatment shake/sundae machines). Heated food products (proteins) are not held below 140 °F (60 °C) or beyond their defined time.

  • Select all applicable

  • Other

Cooking

  • FS27-US Pyrometer: The pyrometer and accessories (e.g., probes) are clean, calibrated, working correctly, and used correctly.

  • Select all applicable

  • Other

General

  • FS28-US Sourcing: All food, food packaging, equipment (including utensils), and cleaning chemicals <br>are from approved sources.

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  • Other

  • FS29-US Employee health: Managers understand employee illness symptoms and reportable illness causes for when an employee cannot be working. Managers also understand when an employee can return to work after illness.

  • Select all applicable

  • Other

  • FS30-US Staff training: All managers (including shift managers) trained and certified in food safety per local requirements or McDonald's minimum requirements in absence of local regulations (apply the standard that is more stringent). The staff is trained on food safety per global requirements and market expectations before commencing work.

  • Select all applicable

  • Other

  • FS31-US Food Safety Checklists: The last 60 days Daily Food Safety Checklists (DFSC) and past two Monthly Food Safety Procedures Verifications (MFSPV) are available. There is no evidence of system failures (e.g., more than 20% (6 or more in 30 days), missed or incorrect <br>completions in the DFSC and MFSPV.

  • Select all applicable

  • Other

  • FS32-US Health Department Inspections: Review the most recent health department inspection and food safety audit reports. All food safety violations noted by the health department have been corrected or have a plan in place to correct issues.

  • Select all applicable

  • Other

  • FS33-US Allergen management: Market specific allergen management program in place.

  • Select all applicable

  • Other

  • FS34 HST1 Are hands-free water taps (faucets) installed for kitchen handwashing units?

  • FS35 HST2 Are hands-free paper towel dispensers installed in place of hands air-dryers?

  • FS36 HST3 Are hand sanitizers or handwashing station available close to kitchen entry?

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