Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Refrigerator, stove, cabinets, working area and cooking equipment are clean, sanitary and in good condition?

  • Food preparation and storage areas are free from animals, rodents, insects, or animal droppings?

  • All cleaning materials and utensils are kept away from food (e.g. in separate storage). Chemical cleaners, pesticides, and other materials are in original containers.

  • Kitchen garbage receptacles are: <br>* Made of durable, leak-proof, and non-absorbent materials:<br>* Lined and covered; and * Emptied to the outdoor garbage receptacle when filled

  • Fire extinguisher approved by the Fire Department is charged and accessible:

  • Refrigerators have a separate inside thermometers showing temperatures of 35-41 degrees F, and there is a temperature log posted documenting daily temperature checks.

  • Freezers have separate inside thermometers showing temperatures of 0 degrees F, and there is a temperature log posted documenting daily temperature checks.

  • Separate or freestanding dry storage areas have thermometers showing temperatures between 50-70 degrees.

  • A sanitizing agent or water temperature of at least 170 F is used for sanitization.

  • Foods are maintained hot (at least 135 F) or cold (maximum 41 F) prior to serving both when packaging for transport and upon arrival at meal services destinations (as appropriate).

  • Meals are transported in safe, sanitary, sealed, covered containers, carriers, or carts.

  • Foods are used on a first-in, First-out basis (date rotation) with appropriate inventory and record-keeping of food storage.

  • Food containers are labeled, free of rust, dents, or bulges; and are kept away from the walls and at least 6 inches off the floor to permit circulation.

  • Separate sinks are available and used for washing hands, fruits and vegetables, and cooking utensils.

  • Separate refrigerators are provided for (as applicable) dairy products and eggs; meat and poultry, and fish; fruits and vegetables; and cooked foods.

  • Heating and ventilation systems are working. Radiators/ Pipes are accessible or covered to prevent and clean.

  • Walls, floors and ceilings are in good repair and clean.

  • The kitchen facility is operated in compliance with applicable provisions of the State Sanitary Code, as evidenced by posted sanitary inspection certificate from municipal board of health.

  • A well supplied first-aid kit is available, accessible to staff, out of reach of children, and includes personal protective equipment and Food Services approved first-aid supplies. Check first-aide contents in accordance with First-Aid checklist.

  • Thermometers are calibrated for accuracy and kept in a sanitation solution when not in use to ensure they do not become contaminated with dirt and other debris.

  • Towels are kept in a sanitation bucket with the proper sanitation solution, when not in use, to ensure they are clean and sanitary for use in the kitchen .

  • Towels are laundered and stored to ensure they are clean and sanitary, or a disposable towel is used and disposed of at the end of the day.

  • Staff is following hygiene regulations: <br><br>*Short fingernails that do not have polish. No bracelets, rings watches or low hanging necklaces. (Wedding ring is allowable)<br><br>*Single use gloves are a available and used by staff.<br>*Hairnets are available and used by staff.<br>*Staff are wearing clean appropriate uniforms for food preparation. No Capris or jackets. Non-slip, closed toe shoes must be worn.

  • Staff are wearing the appropriate Acelero Badge.

  • Menus with recorded substitutions are being kept on file and menu substitutions are being recorded on the Menu Substitution Log. <br><br><br><br><br>

  • All special diet substitutions are being recorded on the Special Diet Substitution Log.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.