Title Page
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Conducted on
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Prepared by
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Location
Personal Hygiene/ Employee Practices
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Are hand-washing sinks clean, unobstructed, and stocked with soap, paper towels, and hand-washing signage?
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Are employees properly washing hands?
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Are employees wearing gloves and cutting gloves, and changing gloves when required?
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Are employees following the employee illness, hair restraint, and jewelry policies?
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Are employees eating, chewing gum, or using tobacco in the department?
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Are drinks properly covered and stored away from food preparation?
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Is the department free of personal items?
Sanitation
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Are food contact surfaces clean to sight and touch, and cleaned using proper methods?
- Yes
- No - Deduct 1 Point
- No - Deduct 2 Points
- No - Deduct 3 Points
- No - Deduct 4 Points
- No - Deduct 5 Points
- No - Deduct 6 Points
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Are test strips available and being used?
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Are cleaning and sanitizing solutions clean, properly mixed, and replaced at the proper frequency?
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Are thermometers sanitized before and after each use, and stored in a sanitary manner?
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Are only authorized chemicals being used?
Product Identification and Date Coding
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Are food and ingredient containers clean, and labeled with an identity?
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Are food items date marked with a preparation date and an expiration or sell by date?
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Are store-packaged items properly labeled?
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Are food items held past the expiration or sell by date?
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Are all spray bottles and chemical containers properly labeled?
Temperature Control
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Are food thermometers available and properly calibrated?
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Are cold foods held and received at 41 degrees F or below?
- Yes
- No - Deduct 1 Point
- No - Deduct 2 Points
- No - Deduct 3 Points
- No - Deduct 4 Points
- No - Deduct 5 Points
- No - Deduct 6 Points
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Are perishable foods kept out of temperature control for longer than 30 minutes when processing or stocking?
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Are foods thawed properly?
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Are foods stored above fill lines or past the load limits of display cases?
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Is air flow blocked in refrigeration units?
Preventing Contamination and Cross Contact
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Are food, utensils, and packaging protected from contamination during preparation, storage, and display?
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Are food and supplies stored at least 6" above the floor?
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Are chemicals stored away from food, single-service items, and equipment?
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Is the Allergen Chart present in the department?
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Is cross-contact of allergens prevented during preparation, storage, and display?
Physical Facilities and Equipment
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Are floors, walls, and ceilings maintained clean?
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Are non-food contact surfaces maintained clean?
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Are hand-contact surfaces maintained clean?
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Are cutting boards, utensils, or pieces of food equipment chipped, heavily scratched, scored, or stained?
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Are trash cans and compost bins clean and not overflowing?
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Are drains maintained clean?
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Are coolers and freezers maintained clean and free of odors?
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Are sales floor cases and display cases maintained clean?
Logs and Certification
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Are logs and cleaning charts complete, accurate, and maintained on file in chronological order?
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Do department managers demonstrate active managerial control and understanding of food safety principles?
