BWW Food Safety Self-assessment Form

Title Page

Imminent Health Risk (IHR)

Imminent Health Risk (IHR): No point values dedicated to the 7 questions; mark within appropriate systemic critical questions, escalate issues as needed, and apply immediate corrective actions.

Cleaning and Sanitation

CS.1 (Major) Hot water reaches a minimum of 85 °F (30°C) at all hand sinks, 110 °F (43°C) at Ware washing sink, and 160 °F (71°C) surface temperature in all high temp dish washing machines
CS.2 (Major) Sanitizer is at proper concentration at all sinks, buckets, cups and low temp ware washing machines
CS.3 (Major) Chemicals are all approved, properly labeled, and stored correctly
CS.4 (Minor) Premises of exterior & interior (back of house) Non-food contact surfaces are clean and maintained
CS.5 (Minor) All sinks and dish washing machines are set up correctly and used properly
CS.6 (Critical) In-use equipment and prep tables are clean and sanitized at proper frequency and maintained
CS.7 (Critical) In-use utensils and small wares are clean and sanitized at proper frequency and maintained
Additional Comments:

Employee Health and Hygene

EH.1 (Minor) Person in charge understands Brand Standards for reportable illnesses & symptoms and team members know what to report
EH.2 (Major) Hand washing sinks are fully stocked, and team members are washing hands properly
EH.3 (Major) Team members are following hygienic practices
EH.4 (Critical) Team members are using gloves properly and avoiding bare hand contact

Time and Temperature

T.1 (Critical) Refrigerated food held at 41 °F (5°C) or below
TT.2 (Major) Time/Temperature Control for Safety (TCS) foods are handled properly
TT.3 (Critical) Foods are cooked to the correct temperature. (NOTE: If food is not cooked at this location, please circle points earned as 7)
TT.4 (Critical) Time/Temperature Control for Safety (TCS) foods in hot holding are maintained ≥ 135°F (57°C) (NOTE: If hot holding does not occur in this location, please circle points earned as 7)
TT.5 (Major) Thermometers are properly calibrated and in-use

Good Retail Practices

GRP.1 (Major) Food and packaging are stored in a manner that is protected and any allergen management requirements are followed
GRP.2 (Major) Food contact surfaces are protected from contamination and handled properly
GRP.3 (Critical) Contamination prevention standards are in place and practices to prevent cross-contamination are properly followed
GRP.4 (Minor) Food is all approved, within date code, and labeled properly
GRP.5 (Minor) Packaging is used in an approved manner

Pest management

PM.1 (Critical) Restaurant is free of evidence of pests and is receiving pest service
PM.2 (Major) All required pest equipment is present and pest service is performed at least monthly
PM.3 (Minor) All required pest documentation is available (license, reports, etc.)

Documentation

DOC.1 (Minor) Cold holding temperature documents (including cooling & thawing records) are complete, accurate, and with corrective actions
DOC.2 (Minor) Cooking temperature documents are complete, accurate, and with corrective actions. (NOTE: If cooking does not occur in this location, please circle points earned as 1)
DOC.3 (Minor) Hot Holding temperature documents are complete, accurate, and with corrective actions. (NOTE: If hot holding does not occur in this location, please circle points earned as 1)
DOC.4 (Minor) Receiving documents are complete, accurate, and with corrective actions
DOC.5 (Minor) Additional required Food Safety documentation and resources are present and accessible as required