Title Page

  • Conducted on

  • Prepared by

  • Drink nozzles clean with no visible build up

  • Drink Station Ice chute is clean with no visible mold or build up

  • Fresh Brewed Tea is labeled with a 4 hr hold time??

  • Bathrooms are properly stocked with paper towels, soap, tissue, running hot water at a minimum of 100F???

  • Mirrors, commodes, floors, doors, and light fixtures are not broken and in good working condition??

  • High chairs cleaned and sanitized with no visible food or stains. High chairs are in good working condition

  • Visible wet floor signs

  • Chemical bottles are properly labeled

  • Bread is within the freshness date

  • Condiment bottles have common names on it??

  • 24 hr hold time on all condiment bottles

  • All produce and other ingredients in the sandwich cooler have a hold time??

  • Hoods over grill area clean with no build up or grease

  • Back splash in the grill and fryer area is cleaned and free of grease.

  • Sanitizer water in the grill area is cleaned and not dirty or cloudy

  • Sanitizer at 200-400 ppm in the grill area

  • Fryers are filtered and skimmed

  • Obstruction to the hand washing sink

  • Hand washing sink temperature is minimum of 100F

  • Hand washing sink in the kitchen is supplied with paper towel, soap, and trash can.

  • Observed cooks wearing gloves while preparing or touching food

  • Observed proper hand washing

  • Reach in cooler 40 degrees or below

  • Reach in freezer 0 +/- 10 Fahrenheit

  • Ice buckets are upside down

  • Ice scoop is in good condition. No visible cracks.

  • Food is properly wrapped and stored in reach cooler.

  • Food is properly wrapped and stored in the reach in freezer

  • 6hr hold time on bacon

  • Towels are fully submerged in a sanitizer bucket of 200-400 ppm or of being used

  • Plates and pan on the serving line turned upside.

  • Gaskets on freezer and cooler doors are in good working condition

  • Bulk sodas are dated and rotated

  • Food in the cooler 6 inches off the ground

  • All product in the walk in cooler is properly labeled

  • Utensils are stored with the handles up.

  • Dishes are cleaned with no visible dirt, food, or labels.

  • Employees are in uniform according to Champion Corner LLC.

  • 3 compartment sinks are set up

  • Detergent and Sanitizer in the are properly dispensing the correct strength of chemical solution.

  • Mops are hung up and stored properly.

  • Dish water temperature is at least a minimum of 110F at the 3 compartment sink??

  • Temperature of Grits is a minimum of 140 F holding

  • Temperature of Shrimp Gravy is a minimum of 140F holding. <br>

  • Temperature of Chicken Wings Holding is a minimum of 140F

  • Temperature of Cooked Sausage is a minimum of 140F

  • Temperature of Hamburger in Aujus Sauce is a minimum of 140F

  • Temperature of Shredded Cheese 40F or below

  • 30 days of Temperatures

  • Are all floors, baseboard, and drains cleaned with no visible s

  • Front reach in cooler is at 34 +/- 2 degree Fahrenheit

  • All kitchen personnel have on proper hair restraint

  • Restaurant maintains an A on the state health inspection

  • Evidence of pest or rodents in the restaurant

  • Observed cross contamination

  • Prep sink clean and only use for prep.

  • Equipment is clean, durable, and good condition.

  • Dumpster door is closed and around the dumpster is cleaned.

  • Is there a 5 hr hold time on grits??

  • Is there a 5 hr hold time on shrimp gravy??

  • Is there a 5 hr hold time on cooked chicken wings??

  • Is there a 5 hr hold time on cheese sauce???

  • Is there a 4hr hold time on Cooked Hamburgers in Aujus Sauce??

  • Is there a Cross Connect or Back Flow in the water system??

  • Sanitizer bucket at 200-400ppm in the prep sink area??

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.