Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
QA Checklist
Beverage Stations (Drinks Machines, Ice Machines & Shake Machines)
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Drive-Thru and Dining Room drinks machine nozzles and inside of ice chute clean? (no mold)
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Shake machine spindle clean, timing of water cup cleaning procedures followed
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Lid on beverage bar ice bin
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Interior ice bin clean at drive thru
Back Line (Hot Holding, and PHF Food)
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Hot Holding temperature ≥57°C (Potentially Hazardous Food)
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Raw chicken temperature ≤ 5°C (Potentially Hazardous Food)
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Potentially Hazardous Food product used is in date / produce tagged 4 hrs
Dishes, Hands & Gloves
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Wash water (44°C), rinse, & submerged in sanitizer (200-400ppm) for 60 seconds (sinks re-filled if water or sanitiser is dirty)
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Hand sink is not blocked, used only for hand washing & fully stocked
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Hands washed when changing duties and between glove changes
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Proper hand washing- using soap, hot water, and washing for 20 sec
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Disposable gloves worn when handling RTE foods
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Disposable gloves changed when contaminated
Food Prep / Storage
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Prepping food on table/sink properly cleaned/sanitised
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Prep sink used only for food prep (clean and in good repair)
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Utensils, pans, knives, cutting boards clean and in good repair
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Approved scoop, ice buckets (not stacked), used for ice only, clean and in good repair (no craks or chips)
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Equipment stored clean – no food debris or buildup
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Dicer block in good repair - no pieces missing
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Slicer cutting blade in good repair – no chips in the cutting edge
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Ice machine interior is clean and free of rust/mold
Cold Storage
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Product temperature ≤5°C (PHF)
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PHF product not out of date/stored protected from contamination
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Proper cooling procedures used for ice baths (<2” shallow pans/product depth)
Frozen Storage
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Product are not frozen hard, with visible ice crystals, and PHF product not out of date
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Toilets/Fixtures Functional
Safe Cooking
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Raw beef (71ºC) , sausage (71ºC) and raw chicken products (74ºC)
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Char-broiler reverberator screen not burned through/no loose wires and in clean, good working order
General Sanitisation
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No evidence of pets; roaches/flies/rodents/pest dropping
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Chemicals not stored with food, single service items, or at or above
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Sanitiser concentration between 200-400 ppm while in use at 3-compartment sink
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Sanitiser buckets and spray bottle concentration is between 200-400ppm
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No employee food/drinks improperly stored or in work area
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Daily Temperature Checklist properly completed with corrective action, working calibrated, thermometer
Toilets
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Soap, paper towels/operating hand dryer present
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Functional toilet in each restroom
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Toilet paper available
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COMMENTS/CORRECTIVE ACTION FOR ANY ITEM CHECKED NO: