Title Page
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Establishment Name:
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Type of Facility:
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Physical Address:
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Person in Charge:
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Inspection Time In:
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Date:
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Person Completing Form:
Cleaning & Sanitation - Food Safety Fundamentals
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DISCLAIMER:
The temp/time profiles are for the US - please check local regulations.
For example these sources can be used for Australia:
Standard 3.2.2 – Food Safety Practices https://www.foodstandards.gov.au/sites/default/files/publications/SiteAssets/Pages/safefoodaustralia3rd16/Standard%203.2.2%20Food%20Safety%20Practices%20and%20General%20Requirements.pdf
Appendix 6 - https://www.foodstandards.gov.au/sites/default/files/publications/SiteAssets/Pages/safefoodaustralia3rd16/Appendix%206%20-%20Cleaning%20and%20sanitising%20surfaces%20and%20utensils.pdf -
Are all surfaces smooth, easily cleanable, and frequently washed?
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Are all equipment kept clean, in proper working order, and meeting local regulations? e.g. ANSI standards
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Are eating utensils properly washed after each use using a three-compartment sink or commercial dishwashing machine?
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Is the high-temp dish machine's minimum washing temperature 151°F and rinse temperature 179°F for 10 seconds?
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Is the low-temp dish machine's minimum wash and rinse temperature between 130°F and 150°F with chlorine sanitizer solution at a minimum of 100ppm?
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Is the manual sink ware washing minimum wash, rinse, and sanitizing sink water temperature 113°F/45°C? Is the sanitizing solution at the proper concentration (chlorine 100mg/L; Quat. 200mg/L; or Iodine 12.5 – 25mg/L) and soaked for 2 minutes?
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Are pocket thermometers and sanitizer test kits readily available to verify temperatures and concentrations?
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Are wiping cloths clean, sanitized, properly stored, and maintained?
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Are the water temperatures accurate?
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If heat sanitizing, are the utensils allowed to remain immersed in 170°F/76°C water for 30 seconds?
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If using chemical sanitizer, is it at the proper dilution?
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Is the water clean and free of grease and food particles?
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Are the utensils allowed to dry?
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Are utensils covered to protect them from dust and contaminants when stored?
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Are chemicals and cleaning supplies kept away from food surfaces when in use?
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Are chemicals properly labeled and stored in a separate area from food storage?
Sign-off
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Inspection Time Out:
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Name & Signature