Compartment Sink/Dish Machine/Ice Machine Safe Assessment

• Conducted on

  Date

• Prepared by

• Location
  Address

• Safe Assessment

Pest Prevention/Maintenance

• Pest prevention program is effective. (Rodents, live cockroaches, birds in the restaurant, pests in food)

  Safe

  At Risk

  N/A

• Pest prevention program is effective for flies inside the restaurant and birds outside the restaurant.

  Safe

  At Risk

  N/A

• Pest control devices are working properly and installed so that they will not contaminate food or food-contact surfaces. Catch trays and glue boards are changed as necessary.

  Safe

  At Risk

  N/A

• Floors, walls, and ceilings are free of excessive dust, debris and standing water.

  Safe

  At Risk

  N/A

• Are vents clean and free of dust build-up and adequate?

  Yes

  No

  N/A

Ice Machine

• Are interior surfaces of the ice machine properly cleaned?

  Safe

  At Risk

  N/A

• Is there an air gap or other backflow prevention device under the ice machine?

  Safe

  At Risk

  N/A

• Is the exterior surface of the ice machine, including door panels, properly cleaned and in good condition?

  Safe

  At Risk

  N/A

Compartment Sink/Dish Machine

• Dishwashing machines surfaces are clean; curtains are clean and in place; final rinse pressure is adequate and wash temperature meets requirements listed on the data plate.

  Safe

  At Risk

  N/A

• Is there an air gap or other backflow prevention device under the compartment sink?

  Safe

  At Risk

  N/A

• Is there an air gap or other backflow prevention device under the dish machine?

  Safe

  At Risk

  N/A

• Are working thermometers calibrated to within +/- 2°F of 32°F?

  Safe

  At Risk

  N/A

• Is the compartment sink maintained clean?

  Safe

  At Risk

  N/A

• Is the compartment sinks used for dishwashing and food prep at the same time

  No

  Yes

  N/A

• Compartment sink properly stocked with detergent and sanitizer

  Safe

  At Risk

  N/A

• Is compartment sink in good repair?

  Pass

  Fail

  N/A

• Compartment sink cleaned and sanitized between dishwashing and food prep

  Safe

  At Risk

  N/A

• Chemical sanitizer solutions are maintained at proper concentration per label instructions.

  Safe

  At Risk

  N/A

• Chick-fil-A approved quat and chlorine sanitizer test kits are present and readily available for use.

  Safe

  At Risk

  N/A

• Are items stacked while still wet?

  Safe

  At Risk

  N/A

• Are drawers, tubs, and buckets holding utensils clean and organized?

  Yes

  No

  N/A

• Is shelving holding clean utensils, equipment, or food-contact packaging soiled?

  No

  Yes

  N/A

• Are lights adequate for cleaning/food handling task and properly shielded above food, food contact surfaces, and packaged food if package integrity could be affected by broken glass?

  Yes

  No

  N/A

• Are cleaning tools stored between uses to avoid contamination of other surfaces?

  Yes

  No

  N/A

• Are interior garbage containers cleaned and emptied as needed?

  Yes

  No

  N/A

Employee

• No bare hand contact occurs with ready-to-eat foods. Disposable gloves are worn over other types of gloves (cut-resistant gloves, cloth gloves, etc.) when handling ready-to-eat foods. Yellow food service gloves are worn when handling raw chicken. Clear food service gloves worn when handling rinsed produce.

  Safe

  At Risk

  N/A

• Eating, drinking and tobacco use are restricted to nonfood areas. Drinking is allowed from closed containers, such as a cup with a lid and straw, handled to prevent contamination of hands or food contact surfaces. Personal items are properly stored in designated areas away from food, utensils and equipment.

  Safe

  At Risk

  N/A

• Gloves are changed whenever damaged or torn. Fingernails are kept trimmed. Fingernail polish is worn in good taste and only in guest service areas.

  Safe

  At Risk

  N/A

• Is jewelry on the hands and wrists limited to a plain ring with no set stones?

  Yes

  No

  N/A

• Are hair restraints used by Team Members working near exposed food and food contact surfaces?

  Yes

  No

  N/A

Food/Nonfood Contact Surfaces

• Foods are not contaminated. Foods and food-contact surfaces are protected from potential microbiological, physical and chemical hazards. Examples of such hazards include but are not limited to: raw animal products above ready-to-eat foods, commingling raw animal species, thumbtacks, chemicals, medicines or first aid supplies stored above food or food-contact surfaces. When tasting food during preparation, utensils are used only once.

  Safe

  At Risk

  N/A

• Food-contact surfaces are properly cleaned and sanitized (at least every 4 hours during continuous use at room temperature with foods that require time/temperature control for safety (TCS)).

  Safe

  At Risk

  N/A

• Food-contact surfaces of equipment, smallwares and utensils are durable, non-toxic, and made of safe materials.

  Safe

  At Risk

  N/A

• Are nonfood contact surfaces durable and in good condition (not including reach-in coolers/freezers)?

  Yes

  No

  N/A

• Are nonfood contact surfaces of equipment, utensils and smallwares for the preparation clean (not including reach-in coolers/freezers)?

  Yes

  No

  N/A

• Are sponges used with clean and sanitized or in-use food contact surfaces?

  Yes

  No

  N/A

Chemicals/Wiping Cloths

• Do original chemical containers have a legible manufacturer's label?

  Safe

  At Risk

  N/A

• Are approved chemicals being used only for their intended purpose?

  Safe

  At Risk

  N/A

• Food-contact surfaces equipment, smallwares and utensils are smooth, easily cleanable, and in good condition.

  Safe

  At Risk

  N/A

• Are chemical containers, such as sanitizer buckets and bottles, properly labeled with the common name of the product?

  Safe

  At Risk

  N/A

• Are wiping cloths kept clean and dry or immersed in properly diluted sanitizing solutions?

  Yes

  No

  N/A