Title Page
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Conducted on
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Prepared by
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Location
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If the item you are evaluating is unavailable, leave the answer blank and enter an explanation in the notes.
If there are multiple items to evaluate, record the worst reading (lower temp for hot items, higher temp for cold items)
Primary/Secondary
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No Chix towels were found laying around (if any towel not actively in use is found please throw it away)
Cook Line Cheese
Cook Line Tomatoes
Hot holding pans
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Holding pans timers set (for every pan in use)
Cook Line Filets
Cook Line Nuggets
Cook Line Spicy fliets
Cook Line Strips
Grilled holding pans
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Grilled timers set (for every pan in use)
Cook Line Grilled Nuggets
Cook Line Grilled Filets
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Who was working Primary at the time?
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Who was working Secondary at the time?
Prep Table
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No Chix towels were found laying around (if any towel not actively in use is found please throw it away)
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Lid closed or in use
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Ice under pans and covered with lids
Prep Table Sliced Chicken
Prep Table Spicy Chicken
Prep Table Lettuce
Prep Table Cheese
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Who was working Prep at the time?
Front counter cold holding
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Front counter low boy cooler temperature
Front Counter Wraps
Front Counter Market Salads
Front Counter Southwest Salads
Front Counter Parfaits
Breading table
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Lid closed or in use
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Ice under pans
Breading table- Milk wash Temp
Breading table- Raw chicken temp
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Who was working in the Breading Area at the time?
Cleaning/Sanitizing
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All paper towel dispensers stocked and functional (Front of house, Back of house, Restrooms etc.)
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All Soap and Sanitizer dispensers stocked and functional (Front of house, Back of house, Restrooms etc.)
Sanitizer bucket, Kicks bucket or sanitizer package available in:
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Front counter
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Primary
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Secondary
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Breading area
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Food prep area
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Sanitizer buckets, kicks bucket and dish sinks all prepared to appropriate sanitizer levels (check box if no buckets are in use)
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Produce wash (select only one answer)
- Sink wash concentration within appropriate levels
- Sink wash concentration too high/low
- Sink Empty (Ready for use with produce wash bottle attached)
- Sink Empty (empty bottle, or no produce wash bottle attached)
Report details
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Date/time report completed
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Who completed this audit?