Title Page

  • Store Number

  • Date and Time

  • Evaluator Name

  • Manager In Charge

  • Location

CRITICAL OPERATIONS ELEMENTS

  • Four (4) or more sizes/types of expired ingredients (non-dough) (-10)

  • Lack of available cleaning supplies, potable water, and/or no functioning hand sink in the production area

  • Refrigerated product(s), or refrigeration unit(s), over 50°F/10°C (including Alfredo sauce) (-10)

  • Mold found on food products and/or on food contact surfaces (-10)

  • Pest control standards past critical thresholds (-10)

  • Dough management procedures neglected (-10)

  • Five (5) or more core apparel, appearance, and/or hygiene violations on one (1) or several store personnel (-10)

  • Mature (M-rated) content, including profanity, found on store premises (-10)

  • Firearms, knives, illegal drugs, marijuana (in any form), or alcohol found on store premises (to the extent permitted by applicable law) (-10)

PRODUCT

  • Dough properly managed and properly proofed (5)

  • Approved product procedures in use (2)

  • Product prepped for expected sales volume (2)

Pizza Great/Remake Calculation (4 per pizza)

  • Pizza#1

  • Pizza#2

  • Pizza#3

  • Pizza#4

  • Pizza#5

Sides: Great/Remake Calculation (3 per side)

  • Side #1

  • Side #2

  • Side #3

FOOD SAFETY

  • All products dated properly and not expired (3)

  • Pest control standards are maintained (3)

  • Store personnel maintain proper appearance and hygiene standards (2)

  • Hand washing and hand sanitizing procedures done properly (2)

  • All food contact surfaces, small-wares, and utensils clean and sanitized (2)

  • Hand washing and dishwashing supplies accessible and properly stocked (1)

  • No bare hand contact with post-bake food (1)

  • All food products are fully protected from cross-contamination and covered in prep, dry, and cold storage, at least 6" (15.2cm) from floor (1)

  • Sanitizer concentration within specified range and temperature (1)

Temperatures

    Bin Bin Bin Bin Bin Bin Cabinet Cabinet Cabinet Cabinet Cabinet Cabinet Cabinet Walk-in Walk-in Cola Cola Cola Other Other
  • End Bake Temperatures

  • Wings Stuffed Cheesy Bread Pan BreadBowl
  • All refrigerated products held within specified temperature ranges (3)

  • All cooked product temperatures at least 165°F / 74°C (3)

IMAGE AND CLEANLINESS

  • Domino's logo apparel (hats, shirts, shorts/pants/skirts, and outerwear) worn properly and represents a positive brand image (3)

  • Aprons must be clean and worn at full-length, tied, during food preparation and not outside the store (2)

  • Hot bags clean and free of debris and mold (2)

  • Production area walls, floors, and baseboards are clean and free of dirt and debris (1)

  • Customer area walls, floors, baseboards, windows, and windowsills are clean and free of dirt and debris (1)

  • Customer area seating, counter, and surfaces are clean, sanitized, and free of dirt and debris (1)

  • Restrooms are clean, sanitary, and fully stocked (1)

  • Walk-in and gaskets clean, free of debris, mold, and mildew (1)

  • Makeline rail, cabinets, and gaskets are clean, free of debris, mold and mildew (1)

  • Store set up properly during operational hours (1)

  • Parking lot and entryway sidewalk are free of debris (1)

  • Bake-wares clean and free of excessive carbon build-up (1)

  • Oven catch trays, oven exterior, and heat rack are free of built-up debris (1)

  • Delivery vehicles represent a positive brand image (1)

EQUIPMENT AND STORE CONDITION

  • Store ceiling, T-bars, and vents are clean and not broken, chipped, or cracked (1)

  • Store walls, floors, and baseboards are not broken, chipped, or cracked (1)

  • Hand sinks operational and handwashing reminder signage is present (1)

  • Customer area seating, counter, and tables are not faded, broken, chipped, or cracked (1)

  • Restrooms and fixtures are not broken, chipped, or cracked (1)

  • Parking lot, entryway sidewalk, and customer-facing building exterior are clean and not damaged (1)

  • Signage is clean, properly illuminated, and not damaged (1)

  • Refrigeration units operational, not broken, chipped, or cracked, and free of rust, and holding temperature (1)

  • Calibrated thermometer(s) available (1)

  • Small-wares and utensils are not broken, chipped, or cracked (1)

  • Bake-wares are not damaged (1)

  • Oven fingers and hood are clean and free from excessive grease buildup and yellowing. Oven, hood, and heat rack are operational and undamaged (1)

  • Sufficient number of hot bags available and are not torn, faded, or melted (1)

  • Calibrated, working scale(s) and product build job aids available (1)

  • Caller ID is installed and working (1)

  • Safe and drop boxes are present, operational, and secured (1)

BRAND SAFETY

  • Delivery experts making drops, carrying less than $20 (or international equivalent) (1)

  • Security callbacks are completed for new and suspicious orders, and for orders where Caller ID is unavailable (1)

  • Safe in use and deposit procedures followed (1)

  • No more than $150 USD in front till (or international equivalent) (1)

  • Safety equipment in use and store personnel delivering safely to customers (1)

  • No weapons, including pocket knives, mace, pepper spray, and similar items (1)

SIGN OFF

  • Manager Name and Signature

  • Additional Observations

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.