Title Page

  • Store Number
  • Conducted on

  • Prepared by

High Violations

  • Temperature: Food temperature NOT within the range of 60 - 125<br>60 or above for cold holding and 125 degrees or below for hot holding

  • Kale and cabbage are in ice container, temperature at 41 degrees and under

  • Proper Cooking: Cooked food reaching 165<br>

  • Employee Health: Unprotected coughing or sneezing, discharge from eyes, nose, and mouth from any associate

  • Proper Hand washing: All associates washing hands before starting work, between duties, re-adjusting face mask, after touching body, eating, and coughing.

  • Temperature logs completed and not falsified<br>

  • Pest: Pest activity or signs of any pest activity such as, rats and/or roaches<br>

  • Pest: Flies touching food or food contact surfaces<br>(No more than 5 flies)

  • Sanitizer - Sanitizer chemical available in the store

  • Hot water: Water in store must reach 120F or above<br>

  • Sewage back up: Drains are fully operable. <br>

  • Toilet: 1 working toilet<br>

Medium Violations

  • Dishwashing procedure (wash, rinse, sanitize)

  • Food protected: Everything being stored in container has lid. Food not attended in timely manner

  • Day dots do not exceed 3 days

  • Rice days dots have a date and time stamp that does not exceed 14 hours

  • Food Contact Surface - Are any handles touching food contact surfaces or food? Ex: tong or knife handle on cutting board, measuring cups on top of non food contact surfaces, ice scooper buried inside ice, raw meat spoon not stored inside bowl)

  • Food Contact Surface: Dishes are clean free of food debris

  • Food Contact Surface: Food processor cleaned and sanitized with no food debris remaining on any part of the processor. Zucchini cutter is free of debris

  • Improper thawing: Meat is not thawing at room temperature, submerged under water, or in standing water

  • Cooks are temping C4 before removing from grill. Removing teriyaki chicken from grill with thermometer to temp chicken

  • Food Protectected - Are all food items labeled in storage, covered and elevated 6”

  • WIC cooler is following proper hierarchy. Ready to eat on top, then shrimp/seafood, then beef, and poultry on the bottom?

  • 2 Compartment Sink is being washed, rinsed and sanitized after use

  • Hand sink: Hand sinks reach 110F and are stocked with paper towel and hand soap.<br>

  • Associate have a pink/soft scar present on their hands without bandaid, finger cover, and gloves.

  • All employee drinks have a lid, straw and are stored in a designated area (NOT THE LOCKERS) (NO BOTTLES OR CANS)<br>

  • Employee practices: All associates washing hand properly. 20 seconds and with hot water. Masks being properly worn. Gloves must be worn at all times

  • Critical sink fixture: All sinks are operable in working condition

  • Ice chute in dining and drive thru, soda nozzles are free of mold.

  • Are all hand sinks accessible with nothing blocking their way to be used?<br>

  • Ice machine in kitchen is free of mold

  • All chemical in storage labeled properly<br>? No unapproved chemicals.

  • Sanitizer: Sanitizer between 200 and 300 ppm in sanitizer compartment of 3 compartment sink, all buckets in restaurant <br>

Low Violations

  • Utensils/equipment condition

  • Wiping cloths are dry and clean in kitchen/ hot holding area

  • Personal items stored inside locker (All locker doors are closed )

  • Tools properly stored

  • All metal cans are in good condition with no dents<br>

  • Floor drains are clean with no debris and mold<br>

  • Hygiene: All associates hand care is taken care of (NAILS ARE CUT, NO FAKE NAILS, NO POLISH)<br>

  • Janitorial items properly stored

  • Lighting

  • Non food contact surfaces-unclean/ torn: shelves, racks, fryer cabinet, wheels, fan guards, under grill, under cooking range, catch pans, counters, gaskets and handles. <br>ALL THESE ITEMS ARE FREE OF DEBRIS AND MOLD

  • All pipes have 1 inch pipe clearance<br>

  • Hood exhaust clean with no grease build up. Hood filters are clean

  • Cooking Equipment : All light shields, fryer baskets and gaskets in good condition<br>

  • Air vents are free of dust<br>

  • Sanitizer strips available in store and not expired<br>

  • Thermometer in WIC, prep table, prep freezer and WIF<br>

  • Floors, Walls, ceilings are clean

  • Soda nozzles on coke rack free of soda syrup build up

  • Fryer/ under cooking range free of grease build up

  • Gasket in good condition. Free of debris. Not torn

  • Food debris under the steam table / WIC / WIF

  • Grill being cleaned immediately after removing teriyaki chicken

  • A dedicated thermometer for the teriyaki chicken.

  • Dumpster lid is closed

  • No standing water in the store

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.