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:
Employee Hygiene - Food Safety Fundamentals
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Are employees wearing the proper uniform, including proper shoes?
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Are hairnets/beard nets being worn?
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Are fingernails short, unpolished, and clean?
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are employees not wearing earrings and watch?
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Are employees wearing disposable gloves and changing them as required?
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Are open sores, cuts, or splints and bandages on hands completely covered while handling food?
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Are hands washed thoroughly using proper hand-washing procedures (soap and warm water for at least 20 seconds) at critical points (before starting work, immediately after using the washroom, and any time needed to prevent cross-contamination)?
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Are wash hand basins used for hand washing only (separate from the food preparation sink)?
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Are aprons worn when cooking but removed when leaving the prep area?
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Is smoking observed only in designated areas away from preparation, service, storage, and warewashing areas?
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Are eating, drinking, or chewing gum observed only in designated areas away from work areas?
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Do employees take appropriate action when coughing or sneezing?
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Are disposable tissues used and properly disposed of when coughing or blowing the nose?
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Are employees asked to stay home from work or assigned duties away from food when exhibiting symptoms of or testing positive for communicable diseases?
Sign-off
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Inspection Time Out:
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Name & Signature