Title Page

  • Epic Wings - Food Safety Assessment

  • Store Number

  • Location
  • Prepared by

  • Time

FS 1.1 - Restaurant Manager and MIC (Manager in Charge) have required food safety certification

  • Can show current Restaurant Manager food protection management certification (Food Handlers Card, ServSafe or Equivalent).

FS 1.2 - Hand Washing SOP's and Procedure Demonstration.

  • Are hand washing SOP's located at all hand sinks? Is there a system or process in place to ensure proper hand washing?

FS 1.3 - Health Department Inspections

  • Most recent Health Department Inspection report available. Restaurant has addressed deficiencies noted in the inspection report.

FS 1.4 - Food Safety Checklist

  • Daily food safety checklist completed, thermometer has been calibrated, and corrective actions taken.

FS 2.1 - Illness

  • Food handlers have no obvious signs of illness and are not working when sick or with infected or open wounds.

FS 2.2 - Personal Items

  • Eating, drinking, smoking, gum-chewing, and personal items are not allowed at work stations and are kept separate from food and beverage areas.

FS 2.3 - Personal Hygiene

  • All restaurant employees follow dress code requirements

  • *Team members and their uniforms are clean and maintained - not soiled, in good condition and reasonably free of odors. *Fingernails must be no longer than the ends of the fingers, and must be clean, smooth, not artificial and not polished (unless gloves are worn and are in good repair) *Jewelry - No dangling jewelry, except earrings no longer than 1/2" below the earlobe. *No jewelry stones are allowed. Plain rings such as a wedding band are allowed. *Employees may not wear watches, bracelets or fitness tracking devices.

FS 3.1 - Pest Prevention

  • Restaurant Manager is effectively preventing pests.

  • *Pest control service reports available *Pest equipment present and functional *All doors and/or windows to the outside are maintained closed

FS 3.2 Pest Activity

  • Restaurant is free of signs of pest activity.

FS 4.1 - Hand Washing Sinks

  • Hand washing sinks in the kitchen area are available, accessible, working, and properly set up (paper towels and soap are stocked).

FS 4.2 - Hand Washing Procedures

  • All employees are observed washing hands properly and only in designated hand washing sinks.

  • 1) Wet hands with 110 degree water, 2) Apply soap, 3) Scrub for 20 sec, 4) Rinse hands, 5) Dry hands with a paper towel, 6) Use your paper towel to turn off water.

FS 4.3 - Glove Usage

  • Employees are properly using disposable gloves

  • *No bare hand contact is allowed for ready to eat foods or raw proteins. *Team members do not have to wear glove when handling raw dough, if proper hand washing procedures are followed. *Gloves must be changed before starting another job and when dirty, torn or contaminated. *Gloves must be worn to cover bandages or band aids. *Hands must be washed in between glove changes.

FS 5.1 - Receiving

  • Temperatures, condition of product, receiving and storage of products to standard

  • *Take the following temps when receiving and log on the Food Safety Checklist: Chicken wings/tenders, liquid eggs, buttermilk (all must temp at

FS 5.2 - Expired Product

  • No expired product or ingredients are observed.

FS 5.3 - Using Approved Food & Beverages

  • All food & beverages are purchased from approved vendors

FS 6.1 - Storage: Food & Packaging

  • All food and packaging are adequately covered to avoid contamination, RTE foods are stored over raw foods.

FS 6.2 - Contamination: Food & Packaging

  • Food and packaging are free from sources of contamination.

FS 6.3 - Washing Produce

  • Vegetables are properly washed before use.

FS 6.4 - Lighting

  • Lighting is adequate and all lights are clean and properly shielded or shatterproof.

FS 7.1 - Food Thermometers

  • Food thermometers are available, operational and calibrated for accuracy. Employees can properly demonstrate proper use of the instrument and procedure for calibration.

FS 7.2 - Equipment Temperatures

  • Equipment is functioning properly, maintaining temperature below 41 degrees.

FS 7.3 - Product Time & Temperature

  • All TCS (Time/Temperature Controlled for Safety) foods in walk-ins and reach-in coolers are at a temperature of 40 degrees or below.

FS 8.1 - Cooking

  • Required cooking time procedures for TCS foods are followed.

FS 9.1 - Cleaning Tools

  • Mops, brooms and cleaning tools are properly stored in their designated area.

FS 9.2 - Back Flow Devices & Prevention

  • All devices (Drains, air gap, vacuum breaker, etc.) are installed and working properly to prevent back siphonage or standing water in floor sinks.

FS 9.3 - Condition: Refrigerators & Reach-ins

  • Walk-in and reach-ins are in good repair and condition. Units are free from water, leaks, condensation and have gaskets, shelving, fan and fan guards in good condition.

FS 10.1 - Clean: Refrigerators & Reach-ins

  • Walk-in and reach-ins are clean, dry, and free of odor. Fans and gaskets are clean.

FS 10.2 - Waste Receptacles

  • Waste receptacles indoors and outdoors, are present, durable, insect/rodent resistant, leak proof, lined and maintained clean.

FS 11.1 - Condition: Equipment/Smallwares/Utensils

  • Tools, utensils, smallwares and equpment are commercial grade and in good condition to ensure clean-ability and minimize risk of physical contamination.

FS 11.2 - Clean - Equipment/Smallwares/Utensils

  • Tools, utensils, smallwares, equipment and food-contact surfaces are cleaned and stored properly.

FS 11.3 - Ice Machines

  • Clean inside and out; in good repair, buckets and scoops are properly stored in a sanitary manner.

FS 11.4 - Beverage Dispensers (soda and beer taps)

  • Clean and free of soil and mold buildup (Including beer lines and taps)

FS 12.1 - Chemicals

  • All chemical containers are labeled (chemical inside container matches label)

FS 12.2 - Dish Washing

  • 3-compartment sink is properly maintained, with appropriate soap/sanitizing agents and adequate hot and cold running water. Test strips are available to test sanitizer concentration.

FS 12.3 - Sanitizer Containers

  • Are properly used, stored and have the proper concentration of sanitizer.

FS 12.4 - Approved Chemicals

  • Only approved chemicals are present, stored, and used properly in the restaurant.

MIC Acknowledgement

  • Signature

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