Information

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • P = Priority (-15%); PF = Priority Foundation (-5%); C - Core (-1.5%)

GENERAL

  • C 507. Foodborne Illness Complaint Sign is posted by the phone.

  • C 511. Recent Health Dept. (or other regulatory agency) inspections are on file and all deficiencies or corrective actions have been addressed.

  • PF 707. Receiving Log filled out for all loads received.

EXTERIOR AREAS

  • C 506. Exterior of facility is secure. Doors are closed, locked and alarmed when not in use.

  • C 501. All doors to the outside are tight and self closing; dock levelers and roll down doors are tight with no gaps greater than ¼ “.

  • C 928. Outside trash area is clean and in good condition. Dumpsters and compactors are located on paved surface.

  • C 929. Outside trash containers are adequate, clean and in good condition; equipped with tight fitting doors & lids; emptied as often as necessary to prevent a nuisance. Dumpsters and compactors are equipped with drain plugs and tight seals- not leaking.

  • C 508. General Store Appearance: Parking lot and surrounding area is free of trash and standing water.

RESTROOMS

  • C 204. Bathroom fixtures are functioning properly and hot and cold (or tempered) running water provided. Restroom doors are self closing; covers are provided for all trash receptacles.

  • C 201. Bathrooms have clean floors.

  • C 206. Bathrooms have no odor.

  • C 202. Bathrooms have clean toilets.

  • C 203. Bathrooms - Everything in working condition.

  • C 207. Bathrooms - Properly stocked (soap, hand towels).

GROCERY / ROTATION

  • C 502. All product is in good condition- no severely dented, rusted or swollen cans, leaking packages, etc.

  • P 807. First In First Out (FIFO). Product is rotated properly. No out of date or expired BABY FORMULA is observed.

  • Record product information:

  • Outdated Product
  • Record product information:

  • Outdated Product
  • PF 807. First In First Out (FIFO). Product is rotated properly. No out of date or expired product is observed.

  • Record product information:

  • Outdated Product
  • Record product information:

  • Outdated Product

CHEMICALS / CLEANING

  • C 301. All cleaning and sanitizing chemicals are USDA/FDA approved and properly used in accordance with label instructions. MSDS sheets are provided for all chemicals used. No use of off the shelf chemicals is permitted. Allowed chemicals Non-Scented Bleach, Goo Gone, Rubbing Alcohol.

  • P 303. All toxic chemicals are properly stored in an area separate from food, equipment, utensils and single service items.

  • C 302. All spray bottles are properly labeled as to contents and used only for the purpose intended.

  • C 924. Ice machines are clean inside and out; in good repair; scoops properly stored in a sanitary manner.

  • C 925. Ice machines are properly plumbed with the required air gaps and back flow prevention devices.

  • C 504. Backflow prevention devices are installed on hose bibbs. No evidence of cross connections or back siphonage.

  • C 503. All sewage is discharged in accordance with all applicable State and local regulations.

  • C 905. All displays, fixtures, shelving (including wire racks) are clean; areas around and underneath are clean.

  • C 919. Dry storage areas are clean & well organized with all items stored at least 6 inches above the floor and on commercial grade (NSF listed or equivalent) shelving.

  • C 904. All cleaning supplies such as mops and brooms are properly stored off of the floor when not in use.

  • C 935. Trash cans are provided; clean and well maintained, and not touching product or product contact surfaces.

  • C 918. Dock areas are clean including around and under dock plates.

  • C 910. Mop water is properly disposed in a service sink or sanitary sink.

HOUSEKEEPING / STORAGE

  • C 907. All floor drains are clean and functioning properly; floors and floor drains are free of standing water.

  • PF 306. Facility has a written, documented pest control program which includes service reports, Material Safety Data Sheets (MSD), copy of license of pest control technician, certificate of insurance for pest control company, map showing the location of all pest control devices and specimen labels for all pesticides used in the facility.

  • C 935. Trash cans are provided; clean and well maintained, and not touching product or product contact surfaces.

  • C 510. Pest control devices are properly installed and maintained. Insect lights are not installed above food preparation or open storage areas.

  • P 509. No evidence of rodents or other pests in the facility.

  • C 932. Shopbacks put away. Perishable shopbacks may not exceed 45°F.

  • PF 912. All products throughout the back area are properly stored to prevent contamination of food, single service items or other food contact surfaces.

  • C 913. All vendor return areas are clean and well organized.

  • C 914. Areas are free of unused equipment; no stock piling of pallets and boxes.

  • C 936. Trash compactor and surrounding floors, walls and ceiling are clean.

  • C 512. Unauthorized personnel, including off duty personnel are following proper food practices (ie. wearing hair net) while in back areas, food preparation & storage areas and other sensitive areas of the facility. Proper signage is present indicating restricted areas.

REVIEW & SIGNATURE

  • Signature of Auditor

  • Signature of PIC

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.