Title Page

  • Conducted on

  • Observer

  • Location

PERSONAL HYGIENE

  • Employees wear clean and proper uniform including shoes.

  • Effective hair restraints are properly worn.

  • Fingernails are short, unpolished, and clean (no artificial nails).

  • Jewelry is limited to a plain ring, such as wedding band and a watch and no bracelets.

  • Hands are washed properly, frequently, and at appropriate times.

  • Burns, wounds, sores or scabs, or splints and water-proof bandages on hands are bandaged and completely covered with a glove while handling food.

  • Eating, drinking, chewing gum, smoking, or using tobacco are allowed only in designated areas away from preparation, service, storage, and ware washing areas.

  • Employees use disposable tissues when coughing or sneezing and then immediately wash hands.

  • Employees appear in good health.

  • Hand sinks are unobstructed, operational, and clean.

  • Hand sinks are stocked with soap, disposable towels, and warm water.

  • A handwashing reminder sign is posted.

  • Employee restrooms are operational and clean.

FOOD PREPARATION

  • All food stored or prepared in facility is from approved sources.

  • Food equipment utensils, and food contact surfaces are properly washed, rinsed, and sanitized before every use.

  • Frozen food is thawed under refrigeration, cooked to proper temperature from frozen state, or in cold running water.

  • Thawed food is not refrozen.

  • Preparation is planned so ingredients are kept out of the temperature danger zone to the extent possible.

  • Food is tasted using the proper procedure.

  • Procedures are in place to prevent cross-contamination.

  • Food is handled with suitable utensils, such as single use gloves or tongs.

  • Food is prepared in small batches to limit the time it is in the temperature danger zone.

  • Clean reusable towels are used only for sanitizing equipment and surfaces and not for drying hands, utensils, or floor.

  • Food is cooked to the required safe internal temperature for the appropriate time. The temperature is tested with a calibrated food thermometer.

  • The internal temperature of food being cooked is monitored and documented.

HOT HOLDING

  • Hot holding unit is clean.

  • Food is heated to the required safe internal temperature before placing in hot holding. Hot holding units are not used to reheat potentially hazardous foods.

  • Hot holding unit is pre-heated before hot food is placed in unit.

  • Temperature of hot food being held is at or above 140 oF.

  • Food is protected from contamination.

COLD HOLDING

  • Refrigerators are kept clean and organized.

  • Temperature of cold food being held is at or below 41 °F.

  • Food is protected from contamination.

REFRIGERATOR, FREEZER, AND MILK COOLER

  • Thermometers are available and accurate.

  • Temperature is appropriate for pieces of equipment.

  • Food is stored 6 inches off floor or in walk-in cooling equipment.

  • Refrigerator and freezer units are clean and neat.

  • Proper chilling procedures are used.

  • All food is properly wrapped, labeled, and dated.

  • The FIFO (First In, First Out) method of inventory management is used.

  • Ambient air temperature of all refrigerators and freezers is monitored and documented at the beginning and end of each shift.

FOOD STORAGE AND DRY STORAGE

  • Temperatures of dry storage area is between 50 °F and 70 °F or State public health department requirement.

  • All food and paper supplies are stored 6 to 8 inches off the floor.

  • All food is labeled with name and received date.

  • Open bags of food are stored in containers with tight fitting lids and labeled with common name.

  • The FIFO (First In, First Out) method of inventory management is used.

  • There are no bulging or leaking canned goods.

  • Food is protected from contamination.

  • All food surfaces are clean.

  • Chemicals are clearly labeled and stored away from food and food-related supplies.

  • There is a regular cleaning schedule for all food surfaces.

  • Food is stored in original container or a food grade container.

CLEANING AND SANITIZING

  • Three-compartment sink is properly set up for ware washing.

  • Dishmachine is working properly (such as gauges and chemicals are at recommended levels).

  • Water is clean and free of grease and food particles.

  • Water temperatures are correct for wash and rinse.

  • If heat sanitizing, the utensils are allowed to remain immersed in 171 °F water for 30 seconds.

  • If using a chemical sanitizer, it is mixed correctly and a sanitizer strip is used to test chemical concentration.

  • Smallware and utensils are allowed to air dry.

  • Wiping cloths are stored in sanitizing solution while in use.

UTENSILS AND EQUIPMENT

  • All small equipment and utensils, including cutting boards and knives, are cleaned and sanitized between uses.

  • Small equipment and utensils are washed, sanitized, and air-dried.

  • Work surfaces and utensils are clean.

  • Work surfaces are cleaned and sanitized between uses.

  • Thermometers are cleaned and sanitized after each use.

  • Thermometers are calibrated on a routine basis.

  • Can opener is clean.

  • Drawers and racks are clean.

  • Clean utensils are handled in a manner to prevent contamination of areas that will be in direct contact with food or a person’s mouth.

LARGE EQUIPMENT

  • Food slicer is clean.

  • Food slicer is broken down, cleaned, and sanitized before and after every use.

  • Boxes, containers, and recyclables are removed from site.

  • Loading dock and area around dumpsters are clean and odor-free.

  • Exhaust hood and filters are clean.

GARBAGE STORAGE AND DISPOSAL

  • Kitchen garbage cans are clean and kept covered.

  • Garbage cans are emptied as necessary.

  • Boxes and containers are removed from site.

  • Loading dock and area around dumpster are clean.

  • Dumpsters are clean.

PEST CONTROL

  • Outside doors have screens, are well-sealed, and are equipped with a self-closing device.

  • No evidence of pests is present.

  • There is a regular schedule of pest control by a licensed pest control operator.

COMPLETION

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