Title Page
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Conducted on
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Prepared by
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Location
Critical Evaluation - Audit
Critical #1 Hand Washing
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Hand sink not obstructed, Not blocked, No items in the sink, Hand washing area clean?
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Hands washed when required, Glove changes, Restroom usage, touching face/clothes, changing stations, tasks, trash, etc,
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Hand wash executed properly, wash hands 20 seconds, use towel to shut off water.
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Paper Towels & Hand Soap stocked at each hand wash station including restrooms.
Critical #2 Health Department
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Most recent Health Inspection is posted - Posted in Console.
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Items noted in Health Inspection corrected in 10 days or less.
Critical #3 Hot Water is Available
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Hand Sink Water 100 F within 30 seconds
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Non - Hand sink minimum temp 110 F - BOH and Restrooms.
Critical #4 Potentially Hazardous Foods Temps
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Hot PHF's minimum temp 140 F - CVAP, Steam Table, Cabinets
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Cold PHF's maximum temp 40 F All refrigerated items, & BF Table
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Food properly cooled, Valley's in rice; 70 F w/in 2 hours, 40 F w/in 6 hours.
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Frozen Proteins & CHUBS are thawed properly - Pull date/thaw date; No product sitting out of cooler; tenders may be thawed under cold running water in sealed bags in case of emergencies.
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HACCP Log Completed, Current shift & last 30 days; Chicken delivery must be completed.
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Calibrated thermometer in use, Calibrate by placing in ice water. Must read 32 F.
Critical #5 Sanitizer
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Sanitizing strength w/in standard - 200ppm
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Sanitizer in approved containers - Red Buckets marked Sanitizer
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Sanitizer buckets no less than 12 inches from food, food items, & or packaging.
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Blue towels are submerged in sanitizer water when not in use. No Blue towels left "laying around."
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Sanitizer Test Strips available & NOT expired. - (At desk/back sink)
Critical #6 Manager / Chicken Temp Procedure
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Manager inserts clean & sanitized thermometer probe from side into thickest part of meat.
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Temperature of Chicken must meet minimum of 160 F
Critical #7 Restaurant Using Approved Items
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All food is approved, - No items used from Walmart, Sam's, etc.
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All packaging & paper items approved. - No items from Walmart, Sam's etc.
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All small wares & tools are approved - No items purchased from unapproved sources.
Critical #8 Refrigerated Items Holding
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No expired items - Prep, thawing, chicken, lettuce, cole-slaw, etc.
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No items marked with incorrect hold times
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No items missing hold times, - CVAP, Steam Table, Bread, Fries, Biscuits, Cabinets, Chicken.
Critical #9 Cross Contamination
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Cooked & Raw product kept separate.
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Old & New PHF's are not mixed. - Chicken, Side items, Rice, etc.
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Ice Machine - No Mold / Mildew
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Physical Contamination - No Misc. items found in ready to eat food, no labels, pens, dropped items, scoops, not inside containers.
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Food Prep Tools are cleaned properly, no build up
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Soda Nozzles no build up
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Small wares maintained - No cracks, dents, burns, (damage) on any small wares
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Wash, Rinse, Sanitize procedures used properly
Critical #10 Pest Control
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No live or dead rodents or droppings observed
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No live or dead cock roaches observed
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No birds nesting inside of restaurant
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No ant trails or excessive fly activity
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Pest Control Report is on file & available - check Pest Log
Critical #11 MOD Serv-Safe Certified
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MOD (on duty) is Serv-Safe certified - Management Certification Log
Critical #12 Food Safety Violations
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No drainage back ups - Drains are clear in all BOH & Restrooms
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No Ill employees working
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BOH free of roof leaks
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All bins labeled -- Flour, Magnesol, Rice, Salt, Sugar
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Employee food no present - Remove all employee food from BOH
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Employee drinks are stored properly, In POPEYES Cup w/ Lid & Straw
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All washing sinks are functional, - Not marked as "Do Not Use"
