Information
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Store Number
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Location
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Prepared by
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Conducted on
Food Safety Inspection
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Store Number
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DM
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Manager
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Date/Time
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Scoring:
Meets Standards select Yes
Does not Meet Standards select No
If a Recurrence select Repeat
Items are weighted:
⚪=1
🔵=4
⚫=6
🔴=Critical Item up to -12 score
A Yes or No will apply the appropriate value to the overall score.
General Conditions
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🔵Food counter clean? (Floors, counters, vents, etc.)
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🔵Sanitize solution available and in use? Tested 200 ppm?
Hot Food Program
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🔴Appropriate product selection for time of day?
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🔵HATCO clean and planogrammed correctly with proper signage?
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🔴Product timed properly? No expired product in HATCO?
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⚪Ovens / Customer microwaves clean?
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🔵WSSR reporting reviewed weekly, current Power Hour posted
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🔵Checkout prep area is clean and organized.
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🔵Employees wash hands and handle food properly (wear gloves)?
Sandwich Case & Condiment Bar
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🔴Appropriate product selection in case?
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Number Missing
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🔵Sandwich case planogrammed correctly with proper signage?
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🔴All items dated correctly and nothing outdated?
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⚪Sandwich case clean and faced?
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⚫Condiment station/cooler clean? Condiment items properly dated?
Johnsonville Brat Station & Roller Grill
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🔴Product available for required program hours?
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🔴Product at proper temperature?
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🔵Station is clean with tongs available?
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⚪Product is properly timed, buns dated?
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⚪Proper signage in place?
Coffee & Cappuccino Program
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🔴Appropriate level of product available for time of day?
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🔵Equipment clean (tops, baskets, spray heads, interior)? <br>
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⚪ Coffee grounds emptied on a timely basis?<br>
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⚪Coffee timers clean and properly used?
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⚪Coffee syrup bottles and pumps are filled and clean?
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⚪Coffee condiment station is clean and supplies in stock?<br>
Creamiser Station
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🔵Half & Half dated 12 days, other bags 30 days (Skim milk dated same as carton use)? Check for cleanliness on outside, top and inside Creamiser? No mold present? Nipples cut to proper length, temp at 33 to 41 degrees?
Fountain Program
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🔵No mold buildup on fountain heads? Ice bin on fountain machine and ice chute clean? All BIBs are within proper selling dates?
Bakery Program
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🔴 Appropriate product selections for time of day? (Never out of cookies & muffins)
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🔵 Bakery case(s) clean and faced / product rotated?
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⚪ Case is set to planogram and proper tags in place?
Product Rotation (Dating & Stales)
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🔵Food Program (Backstock properly dated/rotated)?
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🔵Proper Cooler Rotation (Milk, Juice, Meats & cheese, etc)?
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🔵HP Thaw & Serve Program executed correctly?
Backroom
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🔵Ice maker bin & bucket clean? Scoop properly stored?
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⚪ Triple sinks clean and properly labeled?
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⚪No fresh food in sinks? No chemicals stored above sinks?
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⚪Water filters are clean and properly dated?
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⚪ Sink room overall is up to Holiday standards?
Cooler
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🔵Proper temperature & temp control procedures in place?
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⚪Interior clean and organized? No boxes stored on floor?
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⚪Cooling Fans clean & Lights covered?
Restrooms
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⚫Clean?
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🔵In Good Repair / Working?
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⚪Stocked?
Additional Comments?
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Additional Notes & Comments
