Food Safety Procedures Verification

• Conducted on

  Date

• Prepared by

• INSTRUCTIONS
  
  1. Answer "Yes" or "No" on the items below.
  2. Add photos and notes by clicking on the paperclip icon
  3. To add a Corrective Measure click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority, and due date
  4. Complete audit by providing digital signature
  5. Share your report by exporting as PDF, Word, Excel or Web Link
  
  NOTE: For exclusive use of Illas Management and Affiliates

HYGIENE & SANITATION

• Hand washing procedures, cross contamination prevention, and sanitation supplies

• FS1 - US Required supplies are ar all hand washing sinks to include warm running water. Hand wash sinks are only used for hand washing and not for preparing food or storing equipment. Hand wash sinks are easily accessed by employees.

  Yes

  No

• Select all reasons that apply below:

  Select Hand washing sink knobs/automatic tap not working well Soap dispenser empty/not working No warm running water No paper towel/working hand dryer Soap dispenser does not contain Ecolab approved hand soap Hand washing sink/tap obstructed and not accessible Hand washing sink used for other purposes Other

  • Hand washing sink knobs/automatic tap not working well
  • Soap dispenser empty/not working
  • No warm running water
  • No paper towel/working hand dryer
  • Soap dispenser does not contain Ecolab approved hand soap
  • Hand washing sink/tap obstructed and not accessible
  • Hand washing sink used for other purposes
  • Other

• Describe.

• FS2 - US Hands are properly washed following proper hand washing procedures at the appropriate times. A system is in place to ensure hourly hand washing by all employees.

  Yes

  No

• Select all reasons that apply below:

  Select Hands not washed on hourly basis Hand washing clock/timer not working / not in use/ system not in place Hand washing activity not monitored Hands not washed after using restroom/ taking break Hands not washed after handling raw products and working on other station, e.g. prep table Hands not washed after tasks such as handling waste, touching face, hair, picking something off the floor, etc. Other

  • Hands not washed on hourly basis
  • Hand washing clock/timer not working / not in use/ system not in place
  • Hand washing activity not monitored
  • Hands not washed after using restroom/ taking break
  • Hands not washed after handling raw products and working on other station, e.g. prep table
  • Hands not washed after tasks such as handling waste, touching face, hair, picking something off the floor, etc.
  • Other

• Describe.

• FS3 - US Sanitized towel buckets contain towels and sanitizer solution at the correct concentration checked with a chlorine test strip.

  Yes

  No

• Select all reasons that apply below:

  Select Fresh bucket with sanitized towels not prepared Buckets not labeled No towels in fresh bucket Used towels mixed with fresh towels Buket is soiled Sanitizer level is not at correct concentration Test strips not available Other

  • Fresh bucket with sanitized towels not prepared
  • Buckets not labeled
  • No towels in fresh bucket
  • Used towels mixed with fresh towels
  • Buket is soiled
  • Sanitizer level is not at correct concentration
  • Test strips not available
  • Other

• Describe.

• FS4 - US Sanitizer-soaked towels and grill cloths used at food or beverage preparation and service areas must be placed into the soiled towel bucket after using and not be left sitting out on surfaces.

  Yes

  No

• Select all reasons that apply below:

  Select Grill towels left out on kitchen surfaces Cloth towels left out on kitchen surfaces Cloth towels left out on beverage/service areas Other

  • Grill towels left out on kitchen surfaces
  • Cloth towels left out on kitchen surfaces
  • Cloth towels left out on beverage/service areas
  • Other

• Describe.

• FS5 - US All UHC trays, grill, utensils, prep table utensils, and utensil holders are clean (no build up) and are washed and sanitized at least every 4 hours as per approved procedure. Back sink and soap/sanitizer dispensers or dishwashers must function (hot water 110 F or higher) and all supplies must be available. Check that sanitizer solution has the right concentration with an appropriate test strip.

  Yes

  No

• Select all reasons that apply below:

  Select UHC trays, utensils, and utensil holders are not clean Items are not being cleaned and sanitized every 4 hours Back sink dispenser/ware washer not operating properly Sanitizer solution not at the correct concentration Dirty utensils resting in back sink for more than 4 hours Water at back sink is not 110 F or hotter Test strips not available / damaged / expired / not in usable condition Other

  • UHC trays, utensils, and utensil holders are not clean
  • Items are not being cleaned and sanitized every 4 hours
  • Back sink dispenser/ware washer not operating properly
  • Sanitizer solution not at the correct concentration
  • Dirty utensils resting in back sink for more than 4 hours
  • Water at back sink is not 110 F or hotter
  • Test strips not available / damaged / expired / not in usable condition
  • Other

• Describe.

• FS5 - US - 01 All soiled raw wares that came into contact with raw proteins (such as fresh beef and raw chicken) are washed and sanitized last (unless a warewasher is used). Soiled blue raw beef trays and lids are kept in blue bus box until cleaned. Back sink is properly sanitized after washign wares that came into contact with raw proteins.

  Yes

  No

• Select all reasons that apply below:

  Select Raw ware equipment not cleaned last Raw ware equipment not washed separately Soiled raw beef tray(s) / lid(s) are not stored in blue bus box Back sink / Powersoak sink not cleaned after washing raw ware equipment Raw ware equipment is soaking in Powersoak sink Other

  • Raw ware equipment not cleaned last
  • Raw ware equipment not washed separately
  • Soiled raw beef tray(s) / lid(s) are not stored in blue bus box
  • Back sink / Powersoak sink not cleaned after washing raw ware equipment
  • Raw ware equipment is soaking in Powersoak sink
  • Other

• Describe.

CONTAMINATION PREVENTION

• FS6 - US Appropriate measures are taken to protect water and ice from foreign material, chemicals and/or bacterial contamination. Check that water filters are in date and the ice machine is free from mold or buildup.

  Yes

  No

• Select all reasons that apply below:

  Select Water filter not in date Water filter bypassed Water / ice not protected from possible contamination Ice machine has mold or visible buildup Other

  • Water filter not in date
  • Water filter bypassed
  • Water / ice not protected from possible contamination
  • Ice machine has mold or visible buildup
  • Other

• Describe.

• FS7 - US Opened packages of food in storage (including refrigerators and freezers) are covered/wrapped, labeled and stored according to proper procedures.

  Yes

  No

• Select all reasons that apply below:

  Select Frozen beef Fresh beef Frozen chicken Thawed chicken Fish Breakfast meats Potato products Bakery/buns Produce/salad ingredients Cheese/eggs/dairy Other

  • Frozen beef
  • Fresh beef
  • Frozen chicken
  • Thawed chicken
  • Fish
  • Breakfast meats
  • Potato products
  • Bakery/buns
  • Produce/salad ingredients
  • Cheese/eggs/dairy
  • Other

• Describe.

• FS8 - US Blue disposable glove procedures or dedicated tongs are used to prevent cross-contamination when handling all raw meat or poultry products (including shell eggs) at the grill station and fryer station. Dedicated utensils are used for raw products (e.g. the yellow yolk breaking tool is only used to break egg yolks).

  Yes

  No

• Select all reasons that apply below:

  Select Gloves not discarded when removed/are being used Double set of gloves being worn Proper blue glove procedures not being followed Yellow yolk breaking tool not available Yellow yolk breaking tool used for items other than raw eggs Utensils other than yellow yolk breaking tool used to break raw egg yolks Bare hands used with raw product at grill/fryer Other

  • Gloves not discarded when removed/are being used
  • Double set of gloves being worn
  • Proper blue glove procedures not being followed
  • Yellow yolk breaking tool not available
  • Yellow yolk breaking tool used for items other than raw eggs
  • Utensils other than yellow yolk breaking tool used to break raw egg yolks
  • Bare hands used with raw product at grill/fryer
  • Other

• Describe.

• FS9 - US Clear/white disposable gloves worn for food preparation of ready to eat foods at the sandwich prep table, salad prep table, and in all other areas to prevent bare hand contact with any cooked or ready-to-eat foods.

  Yes

  No

• Select all reasons that apply below:

  Select Hands not washed prior to putting on a new clean pair of disposable gloves Gloves not worn when preparing sandwiches, salads, or burritos Gloves not replaced when damaged/contaminated Gloves not discarded when removed/being reused Gloves not changed and hands not washed if gloves become contaminated Clear gloves are used for handling raw products Double set of gloves being worn Other

  • Hands not washed prior to putting on a new clean pair of disposable gloves
  • Gloves not worn when preparing sandwiches, salads, or burritos
  • Gloves not replaced when damaged/contaminated
  • Gloves not discarded when removed/being reused
  • Gloves not changed and hands not washed if gloves become contaminated
  • Clear gloves are used for handling raw products
  • Double set of gloves being worn
  • Other

• Describe.

• FS10 - US Chemicals are stored away from food and packaging.

  Yes

  No

• Select all reasons that apply below:

  Select Chemical spray bottles/containers stored in the kitchen Chemical spray bottles/containers stored in the service area Chemicals are stored in dry storage near food and packaging Other

  • Chemical spray bottles/containers stored in the kitchen
  • Chemical spray bottles/containers stored in the service area
  • Chemicals are stored in dry storage near food and packaging
  • Other

• Describe.

• FS11 - US The restaurant building, corral and any area within 10 feet (3m) from the building (i.e. inside the Drive-thru lane) is clear from infestation by rats, mice, insects and birds. Check these areas for any signs of pests. If the restaurant has signs of a pest infestation this question is considered a fail. Include in the comments the specifics on what you observed.

  Yes

  No

• Select all reasons that apply below:

  Select Inside the restaurant has visible infestation Inside the restaurant shows signs of infestation Outside the restaurant has visible infestation Outside the restaurant shows signs of infestation Other

  • Inside the restaurant has visible infestation
  • Inside the restaurant shows signs of infestation
  • Outside the restaurant has visible infestation
  • Outside the restaurant shows signs of infestation
  • Other

• Describe.

• FS11 - US - 01 Pest management program and pest prevention steps and behaviours are in place and are being managed effectively. The restaurant is properly pest proofed to prevent entry of pests (e.g. gaps under doors are sealed). Review the most recent pest control report, ensuring all recommendations have been corrected. If the pest management program and pest prevention steps and behaviors are not in place or are not complete, then mark this question as no. Include in the comments specifics on what you observed.

  Yes

  No

• Select all reasons that apply below:

  Select Pest management program is not in place Pest management program is not working effectively Restaurant is not pest-proofed Other

  • Pest management program is not in place
  • Pest management program is not working effectively
  • Restaurant is not pest-proofed
  • Other

• Describe.

• FS12 - US Non-food spill clean-up procedures in place.

  Yes

  No

• Select all reasons that apply below:

  Select 3N1 cleaner/disinfectant not available Staff not trained in the use of the non-food spill procedures Non-food spill procedures not available Other

  • 3N1 cleaner/disinfectant not available
  • Staff not trained in the use of the non-food spill procedures
  • Non-food spill procedures not available
  • Other

• Describe.

STORAGE

• FS13 - US Walk-in freezer and any other primary storage freezers at 0 F (-18 C) or below. Secondary storage freezers are keeping all products solidly frozen.

  Yes

  No

• Check which units are not at proper temperature/keeping products frozen:

  Select Walk-in freezer Reach-in freezer Kitchen wall freezer Grill side freezer Fry freezer Frozen fry dispenser Other

  • Walk-in freezer
  • Reach-in freezer
  • Kitchen wall freezer
  • Grill side freezer
  • Fry freezer
  • Frozen fry dispenser
  • Other

• Describe.

• FS14 - US Refrigerated products inside all refrigerated units are at or below 40 F (4 C) (including shake/sundae reservoir).

  Yes

  No

• Check which units do not meet temperature standard:

  Select Walk-in cooler Reach in cooler Prep line Grill side refrigerator Mc Cafe Shake, Sundae reservoir Milk/beverage coolers Salad displays Other

  • Walk-in cooler
  • Reach in cooler
  • Prep line
  • Grill side refrigerator
  • Mc Cafe
  • Shake, Sundae reservoir
  • Milk/beverage coolers
  • Salad displays
  • Other

• Describe.

• FS15 - US All refrigerated products are in code (within primary shelf life).

  Yes

  No

• What product is not in code?

  Select Fresh Beef Produce Cheese/eggs/dairy Sauces Milk Shakes/sundaes mix Other

  • Fresh Beef
  • Produce
  • Cheese/eggs/dairy
  • Sauces
  • Milk
  • Shakes/sundaes mix
  • Other

• Describe.

• FS16 - US Secondary shelf lives of refrigerated foods held at room temperature and in refrigerators are marked and the products are being used within their secondary shelf lives.

  Yes

  No

• What product is not in code?

  Select Produce Cheese/eggs/dairy Sauces Raw poultry Fresh beef Canadian bacon Other

  • Produce
  • Cheese/eggs/dairy
  • Sauces
  • Raw poultry
  • Fresh beef
  • Canadian bacon
  • Other

• Describe.

• FS17 - US Lefotver heated foods are discarded (including any shakes/sundae mix removed from heat treatment shake/sundae machines).

  Yes

  No

• What product?

  Select Shake/sundae mix Sauces/soups/gravies Food donation products not stored in freezer Other

  • Shake/sundae mix
  • Sauces/soups/gravies
  • Food donation products not stored in freezer
  • Other

• Describe.

COOKING

• FS18 - US Pyrometer with needle probe is calibrated and working correctly.

  Yes

  No

• Check all reasons that apply below:

  Select Probe not complete/missing Pyrometer not in calibration Pyrometer / Probe damaged Unapproved pyrometer in use Other

  • Probe not complete/missing
  • Pyrometer not in calibration
  • Pyrometer / Probe damaged
  • Unapproved pyrometer in use
  • Other

• Describe.

• FOR ITEMS FS19-US - FS22-US, IF ANY ITEM IS MISSED, THE RESTAURANT IS CONSIDERED UNACCEPTABLE ON FOOD SAFETY PROCEDURES VERIFICATION. BE SURE TO CHECK AND OBSERVE A FULL RUN OF PRODUCT FOR EACH SECTION OF GRILL OR FRYER ON OR IN WHICH THE PRODUCT IS BEING COOKED.

• FS19 - US The internal temperatures of beef patties after cooking are at or above 155 F (69 C) and fresh beef patties at or above 175 F (80 C).

  Yes

  No

• What product:

  Select Frozen 10:1 Frozen 4:1 Fresh 4:1 Other

  • Frozen 10:1
  • Frozen 4:1
  • Fresh 4:1
  • Other

• Describe.

• FS20 - US The internal temperatures of raw chicken products after cooking are at or above 165 F (74 C).

  Yes

  No

• What product:

  Select Chicken tenders McNuggets Crispy Chicken Grilled Chicken McChicken Other

  • Chicken tenders
  • McNuggets
  • Crispy Chicken
  • Grilled Chicken
  • McChicken
  • Other

• Describe.

• FS21 - US The internal temperatures of breakfast steak and breakfast sausage after cooking are at or above 155 F (69 C) for sausage made from poultry.

  Yes

  No

• What product:

  Select Breakfast steak Breakfast sausage Other

  • Breakfast steak
  • Breakfast sausage
  • Other

• Describe.

• FS22 - US The internal temperatures of round eggs after cooking are at or above 155 F (69 C).

  Yes

  No

• FS23 - US The internal temperature of Filet-O-Fish portions after cooking are at or above 150F (66 C).

  Yes

  No

GENERAL

• FS24 - US All food, food packaging, equipment (including utensils), and cleaning chemicals are from approved sources.

  Yes

  No

• Check reasons below:

  Select Food not from approved sources Packaging not from approved sources Equipment not from approved sources Cleaning chemicals not from approved sources Other

  • Food not from approved sources
  • Packaging not from approved sources
  • Equipment not from approved sources
  • Cleaning chemicals not from approved sources
  • Other

• Describe.

• FS25 - US Managers understand employee illness symptoms and reportable illness causes for when an employee cannot be working. Managers also understand when an employee can return to work after illness.

  Yes

  No

• Check reasons below:

  Select Manager does not know what symptoms would result in employees not being allowed to work Manager does not know the procedures to follow when presented with an ill employee Manager does not know when an ill employee would be allowed to return to work Manager does not know the reportable illness' cause Other

  • Manager does not know what symptoms would result in employees not being allowed to work
  • Manager does not know the procedures to follow when presented with an ill employee
  • Manager does not know when an ill employee would be allowed to return to work
  • Manager does not know the reportable illness' cause
  • Other

• Describe.

• FS26 - US All managers (including shift managers) are trained and currently certified in food safety through ServSafe (or an equivalent and accredited food safety training course).

  Yes

  No

• What is missing?

  Select Proof of food safety training not available Certification is overdue and needs to be reissued Not all managers have been trained and certified Food safety certificate not available Other

  • Proof of food safety training not available
  • Certification is overdue and needs to be reissued
  • Not all managers have been trained and certified
  • Food safety certificate not available
  • Other

• Describe.

• FS26 - US - 01 All employees are trained and verified on food safety and sanitation per McDonald's current training program and in accordance with local regulations

  Yes

  No

• Choose all that apply.

  Select Proof of food safety training not available Certification is overdue and needs to be reissued Not all managers have been trained and certified Food safety certificate not available Other

  • Proof of food safety training not available
  • Certification is overdue and needs to be reissued
  • Not all managers have been trained and certified
  • Food safety certificate not available
  • Other

• Describe.

• FS27 - US Managers (or staff assigned to complete the checklist) have been trained on and can demonstrate how to properly complete the procedures on the Daily Food Safety Checklist.

  Yes

  No

• Mark all that apply.

  Select Manager/assigned staff does not complete pyrometer check correctly Manager/assigned staff does not complete breakfast grill product checks correctly Manager/assigned staff does not complete regular menu grill product checks correctly Manager/assigned staff does not know how to measure freezer temperatures correctly Manager/assigned staff does not know how to measure frozen/refrigerated product temperatures correctly Other

  • Manager/assigned staff does not complete pyrometer check correctly
  • Manager/assigned staff does not complete breakfast grill product checks correctly
  • Manager/assigned staff does not complete regular menu grill product checks correctly
  • Manager/assigned staff does not know how to measure freezer temperatures correctly
  • Manager/assigned staff does not know how to measure frozen/refrigerated product temperatures correctly
  • Other

• Describe.

• FS28 - US At least the last 60 days of correctly completed Daily Food Safety Checklists are available and the last two correctly completed Monthly Food Safety Procedure Verifications are available.

  Yes

  No

• Mark all that apply.

  Select Last 60 days completed Daily Food Safety Checklist (digital records) not available Incorrect completion of last 60 days completed Daily Food Safety Book Last two completed Monthly Food Safety Procedures Verifications are not available Incorrect completion of last two Monthly Food Safety Procedure Verifications Most current Daily Food Safety book not being used Other

  • Last 60 days completed Daily Food Safety Checklist (digital records) not available
  • Incorrect completion of last 60 days completed Daily Food Safety Book
  • Last two completed Monthly Food Safety Procedures Verifications are not available
  • Incorrect completion of last two Monthly Food Safety Procedure Verifications
  • Most current Daily Food Safety book not being used
  • Other

• Describe.

• FS29 - US Review the most recent health department inspection report, ensuring all food safety violations noted have been corrected or a plan is in place to correct issues.

  Yes

  No

• What is missing?

  Select Health department inspection report not available Violations noted by Health Department have not been corrected Plan not in place to correct issues Other

  • Health department inspection report not available
  • Violations noted by Health Department have not been corrected
  • Plan not in place to correct issues
  • Other

• Describe.

• Auditor's Name & Signature:

  Sign
• Add location
  Address