Home
General
Food Safety Self-Assessment
Food Safety Self-Assessment
Anonymous

Food Safety Self-Assessment

Must be completed quarterly. Process The assessor will show up on the day unannounced, but is under no obligation to disrupt the workday, other than to collect the required items and that the assessment can be reviewed at the end of the session. The food safety assessment will take approximately 1 hour dependant on the store size. Once the assessment is complete the person in charge (PIC) will be asked for a signature and to approve report. This report will get e-mailed to the store within 24 hours of completion. An action plan must be created from the assessment, where corrective actions must be completed. The District Manager/ Operations Manager will then complete a re-assessment and sign off the action plan within 5 weeks.

Use this Template
Print as PDF
graphic of a hand making an okay sign ×

Free Food Safety Self-Assessment Checklist

Use this Template

Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Behaviours ⚠️

Critical

  • Partner is working with diarrhoea

  • Partner is working with severe cough or runny nose

  • Partner is working with an exposed infected lesion on hand, wrist or arm

  • Partner is working with fever

  • Partner is working with symptoms of vomiting

  • Partner is working with jaundice (yellowing of skin or eyes)

  • Exposed bandage on hand is not covered with a blue glove

  • Ice touched with bare hands

  • Ready to eat unpackaged food touched with bare hands

  • Single use gloves washed and reused

  • Did not wash hands after using rest room

  • Did not wash hands before putting on gloves to handle food

  • Did not wash hands before starting shift or after returning from break

  • Did not wash hands after cleaning tasks

  • Did not wash hands after coughing, sneezing or blowing nose

  • Did not wash hands after eating drinking, smoking, chewing tobacco or gum (touching mouth)

  • Did not wash hands after bussing tables or handling dirty dishes/equipment

  • Did not wash hands after touching face, hair, or skin

  • Did not wash hands after handling waste

  • Did not use soap

  • Did not scrub for min 20 seconds

  • Did not dry hands

  • Dried hands on apron

  • Did not use the designated hand sink

Major

  • Access to restroom hand sink is blocked

  • Access to BOH hand sink is blocked

  • Access to Drive Thru hand sink is blocked

  • Access to FOH hand sink is blocked

  • Items are stored in/on hand sink

  • Other tasks are taking place at hand sink

  • Soap dispenser is empty or not present

  • Soap dispenser does not work

  • Fingernails are artificial, have polish or coating of any kind

  • Hair beyond shoulder length is not restrained

  • Food handler is wearing jewellery on the wrist

  • Finger nails are not trimmed or clean

  • Food handler is wearing more than one plain ring

  • Person in charge does not answer the following questions accurately : “What are some of the illness symptoms that would exclude a person from coming to work”

  • Person in charge does not answer the following questions accurately : “What two actions should be taken if a partner informs you they behave been diagnosed with a notifiable disease and still has no symptoms”

  • Person in charge does not answer the following questions accurately : “Where are the documented procedures indicating what to do if a vomit/diarrhoea (biohazard) event occurs in the store”

  • Partner food/beverage is not stored in a designated, covered container in refrigerator

  • Partner food/beverage is stored on shelving next to or above dry goods, small wares or single use items

  • Partner food container is not labelled

  • Partner is eating in front of house food storage area or food prep area

  • Partner is drinking in front of house food storage or food prep area

  • Partner is eating in back of house storage or food prep area

  • Partner is drinking in back of house storage or food prep area

  • Partner is smoking or vaping in store

  • Partner is chewing tobacco in food service area

  • Partner is chewing gum in food service area

MINOR

  • Apron not removed before going on break

  • Apron not removed before Using restroom

  • Apron not removed before Cleaning restroom

  • Apron not removed when taking out rubbish

  • Apron is dirty at the beginning of the shift

  • Partner personal items (not food) are stored near food or food contact surfaces

  • Partner has not received food safety certification/training

  • Partner Barista Food Safety induction not completed

  • Supervisors have not completed Supervisor Training and working with title

  • Store Managers have not completed any management training on safety or hygiene

  • No food hygiene rating signage

  • No letters of the store’s food hygiene rating status

  • Food Safety Policy not present

  • Personal Hygiene policy not present

Temperature 🌡️

CRITICAL

  • Store is operating with a complete lack of mechanical refrigeration for TCS foods

  • TCS food in bar unit held at > +8 degrees Celsius

  • TCS food in BOH unit held at > +8 degrees Celsius

  • Condiment bar carafes at > +8 degrees celsius

  • TCS food in FOH unit held at > +8 degrees Celsius

MAJOR

  • FOH Refrigerator air temp above required temperature

  • BOH refrigerator air temp above required temperature

  • Refrigerated display case air temp above required temperature

  • Other refrigerators air temp above required temperature

  • Product thermometer not present

  • Product thermometer not functioning or calibrated properly

  • Closing shift temps missing for refrigerators / freezers

  • Opening shift temps missing for refrigerators / freezers

  • Mid-day temps missing for refrigerated display case

  • Received TCS food temps missing

  • When required, corrective action not noted

  • Temp logs have complete days missing

  • Temp logs have complete weeks missing

  • Temp logs completed in advance

MINOR

  • FOH refrigerator/freezer gasket is not present

  • FOH refrigerator/freezer gasket is in poor condition

  • BOH refrigerator/freezer gasket is not present

  • BOH refrigerator/freezer gasket is in poor condition

  • Other refrigeration gasket is not present

  • Other refrigerator gasket is in poor condition

  • Items stored on top of BOH refrigerator/freezer blocking vents

  • Items stacked in RTD/E case blocking air flow

  • External rear grille area of display has 3 dimensional dust

  • Reach in refrigerator shelves lined with cardboard, blocking air flow

Pests 🪳

Critical

  • Fruit flies observed on food or inside pastry case

  • Fruit flies observed in multiple areas of store

  • Fruit flies observed on food contact surfaces

  • House flies observes on food or inside pastry case

  • House flies observed on food contact surfaces

  • House flies observed in multiple areas of store

  • Live rodent activity observed

  • Dead rodent observed

  • Chewed bags, nesting material or droppings observed

  • Cockroaches observed in BOH

  • Cockroaches observed in FOH

  • Cockroaches observed in lobby/customer area

  • Ants observed on food or in the pastry case

  • Ants observed on food contact surfaces

Major

  • Fruit flies observed in one area and not observed on food

  • House flies observed in one area and not observed on food

  • Ants observed in cabinets or on counter tops and not observed on food or food contact surfaces

  • Exterior doors are not rodent proof

  • Holes observed in wall and/or ceiling FOH

  • Holes observed in wall and/or ceiling BOH

  • Wall penetrations for incoming plumbing and/or electrical have gaps that are not sealed

  • Ceiling tiles missing or dislodged

  • Pest control devices placed on or above food prep areas

  • Insect attractant light above food prep areas

Minor

  • Ants observed on floor and not observed on food

  • Plumbing fixtures not properly sealed to the wall or countertop

  • Cabinetry/countertop not sealed to the wall or countertop

  • Cabinetry/Countertop horizontal gaps/joints not sealed

  • Wood rotted under stainless steel/ countertop

  • Cabinets have water damage causing disintegration and rot

  • Countertop excessively worn/damaged/pitted

  • Cabinetry/Countertop has bare wood exposed

  • Trash not disposed of as needed indoors

  • Exterior pest harbourage present around building

  • Exterior pest harbourage present around dumpster area

  • Walls dirty in FOH

  • Walls dirty in BOH

  • Walls dirty in restrooms

  • Wall tiles cracked/missing in FOH

  • Wall tiles cracked/ missing in restrooms

  • Bare wood/drywall exposed in FOH

  • Bare wood/drywall exposed in BOH

  • Minor damage to walls/ ceiling in FOH

  • Minor damage to walls/ceiling in BOH

  • Minor damage to walls/ceiling in restrooms

  • Ceiling/ Vents dirty in FOH

  • Ceiling/ Vents dirty in BOH

  • Ceiling/ Vents dirty in Restrooms

  • Ceiling damaged in FOH

  • Ceiling damaged in BOH

  • Ceiling damaged in restrooms

  • Grout lines dissolved/ low

  • Cove moulding damaged/missing

  • Floor tiles missing or loose

  • FOH area floors/baseboards/ drains not maintained clean

  • BOH area floors/ baseboards/drains not maintained clean

  • Restroom area floors/baseboards/drains not maintained clean

  • No pest reports available

  • Mop sink area dirty

  • Mop stored in stagnant water

  • Mop not stored to facilitate proper drying

  • Prep sink leaking in FOH

  • Prep sink leaking in BOH

  • Hand sink leaking in FOH

  • Hand sink leaking in BOH

  • Hand sink leaking in Restrooms

  • Dish machine/ three comp sink leaking

  • Rest room sink/ urinal leaking

  • Other sink/ equipment leaking

  • Loose/ damaged plumbing fixture

Contamination 🧪

Critical

  • Biohazard event is present that cannot be contained within 25ft

  • Sewage observed backing up into facility

  • Store is without drinking water

  • Fire/Flood/Other Natural Disaster taking place

  • Baristas have access to a functioning restroom facility

  • Water temperature at warewashing sink is below 38 degrees Celsius

  • Food or ice is contaminated with chemicals

  • Food or ice is contaminated physically

  • Manual warewashing, procedure not followed in correct order

  • Unapproved food item present intended for customer consumption

  • TCS food found expired per manufacturers use-by-date

  • TCS food removed from original packaging is missing baristas written date code

Major

  • Equipment drain lines are not properly protected by backflow

  • Food items not stored covered/protected

  • Food items stored in the restroom

  • Food items stored on the floor

  • Food contact items stored with visible dirt or food accumulation

  • Food contact items stored chipped/cracked/rusted or otherwise damage

  • Food contact items stored in the restrooms

  • Food contact items stored on the floor

  • Food contact items stored under drain lines/ dripping condensate

  • Food contact items stored on a dirty surface

  • In-use utensils not maintained clean

  • In-use utensils chipped/cracked/rusted or otherwise damaged

  • Cutting board has visible build up in grooves

  • Cutting board chipped/cracked or otherwise damaged

  • In-use ice scoops not maintained clean

  • In use ice scoops chipped/cracked or otherwise damaged

  • In-use ice scoops not stored in a clean designated container

  • In-use steaming pitches have encrusted build up

  • In-use food contact items not from an approved source

  • Other In-use food contact items not maintained clean

  • Other in-use food contact items chipped/cracked/rusted or otherwise damaged

  • Required timer is not present, running or used properly

  • In-use food contact items are not washed/rinsed and sanitized at least every 2 hours

  • Food containers/packages in poor condition or evidence of tampering

  • Damaged/recalled products are not stored seperately and/or not labelled “do not use”

  • Foods/beverages taken out the original container are not name labelled

  • Foods/ beverages repackaged onsite for retail missing required labelling

  • TCS food found expired per manufacturers use-by date

  • TCS food removed from original packaging is missing barista written date code

  • FOH Ice bin lid is left open

  • FOH ice machine lis is left open

  • BOH ice bucket is not labelled for ice only and/or used for other purpose

  • BOH ice machine drop plate has mold/slime build up

  • BOH ice machine bin has mold/slime build up

  • FOH Ice bin has mold/slime build up

  • Ice machine gasket damaged

  • Interior of ice machine chipped, cracked or otherwise damaged

  • FOH ice bin lid cracked/split or otherwise damaged

  • Chemical in unlabelled spray bottle/container

  • Chemical stored in a food container or single-use food container

  • Chemical label not readable

  • Sanitiser container not labelled

  • Chemicals not covered/sealed (excluding sanitizer buckets)

  • Chemicals stored next to or above food/food contact/single use items

  • Chemicals next to or above clean dishes

  • Chemicals stored on/above clean drain board/sanitize basin of the 3 comp sink

  • Chemicals stored on top of the dishwasher

  • Chemicals on or above food preparation counters/sinks

  • Dirty dish storage has potential to contaminate clean dishes

  • Warewashing sink used for storage of cold food preparation counters/sinks

  • Mechanical warewashing taking place with no detergent or liquid detergent less than 1cm

  • Detergent is not available/ used for manual warewashing, when required

  • Clean wiping cloths stored with chemicals or dirty items

  • In-use wiping cloths left on counter, in/on sink, or on shelving

  • Observed hair in contact with food

  • Observed dust in contact with food

  • Observed dust in contact with ice

MINOR

  • Food contact items found stacked/nested while wet

  • Soft sponge/eraser pad in dishwashing or food prep areas

  • Steel wool pads in dishwashing or food prep areas

  • Non-TCS food found without expiration date

  • Non-TCS food found expired per use by date

  • BOH fridge/freezer gasket dirty

  • BOH fridge/freezer shelves dirty

  • BOH fridge/freezer fan guards dirty

  • BOH fridge/freezer interior dirty

  • BOH fridge/freezer exterior dirty

  • FOH fridge/freezer gaskets dirty

  • FOH fridge/freezer shelves dirty

  • FOH fridge/freezer fan guards dirty

  • FOH fridge/freezer interior dirty

  • FOH fridge/freezer exterior dirty

  • Fridge/ freezer shelving not secure

  • Fridge/freezer shelving notably rusted

  • Ice build up observed inside freezer

  • FOH handsink dirty

  • BOH handsink dirty

  • Restroom handsink dirty

  • FOH prep sink dirty

  • BOH prep sink dirty

  • FOH dump sink dirty

  • BOH dump sink dirty

  • Dish sink dirty

  • Dish sink faucets/sprayer dirty

  • Shelving above dish sink dirty

  • Dish machine dirty

  • Countertops dirty

  • Cabinets dirty FOH

  • Cabinets dirty BOH

  • Oven dirty or damaged

  • Ventilation hood dirty or damaged

  • BOH Metro Shelving/Storage units dirty or damaged

  • Espresso machine dirty/ damaged

  • Brewed coffee machine/ clover dirty or damaged

  • Blender pitcher rinser dirty or damaged

  • Blender housing/shroud dirty or damaged

  • Ice machine exterior dirty or damaged

  • Interior of condiment stand dirty

  • Exterior of the condiment stand dirty

  • Encrusted build up in sugar/sweetener dispenser

  • Encrusted build up under napkin dispenser / trash ring

  • Lighting dirty in FOH

  • Lighting dirty in BOH

  • Lighting dirty in restroom

  • Lights out/missing in FOH

  • Lights out/missing in BOH

  • Lights out/missing in restroom

  • Lights out/missing in fridge or freezer unit

  • Lights not properly shielded/ shatter proof in FOH

  • Lights not properly shielded/ shatter-proof in BOH

  • Lights not properly shielded/ shatter- proof in Fridge/ Freezer

  • Handrails dirty or in poor repair

  • Toilet/s dirty

  • No toilet paper

  • Toilet paper not loaded into dispenser

  • Baby changing table/unit dirty

  • Doors dirty

Allergens ‼️

CRITICAL

  • Person-in-charge does not answer the following question accurately: “What are some of the main allergens within our food and beverages”

  • Person-in-charge does not answer the following question accurately: ‘Why are allergens so important to starbucks

  • Person-in-charge does not answer the following question accurately: “Where are the different places to find allergen information for our products”

  • Person-in-charge does not answer the following question accurately: “Why do we not guarantee that all our food and beverages are Allergen Free?”

  • Person-in-charge does not answer the following question accurately: “What equipment is shared that can cause a risk of cross-contamination

  • Allergen tablet unavailable

  • Info not provided, partner unable to direct to allergen information

  • Allergen in formation provided verbally

  • Incorrect allergen info provided

  • Paper based information in use

  • Partner directed to the QR code

MAJOR

  • Allergen sign not present in pastry case

  • Allergen sign not present in the drive thru window

  • Allergen POS sticker not present

MINOR

  • Daily allergen check not completed

  • Daily allergen check completed in advance

  • When required corrective action not noted

Food Safety Self-Assessment
Anonymous

Food Safety Self-Assessment

Must be completed quarterly. Process The assessor will show up on the day unannounced, but is under no obligation to disrupt the workday, other than to collect the required items and that the assessment can be reviewed at the end of the session. The food safety assessment will take approximately 1 hour dependant on the store size. Once the assessment is complete the person in charge (PIC) will be asked for a signature and to approve report. This report will get e-mailed to the store within 24 hours of completion. An action plan must be created from the assessment, where corrective actions must be completed. The District Manager/ Operations Manager will then complete a re-assessment and sign off the action plan within 5 weeks.

Use this Template
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.

Related checklists

CCOHS CA COVID-19 Tips for Restaurants and Food Services
Anonymous
CCOHS CA COVID-19 Tips for Restaurant...
4 Downloads
CCOHS CA COVID-19 Tips for Food Processing
Anonymous
CCOHS CA COVID-19 Tips for Food Proce...
5 Downloads
NEW Self-Assessment Produce Express Ltd. Certification #DC218220
Anonymous
NEW Self-Assessment Produce Expr...
1 Downloads
SQF Audit Checklist - Primary Production
SafetyCulture Staff
SQF Audit Checklist - Primary Production
160 Downloads
Host Safety Self-Assessment [GF 101-6] (1)
Katherine Parr
Host Safety Self-Assessment [GF 101-6...
9 Downloads
Building Health, Safety & Environmental Compliance Review
Graeme Wear
Building Health, Safety & Environment...
54 Downloads
(SP) Building Health, Safety & Environmental Compliance Review (Swimming Pool)
Graeme Wear
(SP) Building Health, Safety & Enviro...
7 Downloads
Pre-Occupancy Workplace Safety Inspection V.2
Anonymous
Pre-Occupancy Workplace Safety Inspec...
1 Downloads
back arrow for carousel
back arrow for carousel
iAuditor Logo Icon ©SafetyCulture 2022