FOOD SAFETY VERIFICATION 2019

• Conducted on

  Date

• Prepared by

• Location
  Address

• FS1-US Is the restaurant infested or does it have signs of active pest infestation? Is the restaurant building adjoining corral, and any area within 10ft (3m) from the building (i.e. inside the drive thru lane) clear from animal or insect infestation?

  inside the restaurant has visible infestation

  inside the restaurant shows signs of infestation

  outside the restaurant has visible infestation

  outside the restauration shows signs of infestation

  Other

• FS2- US Are the internal temperatures of beef patties after cooking at or above 155°F and fresh beef patties at or above 175° F

  Frozen 10:1

  Frozen 4:1

  Fresh 4:1

  Other

• FS3 -US Are the internal temperatures of raw chicken products after cooking at or above 165°?

  Chicken Tenders

  Mcnuggets

  Crispy Chicken

  Grilled Chicken

  McChicken

• FS4 -US Are the internal temperatures of breakfast steak and breakfast sausage after cooking at or above 155°F for sausage made from beef or pork and 165°F for sausage made from poultry?

  Breakfast steak

  Breakfast sausage

  other

• FS5 -US Do cooked round eggs have gelled yolks (are not runny)? are internal temperatures at or above 155°F

  Yes

  No

  N/A

• FS6 -US Can Managers ( or staff assigned to complete the checklist) demonstrate they have been trained on properly completing the procedures on the Food Safety Daily Checklist and can take corrective action? Assess through observation, questioning, and demonstration of knowledge (key is completed training, knowing and demonstrating food safety checks and corrective actions are done appropriately)

  manager does not know how to correctly meet Non- Critical questions's requirements

  Manager does not know how to correctly meet Critical question's requirements

  Other (List areas of manager lack of knowledge

Hygiene & Sanitation

• FS7 -US Is there warm running water and required supplies at all handwashing sinks? Are hand wash sinks easily accessed by employees and only used for handwashing, not preparing food, or storing equipment?

  Select Hand washing sink knobs/automatic tap not working Soap dispnser 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 washinf sink used for other purposes Other

  • Hand washing sink knobs/automatic tap not working
  • Soap dispnser 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 washinf sink used for other purposes
  • Other

• FS8 -US Are hands properly washed following hand washing procedures at the appropriate times and is a system in place to ensure hourly hand washing by al employees?

  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 a break Hands not washed after handling raw products and working on other station,e.g., prep table Hands not washed after tasks (i.e. handling waste, touching face, hair, picking items off 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 a break
  • Hands not washed after handling raw products and working on other station,e.g., prep table
  • Hands not washed after tasks (i.e. handling waste, touching face, hair, picking items off floor,etc.)
  • Other

• FS9 -US Do sanitized towel buckets contain towels and sanitizer solution at the correct concentration checked with a chlorine test strip?

  Select Fresh buckets with sanitized towels not prepared Buckets not labeled No towels in fresh bucket Used towels mixed with fresh towels Bucket is soiled Sanitizer level is not at correct concentration Test strips not available/damaged/expired/not in usable condition Other

  • Fresh buckets with sanitized towels not prepared
  • Buckets not labeled
  • No towels in fresh bucket
  • Used towels mixed with fresh towels
  • Bucket is soiled
  • Sanitizer level is not at correct concentration
  • Test strips not available/damaged/expired/not in usable condition
  • Other