Food Service Establishment Inspection Report

• Document No.

• Site Location

• Address
  Address

• Conducted on

  Date

• Prepared by

(1) FOOD

• 1.01 Source. Wholesome. No spoilage

  Yes

  No

  N/A

• 1.02 Original Container, Properly Labeled

  Yes

  No

  N/A

(2) FOOD PROTECTION

• Potentially hazardous food meets tempt urge requirements during storage, preparation, display, service and transportation

  Yes

  No

  N/A

• Facilities to maintain product temperature

  Yes

  No

  N/A

• Thermometers provided and conspicuous

  Yes

  No

  N/A

• Potentially hazardous food properly thawed

  Yes

  No

  N/A

• Unwrapped and potentially hazardous food not reserved, cross contamination

  Yes

  No

  N/A

• Food protection during storage, preparation, display, service and transportation

  Yes

  No

  N/A

• Handling of food (ice) minimized, methods

  Yes

  No

  N/A

• Food (ice) dispensing utensils properly stored

  Yes

  No

  N/A

PERSONNELL

• Personnel with infections restricted

  Yes

  No

  N/A

• Hands washed and clean, good hygienic practices

  Yes

  No

  N/A

FOOD EQUIPMENT AND UTENSILS

• Food (ice) contact surfaces: designed, constructed, maintained, installed, located

  Yes

  No

  N/A

• Non-Food contact surfaces: designed, constructed, maintained, installed, located

  Yes

  No

  N/A

• Dishwashing facilities designed, constructed, maintained, installed, located, operated

  Yes

  No

  N/A

• Accurate thermometers, chemical test kits provided, gauge cock

  Yes

  No

  N/A

• Pre-flushed, scraped, soaked

  Yes

  No

  N/A

• Wash, rinse water; clean, proper temperature

  Yes

  No

  N/A

• Sanitation rinse: clean, temperature, concentration

  Yes

  No

  N/A

• Wiping cloths: clean, use restricted

  Yes

  No

  N/A

• Food contact surfaces of equipment and utensils clean, free of abrasives and detergents

  Yes

  No

  N/A

• Non-Food contact surfaces of equipment and utensils clean

  Yes

  No

  N/A

• Storage, handling of clean equipment and utensils

  Yes

  No

  N/A

• Single-service article storage and dispensing

  Yes

  No

  N/A

• No re-use of single-service articles

  Yes

  No

  N/A

WATER

• Water source, safe; hot and cold under pressure

  Yes

  No

  N/A

SEWAGE

• Sewage and waste water disposal

  Yes

  No

  N/A

PLUMBING

• Installed, maintained

  Yes

  No

  N/A

• Cross-connection, back siphonage, back flow

  Yes

  No

  N/A

TOILET AND HAND-WASHING FACILITIES

• Number, convenient, accessible, designed, installed

  Yes

  No

  N/A

• Metered faucets run for 15 seconds

  Yes

  No

  N/A

• Toilet rooms enclosed, self-closing doors, fixtures, good repair, clean: Hand cleaner, sanitary towels hand drying device provided, proper waste receptacles, tissue

  Yes

  No

  N/A

GARBAGE AND REFUSE DISPOSAL

• Containers or receptacles covered: adequate number, insect/rodent proof, frequency, clean

  Yes

  No

  N/A

• Outside storage area, enclosures properly constructed, clean: controlled incineration

  Yes

  No

  N/A

INSECT, RODENT, ANIMAL CONTROL

• Presence of insects/rodents - no bird, turtles, other animals

  Yes

  No

  N/A

• Outer openings protected

  Yes

  No

  N/A

FLOORS, WALLS AND CEILINGS

• Floors: constructed, drained, clean, good repair, coving installation, dustless cleaning methods

  Yes

  No

  N/A

• Walls, ceiling, attached equipment: constructed, good repair, clean surfaces, dustless cleaning methods

  Yes

  No

  N/A

LIGHTING

• Lighting provided as required - Fixtures shielded

  Yes

  No

  N/A

VENTILATION

• Rooms and equipment vented as required

  Yes

  No

  N/A

DRESSING ROOMS

• Rooms clean, lockers provided, facilities clean

  Yes

  No

  N/A

OTHER OPERATIONS

• Toxic items properly stored, labeled and used

  Yes

  No

  N/A

• Premises: maintained, free of litter, unnecessary articles, cleaning/maintenance equipment properly stored, authorized personnel

  Yes

  No

  N/A

• Complete separations from living/sleeping quarters, laundry

  Yes

  No

  N/A

• Clean, soiled linen properly stored

  Yes

  No

  N/A

TEMPERATURES

• Hot Foods

• Name & Temp:

• Hot Foods

• Name & Temp:

• Hot Foods

• Name & Temp:

• Cold Equip/Food

• Walk-in Cooler

• Walk-in Freezer

• Set Refrigerated Counter

• Sundae Bar (top & bottom)

• Kitchen Reach-in Freezer

• Kitchen Condiment Counter (top & bottom)

• Management personnel certified

  Yes

  No

  N/A

• Full Name:

• Received By:

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