Food Service Self Inspection Form

Information

A yes response to all items will help ensure a positive inspection. **DENOTES CRITICAL ITEMS

Personal Hygiene

**Are employees eating, drinking, and smoking away from food preparation and dishwashing areas?
**Are food handlers washing hands routinely and at correct times?
Are employees changing gloves regularly and as needed?
**Are employees with illnesses, cuts, and infections, restricted from handling food and cleaning dishes and utensils?
**Employees are NOT wearing jewelry on their hands, wrist, or forearms. (Involved in food preparation)?

**Is potentially hazardous food held below 41 F? Or above 130 F?
Are all fruits and vegetables rinsed under running water in a colander, prior to service or prep?
**Is potentially hazardous food cooled uncovered from 135 F to 70 F within 2 hours and from 70 F to 41 F within 4 hours, under refrigeration in shallow trays, or in a ice bath?
**Is potentially hazardous food rapidly reheated to 165 F, before being placed into hot holding units?
**Is a metal-stemmed food probe thermometer with a range of 0 F to 220 F, provided and used to monitor food temperatures?
Is a thin-tip thermometer available to temp thin meats?
**Is raw meat that is waiting processing, prevented from being held at room temperature for long periods of time?
**Are cutting boards that are used to prepare raw meats, cleaned and sanitized before being used to prepare ready-to-eat foods?
Is potentially hazardous food properly thawed: under running water, under refrigeration, or as part of the cooking process
Are food preparation sinks cleaned and sanitized, before use?
Are kitchen wiping clothes stored in a sanitizing solution between uses?
Are utensil handles stored out of the food product?
**Are minimum internal temperatures being met and checked frequently?

**Are all refrigeration units at 41 F or below?
Is raw meat stored below other food?
Are thermometers conspicuously placed in the warmest part of the cooling units? (I.e. near the door)
Is food covered after the cooling process?
Are freezers at 0 F or below?
Is food stored out from under unprotected condensation/sewer lines?

**There is no evidence of pest or rodents?
**Is food stored separate from personal items, cleaning and maintenance supplies?
Is all food and single-service items stored at least 6 inches off the floor?
**Are dented cans separated for return or disposed of?
Are food storage shelves clean and in good repair?

**Are utensils washed in hot soapy water, rinsed in clear hot water, and sanitized for one minute with a 50-200 ppm chlorine, or a 150-400 ppm quaternary ammonium solution?
Do hot water sanitizing machines have a final rinse of 180 F?
** Do chemical sanitizing machines provide 50-200 ppm chlorine?
Is tableware pre-soaked before washing?
Are all utensils air dried and stored properly?
Are test kits provided and used daily or more frequently, for monitoring the concentration of sanitizers?
Is the wash, rinse, and sanitizer water kept clean?

**Are all hand sinks easily accessible for washing hands?
**Are all hand sinks equipped with soap and single-use towel dispensers?
**Do all hand sinks have hot and cold running water available for washing hands?
Are all the plumbing fixtures in the facility working properly, without leaking?
**Are toxic chemicals labeled correctly and stored from food, equipment, and utensils?
Are dining area wiping clothes stored in a sanitizing solution between uses?
Are clean linens stored on clean, dry surfaces?
Are all lights in kitchen areas shielded or have shatter-proof bulbs?
**Are all food prep and dishwashing sinks indirectly drained, to provide an air gap to prevent back flow?
Are all freezers and refrigeration units commercial grade?
**Is bare hand contact prevented through the use of gloves, utensils, deli tissues, etc.?