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Site conducted
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Conducted on
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Prepared by
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Location
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5 points critical questions: 3 points major questions: 1 point minor questions.
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At least one person with manager food safety level certification on site.
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All employees more then 30days have completed food safety training.
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Delivery temps are documented.
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Eternal food, temperature, checklist are completed stored on file for 30 days and corrective action is included.
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Equipment temperature logs are available and completed with corrective actions for cooking, hot and cold, holding heating and cooling.
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Last 30 days of sanitizer logs are available.
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Thermometer calibration logs are available.
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Health department or equivalent, regulatory inspection available, where applicable. Critical findings for most recent inspection have been corrected
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Food operating permit available.
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Full allergen information available for employees and or customer reference as required by local requirements.
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The PIC has acknowledge of the major food, allergens and symptoms of an allergic reaction specific to the region of operation.
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Question to staff: training - ask a member of the team to explain or demonstrate how to complete a food temperature check.
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Question to management: is PIC aware of recall and food complaint procedures.
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Question to management: can PIC demonstrate acknowledge of the location and content of the up to date food safety management documents? This includes the fool, safety manual, and SDS.
Pg. 2
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No sick or symptomatic food handlers at work: PIC has properly restricted food handlers when required.
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A documented illness, report and procedure is available or PIC has acknowledge of reporting and documentation of exclusions/restrictions responsibilities.
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I’ll required equipment and PPE for bodily fluids cleanup available.
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No smoking, vaping, gum, tobacco, snuff, food, or drinking, tobacco and food prep or food service areas.
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Gloves and Band-Aids available on site for employees use.
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Proper hair, restraints, warning, food prep, or food service areas for team members with hair longer than shoulder length.
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All staff is wearing clean uniforms and or aprons.
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No jewelry, worn or arms or hands except plain ring (I.e. wedding band) no earrings.
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Proper handwashing procedures followed.
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Food handlers do not contact ready to eat foods with bare hands.
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Single used gloves used properly.
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Handwashing sink, assessable and usable.
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Hand wash sink used for handwashing only.
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Hand washing sinks or clean.
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Hand washing sinks or properly stock with soap as single used towels or heated air or high velocity hand drain device.
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Hand washing signage and all hand sinks.
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Food supplied from approved sources.
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Food received at proper temperatures with specifications.
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Food packages received in good condition.
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Returns clearly labeled and identified.
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Shop -country of origin display on all fruit and vegetables.
Pg 3
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Proper use of hierarchy in food storage.
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Food and food contact items stored in appropriate locations.
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Cross contamination prevented during food, storage and preparation.
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Equipment, utensils, and food, contact surfaces, clean and sanitize at proper times.
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And use food, utensils, and single use items are used and stored properly.
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Utensils, equipment, and food contact surfaces are in good repair and utensils, equipment, and food contact services type single use articles or not reuse.
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Proper sanitizing procedure for utensils and wears being demonstrated.
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Cleaning agent and sanitizers are present and readily available for use.
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1, 2 or three compartment, sinks present, and use properly: stopper available and working correctly.
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Temperature of hot water sanitizing at the wear washing machine is documented appropriate at times.
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Sanitizer test kits strips available and not expired.
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Equipment utensils or drive before stacking.
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Wiping cloths and sanitizer cloths are used and stored properly.
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All non- food contact services or clean, cleanable, and in good repair
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All lighting sauces are properly shielded, or shattered proof in areas where food, service utensils, and equipment are stored or prepared.
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Containers previously used for chemicals, not used for food or food utensil storage.
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First aid supplies and employee medication‘s properly labeled and stored to prevent contamination.
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Cooking and heating of ready to eat high risk TCS product for hot holding reaches a minimum required cooking temperature per regulatory requirement.
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High risk TCS food prep and room temperature is done correctly.
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Hot holding equipment properly functioning.
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High risk TCS foods held in cold, holding or held below maximum required, holding temperature per regulatory requirement.
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Frozen foods held solidly frozen.
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Cold holding equipment, proper functioning.
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Food, products, or time and date label win time in LIEU temperature is used as a control.
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No food products using time in lieu Temperature or expired.
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Written procedures are available for food products when time alone is used as he control.
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Prepped thawing, ready to eat TCS foods properly date labeled.
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Commercial prepped Harris TCS food properly dated when original packaging is opened.
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No expired ready to eat high risk TCS product present.
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Any food products not visibly identifiable or labeled with a common name where required.
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Accurate food thermometer present.
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Food products properly thawed/slacked.
Pg 4
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All coolers have functioning thermometers within reasonable range per regulatory requirements.
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All food products or stored first and first out or based on manufactures dating.
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Only institutional /food grade /company approved cleaning chemicals use.
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Cleaning chemicals properly labeled.
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Cleaning chemicals properly stored.
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No critical pest activity observed.
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Insect control devices install to prevent contamination.
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Pest control-external structures satisfactory, including no pest proofing issues and external bait stations in place. Exterior of the building in clean condition with limited and organized storage.
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Pesticides applied only by approved personnel.
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Rodent bait is contained in a covered, tamper-resistant bait station.
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Floors,walls,and ceilings in store, retail food prep line in store, rooms, area, or cleanable, clean and in good repair.
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Vince, an exhaust hose or clean and in good repair.
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All refrigeration gaskets are clean and in good repair.
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Lighting is adequate.
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Light fixtures are clean.
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Trash receptacles, back of house or of significant availability, capacity, and not overflowing.
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Trash containers are maintain cleaned.
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Dumpster/recycling/compost area is regularly cleaned, and free of excess debris: dumpster plug is in place.
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Dumpsters, outdoor garbage and recycling/compost containers and lids are kept close and containers are in good repair.
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No sewage BACKED into facility.
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Hot and cold water are available at facility.
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Hot water should be at least 110.
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Metered and automatic faucets provide water for minimum of 15 seconds.
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backflow prevention or air gap present at all sinks, and beverage dispensers.
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Minimum of one functioning toilet available in the facility.
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Toilet tissue available at each toilet.
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All plumbing in good repair.
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Employee, clothing and personal items are properly stored.
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Cleaning tools ( mops, brooms, And similar items) or properly stored/in good condition and proper type.
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All restrooms are clean, free of odors and well maintained.
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Storeroom, clean, organized, and well maintain.(help tech should include: including glass.
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Staff areas(if present) clean and well maintained.
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Cleaning room and mop area, clean and well-maintained.
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Fountain/frozen beverage products properly name labeled.
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Fountain food, contact equipment, nozzles, and ice dispensing system, clean and maintained.
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All nonfood contact coffee equipment. ( hot and iced cleaned and maintained.
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Coffee and cappuccino countertops, maintain clean.
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Cappuccino equipment, maintain clean.
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All hot beverage items or properly name labeled.
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Dairy base creamers properly dated.
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Dera base creamers not expired.
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All hot beverages cups/lids/straws holders and condiment maintain clean.
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Roller grill/plate grill products held at proper temperature per regulatory Requirements.
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Roller grill/plate grill food contact surfaces clean, and in good repair.
Pg 5
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Roller Grill/plate grill non-food contact equipment and cabinets clean and in good repair.
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Roller grill/plate grill products properly name labeled.
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Roller grill tong hold the present and maintain clean.
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Bakery case items have name labels.
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calorie information is displayed for all applicable food service items.
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Bakery items, tissue paper, or tongues available for customers.
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Bakery case interior/exterior maintain clean and in good repair.
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Chili and cheese dated.
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Chili and cheese expired.
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Chili and cheese equipment maintain clean.
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Ching cheese equipment, maintain in good repair.
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Condiment containers, equipped with lids or sneeze guards.
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Condiment station containers dated and not expired but items being held longer than 24 hours.
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Condiment station containers are clean and free of encrusted buildup.
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Grab and go cooler temperatures, maintain proper temperature of food products.
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Does the store have open facilities tickets relating to food safety.?
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List your observations relating to stage structure in the text box.<br>
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Was any other food safety risk observed that is included in the assessment?
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Did the PSC walk the store with the auditor?
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Are There evidence of falsified documents?
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Fountain equipment, counters, or maintain and in good repair.
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Coffee, equipment, counters, or maintain and in good repairs. Are you
Untitled Page
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Outside of machine clean and dust free.
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Drip tray clean and santitized, no evidence of dried product.
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Underside of bases, canisters,and dispenser area free of mold or dried product.
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Door seal mold free, properly seated in place, holding temperature of below 41 degrees.
Soda Fountain
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Nozzles clean and ice chute clean.
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No presence of mold.
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Drip basin free of build up.
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Supplies stocked, no sign of mold in supply basins.
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Ice drain clear of build-up,chest cover in place, mold-free.
Forster/F’real/Soft Serve
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Machine are regularly cleaned.
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Inside of machine regularly sanitized, mold free.
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All product/SKUs available.
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Serving cups and utensils readily available.
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Machine in good working order, exterior clean and dust-free.
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Machine filters clean.
Cabinets and Countertops
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All counters and machine backs clean & dust-free.
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No debris under/behind/beside machine.
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Cabinets insides clear of dust,food sediment, and spills.
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Cabinets clean on outside.
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No broken door hinges.
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No cabinets sticking out.
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Under cabinet floors clean with no food or drink spills.
Bakery/Packaged Bakery
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All items in stock; rotated.
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No expired product in bakery case.
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Bakery case set to planogram.
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Tissue/wax paper, tongs (if applicable) available, neat, and organized.
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Baker case trays and glass or clean.
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No dust or excessive crumbs.
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Bakery at front counter is set to planogram.
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No expired product.
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All product available at front counter.
Additional storage
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Sales floor and baseboards clean.
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No slip/trip/fall hazards.
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warehouse totes not being used for storage and being return to distributor.
Promotion/ m erchandising
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Outside window displays present and in proper place.
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In store promotions and signage in proper area. <br>Clean and properly displayed.
Store Health Requirements
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Stem/Probe thermometer available, working, and used to temp products.
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Staff demonstrates knowledge on how to calibrate thermometer.
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Current State Food Handlers Certificate displayed. <br>
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All other certificates displayed/on hand as required by state law.
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All food logs available and up to date. Includes: Both product temperature logs (oven and sandwich warmer),sanitizer log, and equipment log.
Overall Store Cleanliness
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Inside ceiling tiles clean( no water spots).
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Vents clean with no dust build up.
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lights in working order.
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Restrooms clean and ready for customer use. <br>
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Well stocked with soap, hand towels/dryer.
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Pumps are clean.
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Washer fluid at least 1/2 full with squeegees available at all pumps.
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Sidewalks and drive area free of litter, cigarettes butts, gum spots and trash lines
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How many pumps are down?
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