Title Page
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Conducted on
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Prepared by
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Address
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Store Number:
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Manager on Duty:
Fountain
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All items including allergens labeled, separated with no cross contamination.
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Scoops and spades clean and in good condition.
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All food items not in use covered; anything out of original container stored in microlites are labeled<br>
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Proper use of day dots<br>
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PHF foods in refridgeration stored at £ 41° <br>
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Items stored in fountain rail £ 45° <br>
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Ice cream temperature £ 12°, and FriendZ mix temperature £ 15°<br>
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Thermometers present, working, and easily visible in all cold holding units; not cross contaminating food, and removed from original packaging<br>
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Food contact surfaces of fountain equiptment properly cleaned<br>
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Non food contact surfaces in fountain properly cleaned and in good repair<br>
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Dipper well running with plug in place when ice cream scoops are present in well<br>
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Gasket & lids clean and in good repair<br>
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Flatware/ paper goods stores properly<br>
Kitchen, Food Prep and Storage
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Potentially hazardous foods, including shell eggs, in refrigerated drawers or line refrigerators ≤41°F<br>
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Breakfast items ≤41°F or time stamped and held for less than 4 hours<br>
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Potentially hazardous foods in walk in refrigerator ≤41°F<br>
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Potentially hazardous foods in walk in freezer ≤ 0°F and in stand up freezer ≤ 10°F<br>
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Dressings and condiments in Squeeze bottles ≤45°F<br>
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Thermometers present, working, and easily visible in all cold holding units; not cross contaminating food, and removed from original packaging<br>
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All gaskets in kitchen, including in the walk in cooler & freezer, are clean and not torn<br>
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Microwave surfaces throughout restaurant clean and maintained<br>
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No cross contamination of crocks in salad unit; crocks not filled less than 1" from top; and, interior of salad unit clean and maintained<br>
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Walk in cooler clean<br>
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Walk in cooler in good repair<br>
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Walk in freezer clean and floors free of excessive ice build-up<br>
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Walk in freezer in good repair<br>
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Steam table products ≥140°F (160° - 175° FIC standard)<br>
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Soup & Chowder ≥140°F (160° - 180° FIC standard)<br>
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Minimum cooking temperatures met<br>
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Proper thawing of foods<br>
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All food items covered<br>
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Raw food including shell eggs stored properly<br>
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Allergens in kitchen properly stored<br>
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Proper use of day dot system<br>
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Potentially hazardous food products not expired<br>
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Utensils clean and stored properly<br>
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Cutting boards clean and in good condition<br>
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Knives clean, in good condition and stored properly<br>
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Food prep & storage containers clean, not cracked, NSF approved and stored properly<br>
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Slicer and dicer and lettuce spinner clean<br>
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Grill hoods professionally cleaned and Ansul within last 6 months. K Type & ABC Fire extinguishers present, mounted, dated and not expired. Extinguishers charged<br>
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Grill screens present, clean, and in good condition, no gaps or missing screens<br>
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All equipment commercial grade<br>
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Dry storage area clean<br>
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Dry storage area in good repair<br>
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Food, including allergens, protected during storage and free from contamination<br>
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No reuse of single service items<br>
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China/Glassware clean and stored properly<br>
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Squeeze bottles clean<br>
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Grill surface, exterior of grill, grill stand, grill board, wheels/legs are clean - no build up<br>
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BONUS QUESTION: Deep fat fryers are clean inside and out, including inside cabinet under unit<br>
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All other kitchen equipment clean – stand up freezer, grill drawer, heat lamps, toasters, soup wells, French fry holding cabinet, shelving, holding units, Panini press, broiler, Ovention ovens<br>
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Dish washer reaching proper temperature/PPM<br>
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Dish washer is not leaking, gauge is accurate and rinse pressure is appropriate<br>
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Dish washer is clean<br>
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3 Bay Sink labeled and MOD knows procedure for use<br>
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Broken glass bucket present<br>
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Ice scoop/ice bucket stored properly and in good condition<br>
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Ice machine interior clean<br>
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Ice machine exterior clean<br>
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Mops, brooms & buckets clean and stored properly<br>
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Cleaning supplies properly stored<br>
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Ecolab chemicals properly titrated<br>
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Cleaning supplies properly labeled and MSDS/SDS present<br>
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2 Emetic kits present, stocked and properly stored<br>
Service Aisle
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Potentially hazardous food in service aisle salad unit or upright refrigerator ≤41˚F<br>
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Potentially hazardous food in condiment/expo rail ≤45°F<br>
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Dressings stored ≤45°F in clean containers, no cross contamination<br>
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All food items not in use covered<br>
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Salad unit or upright refrigerator clean<br>
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Salad unit or upright refrigerator gaskets are clean and not torn<br>
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Allergens labeled, covered, separated and stored properly<br>
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Utensils clean and correctly stored<br>
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Thermometers present, working, and easily visible in all cold holding units; not cross contaminating food, and removed from original packaging<br>
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Food contact surfaces (shelving and serving trays) clean and maintained<br>
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Soda machine clean and maintained and ice scoop present properly stored<br>
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Coffee & tea machine surfaces clean & maintained<br>
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Silverware/ paper goods stored properly<br>
General Facilities- Floors/walls/ceilings and Backflow Prevention
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Walls, ceilings, light fixtures and vents clean<br>
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Lighting provided as required and shielded/shatter proof. Light shields present are in good repair and no light bulbs burnt out in food prep and storage areas.<br>
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Floors and baseboards clean, drain covers present; choose the appropriate answer depending on the number of areas observed with unclean floors<br>
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Floor drains clean<br>
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Floors and baseboards in good condition<br>
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No cross-connection, back siphon age, backflow<br>
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All trash cans are clean; select the correct answer based on the number of occurrences observed<br>
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Walls, ceilings and vents in good condition<br>
Dining Room
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Greeter stand/area clean and organized<br>
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Menus and menu inserts clean and not torn<br>
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Retail Cabinet clean, stocked properly<br>
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Ceilings, vents, walls, woodwork clean and in good condition<br>
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Windows and window treatments clean and maintained<br>
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Floors/ Carpet/ Baseboards clean and in good condition<br>
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Booths and tables cushions, edges, bases, legs, chairs clean & in good condition<br>
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High chairs/boosters clean and in good condition<br>
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Items on tables clean<br>
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Dining room cleaning tools clean, maintained and stored properly<br>
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Dining room lights clean and functioning<br>
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Comfortable ambiance<br>
Rest Rooms
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Ceilings and fixtures clean and in good condition<br>
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Restrooms are odor free<br>
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Restroom supplies stocked<br>
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Toilet rooms enclosed, self-closing/locking doors<br>
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Floors and baseboards clean, drain covers present<br>
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Floor drains clean<br>
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Floors and baseboards in good condition<br>
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Walls clean, in good condition<br>
Overall Food Safety Behaviors and Documentation
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Hand washing sinks stocked, in good repair with nothing blocking access<br>
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Proper glove use and hand washing observed<br>
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Thermometer present and calibrated, back up thermometer present<br>
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Employee food properly stored, no eating or drinking in food prep areas<br>
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Anti-choking procedures posted<br>
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Management Personnel (anyone who runs a shift) has food safety certificate present<br>
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Food handler food safety knowledge questions<br>
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Exclusion / restriction policies posted or manager knowledgeable of exclusion/restriction policies<br>
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HACCP forms and daily walk thrus complete<br>
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All criticals on most recent health department inspection are corrected<br>
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Produce washed prior to prep and no other cross contamination present<br>
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Appropriate test strips present<br>
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Sanitizer solution stored in red bucket, at proper concentration, in proper location and wiping cloths stored in buckets<br>
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The 30 Minute Shake is occurring<br>
Employee Appearance
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Employees wearing proper hair restraints<br>
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Personal belongings stored separately, away from food, food prep areas and paper products<br>
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Employees have finger nails clean and neatly trimmed, no fake nails or colored nail polish; and, are following the jewelry policy<br>
Adherence to Employment Break Regulations
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Employee break policies are being followed<br>
Insect, Rodent, Animal Control
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Pest activity not present<br>
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Pest prevention properly in place<br>
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Fly lights properly installed<br>
Exterior
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Dumpster area clean, in good condition with no signs of rodent activity<br>
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Grease dumpster clean with no spillage and lid closed<br>
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Parking lot and sidewalks clean<br>
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Parking lot and sidewalks in good condition<br>
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Shrub beds clean<br>
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Trash cans/ashtrays empty and clean<br>
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Vestibule/Carryout clean, free of clutter and no odor<br>
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Back door exterior, surrounding area and pad clean<br>
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Exterior lighting working and clean; exterior signage present and clean<br>
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Carryout area in good condition and lights working<br>
Employee Safety
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Slip Resistant Shoes
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Company Locations Only: Slip resistant overshoes available and procedure in place for issuing to employees<br>
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Cut proof gloves for food prep<br>
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PPE present and readily available<br>
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Bandages available<br>
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Wet Floor signs on hand<br>
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Back door area clean, security policy sticker posted, door alarmed, and if rear door is unlocked/open MOD is present<br>
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Company Locations Only: 22 Gallon trash can in use<br>
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Auditor Signature
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MOD Signature