FSRA Store Self-Assessment Checklist

• Conducted on

  Date

• Prepared by

• Location
  Address

Retail Area: Walk-In Cooler

• A105 Temperature - Equipment & Process TCS foods are maintained at 41°F or below

  Compliant

  Non-Compliant

  N/A

• - Walk-In Cooler has an easily viewable, working thermometer

  Yes

  No

  N/A

C313 Food Handling

• Foods and food-contact packaging are stored at least 6" off the floor

  Yes

  No

  N/A

C307 Food Handling

• Foods protected from contamination

  Yes

  No

  N/A

C325 Equipment & Utensils

• Non-food contact surfaces of equipment & utensils are properly cleaned

  Yes

  No

  N/A

C341 Facilities & Controls

• Lighting is adequate in the storage area; lights are shielded/shatterproof above packaged foods

  Yes

  No

  N/A

C339 Facilities & Controls

• Fan guards are clean

  Yes

  No

  N/A

C335 Facilities & Controls

• Floors, walls and ceilings are free from excessive dust, debris & standing water

  Yes

  No

  N/A

C337 Facilities & Controls

• Floors, walls & ceilings are smooth, easily cleanable, and in good repair

  Yes

  No

  N/A

Retail Area: Express Case

• A107 Temperature - Process Related TCS foods are properly handled at proper temperature & not temperature abused before being displayed

  Compliant

  Non-Compliant

  N/A

C351 Express Case

• Express case vents and load lines not obstructed, follows planogram to ensure air flow

  Yes

  No

  N/A

• A101 Temperature - Equipment Cold TCS foods are maintained at 41°F or below

  Yes

  No

  N/A

• Express case is equipped with accurate, easily-viewable thermometers

  Yes

  No

  N/A

• A119 Food Handling - Coding TCS foods not held/sold past expiration date

  Yes

  No

  N/A

• A121 Food Handling Foods and packaging in sound condition

  Yes

  No

  N/A

• C307 Food Handling Foods protected from contamination.

  Yes

  No

  N/A

C320 Cleaning & Sanitation - Equipment

• Cases cleaned and sanitized as required

  Yes

  No

  N/A

Retail Area: Hatco/Hot Dog Display

• A107 Temperature TCS foods are properly handled at proper temperature and not temperature abuses before being displayed.

  Compliant

  Non-Compliant

  N/A

Hatco

• Ensure: - Hatco products are not stacked 2 or more high. Hot dog unit door is closed.

  Yes

  No

  N/A

• A103 Temperature - Equipment TCS foods are maintained at 140°F or above

  Compliant

  Non-Compliant

  N/A

• Hatco/Hot Dog Displays are equipped with accurate, easily-viewable thermometers

  Yes

  No

  N/A

• A119 Food Handling-Coding Ensure all products are in Wawa/manufacturer code

  Compliant

  Non-Compliant

  N/A

B226 Food Handling - Product Labelling

• - Ensure products are in proper boxes

  Yes

  No

  N/A

• C325 Equipment and utensils Ensure following are clean: - Sides of equipment - Shelves & racks

  Yes

  No

  N/A

Retail Area: Coffee Island

• A117 Food Handling - Contamination Foods on display protected from contamination

  Compliant

  Non-Compliant

  N/A

• A107 Temperature Ensure products being loaded into case and not temperature abused

  Compliant

  Non-Compliant

  N/A

C351 Display Cooler - Process Related

• - Coolers do not have ice buildup, cooler is fully loaded with no gaps.

  Yes

  No

  N/A

• A101 Temperature Equipment foods are maintained at 41F or below.

  Compliant

  Non-Compliant

  N/A

• A119 Food Handling Coding TCS foods not sold past expiration date.

  Compliant

  Non-Compliant

  N/A

B226 Food Handling - Product Labeling

• - Ensure Wawa allergen label is present at each drop-in cooler

  Pass

  Fail

  N/A

• A133 Personal Hygiene Food service gloves worn when handling food/food contact surfaces

  Compliant

  Non-Compliant

  N/A

• A143 Facilities & Control Pest management is effective

  Yes

  No

  N/A

C347 Facilities & Control

• Interior garbage containers clean & emptied as needed

  Yes

  No

  N/A

• C320 Cleaning and sanitation equipment Ensure Case has no heavy buildup of dust, mold-like growth & debris

  Yes

  No

  N/A

Retail Area: Bakery Case

• A117 Food Handling - Contamination Foods on display protected from contamination

  Compliant

  Non-Compliant

  N/A

• B226 Food Handling Ensure: - Allergen sticker is present. - Tags for all products present & correctly positioned. - "Please Use Tissue" sign present

  Pass

  Fail

  N/A

• C339 Facilities and Controls Fan guards clean

  Yes

  No

  N/A

• C325 Equipment and Utensils Ensure following are clean: - Sides of equipment and door handles - Shelves & racks

  Yes

  No

  N/A

Retail Area: Self-Serve Drink Area

• A107 Temperature Ensure: - Each flavor being loaded into iced coffee immediately.

  Compliant

  Non-Compliant

  N/A

• C351 Door is not left open

  Yes

  No

  N/A

• A101 Temperature Equipment Cold TCS foods are maintained at 41F or below.

  Compliant

  Non-Compliant

  N/A

• C301 Each iced coffee unit is equipped with accurate, easily- viewable thermometers

  Yes

  No

  N/A

• A125 Food Handling - Contamination Food contact surfaces clean & sanitized

  Compliant

  Non-Compliant

  N/A

C311 Food Handling - Product. Labeling

• - Ensure cappuccino hoppers are identified w/ name of product

  Yes

  No

  N/A

B215 Equipment & Utensils

• - Ensure iced coffee shears stored in sanitary manner & only being used to cut food contact surfaces

  Pass

  Fail

  N/A

C323 Equipment & Utensils

• C323- Ensure plastic is not left on iced coffee nozzles

  Yes

  No

  N/A

• C325- Ensure self-serve drink area shelving & cabinets are clean

  Yes

  No

  N/A

• A143- live pests - Any rodents or cockroaches - 10+ house / fruit flies in area OR 30 throughout store - Pest debris (droppings/bedding/shells) - Signs of pest activity (chewed containers, dead pests)

  Compliant

  Non-Compliant

  N/A

C335 Facilities & Control

• C335 Ensure: - Floors, floor drains, walls and ceiling are free from excess dust and debris

  Yes

  No

  N/A

• C320- Ensure Icee machine free of heavy dust build-up, MLG & debris

  Yes

  No

  N/A

Retail Area: Retail & Lobby Area

C305 Temperature Control

• Frozen Foods are held solidly frozen

  Yes

  No

  N/A

• A117 Food Handling- Ensure samples not left unattended (if sampling is taking place)

  Compliant

  Non-Compliant

  N/A

• A121 Food Handling Ensure: - Oranges & bananas not moldy - No bloated packaging for bacon, hot dogs, yogurts

  Compliant

  Non-Compliant

  N/A

B232 Food Handling - Product Labeling

• Consumer advisory posted reminding customers to wash produce

  Pass

  Fail

  N/A

C316 Food Handling - Product Labeling

• Country of Origin Labeling (COOL) in place for hand fruits

  Yes

  No

  N/A

• A143- live pests - Any rodents or cockroaches - 10+ house / fruit flies in area OR 30 throughout store. - Pest debris (droppings/bedding/shells) - Signs of pest activity (chewed containers, dead pests)

  Compliant

  Non-Compliant

  N/A

C337 Facilities & Control

• Floors walls and ceilings are smooth,easily cleanable and in good repair.

  Yes

  No

  N/A

C339 Facilities & Control

• - Ensure all vents & air returns are free from excessive dust/debris

  Yes

  No

  N/A

• C335 Facilities and Control floors,walls and ceiling free from dust and debris.

  Yes

  No

  N/A

Restroom

• C333 Restrooms are stocked, maintained, clean & in good repair

  Yes

  No

  N/A

• C337 Ensure: - Floors, floor drains, walls, doors/windows and ceiling are free from dust and debris.

  Yes

  No

  N/A

• C335 Facilities and Control floors walls and ceilings are free from debris and standing water.

  Yes

  No

  N/A

• A143 Facilities and Control pest management is effective.

  Compliant

  Non-Compliant

  N/A

C315 Cleaning & Sanitation

• C315 All cleaning tools are stored properly between uses, cleaning equipment task-appropriate & durable

  Yes

  No

  N/A

• A143 Faciliyies and control pest management is effective.

  Compliant

  Non-Compliant

  N/A

• A129 Cleaning and sanitation chemicals are used correctly and used only for intended purpose.

  Compliant

  Non-Compliant

  N/A

B233 Facilities & Controls

• B233 Original containers of toxic materials have legible manufacturer's label, working bottles are labelled & only required chemicals are present

  Yes

  No

  N/A

C343 Facilities & Controls

• No pest harborage sites exist

  Yes

  No

  N/A

• Ensure: - Floors, floor drains, walls, doors/windows free of dust and debris

  Yes

  No

  N/A

• Floors walls and ceilings free of standing water .

  Yes

  No

  N/A

Internal Trash Area

• A143 live pests - Any rodents or cockroaches - - 10+ house / fruit flies in area OR 30 throughout store - Pest debris (droppings/bedding/shells) - Signs of pest activity (chewed containers, dead pests)

  Compliant

  Non-Compliant

  N/A

C349 Facilities & Controls

• Trash cans are lidded & closed between uses. Trash cans are emptied as necessary and trash area is clean

  Yes

  No

  N/A

• - Lids are closed when not in use - Trash cans not overflowing or encrusted in debris - Trash room area clean

  Yes

  No

  N/A

• No pest entry points exist

  Yes

  No

  N/A

C345 Facilities & Controls

• Ensure: - Pest fly lights working - Air curtains working (if available) - Interior glue boards do not have dead rodents on them

  Yes

  No

  N/A

• Floors, walls and ceilings are smooth, easily cleanable & in good repair

  Yes

  No

  N/A

• Floors, walls & ceilings are free of excessive dust, debris & standing water

  Yes

  No

  N/A

• - Ensure wet mop is hung up to air dry after use in designated area

  Yes

  No

  N/A

External Trash Area

• No pest entry point exists Exterior doors do not have a gap greater than 1/4" between door &

  Yes

  No

  N/A

• Ensure: - Pest fly lights working. - Air curtains working (if available). - Interior glue boards do not have dead rodents on them. - Exterior bait boxes are in place

  Yes

  No

  N/A

• Exterior garbage storage is covered and doors kept closed between uses. Containers emptied as necessary for pest prevention

  Yes

  No

  N/A

External Customer Area

C325 Facilities & Controls

• Non-food contact surfaces clean

  Yes

  No

  N/A

• - Ensure any tables are clean (if applicable)

  Yes

  No

  N/A

• Ensure: - Trash receptacles not overflowing/encrusted in debris - Exterior area around dumpsters/compactors clean

  Yes

  No

  N/A

Dishroom

• A129 Ensure: - Chemicals are hooked up to dispensers. - Chemicals are only stored in chemical containers

  Compliant

  Non-Compliant

  N/A

• A127 Cleaning & Sanitation Chemical sanitizer solutions maintained at proper concentration & temperature

  Compliant

  Non-Compliant

  N/A

B239 Cleaning & Sanitation

• Sanitizer test kits are open & available

  Pass

  Fail

  N/A

B237 Cleaning & Sanitation

• Detergent/sanitizer basins filled with enough solution to immense the largest piece of equipment being washed/sanitized

  Pass

  Fail

  N/A

C319 Cleaning & Sanitation

• Warewashing systems are properly cleaned, maintained & operated

  Yes

  No

  N/A

B235 Cleaning & Sanitation

• Cleaning/maintenance tools not cleaned in food prep/3- bay sinks

  Pass

  Fail

  N/A

C321 Cleaning & Sanitation

• Clean utensils, equipment and packaging are stored in sanitary manner

  Yes

  No

  N/A

• A139 Facilities & Controls Air gaps/backflow prevention devices in place

  Compliant

  Non-Compliant

  N/A

• A143 Pest management is effective

  Compliant

  Non-Compliant

  N/A

B241 Facilities & Controls

• Hot & cold water available at all sinks

  Yes

  No

  N/A

• B2333 Bodily fluid Clean Up Kit, Convection Oven and Toaster Cleaner, Disposable Sanitizer Wipes, Emergency Sanitizer, Extra Mild Hand Soap, Foam San, Q San 7.5, Neutral Stone and Floor Cleaner, Pristine Restroom Toilet and Urinal Cleaner, Stera Sheen, Ultra Deli Detergent, Urnex Clearly Coffee Bowl Cleaner, Schaerer/Urnex Rinza Steam Wand Cleaner, Schaerer/Urnex Cafiza Espresso Cleaning Tablets

  Pass

  Fail

  N/A

• Ventilation systems clean & adequate

  Yes

  No

  N/A

• Ensure following are in good condition & easily cleanable: - Cutting boards, ice scoops, Razzle spindle, Duke chicken warmer

  Yes

  No

  N/A

• C335 Facilities and controls floors walls and ceiling easily cleanable and in good repair.

  Yes

  No

  N/A

• C337 Floors walls and ceilings free of dust debris and standing water.

  Yes

  No

  N/A

C327 Equipment & Utensils

• Non-food contact surfaces durable, non-toxic, cleanable & in good condition

  Yes

  No

  N/A

B217 Personal Hygiene

• Handwashing facilities are located convenient to area & used only for handwashing

  Yes

  No

  N/A

B219 Personal Hygiene

• Handwashing facilities clean & stocked at all times

  Yes

  No

  N/A

Back Storage Area

• A115Ensure: - Bread/bakery products not stored under boards w/ pins/tacks. - Medicines/first aid supplies not stored where they can contaminate

  Compliant

  Non-Compliant

  N/A

• Ensure: - Food, water and drinks are 6" off the floor. - Food contact packaging is 6" off of the floor. - Note: there is an exception for soda, water and milk stored in plastic

  Yes

  No

  N/A

• Ventilation systems clean and adequate

  Yes

  No

  N/A

• Floors walls and ceilings are smooth easily cleanable and in good repair.

  Yes

  No

  N/A

• Floors walls and ceilings are free of dust debris and standing water.

  Yes

  No

  N/A

• No pest entry point exists Ensure: - Exterior doors do not have a gap greater than 1/4" between door &

  Yes

  No

  N/A

• Pest control devices working properly

  Yes

  No

  N/A

• A143 pest management is effective.

  Yes

  No

  N/A

C330 Personal Hygiene

• Eating, drinking & tobacco use standards followed

  Yes

  No

  N/A

Coffee Area

• Non-food contact surfaces properly cleaned

  Yes

  No

  N/A

• A143 pest management effective

  Compliant

  Non-Compliant

  N/A

• Floors walls and ceilings are smooth easily cleanable and in good repair.

  Compliant

  Non-Compliant

  N/A

• Floors walls and ceilings are free of dust debris and standing water.

  Compliant

  Non-Compliant

  N/A

• Ventilation systems clean and adequate

  Compliant

  Non-Compliant

  N/A

• Foods are protected from contamination.

  Compliant

  Non-Compliant

  N/A

C329 Cleaning & Sanitation

• Sanitizer buckets kept clean, separate cloths used to wipe food & non-food contact surfaces

  Yes

  No

  N/A

• Ensure: - Sanitizer buckets are not kept on floor.

  Yes

  No

  N/A

C331 Personal Hygiene

• - Hair restraints used - Necklaces tucked under shirts (if worn) - 1 plain band w/ no stones worn only - Bracelets/watches not worn - Fingernails w/ jewelry/rhinestones not worn

  Yes

  No

  N/A

Specialty Beverage & Food Service

• A131 Personal Hygiene Hands washed after contamination or changing gloves

  Compliant

  Non-Compliant

  N/A

• A135 Personal Hygiene Associate health policy followed

  Compliant

  Non-Compliant

  N/A

• Ensure food service gloves are being worn when: - Handling RTE food - Handling clean food contact surfaces in FS area - Removing tabs for creamers at coffee island

  Compliant

  Non-Compliant

  N/A

• Handwashing facilities accessible & used only for handwashing

  Pass

  Fail

  N/A

Specialty Beverage & Food Service, con't

• Ensure: - Clean uniform worn - Hair restraints used - Necklaces tucked under shirts (if worn) - 1 plain band w/ no stones worn only - Bracelets/watches not worn - Fingernails w/ jewelry/rhinestones not worn

  Yes

  No

  N/A

• A119 Food Handling TCS foods in code

  Yes

  No

  N/A

• Hand washing facilities stocked at all times.

  Pass

  Fail

  N/A

• A115 Food Handling Foods protected from contamination

  Yes

  No

  N/A

• A121 Food Handling Foods are from commercial suppliers & in sound condition

  Yes

  No

  N/A

B207 Food Handling

• Proper cooling/handling methods used for donation program

  Yes

  No

  N/A

B225 Food Handling

• TCS foods properly coded & in code

  Pass

  Fail

  N/A

C340 Food Handling

• Milkshake log on magnet maintained

  Yes

  No

  N/A

C311 Food Handling

• Foods properly identified

  Yes

  No

  N/A

• A107 Temperature - Process Related TCS foods properly handled at proper temperature & not temperature abused before being displayed

  Compliant

  Non-Compliant

  N/A

• C351 temperature control rss- Products not overfilled

  Yes

  No

  N/A

• A101 Temperature Control Cold TCS foods are maintained at 41°F or below

  Compliant

  Non-Compliant

  N/A

• Only score if NO process issues are seen (A107/C351). and temps are out of range

  Yes

  No

  N/A

Foodservice

• A103 Temperature Control Hot TCS foods are maintained at 140°F or above

  Compliant

  Non-Compliant

  N/A

• A109 Temperature Control Hot-held foods reheated to 165°F for 15 seconds

  Compliant

  Non-Compliant

  N/A

• C305 Confirm products in freezer are hard to touch.

  Yes

  No

  N/A

B209 Temperature Control

• Thermometers provided & accurate

  Yes

  No

  N/A

• - Ensure two accessible, working thermometers are available

  Pass

  Fail

  N/A

• - Ensure each Silverking, RSS & OWS has easily viewable, working

  Yes

  No

  N/A

• A127 Equipment & Utensils Chemical sanitizer solutions maintained at proper concentration & temperature

  Compliant

  Non-Compliant

  N/A

• - Ensure two sanitizer buckets' concentrations are between 150

  Yes

  No

  N/A

• Food contact surfaces smooth, cleanable & in good condition

  Compliant

  Non-Compliant

  N/A

• Ensure: - Non-food contact surfaces not cracked or damaged - Quesadilla handles/knife handles not cracked or damaged - Black wicker baskets not damaged - Utensil handles not damaged

  Yes

  No

  N/A

• Ensure following are clean: - Sides of all equipment (RSS/OWS/Silverking/Ice Machine/HFT/Duke

  Yes

  No

  N/A

• A125 Cleaning & Sanitation Food contact surfaces are cleaned & sanitized

  Compliant

  Non-Compliant

  N/A

• - Review HACCP log 4 hour equipment/utensil checks for completion

  Yes

  No

  N/A

• Ensure: - Sanitizer bucket/lid free of debris - Q-san wipes from bucket used quickly after being dispensed - Same Q-san wipe is not used to wipe non-food contact surface

  Yes

  No

  N/A

• Clean utensils, equipment & food contact packaging stored in a sanitary manner

  Yes

  No

  N/A

• A143 - live pests, pest management effective.

  Compliant

  Non-Compliant

  N/A

• - Floors are free from standing water. - Dead insects not excessively present

  Yes

  No

  N/A

• Floors walls and ceilings free of dust and debris easily cleanable, in good repair.

  Yes

  No

  N/A

• - Ensure vents/air returns are free from excessive dust/debris - Ensure equipment fan guards are free from excessive dust/debris

  Yes

  No

  N/A

Demonstration of Knowledge

• Store team awareness of Associate Health Policy and identify factors (exposed cuts, frequent bathroom, jaundice, persistent sneezing,coughing)

  Compliant

  Non-Compliant

  N/A

• Ensure: - MOD can name all 5 exclusionary foodborne illnesses ( Salmonella,shigella,E.coli,Hepatitis A, Norovirus)

  Yes

  No

  N/A

• A123 Equipment & Utensils Food contact surfaces of equipment & utensils durable, non-toxic & made of safe materials

  Compliant

  Non-Compliant

  N/A

• A140 Food Handling HACCP logs completed properly & available

  Compliant

  Non-Compliant

  N/A

• A121 Food Handling Foods are from commercial suppliers

  Compliant

  Non-Compliant

  N/A

• C330 personal hygiene eating, drinking and tobacco use standards followed.

  Compliant

  Non-Compliant

  N/A

• C331 personal hygiene dress standard followed.

  Yes

  No

  N/A

B201 Facilities & Controls

• Certified Food Protection Manager is employed by facility

  Pass

  Fail

  N/A

• - Refer to Food Manager Certification Requirements chart on

  Yes

  No

  N/A

B227 Facilities & Controls

• Live animals not permitted in food service & storage areas

  Pass

  Fail

  N/A