Information

  • Restaurant #

  • Conducted on

  • Prepared by

  • Location
  • Time and date of visit:

Exterior Cleanliness

  • Does parking lot appear to be clean and in good repair? No litter?

  • Is the drive thru menu board clean and in good repair? No light gaps.

  • Is the correct POP in place and properly priced?

  • Is the drive thru lane clean and free of litter? No gum, cigarette butts or build up along the curbs or under windows.

  • Does the drive thru window area appear to be clean and free of clutter? No fingerprints.

  • Does the landscaping appear to be clean and well maintained?

  • Do the sidewalks appear to be clean and in good condition?

  • Does the building appear to be clean and in good condition?

  • Comments:

Interior Cleanliness

  • Are the restrooms clean and stocked? Free of odor? Seats Secure?

  • Are the floors, tables and seating clean and in good condition?

  • Are the trash containers clean and in good condition? Liners tucked? No odors?

  • Is the beverage area clean, stocked and clutter free?

  • Is the front counter clean and clutter free?

  • Is all lighting working and in good repair?

  • Are the highchairs clean ready to use ?

  • Are the highchairs in good condition with functioning safety belts?

  • Comments:

Team Image

  • Are all employees wearing a complete uniform. Hat, shirt, belt, correct pants, slip-resistant shoes. Hair restrained. Good hygiene and grooming standards are practiced.

  • Are all managers wearing a complete uniform? Present Profesional image?

  • Are all food handlers wearing gloves?

  • Comments:

Kitchen Cleanliness

  • Are the floors, walls and baseboards clean and in good condition?

  • Are the grills maintained and in good condition? Sides have no buildup?

  • Is all lighting working and in good repair? No bugs, dust or cracked lenses.

  • Hot dog warmer, clean and working properly?

  • Are the bun toasters clean and working in good condition? Properly toasting buns?

  • Are all produce and prep containers free of chips, cracks or visible wear?

  • Are both make tables cooling efficiently and in good working order? Gaskets in good repair?

  • Are the fryers clean and free of carbon and grease build up?

  • Are the fryers being filtered twice daily?

  • Is the ice machine clean and functioning properly?

  • Is their a visible plan to change and maintain custard machine at optimum level? Is custard machine working and in good order?

  • Are all refrigerated equipment clean and functioning properly? Gaskets, fan guard, shelving, stocked correctly, no expired products.

  • Is the dish area clean and well maintained? Serán wrap holders, shelves.clean and organized?

  • Is the prep area equipment clean and well maintained?

  • Are all storage areas clean and organized? Box flaps, shelving labeled.

Restaurant Systems

  • Are travel paths being completed every 30 minutes?

  • Are daily and weekly checklists being completed as required?

  • Are temperature checks being completed as required?

  • Is the cleaning list being utilized as intended on a daily basis?

  • Is the positioning board set up and used correctly? Is all information up to date?

  • Are crew schedules completed and posted at least 1 week in advance?

  • Are all available headsets in use at all times? Is the MOD wearing a headset?

  • Are both main boards open during peak periods?

  • Does the crew know red check goals? Speed of service goals? Where restaurant is MTD ?

  • Are table touch's being completed frequently?

  • Comments:

Top 12 Critical Safety Factors

  • Are hand washing procedures being properly executed correctly and consistently at a properly stocked hand washing sink?

  • Are all health inspection violations corrected within 10 days of the citation?

  • Do all sinks meet the minimum hot water requirement and are they in good repair?

  • Does sanitizer meet the correct PPM at all sinks and open stations with properly labeled spray bottles and buckets?

  • Are items held at room temperature marked with proper holding times and discarded when expired?

  • Is the restaurant free of any rodent, insect and pest activity?

  • Are temp logs completed and Recorded consistently and correctly?

  • Is the restaurant free of other critical food safety violations? (drains backed up, reverberator screens, all chemicals labeled)

  • Comments:

Goal Achievement

  • Is the restaurant meeting or exceeding their sales plan?

  • Is the restaurant at or under their labor plan?

  • Is the restaurants meeting its training plan goal? Bench plan ?

  • Comments:

Overall Visit Comments

  • Auditor Comments:

  • Auditor Signature

MOD Comments and Acknowledgement

  • MOD Comments:

  • By signing this form you acknowledge the following; that you have reviewed this report with the auditor, that you have 10 days to correct any of the negative findings in this report. Failure to correct negative findings within the specified time will result in disciplinary action up to and including termination of employment.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.