Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
GENERAL INFORMATION
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Manager/Owner Name
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Name(s) of PIC/person(s) in charge (Foodsafe, NFSTP certification or equal)
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Date and Time Self Audit was commenced.
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Date and Time Self Audit was completed.
TRAINING AND CERTIFICATIONS
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Foodsafe or NFSTP certifications appropriately displayed
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In-House Training Programs
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Other Certifications
PERSONNEL HYGIENE PRACTICES
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Employee health poster available
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Employees wear proper uniform including proper shoes
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Hair restraint is worn
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Fingernails are short, unpolished and clean
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Jewelry is limited to watch, simple earrings and plain rings
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Hands are washed or gloves are changed at critical points
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Open sores, cuts, or splints and bandages on hands are completely covered while handling food
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Hands are washed thoroughly using proper hand-washing procedures at critical points
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Eating, Drinking or chewing gum are observed only in designated areas away from work areas
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Staff beverages are covered with a lid and straw and stored away from food preparation area
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Staff take appropriate action when coughing or sneezing
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Disposal tissues are used and disposed of when coughing/blowing nose
HANDWASHING
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Hand sinks accessible and stocked with soap and paper towels
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Staff wash hands in hand-washing sinks only
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Staff observed washing hands between tasks (handling raw meat, seafood, mops, garbage, etc.
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Employees wash hands before starting work and returning from break
PROCUREMENT and RECEIVING FOOD
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Food items are purchased from approved source. (Government Approved)
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Temperature of incoming truck checked and logged
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Potentially Hazardous Food (PHF) received at temperature < 4° c or below
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Frozen food received at temperature < -18° c or below
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Deliveries are accepted at non peak times
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Product has proper labels and dates
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Food is inspected before placed into storage (free from damage, contamination, adulteration and spoilage)
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Check for potential of cross-contamination
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Pallets are checked for cleanliness and potential for contamination
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Food deliveries are kept 6" off the floor before being stored
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Policy in place for rejection of goods
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Documentation maintained for rejected materials
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Minimum time on dock maintained
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Log Books Current and Maintained
DRY FOOD STORAGE
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Temperature is appropriate <br>between 50° F and 70° F
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Evidence that temperatures are monitored and recorded
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Record temperature
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FIFO Maintained (first in first out)
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Adequate air circulation
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All food and paper supplies are 6" off the floor
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Food is stored at least 18" below sprinkler head(s)
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Is storage area well lit
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Protective light shields cover all light sources
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All food is labeled with name and delivery date
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Bulk foods are labeled with common name if not in original container<br>
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There is no bulging, dented or leaking canned goods in storage
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No evidence of leaks and moisture
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Food is protected from contamination
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All surfaces and floor are clean
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Chemicals are stored away from food and other food related supplies
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Log Books are Current and Maintained
COLD FOOD STORAGE
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WALK-IN FREEZER
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Thermometer is conspicuous and accurate
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Evidence that temperatures are monitored and recorded
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Record temperature here. (must be < -18)
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FIFO Maintained (first in first out)
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Monitored for cross contamination
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Food is checked for thawing and/or refreeze
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Food is stored 6" off floor
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All food is properly wrapped, labeled and dated
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Unit is clean inside and out
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Log Books are Current and Maintained
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WALK-IN REFRIGERATOR
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Thermometer is conspicuous and accurate
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Evidence that temperatures are monitored and recorded
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Record temperature here. (must be < 4c)
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FIFO Maintained (first in first out)
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Food is stored 6" off floor
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All food is properly wrapped, labeled and dated
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Food being thawed is on lowest shelf(s)
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Unit is clean inside and out
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REACH-IN FREEZER
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Thermometer is conspicuous and accurate
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Record temperature here. (must be <-18c)
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Evidence that temperatures are monitored and recorded
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FIFO Maintained (first in first out)
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All food is properly wrapped, labeled and dated
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Unit is clean inside and out
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REACH-IN REFRIGERATOR
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Thermometer is conspicuous and accurate
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Evidence that temperatures are monitored and recorded
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Record temperature here. (must be <4c)
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FIFO Maintained (first in first out)
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All food is properly wrapped, labeled and dated
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Food being thawed is on lowest shelf(s)
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Unit is clean inside and out
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MILK REFIGERATOR
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Thermometer is conspicuous and accurate<br>
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Evidence that temperatures are monitored and recorded
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Record temperature here. (must be < 4c)
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FIFO Maintained (first in first out)
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Unit is clean inside and out
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Log Books are Current and Maintained
FOOD HANDLING and PREPARATION
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Frozen food is thawed under refrigeration or in cold running water
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Color coded cutting boards used
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Food is not allowed to become cross contaminated
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Thermometers are being utilized
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Food is handled with utensils, clean gloved hands or clean hands
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Utensils are handled to avoid touching parts that will be in direct contact with food
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Reusable towels are used only for sanitizing equipment surfaces and not for drying hands, utensils, floors and ect...
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Food prep coolers and condiment trays monitored
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Log Books are Current and Maintained
COOKING and FOOD PREP
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Color coded cutting boards?
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Separate utensils and knives utilized
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Temperature Probes Utilized
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Cross Contamination minimized
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Log Books Current and Maintained
UTENSILS and EQUIPMENT
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Drawer(s) are clean
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Rack(s) are clean
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Equipment is covered when clean and not in use
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Ice scoops are stored in appropriate container and not in ice machine
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Dishes are free of stains and food debris
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Pots and pans are free of carbon build up, stains and food debris
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EQUIPMENT OPERATION
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Inoperative equipment has been repaired, replaced or removed from the community
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Only approved equipment are installed in an approved manner
CLEANING and SANITIZING
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Is can opener clean
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Wiping cloths are stored in sanitizing solution while in use Sanitizing solution <br>100 ppm Chlorine OR 25 ppm OR 200 ppm quat
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Is toaster clean
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Is slicer clean
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Is mixer clean
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Is coffee machine clean
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Is juice machine clean
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Is soda machine clean
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Is microwave clean
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Is convection oven clean
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Is range/oven clean
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Is char broiler clean
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Is steamer clean, free of lime build up
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Is range hood and filters clean
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Note Date of last professional cleaning of range hood and vent
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Is deep fryer clean and properly aligned under fire suppression nozzle
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Ice Machine Maintained
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Is steam table clean and free of lime build up
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Are carts clean and wheels free of rust and debris
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THREE COMPARTMENT SINK
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Three compartment sink is used
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Three compartment sink WASH hot, soapy water
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Three compartment sink RINSE clean, warm water to remove detergents
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Three compartment sink SANITIZE one minute in clean, warm (at least 75° F) water at:<br>50ppm chlorine OR 12.5 ppm iodine OR 200 ppm quat
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Three compartment sink AIR DRY on drainboard/sink
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DISHMACHINE CHEMICAL
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Type:
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DISHMACHINE HIGH TEMPERATURE
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Temperature:
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Log Books Current and Maintained
GARBAGE STORAGE and DISPOSAL
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Kitchen garbage cans are clean and covered when not in use
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Garbage cans are emptied as necessary
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Boxes and containers are removed from site
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Dumpster lid(s) are closed
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Dumpster area is clean
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Staff wash hands after handling trash
INTEGRATED PEST CONTROL
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Contracted to Pest Control Company (name company)
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Date of last inspection
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Pest Control records available
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Pest control devices not located in food preparation areas
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No evidence of insect or pests is present
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Screens are on open windows and doors are in good repair
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Door sweeps restrict the passage of pests
PROVINCIAL INSPECTION
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Health Authority
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Date of last inspection
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Result of previous inspections
SIGNATURES
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Signature of PIC
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Signature of Auditor