Health Inspection

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1.0 - Food

• 1.1 - Source sound condition- no spoilage? (5)

  Yes

  No

  N/A

• 1.2 - Original container or properly labeled? (1)

  Yes

  No

  N/A

2.0 - Food Protection

• 2.3-Potentially hazardous food meets temp requirements during storage, prep, display, transport (5)?

  Yes

  No

  N/A

• 2.4 -Facilities to maintain product temp? (4)

  Yes

  No

  N/A

• 2.5 - Thermometers provided and conspicuous?

  Yes

  No

  N/A

• 2.6 -Food properly thawed? (2)

  Yes

  No

  N/A

• 2.7 -Unwrapped and potentially hazardous food not reserved. (4)

  Yes

  No

  N/A

• 2.8- Food protection during storage, prep, display, transport (2)?

  Yes

  No

  N/A

• 2.9- Handling of food (ice) minimized? (2)

  Yes

  No

  N/A

• 2.10 In use food (ice) dispensing utensils properly stored? (1)

  Yes

  No

  N/A

3.0 - Personnel

• 3.11- Personnel with infections restricted? (5)

  Yes

  No

  N/A

• 3.12- Hands washed and clean, good hygienic practices? (5)

  Yes

  No

  N/A

• 3.13- Clean close, hair restraints?

  Yes

  No

  N/A

4.0 - Food equipment and utensils

• 4.14- Food (ice) contact surfaces designed, constructed, maintained, installed , located? (2)

  Yes

  No

  N/A

• 4.15- Non-food contact surfaces designed, constructed, maintained?(1)

  Safe

  At Risk

  N/A

• 4.16- Dishwashing facilities designed, constructed, maintained?(2)

  Yes

  No

  N/A

• 4.17 Accurate thermometers, chemical test kits provided? (1)

  Yes

  No

  N/A

• 4.18- Pre-flushed, scraped, soaked? (1)

  Yes

  No

  N/A

• 4.19- Wash, rinse water clean, proper temperature? (2)

  Yes

  No

  N/A

• 4.20- Sanitization rinse clean, temperature, concentration, exposure time, equipment, utensils sanitized? (4)

  Yes

  No

  N/A

• 4.21- Wiping cloths clean, use restricted? (1)

  Yes

  No

  N/A

• 4.22- Food contact surfaces of equipment and utensils clean, free of abrasives, detergents? (2)

  Yes

  No

  N/A

• 4.23- Non-contact Food surfaces of equipment and utensils clean, free of abrasives, detergents? (1)

  Yes

  No

  N/A

• 4.25- Storage, handling of equipment and utensils? (1)

  Yes

  No

  N/A

5.0-Toilet and Handwashing Facilities

• 5.31Number, convenient, accessible, designed, installed? (4)

  Yes

  No

  N/A

• 5.32- Toilet rooms enclosed, self closing doors, fixtures good repair, clean, hand cleanser, sanitary towels, hand drying devices, proper waste receptacles? (2)

  Yes

  No

  N/A

6.0 - Garbage and Refuse Disposal

• 6.33- Containers or receptacles, covered, adequate number, insect and rodent proof, frequency, clean? outside of containers clean? (2)

  Yes

  No

  N/A

• 6.34- Outside storage area enclosures properly constructed , clean, ( nothing on ground and doors closed) controlled? (1)

  Yes

  No

  N/A

• 6.35- Presence of insects, rodents- outer openings protected? Doors fully closed? (4)

  Yes

  No

  N/A

• 6.36- Floors constructed, drains , clean, good repair? (1)

  Yes

  No

  N/A

• 6.37- Walls, ceilings equipment good repair and clean- no splatters on walls or build up around walls? (1)

  Yes

  No

  N/A

7.0 Lighting

• 7.1- Lighting provided, shielded? (1)

  Yes

  No

  N/A

8.0- General

• 8.1- Rooms clean, tables clean floors clean? (1)

  Yes

  No

  N/A

• 8.2- Toxic items properly stored, labeled, used? No chemicals stored on cook line, on any table? (5)

  Yes

  No

  N/A

• 8.42- Premises free of litter, unnecessary articles, cleaning materials properly stored? (1)

  Yes

  No

  N/A

• 8.44- Clean, soiled linens properly stored? No towels laying around, all soiled items in container? (1)

  Yes

  No

  N/A

• 8.45- Current permit posted?

  Yes

  No

  N/A

• 8.46- Current inspection report posted?

  Yes

  No

  N/A