Internal Health Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

FOOD PROTECTION MANAGEMENT

• PIC assigned?

  Yes

  No

  N/A

• PIC serve safe certified?

  Yes

  No

  N/A

• PIC Allergen certified?<br>

  Yes

  No

  N/A

• PIC Knowledgable?

  Yes

  No

  N/A

• PIC performing duties?

  Yes

  No

  N/A

• Reporting of diseases by employee and PIC (learned Mass food code)

  Yes

  No

  N/A

• Conformance w/ approved procedures/HACCP plans

  Yes

  No

  N/A

• Reduced oxygen packaging/ variance required

  Yes

  No

  N/A

• Consumer Advisories

  Yes

  No

  N/A

• All required permits are properly posted

  Yes

  No

  N/A

• EEOC/OSHA poster displayed

  Yes

  No

  N/A

• MSDS sheets posted for all chemicals

  Yes

  No

  N/A

• No choking & CPR posters displayed

  Yes

  No

  N/A

• Food handlers permits are posted

  Yes

  No

  N/A

• Temp minder information easy to locate

  Yes

  No

  N/A

• Dishwasher and bartender trained on use of dishwasher

  Yes

  No

  N/A

FOOD

• Approved source (vendors)<br>

  Yes

  No

  N/A

• No spoilage, discard all unsafe foods

  Yes

  No

  N/A

• Receiving / sound condition

  Yes

  No

  N/A

• Labeling of ingredients, accuracy, allergens

  Yes

  No

  N/A

• Approved food or color additives

  Yes

  No

  N/A

• Food containers NSF approved, properly labeled

  Yes

  No

  N/A

• Use by dates on all prepared foods

  Yes

  No

  N/A

• Proper storage charts followed

  Yes

  No

  N/A

FOOD PROTECTION, TIME AND TEMP CONTROL

• Cooking temperatures

  Yes

  No

  N/A

• Reheating (charts)

  Yes

  No

  N/A

• Cooling (charts)

  Yes

  No

  N/A

• Hot holding (timers every 2 hours check)

  Yes

  No

  N/A

• Cold holding

  Yes

  No

  N/A

• Time as a public health control, variance

  Yes

  No

  N/A

• Parasite destruction / records retained

  Yes

  No

  N/A

• Facilities to maintain product temperature

  Yes

  No

  N/A

• Food thermometers provided (temp minder CCP tool in use)

  Yes

  No

  N/A

• PHF's properly thawed ( max 2 hrs under running water )

  Yes

  No

  N/A

• Time-temperature indicator labels

  Yes

  No

  N/A

• Proper cutting boards for task at hand

  Yes

  No

  N/A

FOOD PROTECTION FROM CONTAMINATION

• No reservice of PHF'S or unwrapped foods

  Yes

  No

  N/A

• Food protection, storage, display, transportation

  Yes

  No

  N/A

• Separation, segregation, and no cross contamination

  Yes

  No

  N/A

• Proper washing of fruits and vegetable

  Yes

  No

  N/A

• Handling of food and ice minimized

  Yes

  No

  N/A

• Food utilized and properly stored

  Yes

  No

  N/A

PERSONNEL

• Personnel with infections restricted / excluded

  Yes

  No

  N/A

• Proper adequate hand washing

  Yes

  No

  N/A

• Prevention of contamination from hands

  Yes

  No

  N/A

• Prevention of contamination on saliva from open beverages

  Yes

  No

  N/A

• Good hygienic practices

  Yes

  No

  N/A

• Clean clothes, bathed, hair restraints

  Yes

  No

  N/A

• Only single wedding band- no jewelry

  Yes

  No

  N/A

• No fake nails, long nails, or nail polish

  Yes

  No

  N/A

• Disposable gloves in use when handling all food items (no latex)

  Yes

  No

  N/A

EQUIPMENT & UTENSILS

• Food contact surfaces designed, maintained, installed

  Yes

  No

  N/A

• Non-food contact surfaces designed, maintained, installed

  Yes

  No

  N/A

• Dishwashing facilities designed, maintained, installed

  Yes

  No

  N/A

• Three compartment sink provided, drainboards

  Yes

  No

  N/A

• Low sanitizer alarm installed (new installations)

  Yes

  No

  N/A

• Equipment thermometers and pressure gauge

  Yes

  No

  N/A

• Sanitizer test kits provided

  Yes

  No

  N/A

• Pre-flushed, scraped, soaked

  Yes

  No

  N/A

• Wash, Rinse, water clean, proper temperature

  Yes

  No

  N/A

• Food contact surfaces cleaned and sanitized

  Yes

  No

  N/A

• Wiping clothes, clean, sanitized, use restricted

  Yes

  No

  N/A

• Quats Sanitizer solution for washcloths is available and being used (220 PPM) Changed/tested every 4 hours

  Yes

  No

  N/A

• Dishwasher clock to track chemical times

  Yes

  No

  N/A

• Clean equipment and utensils properly stored

  Yes

  No

  N/A

• Single service articles stored, dispensed

  Yes

  No

  N/A

• No re-use of single service articles

  Yes

  No

  N/A

• Soda nozzles and ice dispensers clean and free from slime

  Yes

  No

  N/A

• All products elevated at least 6" off the floor

  Yes

  No

  N/A

• Shelving clean, no rust or corrosion

  Yes

  No

  N/A

• Helium/CO2 cylinder properly secured with chain to equipment, shelving or storing area

  Yes

  No

  N/A

• Lid kept close when not removing ice

  Yes

  No

  N/A

• Ice scoop used to obtain ice

  Yes

  No

  N/A

• Ice scoop is stored outside bin in separate container according to local health requirements

  Yes

  No

  N/A

• Ice machine filters clean, free of dust

  Yes

  No

  N/A

• Ice machine clean inside and out

  Yes

  No

  N/A

• All glass wear is free of chips or cracks

  Yes

  No

  N/A

• Cooking and preparation equipment is clean and free of grease and residue buildup

  Yes

  No

  N/A

• Coolers and freezers clean and organized- no freezer burn

  Yes

  No

  N/A

• Water heater clean and in good condition

  Yes

  No

  N/A

• Exhaust hood cleaned and functioning properly/ up to date inspection sticker

  Yes

  No

  N/A

• Grills Clean or debris, coal in good repair

  Yes

  No

  N/A

• All cooking equipment clean and sanitized

  Yes

  No

  N/A

• Fyolators clear of build-up

  Yes

  No

  N/A

• Condiment bins clean

  Yes

  No

  N/A

• Ketchup vol-pack cow clean

  Yes

  No

  N/A

• Squirt btls clean and stored properly

  Yes

  No

  N/A

• Rolling racks clean & clear of debris

  Yes

  No

  N/A

• Ice cream machines clean and logged

  Yes

  No

  N/A

• Milkshake spinners clean and sanitized

  Yes

  No

  N/A

• Clean gaskets on all refrigeration/ not cracked, broken

  Yes

  No

  N/A

• Knife holder clean, organized

  Yes

  No

  N/A

• Bar dump sinks free of debris

  Yes

  No

  N/A

WATER

• Water safe, hot, and cold under pressure

  Yes

  No

  N/A

SEWAGE

• Sewage and waste water disposal

  Yes

  No

  N/A

PLUMBING

• Installed and maintained

  Yes

  No

  N/A

• Cross connection, back siphonage, back flow

  Yes

  No

  N/A

TOILET AND HAND WASHING FACILITIES

• Number, convenient, proper signage

  Yes

  No

  N/A

• Location handicap accessible

  Yes

  No

  N/A

• Toilet enclosed, self closing doors, good repair, clean fixtures

  Yes

  No

  N/A

• Hand cleaning, hand drying, toilet tissue, signage

  Yes

  No

  N/A

REFUSE DISPOSAL

• Adequate number, frequency, covered, clean, vermin proof

  Yes

  No

  N/A

• Outside storage area clean, properly constructed

  Yes

  No

  N/A

INSECT, RODENT, ANIMAL CONTROL

• Fruit flies

  Yes

  No

  N/A

• Insects, rodents, animals, outer openings

  Yes

  No

  N/A

PHYSICAL FACILITIES

• Floors, constructed, cleanable, good repair, dustless cleaning methods

  Yes

  No

  N/A

• Walls, ceiling, attached equipment, constructed, clean, good repair, dustless cleaning method

  Yes

  No

  N/A

• Adequate lighting, fixtures shielded

  Yes

  No

  N/A

• Rooms and equipment vented

  Yes

  No

  N/A

• Dressing rooms clean, lockers provided

  Yes

  No

  N/A

• Nothing stored on top of lockers

  Yes

  No

  N/A

• No wires running across floors

  Yes

  No

  N/A

• Floors clear of grease and debris

  Yes

  No

  N/A

• Floor and aisle ways clear of obstructions or hazards

  Yes

  No

  N/A

• Emergency exits clearly marked and functioning

  Yes

  No

  N/A

• Emergency exit lights functioning properly

  Yes

  No

  N/A

• Fire exits unobstructed

  Yes

  No

  N/A

• No visible electrical hazards

  Yes

  No

  N/A

• No visible fire hazards

  Yes

  No

  N/A

• Fire extinguishers serviced/inspected and in proper places. Not visually or physically obstructed.

  Yes

  No

  N/A

• Fire extinguishers mounted with top of extinguisher no more than 5 feet above the floor

  Yes

  No

  N/A

• Cigarette receptacles clean and presentable

  Yes

  No

  N/A

• Trash cans are clean and trash removed when 3/4 full, odor free with no refuse visible

  Yes

  No

  N/A

• Drains are clear, screwed tight, odor free

  Yes

  No

  N/A

• Fixtures (hand, mop and prep sinks, faucets, toilets, ect.) are clean, odor free and free of residue

  Yes

  No

  N/A

• Mirrors, pictures, ornaments, displays and props clean, free of dust, organized and straightened

  Yes

  No

  N/A

• Exterior ground surfaces free of debris or clutter, swept and clean, free of stains or spills

  Yes

  No

  N/A

• Exterior structures and surfaces clean, free of graffiti and stains, no peeling or chipped paint and odor free

  Yes

  No

  N/A

• Exterior ground surfaces free of cracks and holes

  Yes

  No

  N/A

• Handicapped ramps and sidewalks in place and marked meeting current standards

  Yes

  No

  N/A

• Windows are clean, no streaks, greasy prints,soil or food debris

  Yes

  No

  N/A

• Window sills clean, no trash visible

  Yes

  No

  N/A

• Tables, countertops, chairs and benches are clean and presentable

  Yes

  No

  N/A

• Return and supply air vents are clean, firmly attached, and free of surrounding dust or residue

  Yes

  No

  N/A

• HVAC filter clean and changed regularly

  Yes

  No

  N/A

• Doors, frames and hardware clean and in good repair

  Yes

  No

  N/A

• Walls, baseboards and ledges are clean and in good repair

  Yes

  No

  N/A

• Ceilings clean and free of cobwebs and dust

  Yes

  No

  N/A

• Proper dusting of ledges, jukebox, tops of light fixtures, emergency lights and artwork

  Yes

  No

  N/A

• Ceiling fans clean and free of dust

  Yes

  No

  N/A

• Floor mats clean and in good repair

  Yes

  No

  N/A

• Foot and handrails clean and polished

  Yes

  No

  N/A

OTHER OPERATIONS

• Toxic items in original labeled container

  Yes

  No

  N/A

• Labeled common name items

  Yes

  No

  N/A

• Separation

  Yes

  No

  N/A

• Pesticides use restricted

  Yes

  No

  N/A

• Medicines, first aid storage restricted

  Yes

  No

  N/A

• Premises maintained, unnecessary articles and maintenance equipment properly stored, mop sink provided

  Yes

  No

  N/A

• Separation from living/sleeping quarters, laundry

  Yes

  No

  N/A

• Clean and soiled linen properly stored

  Yes

  No

  N/A

• Empty bread racks stored properly

  Yes

  No

  N/A

• Empty kegs stored properly

  Yes

  No

  N/A

• Grease collection site clean and in good repair

  Yes

  No

  N/A