Title Page
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Conducted on
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Prepared by
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Location
Section 1: General
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Manager Certification: RM and PIC has received food safety managements certification.
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Bonus: PIC Certification---For PIC/TLs with ServSafe certification up to 5 people.
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Bonus: TL Food Safety Certification. For TLs with proof of current JIB TL Food Safety Certification.
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Food Permit--Valid Food Permit posted
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Health Department Inspection: The most recent Health Dept inspection report is at the restaurant, and all noted deficiencies have been addressed.
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Food Safety Standards validated throughout the day: Daily FSC, thermometer calibration completed and corrective actions taken.
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Corrective Action Plan--NSF previous failure: For previously failed assessments, a copy of corrective action plan is available for all "Priority" standards and/or improvement on previously missed standards is observed.
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Bonus: Corrective Action improvement. Previous Assessment was a "Pass." Most recent "passed" Food Safety Assessment available and all previous deficiencies (within manager control) addressed.
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Immediate Corrective Action: All items observed unacceptable during today's assessment are corrected during assessment.
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PIC Knowledge of Health Inspections: PIC can demonstrate they understand the requirements if a failed health department inspection occurs.
Section 2: Employee Health and Hygiene
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Illness: Food handlers have no obvious signs of illness/not working when sick/infected or with open wounds.
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Eating, Drinking, Smoking, Gum Chewing and Personal Items: Eating, drinking, smoking, gum chewing and personal belongings are kept separate for food and beverage areas.
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Team Appearance: All restaurant employees follow dress code requirements.
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PIC Knowledge of Illness Policy: PIC can explain the employee illness policy and when to restrict or exclude ill TMs.
Section 3: Pest Control
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Pest Prevention: Restaurant is effectively controlling pests. (Look at last pest inspection report)
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Pest Activity: The facility is free of signs of pest activity.
Section 4: Hand Washing/Hand Sinks
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Handwashing Sink Availability: Hand washing sinks in kitchen areas are available, accessible, working and properly setup. Hot water is available within 30 seconds.
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Handwashing Sink Usage: Hand wash sinks are used only for hand washing.
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Handwashing: All employees are observed washing hands properly and only in designated hand washing sinks.
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Glove Usage: Employees are properly using disposable gloves.
Section 5: Food Receiving and Storage
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Food Receiving: Evidence of food receiving to standard. Temps, condition, receiving and storage procedures to standard.
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Expired Products/Ingredients: No expired products/ingredients are noted. (Photo required for non compliance.)
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PIC Knowledge of Purchasing Food: PIC can describe the correct procedure to purchase foods.
Section 6: Food Contamination Prevention and Protection
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Food and Packaging are stored properly and protected from contamination: Adequately covered, RTE foods stored over raw foods. (Photo required for non compliance.)
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No Food or Packaging Contamination Observed. (Photo required for non compliance.)
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Proper Washing: Fruits and vegetables are properly washed before use.
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Lighting: Lighting is adequate and all lights are clean and properly shielded or shatterproof. (Photo required for non compliance.)
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8 Major Food Allergens Job Aid: Posted to be viewed by TMs.
Section 7: Temperature Control/Storage
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Food Thermometers: Food thermometers are available, operational and accurate; employees can demonstrate proper procedure to calibrate and use the instrument.
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Equipment Thermometers: Equipment thermometers are present, functional and located in the warmest part of the refrigeration/freezer unit. (Photo required for non complaince.)
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Refrigeration and Freezer Equipment: Are maintaining proper temps (41 or below for coolers, 20 or below for freezers including walk-ins.)
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Walk-in and Freezer Product Temps: Products are at a temp of 41 or below and frozen foods are maintained at a temp of 20 or below.
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Refrigerated Natural Cheese Temp
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Shake Mix temp (only if open bag)
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Temp of any freezer product
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Temp of any freezer product
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POU--Refrigerator and Freezer Product Temps: Cold, TCS foods are maintained at a temp of 41 or below and frozen foods are maintained at a temp of 20 or below.
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Pou Product Temp
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Pou Product Temp
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Pou Product Temp
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Pou Product Temp
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Pou Product Temp
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Pou Product Temp
Section 9: Cooking Temperature
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Internal Temp Perparation/Cooking: Required cooking time procedures for TCS foods are followed.
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Final Flip and Check: JIB final flip and visual check is followed.
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Temperature Evaluation: Employee can independently and without coaching demonstrate the correct procedure to take temperature of a food item and grill.
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PIC Knowledge of Internal Cooking Temps: PIC has knowledge of proper internal cooking temps
Section 10: Maintenance and Repair--Non-Food Contact, Facilities/Equipment
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Non-food Contact Food Surface Condition: Floors, walls, ceilings and other non-food contact surfaced properly constructed and in good condition.
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Restrooms: All restrooms are clean, stocked and in good repair. Sinks, toilets, soap dispensers and paper towel holders are functioning properly. Hot and cold running water is available at the sink.
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Doors and Windows: All doors and drive thru windows to the outside are self-closing and/or maintained closed and tightly fitting with no gaps greater thatn1/4".
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Drains: All drains working properly, clean and free of standing water.
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Cleaning tools: Mops, brooms and cleaning tools are properly stored.
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Back flow devices: All back flow devices are installed and working properly to prevent back siphonage where necessary.
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Refrigerator and Freezer Condition: Walk-in and POU refrigerators and freezers are in good repair and condition. Observe water/leaks/condensation and check gasket condition, shelving, fans and fan guards
Section 11: Cleanliness, Non-Food Contact, Facilities and Equipment
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Clean Refrigeration and Freezers: Walk-in and POU refrigerators and freezers are clean, dry and free of odor. Fans and gaskets are clean.
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Waste Receptacles: Waste receptacles inside and out are present, durable, insect/rodent resistant, leak proof, lined, maintained clean and kept covered.
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Non-Food Contact Surfaces Clean: Floors, walls, ceilings and other non-food contact surfaced are CLEAN and kept free of an accumulation of dust, dirt, food residue and other debris.
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Dumpster Area: Dumpsters, trash compactor and grease bins/containers are maintained clean and in good repair. Surrounding areas are maintained clean.
Section 12: Condition and Sanitation, Food Contact, Equipment and Utensils
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Smallwares/Utensils Condition: Tools, utensils, smallwares and equipment are commercial grade and in good condition.
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Smallwares/Utensils Clean: Tools, utensils, smallwares and food contact surfaces are cleaned at an appropriate frequency and are clean to sight and touch to prevent cross contamination.
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Equipment and Food Contact Surfaces Clean: All equipment and food contact surfaces are cleaned at an appropriate frequency and are clean to sight and touch.
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Equipment and Utensils Air Dried: Equipment and utensils are properly stored and air dried. (Upside down pans and utensils.)
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Ice Machines: Clean inside and out and in good repair. Buckets and scoops are properly stored in a sanitary manner.
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Beverage Dispensers: Clean and free of soil and mold buildup.
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PIC Knowledge Water Outage: PIC has knowledge and can explain proper procedure to ensure ice and water are safe.
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Team Knowledge Allergen Awareness: Customer Service TM can answer Allergen Awareness question or refer to poster and then answer correctly. (1. What food items are safe to eat if a customer has a severe dairy allergy? 2. Do you serve gluten free items? 3. Can you tell me which food items contain soy?)
Section 13: Sanitizer/Chemicals
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Chemicals Labeled: All chemical containers labeled.
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3-Compartment Sinks and Dish Washer: Properly maintained, with appropriate soap/sanitizing agents and adequate hot and cold running water. Test strips are available to test sanitizer concentration.
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Sanitizer Containers and Wiping Towels: Properly used and stored, sanitizer at proper concentration.
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Approved Chemicals: Only approved cleaning chemicals are present, stored and used properly.
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PIC Knowledge of Proper Dishwashing: PIC and TMs properly wash, rinse and sanitize dishes at the 3 compartment sink.
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PIC Knowledge of Bodily Fluids Cleanup: PIC can describe correct procedure or show written procedure to respond to properly clean areas exposed to vomit, blood or diarrheal events in the restaurant.
Section 14: Food Security
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Exterior of Facility: Exterior of facility is secure; doors are closed and locked when not in use. The parking lot is properly illuminated at night.
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Unauthorized Personnel: Unauthorized personnel, including off duty personnel are restricted from back areas, food prep and storage areas.
Section 15: Imminent Health Hazards
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Imminent Health Hazards: Restaurant is free of any imminent health hazards while operating.
Section 16: Appeal
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Assessment Appeal: Does the PIC have any question results they wish to have appealed?
