Title Page

  • Store #/Location

  • Conducted on

  • Prepared by

  • Manager In Charge

  • # Criticals (If more than 3, include total in notes)

  • 0.0.7 Is the Pest Control Report from a certified Pest Control Operation?

  • Picklist

  • 0.0.3 CRITICAL: Is a fully stocked biohazard kit available?

  • Picklist

  • 1.1.1 CRITICAL: 3 or 4 compartment sink is present and used properly

  • Picklist

  • 1.2.1 BOH area and fixtures clean including all floors, walls, counters, ceilings, lights, sink(s), storage, and lockers

  • Picklist

  • 1.3.1a BOH Refrigerators/Freezers clean and in good repair

  • Picklist

  • 1.3.1c CRITICAL: BOH Refrigerator/Freezers Air Temperature Meet Temperature Standards

  • Picklist

  • 1.5.1 Water filter is changed every six months

  • Picklist

  • 2.2.2 Baked goods case clean and baked good properly labeled

  • Picklist

  • 2.3.1 Store lobby is clean and acceptable temperature

  • Picklist

  • 2.3.3 Snacks area is clean, stocked and has proper signage

  • Picklist

  • 2.4.1b Cold case clean and in good repair (For SEE purposes, also assess if properly stocked)

  • Picklist

  • 2.4.1c CRITICAL: Cold case Air Temperature meets temperature standards

  • Picklist

  • 2.7.1 Freshness cue/cube clean and merchandised properly

  • Picklist

  • 2.8.1 Doors remain closed at all times

  • Picklist

  • 2.9.1 Guest (lobby) restrooms are clean and maintained

  • Picklist

  • 2.9.2 Team member (BOH) restrooms are clean and maintained

  • Picklist

  • 3.1.1 Store exterior area and furniture clean and in good repair

  • Picklist

  • 3.4.1 FOH area floors, walls, ceilings, counters are clean

  • Picklist

  • 3.4.2 All FOH/Blending Area fixtures are clean

  • Picklist

  • 3.5.1a Dipbox clean and in good repair

  • Picklist

  • 3.5.1c CRITICAL: Dipbox at proper temperature with no significant ice buildup (No more than 1/2 inch of buildup)

  • Picklist

  • 3.5.1d Dipwell clean and in good repair, water running

  • Picklist

  • 3.5.2b Blender jars, lids, base and enclosure are in good repair

  • Picklist

  • 3.5.2c CRITICAL: Blender jars, lids, base, and enclosures are clean

  • Picklist

  • 3.5.3b Multi-fruit juicer(s) are in good repair

  • Picklist

  • 3.5.3c CRITICAL: Multi-fruit juicer(s) clean

  • Picklist

  • 3.5.5b Citrus juicer clean and in good repair

  • Picklist

  • 3.5.6b Crathcos clean and in good repair

  • Picklist

  • 3.5.7b Under counter/upright refrigerators/freezers clean and in good repair

  • Picklist

  • 3.5.7c CRITICAL: Under counter/upright refrigerators/freezers Air Temperature meets temperature standards

  • Picklist

  • 3.5.8a Toaster/TurboChef clean and in good repair

  • Picklist

  • 3.10.1 CRITICAL: All team members in the FOH and BOH are wearing gloves; When gloves are required, food handlers do not contact ready-to-eat foods (fresh produce) with bare hands

  • Picklist

  • 3.1.2 Proper drinking/eating in food service area

  • Picklist

  • 4.1.1 CRITICAL: Wiping cloths stored properly and are at the proper concentration (per manufacturer specifications); spray bottles at proper concentration

  • Picklist

  • 6.7.2 CRITICAL: Sanitizer test kits/strips available and not expired

  • Picklist

  • 4.1.2 Chemicals are approved and properly labeled

  • Picklist

  • 4.1.2b CRITICAL: Chemicals are not stored next to or above food contact items

  • Picklist

  • 4.2.2b Floor drains clean and in good repair

  • Picklist

  • 4.3.1a CRITICAL: Ice Machine clean and in good repair; scoop and bucket properly stored

  • Picklist

  • 4.3.1b CRITICAL: Ice Machine bucket and scoop clean and in good repair

  • Picklist

  • 4.3.1c Ice Machine exterior and filter screen clean

  • Picklist

  • 4.4.1 No expired product present

  • Picklist

  • 4.4.2 All perishable TCS (Time/Temperature Control for Safety) foods that are prepped, thawed, and ready to eat are properly day-dotted with the designated shelf-life

  • Picklist

  • 4.6.1 Health inspection available and all critical findings on the previous inspection have been corrected

  • Picklist

  • 4.6.2 Store consistently using Front Line Excellence Log (FLEX Log)

  • Picklist

  • 4.13.1 Manager has appropriate food safety certification

  • Picklist

  • 4.14.1 Documented Team Member Health Policy is available and/or Manager demonstrates knowledge of policy

  • Picklist

  • 4.14.1b CRITICAL: Sick team members are not working in the store

  • Picklist

  • 4.15.1 CRITICAL: Allergen list is in the Nutritional Guide Binder and manager demonstrates knowledge of policy

  • Picklist

  • 4.8.1 Utensils/equipment/contact surfaces in good repair and proper type

  • Picklist

  • 4.8.2 Food Contact Surfaces cleaned and sanitized

  • Picklist

  • 6.1.3 Food and food contact items (non-disposable) stored in appropriate locations

  • Picklist

  • 4.9.1 CRITICAL: No pest activity is observed

  • Picklist

  • 4.9.2 Pest activity prevented through proper sealing of outer openings and elimination of harborage conditions

  • Picklist

  • 4.10.1a CRITICAL: Cross contamination prevented during food storage, preparation, and handling

  • Picklist

  • 4.10.1b CRITICAL: Jamba Approved Produce Wash is used and maintained properly

  • Picklist

  • 4.11.1 Products stored first in, first out or based on manufacturer's dating

  • Picklist

  • 4.12.1 CRITICAL: Accurate food thermometers are present

  • Picklist

  • 4.16.1a Handwashing sinks are accessible/usable, properly stocked, used only for handwashing, and handwashing reminder signs are present

  • Picklist

  • 4.16.1b CRITICAL: Proper handwashing taking place at appropriate times including at least every 30 minutes

  • Picklist

  • 4.17.1 CRITICAL: Hot and cold water are available at facility

  • Picklist

  • 4.18.1 Back flow prevention present at all sinks (includes if dish sprayer hangs below sink's flood rim)

  • Picklist

  • 4.19.1a CRITICAL: All perishable TCS (Time/Temperature Control for Safety) foods in cold holding are ≤ 41°F

  • Picklist

  • 4.19.1b CRITICAL: Items in hot holding ≥ 140°F

  • Picklist

  • INTERNAL SEE EXTREME CRITICAL: Cash in safe matches safe fund total and/or any variances can be proven accounted for. Include cash total and variances in notes.

  • Picklist

  • INTERNAL SEE CRITICAL: Store Operating Funds pages in FLEX log are properly completed. Safe has sticker reminding of phone scams.

  • Picklist

  • Additional Comments/Notes

Covid

  • JCOV1.1.1 CRITICAL: Straws remain wrapped and are not inserted into smoothies

  • Picklist

  • JCOV1.1.2 CRITICAL: Spoons are never served inside of bowls of oatmeal and/or smoothie bowls

  • Picklist

  • JCOV1.1.3 CRITICAL: All delivery bags of products are sealed and tamper proof; team members are knowledgeable of process

  • Picklist

  • JCOV1.1.4 CRITICAL: Sampling is not taking place

  • Picklist

  • COV1.1.1 INFORMATIONAL ONLY: MIC can explain the process to report a COVID-19 case

  • Picklist

  • COV1.1.2 CRITICAL: Working non-contact thermometer present to check crew member temperature

  • Picklist

  • COV1.1.3 CRITICAL: Pre-Shift Health Screening is in place

  • Picklist

  • COV1.1.4 CRITICAL: All team members are wearing masks, or facial coverings, and are wearing them correctly. Face masks/facial coverings are available.

  • Picklist

  • COV1.1.5 CRITICAL: FOH and door signage for social distancing is in place and dining room social distancing is being practiced where applicable (per local requirements)

  • Picklist

  • COV1.1.6 CRITICAL: Purell FoodService Surface sanitizer and/or KAY Peroxide Multi-Surface Cleaner & Disinfectant is available and used every 30 minutes on high touch points

  • Picklist

  • COV1.1.7 CRITICAL: Hand sanitizer available for guests in the FOH. ALl hand sanitizer must contain at least 60% Alcohol (Isopropanol and/or Ethanol).

  • Picklist

  • COV1.1.8 INFORMATIONAL ONLY: Sanitizer wipes available to provide to guests

  • Picklist

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.