Title Page
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Conducted on
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Prepared by
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Location
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Food Safety Self Assessment
Food Safety Self Assessment
1. General
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1-1. Manager Certification: Restaurant Manager and PIC (Person in Charge)/Team Leader has received food protection management certification.
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1-2. General Policies & Knowledge Check: All required job aids, standards, and policies are visible. PIC has demonstrated knowledge of procedures and systems
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1-3. Health department Inspection & Failed FSA: All noted deficiencies and corrective actions have been addressed on the most recent health department report and on the most recent failed FSA. PIC can demonstrate knowledge of health inspection procedure.
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1-4. FS Checklist: Daily Food Safety checklist completed, thermometer calibration completed, and corrective actions taken.
2. EMPLOYEE HEALTH & HYGIENE
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2-1. Illness: Food handlers have no obvious signs of illness / not working when sick or with infected or open wounds. Illness policy visibly posted and can demonstrate knowledge of policy.
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2-2. Personal Items: Eating, drinking, smoking, gum-chewing, and personal items are not allowed at workstations and are kept separate from food and beverage areas.
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2-3. Personal Hygiene: All restaurant employees follow dress code requirements.
3. PEST CONTROL
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3-1. Pest Prevention: Restaurant Manager effectively controlling pests.
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3-2. Pest Activity: The restaurant is free of signs of pest activity.
4. HAND WASHING/HAND SINKS
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4-1. Hand washing Sinks: Hand washing sinks in kitchen areas are available, accessible, working, and properly set up.
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4-2. Hand washing Procedures: All employees are observed washing hands properly and only in designated hand washing sinks.
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4-3. Glove Usage: Employees are properly using disposable gloves.
5. FOOD RECEIVING & STORAGE
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5-1. Receiving: Evidence of food receiving to standard – Temperatures, condition, receiving and storage procedures to standard.
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5-2. Expired Products: No TCS expired products/ingredients are noted.
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5-3. Using Approved Food & Beverage: PIC can describe the correct procedure to purchase foods.
6. CONTAMINATION PREVENTION
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6-1. Storage: Food & Packaging: Adequately covered, RTE foods stored over raw foods.
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6-2. Contamination: Food & Packaging
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6-3. Washing Produce: Fruits and vegetables are properly washed before use.
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6-4. Lighting: Lighting is adequate and all lights are clean and properly shielded or shatterproof.
7. TEMPERATURE CONTROL/STORAGE
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7-1. Food Thermometers: Are available, operational and accurate; employees can demonstrate the proper procedure to calibrate and use the instrument.
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7-2. Equipment Thermometers: Are present, functional and located in the warmest part of the refrigerator or freezer unit (near door). Equipment is functioning properly.
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7-3. Product Temperatures: TCS foods in walk-ins and POUs are at a temperature of 41oF (5°C) or below, and frozen foods are at a temperature of 20°F (or -6°C) or below. Time of TCS foods effectively monitored during prep and thaw.
8. TEMPERATURE CONTROL PREPARATION/STAGING
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8-1. TPHC: Approved time as a public health control (TPHC) procedures are followed.
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8-2. Hot Holding: TCS foods are held at a temperature of 135oF (57oC) or above.
9. COOKING TEMPERATURE
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9-1. Cooking: Required cooking time procedures for TCS foods are followed.
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9-2. Final Flip and Check: JIB final flip visual check followed.
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9-3. Temperature Taking: Employee can independently and without Coaching demonstrate the correct procedure to take the temperature of a food item and grill. PIC has knowledge of proper internal cooking temperatures.
10. CONDITION: NON-FOOD CONTACT
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10-1. Condition: Non-Food Contact Surfaces: Floors, walls, ceilings and other non-food contact surfaces are properly constructed and in good condition.
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10-2. 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 than 1/4”.
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10-3. Cleaning Tools: Mops, brooms and cleaning tools are properly stored.
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10-4. Back Flow Devices & Prevention: All devices (i.e. drain, air gap, vacuum breaker, etc.) are installed and working properly to prevent back siphonage or standing water in floor sinks.
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10-5. Condition: Refrigerators and Freezers: Walk-In and POU Refrigerators and Freezers are in good repair and condition. Observe water/leaks/condensation, and check gasket condition, shelving, fan, and fan guards.
11. CLEANLINESS: NON-FOOD CONTACT
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11-1. Clean: Refrigerators & Freezers: Walk-In and POU Refrigerators and Freezers are clean, dry, and free of odor. Fans and gaskets clean.
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11-2. Waste Receptacles: Waste receptacles indoors and outdoors, are present, durable, insect/rodent resistant, leak proof, lined, maintained clean.
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11-3. Clean: Non-Food Contact Surfaces: Floors, floor drains, walls, ceilings and other non-food contact surfaces are CLEAN and kept free of an accumulation of dust, dirt, food residue, and other debris.
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11-4. Dumpsters: Dumpsters, trash compactors and grease bins/containers are maintained, clean, closed, and in good repair. Surrounding areas are maintained and clean.
12. CONDITION AND CLEANLINESS: FOOD CONTACT
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12-1. Condition: Equipment/Smallwares/Utensils: Tools, utensils, smallwares and equipment are commercial grade and in good condition to ensure clean-ability and minimize risk of physical contamination.
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12-2. Clean: Equipment/Smallwares/Utensils: Tools, utensils, smallwares, equipment and food-contact surfaces are clean and stores properly.
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12-3. Ice Machines: Are clean inside and out; in good repair, buckets and scoops are properly stored in a sanitary manner.
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12-4. Beverage Dispensers: Are clean and free of soil and mold buildup.
13. SANITIZER/CHEMICALS
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13-1. Chemicals Labeled: All chemical containers labeled.
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13-2. Dish Washing: 3-Compartment sinks and dish washing machines are properly maintained, with appropriate soap/sanitizing agents and adequate hot and cold running water, and is being used to clean and sanitize properly. Test strips are available to test sanitizer concentration.
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13-3. Sanitizer Containers: Are properly used and stored, sanitizer at proper concentration.
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13-4. Approved Chemicals: Only approved chemicals are present, stored, and used properly in the restaurant.
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13-5. PIC Bodily Fluids Cleanup: PIC can describe correct procedure or show written procedure and respond to properly clean areas exposed to vomit, blood or diarrheal events in the restaurant.
14. IMMINENT HEALTH HAZARDS
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14-1. Imminent Health Hazards: Restaurant is free of any imminent health hazards while operating.
15. APPEAL
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15-1. FSA Appeal: Does the PIC have any question results they wish to appeal?
