Information

  • Restaurant Name & Number

  • Conducted on

  • Managers On Duty

  • Prepared by

Manager on Duty

  • Is a manager present on the floor at time of arrival?

  • Select date

  • Does MOD have Food Safety Certification in compliance with local laws?

  • Picture of Food Safety Certification

  • Is Department of Health Inspection folder prepared for inspection?<br>- Thermometer<br>- Sanitizer and Detergent Test Strips<br>- Restaurant Permit<br>- Copies of Food Safety Course Cards/Certificates<br>- Any other materials as required by local laws

Exterior

  • Awnings are clean, set up properly and damage free.

  • Picture of Awnings

  • Sidewalk outside of storefront is swept and free of stains.

  • Picture of Sidewalk/Storefront

  • Windows and door are clean and streak free.

  • Appropriate signage is posted.<br>- Hours of operation<br>- Free Wifi<br>- LPQ App<br>- LPQ Catering<br>- CO2 neutral

  • Picture of Signange

  • Take Away Menu is available at retail counter.

  • Picture of Take-Away Menus

  • A-Frame is in place and posting currents specials.

  • Picture of A-Frame

  • All required permits, postings and inspections are in proper place and up to date

  • Picture of permits

Retail Quality/Service

  • Catering display is up by retail.

  • Picture of catering display

  • Condiment station is fully stocked and clean.

  • Picture of condiment station

  • Retail products on display are cleaned and FIFOed.

  • Picture of retail display

  • Retail blackboards are up to date with correct prices.

  • Picture of blackboards

  • Retail bread is displayed properly. Bread matches proper specifications.

  • Picture of bread display

  • Cold pastry products match proper specifications. Case is fully stocked. Glass is clean and free of streaks/fingerprints.

  • Picture of cold pastry display

  • Bakery products match proper specifications. Display is fully stocked. Glass is clean and free of streaks/fingerprints.

  • Picture of ambient pastry display

  • What time of day is it?

  • Pastries and bread are served to specification in proper packaging.

  • Hot beverages are prepared to spec. Order 2 hot drinks (at least 1 Espresso based). 1 points for each properly prepared beverage.

  • Picture of hot beverages

  • Cold beverages are prepared to specification. Order 2 cold drinks (at least 1 Espresso based). 2 points for each properly prepared beverage.

  • Picture of cold beverages

  • Seasonal beverage is prepared to spec

  • Picture of seasonal beverages

  • Garnishes are prepped to spec and are kept cold on ice?

  • Photo of garnishes

  • Coffee timers are in place and being used.

  • Picture of coffee timers

  • Is espresso machine water filter clean and in good condition?

  • Picture of filter

  • Is espresso machine properly calibrated? <br>- Single Shot of Espresso 16-20 seconds<br>- Double Shot of Espresso 23-27 seconds<br>

  • Is coffee equipment well-maintained? Check cleanliness of all shuttles and espresso machines.

  • Retail batches are prepared to spec, and properly labeled with expiration date. Pars set are sufficient for business. Try lemonade, iced tea, cold brew, and iced green tea. 1 point for each.

  • Wine storage guidelines are being followed. Opened bottles are dated.

  • Retailer Knowledge Book is available for team members.

  • Opening, Mid, and Closing retailer checklist is posted and regularly follwed.

  • Picture of posted checklists

  • Pastry waste log is filled out daily.

  • Picture of waste log

  • FOH team is properly trained on most recent specials. (Briefly quiz team members on duty)

  • FOH team properly trained on core menu item execution. (Briefly quiz team members on duty)

Retail Food Safety

  • Container of sanitizer for steam wand only is near the espresso machines.

  • Steam wand is properly cleaned inside and outside. All holes on the base of the wand produce steam.

  • Walls behind equipment are clean and free of stains. Areas under equipment are free of debris.

  • Two thermometers are present and calibrated in each refrigerator.

  • Beverages (Milk, Juices and batches) are FIFOed, held below 41F, and clearly organized. No products should be expired.

  • Area under coolers is free of debris. Counters are organized and clear of clutter.

  • Baseboards are well maintained.

  • Garbage cans are cleaned inside and outside.

  • Sanitizer solution is at room temperature or cooler. Test strips indicate 150-200PPM. Rags in bucket are completely submerged.

  • Running hot water is available at hand washing sink. Hand washing signs are posted by sink areas. Soap and paper towel dispensers are properly functioning. Trash can is nearby for soiled towels.

  • Ice bin is clean and free of debris. Scoop is held in a separate container.

  • All dry goods are stored at least 6 inches off the ground.

  • All required equipment is properly functioning and cleaned (espresso machines, refrigerators, bread slicer, and coffee brewer)

  • Proper hygiene practices are in place. All team members are wearing hats while working in food service areas. Team members are using gloves when handling ready to eat food. All team members are in full uniform (black pants, black belt, apron, and NON-SLIP SHOES)

Dining Room Service

  • Are there any signs of pests - rodents, insects, or other animals?

  • Dining room chalk board is up to date with most current specials, and soup of he day.

  • Picture of chalk board

  • Tables are set to specification. Oils, vinegar, jams, spreads are available throughout the dining room. Each table has a set of salt and pepper mills as well as sugar dispenser. All condiments are appropriately filled.

  • Picture of communal table

  • Table top chalk boards are used to communicate any current specials.

  • Picture of table top chalk boards

  • Completed dishes in the window are being run in a reasonable time period. Food should not be sitting in the window for more than 1 minute.

  • No outstanding facilities issues. Walls are free of damage and stains. Baseboards are being maintained. Tables and chairs are in good condition.

  • Server Knowledge book is available for team members.

  • Opening, Mid and Closing Server checklists are posted.

  • Picture of Opening, Mid and Closing server checklists

  • Servers have signed credit card receipts on them at all times (not in drawers, cups or anywhere exposed)

Dining Room Food Safety

  • Are there any signs of pests - rodents, insects, or other animals?

  • Sanitizer solution is at room temperature or cooler. Test strips indicate 150-200PPM. Rags in bucket are completely submerged.

  • Table bases are well maintained.

  • Tables are quickly cleared when guests leave. The surface is wiped down with sanitizer solution.

  • Server stations are cleaned, maintained throughout shift and free of personal belongings. Each station is fully stocked with enough silverware, glasses and paper.

  • Picture of server station(s)

  • Silverware is polished. Drawers and cabinets are clear of any food particles. Condiments are wiped down.

  • Dining room floor is clear of debris. Menus look clean and are in good condition.

  • Picture of dining room

Kitchen Quality

  • Cook Position Book is available for team members.

  • Line setup sheet is updated and followed.

  • Picture of line setup sheet

  • AM Prep batch recipes are prepared to specifications, properly labeled with name, expiration date and cook's initials. - Quinoa Taboule - Lentil - Avocado Mash - Kale Mix Quinoa, lentil, and corn salsa are full of herbs. Avocado Mash is green and tastes fresh. Kale mix includes appropriate ratio of carrots, fennel and cucumber halves, looks and tastes fresh. (2 Points for each properly prepped item)

  • Picture of quinoa taboule and lentil batches

  • AM Knife cuts and produce prep are executed to spec. - Cucumber Coins - Cucumber Halves - Radish Coins - Fennel - Parsley Cucumber and radish coins are sliced thinly using a mandolin. Cucumbers for salads are cut in half. Fennel is cut and cored before being shaved. Parsley for garnish is chopped to the appropriate size. (2 Points for each properly prepped item)

  • Pictures of prepped produce items

  • Greens look fresh and washed. - Mesclun - Arugula - Kale Arugula - Kale Kale is cut to thin batons. Kale Arugula is prepared to the proper ratio (3# kale to 2# arugula)

  • PM Produce Knife cuts are prepped to spec. - Lemon Wedge - Scallions - Diced tomatoes - Carrot Ribbons Lemon are cut in 6 wedges. Scallions are thin and fresh. Tomatoes are diced small and cubes are not soft or smushed. Carrot ribbons are thin and almost translucent. (2 points for each properly prepared item)

  • PM Prep is executed per spec. - Quiche Lorraine - Veggie Quiche - Seasonal Frittata - Blue Cheese crumbles Quiches and frittatas are cut to appropriate size. Blue cheese is cut in wedges for boards and sides, and crumbled for salads. (2 Points for each properly prepared item)

  • Garnish Prep is executed to spec. - Figs - Walnuts - Croutons - Dill Figs are small diced. Walnuts are chopped. Croutons are large diced and appropriately toasted. Dill is picked, not chopped. (1 Point per properly prepared item)

  • Core menu items - Check for portion sizes and presentation. (Check 2 tartines, 2 salads, 1 side and 1 soup - 2 points for correct item, 1 point if and ingredient is missing, 0 points if two or more ingredients are missing)

  • Pictures of core menu items

  • Take away tickets are executed under 7 minutes and in proper packaging. (7min or less = 5 points, 7-9 minutes = 4 points, 9-11 minutes = 3 points, 11-13 minutes = 2 points, 13-15 = 1, 15 or greater = 0 points)

  • Dining room tickets are executed under 12 minutes. (12min or less = 5 points, 12-15 minutes = 4 points, 15-17 minutes = 3 points, 17-19 minutes = 2 points, 19-20 = 1, 20 or greater = 0 points)

Kitchen COGS

  • Prep sheets are filled out correctly. Pars set are appropriate for business.

  • Picture of prep sheets

  • Order sheets are up to date and being utilized. Par levels are established and updated frequently.

  • Picture of order sheets

  • Deliveries from production and outside vendors are checked, put away in a timely manner, and FIFOed.

  • Scales are working. Portioning tools are in place and being used.

  • All proteins portioned to correct weights (Turkey 80g, ham 85g, tartine chicken 80g, salad chicken 60g, chicken curry 150g, and salmon 85g. 1 point for each.

Kitchen Food Safety

  • Are there any signs of pests - rodents, insects, or other animals?

  • Sanitizer solution is at room temperature or cooler. Test strips indicate 150-200PPM. Rags in bucket are completely submerged.

  • Soup and oatmeal are held above 140F. Each container has a lid and appropriate tool for service. Oatmeal scoop is held in a separate container.

  • All items are stored at proper temperatures (below 41F and smoked salmon below 38F). Do a line check and check at least 8 cold items.

  • Two thermometers are present and calibrated in each refrigerator.

  • Is walk-in 41F or lower? Check the temperature of 5 ingredients. Is walk-in temperature log in use?

  • Picture of temp log

  • Kitchen is clean and organized. Area under coolers is free of food particles or debris. Counters are clear of clutter.

  • Picture of kitchen line

  • Cutting boards are free of stains and divots

  • All required kitchen equipment is present, properly cleaned, working and maintained. Gaskets on all refrigerators are clean and not torn.

  • Merry Chef is cleaned and properly maintained. Filters are clean and correctly inserted. Oven cleaner and extra silicon pads are available.

  • Picture on merry chef - inside and outside

  • Running hot water is available at hand washing sink. Hand washing signs are posted by sink areas. Soap and paper towel dispensers are properly functioning. Trash can is nearby for soiled towels.

  • Opening, Mid and Closing checklists are posted.

  • Picture of checklists

  • Egg temperature logs are being filled out every hour during peak times. Sous Vide is set to 143.5F.

  • Picture of egg temperature logs

  • All Daily Book temperature logs are completed for AM and PM daily. (Retail, kitchen and Grab&Go)

  • Picture of today's pages in daily book

  • Allergen policy is posted and followed (Quiz or drill with an order)

  • Dishwasher is working properly with temperature and ppm reading correctly. Machine and area cleaned and maintained properly. Testing strips are available for use. Smallwares cleaned and sanitized for business needs.

  • Garbage cans and dust pans are clean, and free of debris or standing water.

  • Cleaning supplies are stored properly and away from food.

  • Dry goods are stored at least 6 inches off of the ground.

  • Proper hygiene practices are in place. All team members are wearing hats while working in food service areas. Team members are using gloves when handling ready to eat food. All team members are in full uniform (black pants, black belt, apron, and NON-SLIP SHOES)

  • All pest control products are approved and provided by pest control company.

  • KM/LKS has food safety certification as required by local health laws?

Dry Storage/Walk-In

  • Are there any signs of pests - rodents, insects, or other animals?

  • Ice machine is clean inside and out. Filter has been changed recently and dated. Ice scoop is held in a separate container outside of the machine.

  • Picture of ice machine set up

  • No expired products can be found in the walk-in, storage areas, or kitchen.

  • Food storage is zoned correctly. (Ready to eat foods on top shelves, proteins and any uncooked eggs on bottom shelves). Shelves organized using FIFO and grocery store method. Floor is clean and free of debris.

  • Picture of walk-in refrigerator

  • Shelves in the walk-in are maintained, free of rust or mold.

  • Mop sink is well maintained. Mops look clean and regularly changed out.

  • Picture of mop sink

  • Cleaning supplies are stored properly

  • Picture of cleaning supplies

  • All boxes are stored 6 inches off the ground. Area is cleaned and organized.

  • Picture of dry storage

Team Member Areas

  • All personal belongings are stored properly and off of the floor.

  • Picture of employee lockers/shelves

  • Break area is clear of any leftover food or dirty dishes.

  • Picture of employee break area

Bathrooms and Facilities

  • Running hot water is available at hand washing sink. Hand washing signs are posted by sink areas. Soap and paper towel dispensers are properly functioning. Trashcan is nearby for soiled towels.

  • Bathrooms are clean, regularly checked, and fully stocked with necessary paper.

  • Picture of guest bathrooms

  • Bathroom Log is in Place and filled out every 30 minutes?

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.