Management Restaurant Food Safety Visit Template

• Site

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

Exterior Cleanliness

• Is signage in place, in good repair and clearly visible?

  Yes

  No

  N/A

• Does the landscaping appear to be clean and well maintained?

  Yes

  No

  N/A

• Do the sidewalks appear to be clean and in good condition?

  Yes

  No

  N/A

• Does the building appear to be clean and in good condition? (including windows)

  Yes

  No

  N/A

• Attach photos of location exterior

  Media

Interior Cleanliness

• Are the restrooms clean and stocked? Free of odor? Seats Secure?

  Yes

  No

  N/A

• Are the floors, tables and seating clean and in good condition?

  Yes

  No

  N/A

• Are the trash containers clean and in good condition? Liners tucked? No odors?

  Yes

  No

  N/A

• Is the front counter clean and clutter free?

  Yes

  No

  N/A

• Is all lighting working and in good repair?

  Yes

  No

  N/A

• Is the playground area clean and well maintained?

  Yes

  No

  N/A

• Attach photos of location interior

  Media

Product Observations

• What product(s) did you order?

• Was your order prepared correctly?

  Yes

  No

  N/A

• Yes

  No

  N/A

• Attach photographs of your order

Team Members & Drive-Thru

• Are all employees practicing good hygiene and grooming standards?

  Yes

  No

  N/A

• Are all managers wearing a complete uniform?

  Yes

  No

  N/A

• Are all food handlers wearing gloves?

  Yes

  No

  N/A

• Does this location have drive-thru facilities?

  Yes

  No

  N/A

Drive Thru Experience

• Was the order taker on script and professional?

  Yes

  No

  N/A

• Did the order taker try to up sell?

  Yes

  No

  N/A

• Did you see a smile at the window?

  Yes

  No

  N/A

• Did the employee say thank you?

  Yes

  No

  N/A

• Was a parting phrase used?

  Yes

  No

  N/A

• Was the drive thru time acceptable?

  Yes

  No

  N/A

• What was the drive-thru time? (please record)

Kitchen Cleanliness

• Are the floors, walls and baseboards clean and in good condition?

  Yes

  No

  N/A

• Is all lighting working and in good repair? No bugs, dust or cracked lenses.

  Yes

  No

  N/A

• Is the microwave clean?

  Yes

  No

  N/A

• Are fryer surfaces clean and free of grease build up?

  Yes

  No

  N/A

• Are the fryers clean and free of carbon and grease build up?

  Yes

  No

  N/A

• Is all refrigerated equipment clean and functioning properly? Gaskets, fan guard, shelving, stocked correctly, no expired products.

  Yes

  No

  N/A

• Are all storage areas clean and organized? Box flaps, shelving labeled.

  Yes

  No

  N/A

• Is the prep area and equipment clean and well maintained?

  Yes

  No

  N/A

• Is the break/training area clean and organized?

  Yes

  No

  N/A

Restaurant Safety and Processes

• Are temperature checks being completed as required?

  Yes

  No

  N/A

• Is the cleaning calendar being utilized as intended on a daily basis?

  Yes

  No

  N/A

• Is the communication board set up and used correctly? Is all information up to date?

  Yes

  No

  N/A

• Is cross-contamination not apparent In any stations or storage areas?

  Yes

  No

  N/A

• Are all health inspection violations corrected within 10 days of the citation?

  Yes

  No

  N/A

• Are cookouts and temperature checks Recorded consistently and correctly?

  Yes

  No

  N/A

• Is the restaurant free of any rodent, insect and pest activity?

  Yes

  No

  N/A

• Is the restaurant free of other critical food safety violations? (drains backed up, reverberator screens, all chemicals labeled)

  Yes

  No

  N/A

Comments and Sign-Off

• General comments and findings

• Attach any further media if required

  Media

• Signature

  Sign

• By signing this form you acknowledge the following; that you have reviewed this report with the auditor, that you have 10 days to correct any of the negative findings in this report. Failure to correct negative findings within the specified time will result in disciplinary action up to and including termination of employment.