Information
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Document No.
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Conducted on
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Prepared by
Purpose
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Investigation
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Follow-Up
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Complaint
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Regular
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Other
Site Information
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Establishment
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Location
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Supervisor
Food
FOOD
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Laboratory results of previous sampling
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72 hours retention of food samples
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Source: Sound Condition. No spoilage
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Original container properly labeled
Food Protection
FOOD PROTECTION
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Potentially hazardous food meets temperature requirements during storage, preparation, display service, transportation (7C or below/ or 62C or above). Food cooked to proper temperature.
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Facilities to maintain product temperature
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Thermometers provided and conspicuous
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Potentially hazardous food properly thawed
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Unwrapped and potentially hazardous food not reserved
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Food protection during storage, preparation, display, service, transportation
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Handling of food (ice) minimized
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Fruits and vegetables washed & disinfected thoroughly
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In use food (ice) dispensing utensils properly stored
Personnel
PERSONNEL
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Personnel with infections restricted
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Hands washed and clean, good hygienic practices, disposable gloves used
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Clean clothes, hair restraints
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Food handlers authorization cards
Food Equipment & Utensils
FOOD EQUIPMENT & UTENSILS
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Food (ice) contact surfaces designed, constructed, maintained, installed, located
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Non-food contact surfaces designed, constructed, maintained, installed, located
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Dish washing facilities designed, constructed, maintained, installed, located, operated
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Accurate thermometers
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Pre-flushed, scraped, soaked
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Wash, rinse water, clean, proper temperature
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Sanitation rinse: clean, temperature, concentration, exposure time, equipment, utensils sanitized
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Wiping cloths: clean, stored, restricted
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Food contact surfaces of equipment and utensils clean, free of abrasives, detergents
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Non-food contact surfaces of equipment and utensils clean
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Storage, handling of clean equipment/utensils
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Single-service articles storage, dispensing, used
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No re-use of single-service articles
Water
WATER
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Ware source safe: hot and cold under pressure
Sewage
SEWAGE
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Sewage and waste water disposal
Plumbing
PLUMBING
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Installed, maintained
Toilet & Handwashing Facilities
TOILET and HANDWASHING FACILITIES
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Number, convenient, accessible, designed, installed
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Toilet rooms enclosed, self closing doors, fixtures, good repair, clean, hand cleanser, sanitary towels/ tissue/hand drying devices provided, proper waste receptacles
Garbage & Refuse Disposal
GARBAGE and REFUSE DISPOSAL
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Containers or receptacles covered, adequate number, insect/rodent proof, frequency, clean
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Outside storage area enclosures properly constructed, clean, controlled incineration
Insect, Rodent, Animal Control
INSECT, RODENT, ANIMAL CONTROL
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Presence of insect/rodents- outer openings protected, mo birds or animals
Floors, Walls & Ceilings
FLOORS, WALLS, CEILINGS
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Floors constructed, drained, clean, good repair, covering installation, dustless cleaning methods
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Walls, ceiling, attached equipment, constructed, good repair, clean surfaces, dustless cleaning methods
Lighting
LIGHTING
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Lighting provided as required, fixtures shielded
Ventilation
VENTILATION
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Rooms and equipment vented as required
Dressing Rooms
DRESSING ROOMS
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Rooms clean, lockers provided, facilities clean, located, used
Other Operations
OTHER OPERATIONS
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Necessary toxic items propyl stored, labelled, used
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Premise maintained, free of litter, unnecessary articles, cleaning maintenance equipment properly stored, authorized personnel
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Complete separation from living/sleeping quarters, laundry
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Clean soiled linen properly stored
