Title Page

  • Conducted on

  • Prepared by

  • Location

Personal Hygiene and Employee Practices

  • Are hand-washing sinks clean, unobstructed, and stocked with soap, paper towels, and hand-washing signage?

  • Are employees properly washing hands?

  • Are employees wearing gloves, cutting gloves, and changing gloves when required?

  • Are employees following the illness, hair restraint, and jewelry policies?

  • Are employees eating, chewing gum, or using tobacco in the department?

  • Are drinks properly covered and stored away from food preparation?

  • Is the department free of personal items?

Sanitation

  • Are food contact surfaces clean to sight and touch, and cleaned using proper methods?

  • Are cleaning and sanitizing solutions maintained clean, properly mixed, and replaced at the proper frequency?

  • Are test strips available and being used?

  • Are thermometers sanitized before and after each use, and stored in a sanitary manner?

  • Are only authorized chemicals being used?

Product Identification and Date Coding

  • Are food and ingredient containers clean, and labeled with an identity?

  • Are food items date marked with a preparation date and an expiration or sell by date?

  • Are store-packaged items properly labeled?

  • Are food items held past the expiration or sell by date?

  • Are all spray bottles and chemical containers properly labeled?

Temperature Control

  • Are food thermometers available and properly calibrated?

  • Are cold foods held and received at 41 degrees F or below?

  • Are foods cooked and re-heated to proper minimum internal temperatures?

  • Are hot foods held at 135 degrees F or above?

  • Are foods cooled using proper methods, and within the required time and temperature parameters?

  • Are perishable foods kept out of temperature control for longer than 30 minutes when processing or stocking?

  • Are foods thawed properly?

  • Are foods stored above fill lines or past the load limits of display cases?

  • Is air flow blocked in refrigeration units?

Preventing Contamination and Cross Contact

  • Are food, utensils, and packaging protected from contamination during preparation, storage and display?

  • Are food and supplies stored at least 6" above the floor?

  • Are chemicals stored away from food, single-service items, and equipment?

  • Is the Allergen Chart present in the department?

  • Is cross-contact of allergens prevented during preparation, storage and display?

Physical Facilities and Equipment

  • Are floors, walls, and ceilings maintained clean?

  • Are non-food contact surfaces maintained clean?

  • Are hand-contact surfaces maintained clean?

  • Are cutting boards, utensils, or pieces of food equipment chipped, heavily scratched, scored, or stained?

  • Are trash cans and compost bins clean and not overflowing?

  • Are drains maintained clean and free of odors?

  • Are coolers and freezers maintained clean and free of odors?

  • Are sales floor and display cases maintained clean?

Logs and Certification

  • Are temperature logs complete, accurate, and maintained on file in chronological order?

  • Are cleaning logs and calendars complete, accurate, and maintained on file in chronological order?

  • Do department managers demonstrate active managerial control and understanding of food safety principles?

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.