Title Page

  • Store Number

  • Conducted on

Facility

  • 1. Restaurant MUST have hot water.

  • 2. Toilets drains, and sink must not be overflowing or be backed up.

  • 3. Sanitizer and sanitizer test strips MUST be available inside the store.

  • 4. All 3 sanitizer buckets are at 150-400ppm.

  • Did you correct the violation?

  • 5. NOTHING on the floor, including water.

  • Did you correct the violation?

  • 6. There are NO rodent or pest activity/droppings.

  • 7. Flies cannot be touching food and food contact surfaces.

  • 8. All handsinks are functional, accessible, and fully stocked with paper towels and hand soap.

  • Did you correct the violation?

  • 9. Chemicals stored away from food and food contact surfaces.

  • Did you correct the violation?

  • 10. Chemicals are properly labeled and/or with common name.

  • Did you correct the violation?

  • 11. Dumpster area is free of debris, lids covered, and gates closed.

  • 12. FOH and BOH trash bins are not overflowing.

  • Did you correct the violation?

  • 13. Walk-in cooler and Walk-in freezer doors must have door sweep attached and in good condition.

  • 14. All ceiling vents must be clean and free of dust.

  • 15. Floors must be clean and free of debris and water.

  • 16. All drains must be clean. Drains must have at least 1 inch air gap.

Associates

  • 1. Open wound is covered with band-aid and disposable glove.

  • Did you correct the violation?

  • 2. Hands are washed before starting/returning to work, when switching tasks, after touching body, after eating, after drinking. (20 seconds handwashing)

  • Did you correct the violation?

  • 3. Associates are wearing hair net/restraint.

  • Did you correct the violation?

  • 4. Associates are wearing non-slip/oil resistant shoes.

  • 5. Back of House associates are wearing safety belt

  • 6. Associates are in good health; no unprotected coughing or sneezing, discharge from eyes, nose, or mouth.

  • 7. Associates eating or drinking in designated area.

  • 8. Drinks MUST be stored in designated area with LID and STRAW.

  • Did you correct the violation?

FOH Service Area

  • Hot holding food are held at 140F or higher.<br>*Medium: 126F - 139F<br>*High: 60F - 125F

  • What is the temperature?

  • What is the temperature?

  • Temperature Log are filled daily 3 times a day and not falsified.

  • Sanitizer towel MUST be stored in sanitizer bucket when not in use.

  • Teriyaki Chicken knife and cutting board are cleaned every 2 hours

  • Serving spoons/tongs/spoodle handles are NOT buried/touching food.

  • Serving spoons/tong/spoodle storage container is free of debris.

  • Did you correct the violation?

  • All food containers, lids, and serving utensils are faced down. (To-Go boxes, bowls, ala carte boxes, etc)

  • Food contact containers or surfaces are not on the floor.

  • Both white rice holder and brown rice cooker/holder are clean and in good condition. Plugged in outlet.

  • Drink station is free of mold, mildew, or food debris.

  • Nothing on floor, including water.

Drink Stations

  • Soda nozzles are clean daily and free of mold, mildew, or build-up.

  • Ice dispenser/machine are clean and free of mold, mildew, or build-up.

  • Did you correct the violation?

  • Drink stations are clean and free of mold, mildew, or build-up.

  • Did you correct the violation?

  • Tea brewer, parts, and equipment, are clean and free of mold, mildew, or build-up.

  • Did you correct the violation?

Kitchen Area

  • Nothing on floor, including water.

  • All cooked food meets final cooking temperature of 165F or higher.

  • Did you correct the violation?

  • All condiments on cook line must have date/day dot not exceeding 3 days.

  • All cooking surfaces are be cleaned after each use, no food debris or build up on wok ranges. Grease build up under the cooking range.

  • Towels at cooking range are DRY at all times.

  • Did you correct the violation?

  • All hoods and vents, light covers and ansul tip covers/stems are clean. No hood filter gaps greater than 1 inch.

  • Metal scrubbies are in good condition

  • Did you correct the violation?

  • Cold holding foods are held at 41F or less.<br>*Medium 42F - 59F<br>*High 60F - 125F

  • What is the temperature?

  • What is the temperature?

  • All reach-in cooler and reach-in freezer have a designated thermometer.

  • Gaskets are clean and in good condition.

  • All cold holding food have a day dot, not exceeding 3 days for meats and not exceeding 7 days for veggies.

  • Did you correct the violation?

  • Weight scales are clean and free of debris.

  • Did you correct the violation?

  • Raw meat scoops and weight bowls are clean. Scoops are stored in bowl.

  • All food items are stored following FIFO:<br>Ready-to-Eat<br>Shrimp<br>Beef<br>Chicken

  • Did you correct the violation?

  • Grill station has a dedicated thermometer at the station.

  • Did you correct the violation?

  • Teriyaki chicken is temped in four different areas per piece prior to serving.

  • Did you correct the violation?

  • Grill, grill press and grill equipment are clean and in good condition.

  • All deep fried items are being "actively cooked".

  • Fryer items are temped to 165F when cooking in fryer is completed.<br>*Medium 121F - 134F<br>*High 120F or under

  • What is the temperature?

  • What is the temperature?

  • Fryer baskets are in good working condition.

  • Unit is clean and free of oil build-up, including inside of fryer, fryer door, and under the fryer.

  • Rice cooker pot, rice cooker lid, rice scooper, and rice fork are cleaned after each batch.

  • Rice pans in the rice cabinet are held at 140F or above.

  • Rice pans have time dots and lids.

  • Rice cabinet gasket are clean and in good condition.

  • Rice cabinet is cleaned daily and free of food debris. Hot water added daily.

  • Rice pans in use is FIFO. Oldest at the top, Newest at the bottom

Prep Area and Dishwashing Area

  • Nothing on the floor, including water.

  • All items must be stored at least 6 inches off the floor.

  • Food prepped ONLY in 2 Compartment Prep Sink area.

  • Prep sinks are being washed (soapy water), rinsed, and sanitized before and after each use.

  • All produce are washed before prepping.

  • Boxes are folded down and not on floor.

  • Food slicer machine is cleaned after each use. No food debris. Covered when not in use.

  • Cut cabbage is only out for a maximum of 2 hours. Place in freezer for 5 minutes to reach desired temperature.

  • NO EMERGENCY MEAT THAWING. Proper thawing is being followed by sales volume.

  • Cutting gloves are being worn when prepping including when using slicer machine.

  • Cutting boards must be cleaned and sanitized after each use and in good condition.

  • Cutting mat in use and in good condition. NO rags being used as a cutting mat.

  • Sugar, K-starch, brown rice, and white rice cart are clean and in good condition. FIFO is followed. Labels for each item are visible and easy to read.<br>*No measuring cups inside

  • Knives and Knife holder are clean and in good condition. No debris or build-up.

  • Sanitizer solution is between 150-400ppm.

  • No wet nesting. Dishes must be air dry.

  • All dishes and items must be stored upside down.

  • All clean utensils and containers must be free of debris, water, date/day dot, residue, or build-up.

  • Shelves, 3 compartment sink, microwave, and wall must be clean and free of build-up, mold, mildew, or food debris. Must be in good condition.

  • Nothing on the floor, including water.

  • Microwave is clean and free of debris inside and out and in good working condition.

  • Chow Mein noodles in the microwave for >2 minutes

  • Soda racks are clean, free of debris, or mold. No leaks or or build-up.

  • No dented cans.

Walk-in Cooler

  • Nothing on the floor, including water.

  • All products are held at 41F or below. Must have dedicated thermometer inside of walk-in cooler. Note: Do not use fixed thermometer outside of the door.<br>*Medium 42F - 59F<br>*High 60F - 125F

  • What is the temperature?

  • What is the temperature?

  • All products are stored at least 6 inches off the floor.

  • All food are stored following FIFO:<br>Ready-to-Eat<br>Shrimp<br>Beef<br>Chicken

  • All containers are in good condition with date dots. No cracked lids or containers.

  • Shelves and gasket must be clean and free of build-up, mold, mildew, or food debris. Must be in good condition.

  • Lights are in good working condition and protected by a light shield.

  • Fan cover must be clean and free of mold, mildew, or build-up.

  • Air curtain is fully covering the doorway, clean, and in good condition.

  • Employee meals are inside a dedicated container with day dot and is stored below bottom shelf.

  • Door handles are clean and no build-up. Door gasket must be in good condition.

Walk-in Freezer

  • Floor is clean and free of debris.

  • Employee meals are inside a dedicated container with day dot and is stored below bottom shelf.

  • All products are stored at least 6 inches off the floor.

  • All food are stored following FIFO:<br>Ready-to-Eat<br>Shrimp<br>Beef<br>Chicken

  • Shelves and gasket must be clean and free of build-up, mold, mildew, or food debris. Must be in good condition.

  • Lights are in good working condition and protected by a light shield.

  • Fan cover must be clean and free of mold, mildew, or build-up.

  • Air curtain is fully covering the doorway, clean, and in good condition.

  • Employee meals are inside a dedicated container with day dot and is stored below bottom shelf.

  • Door handles are clean and no build-up. Door gasket must be in good condition.

Restrooms

  • Toilet and sink is working and in good condition. Not clogged or backed up.

  • Toilet paper, paper towel, and hand soap is fully stocked.

  • Employee handwashing signage is visible and easy to read.

Chemical Storage/Closet

  • Chemicals are labeled and stored in approved container with approved lid. No cracked containers/lids.

  • Chemicals are stored below everything.

  • Restroom caddy/bucket is stored in bottom shelf or above chemical shelf away.

Sign Off

  • Inspector's Name & Signature

  • GM/ACO Name & Signature

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.