Title Page

  • Client / Site

  • Conducted on

  • Prepared by

  • Location

Customer Area

Exterior of the Store

  • Drive Thru Lane

  • Drive thru menu boards/speakers are clean

  • Drive thru lane does not have trash/cigarettes on ground

  • Drive thru window area clean

  • Drive thru window is closed when no cars are in queue

  • Drive thru trash can is not overflowing

  • Drive thru menu boards in good repair

  • Dumpster/Trash Area

  • External recycling/compost bins present and in use or curbside pickup used where applicable

  • Entrance and patio of the Store

  • Doors/Windows below 12 feet clean

  • Exterior door is not left open without air curtain operating

  • Sidewalk/patio have no recent spills/no excessive trash on the ground

  • Trash can(s) are not over flowing

  • Tables/chairs are clean and in good repair

  • Planters are clean and in good repair

  • Umbrellas clean and in good repair, locked into place

  • Building awnings/soffit in good condition/not weathered

  • Exterior walls in good repair

  • Landscaping clean and in good condition

Café: Entrance and Customer

  • General Cleanliness and Condition

  • Walk off mat clean

  • Walk off mats in good repair

  • Door threshold is clean

  • Doors are in good repair and rodent proof

  • No Smoking signage posted at all customer entrances (leading outdoors) (NA - CA, FL, CO)

  • Café ledges clean and windows below 12 feet are clean

  • Windows above 12 feet clean

  • Café Ceiling/Ducting/Lighting/Vents below 12 feet clean and lights are not out or missing

  • No dust build up/splatter on ceiling/vents/lighting in FOH above 12 feet

  • No lighting burned out at or above 12 feet

  • Café chairs/tables/lamps clean and in good repair

  • Café floor fixtures (baskets/newspaper stands/black apron rack) are clean

  • Café retail shelving clean

  • Retail shelving not damaged

  • Food

  • Retail packaged coffee within code date

  • Ambient pre-packaged RTE food within code date (Madelines date coded)

  • Recycling/Compost Bins

  • Customer recycling and/or compost bin is present near the condiment bar or entrance with dividers and appropriate bags, where applicable (Bags: blue=recycling, green=compost, clear=trash)

Restrooms

  • Fixtures and condition

  • Restroom fixtures clean (Hand sink / faucets/toilet/mirror/air fresheners/handrails/baby changing table)

  • Restroom faucets/drainpipes are not dripping/secure/free of damage/scald guard present

  • Approved soap/paper towel dispensers properly stocked and working

  • Soap is not stored in caramel bottle/syrup bottle at hand sink

  • Handwashing signs are present at hand sinks

  • Hand sink(s) have warm water 100-120 °F (38-49 °C)

  • Restroom fixtures are in good repair and free of graffiti (Handsink /faucets / toilet / mirror/ baby changing table/doors)

  • Paper towel/soap/toilet paper dispensers/sconce shade/garbage cans are in good repair and free of graffiti

  • Toilet tissue is loaded into the dispenser and not available to customers outside of the dispenser.

  • No odor present

  • General Cleanliness

  • Restroom ceiling/lighting/walls in good repair with no graffiti present

  • No Smoking signage posted in restrooms where required (NYC & NM)

  • Food/food contact equipment not stored in restroom

  • Floor/Walls/Ceiling

  • Floors are free of excessive crumbs/trash/debris

  • Floors are free of dark encrusted build-up

  • Floors/cove molding/concrete in good repair

  • Trash cans not overflowing

  • Ceiling/Lighting/Vents below 12 feet maintained clean and no lights are out/missing

  • Ceiling is free of water damage and chipped paint/paint repair color matches

Condiment Bar

  • General Cleanliness and Condition

  • Condiment bar is free of excessive spills

  • No build up under napkin holders/in trash cabinet/under trash ring/under sugar/sweetener pack container

  • No encrusted buildup in sugar/sweetener pack container

  • Condiment/stir stick containers clean

  • Cabinet with trash can is clean

  • Smallwares

  • Condiment bar shaker tops are not dented or otherwise damaged

  • All condiment bar shaker(s) labeled

  • Condiment bar shakers/carafes labels are not peeling/worn/not readable

  • Condiment bar shakers/Carafes are not visibly dirty

  • Condiment bar carafes are not chipped/scratched/dented or otherwise damaged

  • Condiment bar carafes do not have adhesive buildup

  • Condiment bar bulk sugar container labeled

  • Food

  • Condiment bar packages within code date and open packages dated vanilla/chocolate/cinnamon/nutmeg

  • Food items stored protected, approved food covering used (indicate product improperly stored)

  • Food contact items properly stored

  • All Carafes are <41°F (Canada 40°F/4°C)

Pastry Case Station

Pastry Case

  • General Food Safety

  • Ambient pre-packaged RTE food within code date at the POS

  • All products within the pastry case have signage

  • Allergen Signage present in pastry case

  • Warming display sticker present For Display Only

  • Non-PHF RTD within code date

  • Sandwiches/Boxes/Salads/Fruit Cups/Yogurt Parfaits within expiration date

  • Product is not stored over front vents in the RTD&E case

  • Stored multi-day pastries dated and within code date

  • Food items stored protected, approved food covering used (indicate product improperly stored)

  • Butter/Cream Cheese are not stored at room temperature in the upper portion of the pastry case

  • Potentially hazardous samples are actively sampled and not left at room temperature

  • No product above 41°F (Canada 401/4°C) in RTD/E case

  • Equipment and Smallwares

  • Pastry tongs are free of multiple dried on product build up

  • In-use tongs stored in a clean designated container

  • External rear grill area (vent/condenser coils) and filter cover clean/free of dust

  • No damaged shelves, broken pieces

  • Internal lighting working in case

  • Pastry cart clean/free of dust

  • Baskets on front of pastry case are clean and free of crumbs

  • Thermocouple present in the store/working/in good repair/calibrated (Sandwich stores only) (Critical)

  • General Cleanliness

  • Top portion of the pastry case clean and free of crumbs

  • Floor/Walls/Ceiling

  • Floors are free of excessive crumbs/trash/debris (including under refrigerators and cabinetry)

  • Floors are free of dark encrusted build-up (including under refrigerators and cabinetry)

  • Floors/cove molding/concrete in good repair

  • Trash/Recycling/Compost cans not overflowing

  • Recycling and/or compost bins are present where applicable and have appropriate bags and labels on designated bins and/or cabinet doors (Bags: blue=recycling, green=compost, clear=trash)

  • Cabinet doors/drawers/hinges/facings/handles in good repair

  • Cabinets are free of water damage/rot and no bare wood exposed

  • Cabinets and drawers clean

  • Countertops (including under equipment) clean

  • Countertops have no peeling stickers/adhesive residue on counter

  • Countertops sealed to wall/splash guard juncture/horizontal gaps

  • Countertops not excessively worn/damaged/pitted and facings in good repair

  • Signage clean

  • Walls clean

  • Walls free of bare wood/exposed dry wall/covering are secure and intact/chipped paint/holes

  • Ceiling/Lighting/Vents below 12 feet maintained clean and no lights are out/missing

  • Ceiling/Lighting/Vents at or above 12 feet maintained clean and no lights are out/missing

  • Ceiling is free of water damage and chipped paint/paint repair color matches

REFRIGERATORS, FREEZERS and CHILLED CASES

  • Thermometer located in front of case or refrigerator

  • Thermometer does not have any breaks or gaps in the red "gauge" line /All broken thermometers removed from the equipment

  • Refrigerator/food case is not above 41°F (Canada 401/4°C)

  • Refrigerator is clean (shelves/fan guards/ interior/exterior/floor)

  • Refrigerator shelves/door free of damage

Warming Station

  • Smallwares

  • For-here cups and plates are not chipped/cracked

  • For-here serveware stored clean

  • Cutlery free of rust and not bent

  • Warming tongs/knives are free of multiple dried on product build up

  • In-use tongs stored on a clean cutting board or other clean surface

  • Utensil holder not rusting/in poor repair

  • Cutting boards are free of visible dried build up in grooves

  • Food contact items are from an approved source and food grade

  • Silverware/unwrapped plasticware stored handles up

  • Silverware/ unwrapped plasticware not Stored with handles in multiple directions if laid flat

  • Silverware/ plasticware stored in clean container

  • Plexi cubes not cracked/chipped

  • In use plexi cubes are clean

  • Oven

  • Warming oven interior/hinges/back of oven clean/under tray

  • Warming oven exterior/vents clean

  • Oven tray is not cracked/chipped

  • Food

  • Non-PHF food within code date

  • PHF foods within code date

  • Food items stored protected, approved food covering used (indicate product improperly stored)

  • Food contact items properly stored

  • Floor/Walls/Ceiling

  • Floors are free of excessive crumbs/trash/debris (including under refrigerators and cabinetry)

  • Floors are free of dark encrusted build-up (including under refrigerators and cabinetry)

  • Floors/cove molding/concrete in good repair

  • Trash/Recycling/Compost cans not overflowing

  • Recycling and/or compost bins are present where applicable and have appropriate bags and labels on designated bins and/or cabinet doors (Bags: blue=recycling, green=compost, clear=trash)

  • Drains clean/no strong odors present

  • Cabinet doors/drawers/hinges/facings/handles in good repair

  • Cabinets are free of water damage/rot and no bare wood exposed/no cabinet built over drain with no access

  • Cabinets and drawers clean

  • Countertops (including under equipment) clean

  • Shelving not damaged in cabinetry

  • Countertops have no peeling stickers/adhesive residue on counter

  • Countertops sealed to wall/splash guard juncture/horizontal gaps

  • Countertops not excessively worn/damaged/pitted and facings in good repair

  • Sink/ice bin/drain pan sealed to counter top

  • Signage clean

  • Walls clean including behind oven (free of grease & splatter)

  • Walls free of bare wood/exposed dry wall/covering are secure and intact/chipped paint/holes

  • Ceiling/Lighting/Vents below 12 feet maintained clean and no lights are out/missing

  • Ceiling/Lighting/Vents at or above 12 feet maintained clean and no lights are out/missing

  • Ceiling is free of water damage and chipped paint/paint repair color matches

  • No ceiling tiles missing/dislodged, sprinkler rings not missing

REFRIGERATORS, FREEZERS and CHILLED CASES

  • Thermometer located in front of case or refrigerator

  • Thermometer does not have any breaks or gaps in the red "gauge" line /All broken thermometers removed from the equipment

  • Refrigerator/food case is not above 41°F (Canada 40°F/4°C)

  • Product temperature is at or below 41°F (Canada 40°F/4°C)

  • Refrigerator is clean (shelves/fan guards/ interior/exterior/floor)

  • FOH Refrigerator gaskets clean and not damaged (ordered/replaced by store)

  • Refrigerator shelves/door free of damage

Brewing Station

Brewing Station/Backline

  • Fixtures and condition

  • Faucet fixtures secure/free of damage/not dripping (including drainpipes)

  • Sink/faucet is clean

  • Sink/drain pan sealed to counter top

  • Equipment

  • Coffee Brewer maintained clean

  • Coffee warmers maintained clean

  • Coffee grinder and scale maintained clean

  • Bunn membrane discolored or damaged

  • Clover machine maintained clean

  • Smallwares

  • Spoodle/coffee scale scoop clean and free of chips/dents

  • Spoodle stored in a clean designated storage container

  • Tea tongs are stored in a clean designated storage container

  • 8 qt. cubes/lids are free of adhesive build up/stains/scratches/chips

  • Coffee filters stored covered and protected

  • Food contact items not stored under dripping condensate or sewage lines

  • Food contact items are from an approved source and food grade

  • Stored smallwares are clean

  • Clean smallwares stored covered/inverted/on a clean surface

  • Clean smallwares stored separated from non -food related items

  • Unpackaged cups/lids are stored inverted and in plexi cubes

  • Plexi cubes not cracked/broken/no peeling tape

  • In use plexi cubes are clean

  • Single use cups/lids/reusable cups are free of splash/splatter and stored away from splash range of sinks

  • Exposed lids store sip side up

  • Sample cups stored protected

  • Pour Over Brewing smallwares are clean and free of damage

  • Pour over brewing coffee scoop stored in clean designated container

  • Airpots not chipped/excessively dented

  • Airpots labeled

  • Clover whisk and scraper clean, stored properly

  • Coffee

  • Ground coffee and whole bean coffee stored protected

  • Ground coffee for pour over dated

  • Tea and whole bean coffee (including 5 pound bullets) is dated and within code date

  • Food

  • Food items stored protected, approved food covering used (indicate product improperly stored)

  • Food items not stored under dripping condensate or sewage lines (specify location)

  • Floor/Walls/Ceiling

  • Floors are free of excessive crumbs/trash/debris (including under refrigerators and cabinetry)

  • Floors are free of dark encrusted build-up (including under refrigerators and cabinetry)

  • Floors/cove molding/concrete in good repair

  • Trash/Recycling/Compost cans not overflowing

  • Recycling and/or compost bins are present where applicable and have appropriate bags and labels on designated bins and/or cabinet doors (Bags: blue=recycling, green=compost, clear=trash)

  • Drains clean/no strong odors present

  • Cabinet doors/drawers/hinges/facings/handles in good repair

  • Cabinets are free of water damage/rot and no bare wood exposed/no cabinet built over drain with no access

  • Cabinets and drawers clean

  • Countertops (including under equipment) clean

  • Shelving not damaged in cabinetry

  • Countertops have no peeling stickers/adhesive residue on counter

  • Countertops sealed to wall/splash guard juncture/horizontal gaps

  • Countertops not excessively worn/damaged/pitted and facings in good repair

  • Signage clean

  • Walls clean

  • Walls free of bare wood/exposed dry wall/covering are secure and intact/chipped paint/holes

  • Ceiling/Lighting/Vents below 12 feet maintained clean and no lights are out/missing

  • Ceiling/Lighting/Vents at or above 12 feet maintained clean and no lights are out/missing

  • Ceiling is free of water damage and chipped paint/paint repair color matches

  • No ceiling tiles missing/dislodged, sprinkler rings not missing

CBS Station

Cold Beverage Station

  • General Cleanliness and Condition

  • Sure Shot FMD is not above 41° F (Canada 407/4°C)

  • Blender(s)/housing clean

  • Blender shroud free of cracks or pieces missing

  • Blender Pitcher Rinser (BPR) clean including underside/no major leaks

  • Smallwares

  • Ice scoops at CBS are stored in clean designated container

  • Ice scoops at CBS are free of chips and handle is not broken

  • Ice scoop is clean and free of splatter and adhesive build up, sanitized every 2 hours

  • Unpackaged cups/lids are stored inverted and in plexi cubes

  • Plexi cubes not cracked/broken

  • In use plexi cubes are clean

  • Single use cups/lids/reusable cups are free of splash/splatter and stored away from splash range of sinks

  • Exposed lids store sip side up

  • Sample cups stored protected

  • CBS pitchers/8 qt. cubes/lids are free of adhesive build up/stains/scratches or chips

  • Blender Pitchers/shakers/lids are free of stains/scratched/chips

  • In use banana tongs do not have multiple use build up and stored in a clean designated container

  • CBS for-here serveware cups/plates are not chipped/cracked and stored clean

  • FIZZIO lids are stored in a separate container, not in water

  • In use blender pitchers and shaker lids stored properly/blender pitchers and shakers not stored stacked on top of another/pitcher or shaker lids not stored on the bottom of the overturned pitcher or shaker

  • Equipment

  • CBS ice bins/caddies/FoH ice machine is absent of mold/slime build up

  • CBS ice bins/caddies covered and protected , in good condition

  • FIZZIO carbonation machine clean, clamp without build up

  • Sure Shot Frappuccino Milk Dispenser (FMD) and cream dispensers labeled with contents on exterior of unit

  • Sure Shot/Frappuccino Milk Dispenser (FMD) is clean

  • Thermometer located in Sure Shot/Frappuccino Milk Dispenser (FMD)

  • Nitro cold brew unit interior and exterior clean, gaskets in good condition

  • Thermometer does not have any breaks or gaps in the red "gauge" line

  • Food

  • Dairy/Soy in reach in within date code

  • Tea and coffee pitcher(s) dated

  • Opened dry inclusion bags/pouches dated

  • CBS beverage syrups within code date and dated

  • CBS sauces/concentrates (specify product)/soda mixes/refreshers mixes within code date and dated

  • CBS powders/mocha with in code date and dated

  • Peeled bananas dated and within code date

  • CBS dry inclusions(DIDs)/protein powder/shakers labeled with contents

  • All squeeze bottles labeled

  • Food items stored protected, approved food covering used (indicate product improperly stored)

  • PHF are not left on counter above 41°F (Canada 407/4°C) (milk/soy/coconut/ whipped cream )

  • PHF samples are not left on the counter at room temperature

  • Floor/Walls/Ceiling

  • Floors are free of excessive crumbs/trash/debris (including under refrigerators and cabinetry)

  • Floors are free of dark encrusted build-up (including under refrigerators and cabinetry)

  • Floors/cove molding/concrete in good repair

  • Trash/Recycling/Compost cans not overflowing

  • Recycling and/or compost bins are present where applicable and have appropriate bags and labels on designated bins and/or cabinet doors (Bags: blue=recycling, green=compost, clear=trash)

  • Drains clean/no strong odors present

  • Cabinet doors/drawers/hinges/facings/handles in good repair

  • Cabinets are free of water damage/rot and no bare wood exposed/no cabinet built over drain with no access

  • Cabinets and drawers clean

  • Countertops (including under equipment) clean

  • Shelving not damaged in cabinetry

  • Countertops have no peeling stickers/adhesive residue on counter

  • Countertops sealed to wall/splash guard juncture/horizontal gaps

  • Countertops not excessively worn/damaged/pitted and facings in good repair

  • Sink/ice bin/drain pan sealed to counter top

  • Signage clean

  • Walls clean

  • Walls free of bare wood/exposed dry wall/covering are secure and intact/chipped paint/holes

  • Ceiling/Lighting/Vents below 12 feet maintained clean and no lights are out/missing

  • Ceiling/Lighting/Vents at or above 12 feet maintained clean and no lights are out/missing

  • Ceiling is free of water damage and chipped paint/paint repair color matches

  • No ceiling tiles missing/dislodged, sprinkler rings not missing

REFRIGERATORS, FREEZERS and CHILLED

  • Thermometer located in front of case or refrigerator

  • Thermometer does not have any breaks or gaps in the red "gauge" line /All broken thermometers removed from the equipment

  • Refrigerator/food case is not above 41°F (Canada 407/4°C)

  • Product temperature is at or below 41°F (Canada 407/4°C)

  • Refrigerator is clean (shelves/fan guards/ interior/exterior/floor)

  • FOH Refrigerator gaskets clean and not damaged (ordered/replaced by store)

  • Refrigerator shelves/door free of damage

Espresso Bar Station

Espresso Bar

  • Equipment

  • Bar ice bins/caddies is absent of mold/slime build up

  • Bar ice bins/caddies covered and protected

  • Blender Pitcher Rinser (BPR) clean/no leaks from base or unit

  • Espresso Machine Clean

  • Top of espresso machine clean/no dust

  • Espresso machine food parts clean-bean hopper clean and not damaged, and espresso pour spout clean and not damaged

  • Espresso machine steam wand and area above steam wand is free of dried on/encrusted build-up

  • Espresso drain pan and plug present, Mastrena logo present

  • Dish area clean (if in FoH)

  • Food

  • Milk/soy within code date

  • Steaming pitchers are labeled with product type and correct pitcher used when steaming beverage

  • Bar vanilla/chocolate/cinnamon/ sugar/cinnamon dolce/pumpkin spice powder shaker(s) labeled

  • Bar caramel/mocha squeeze bottles labeled

  • Food items stored protected at the bar, approved food covering used (indicate product improperly stored)

  • Food contact items are from and approved source and food grade

  • Food items not stored under dripping condensate or sewage lines at the bar

  • Samples not left uncovered on counter at the bar/handoff plane

  • PHF are not left on counter above 41°F (Canada 40°F/4°C) (milk/soy/cocount/ whipped cream )

  • PHF samples are not left on the counter at room temperature

  • Beverage syrups within code date and dated - list flavor

  • Sauces (specify product) within code date and dated

  • Powders/mocha with in code date and dated

  • Whole bean coffee within code date (including 5 lb bullets)

  • Milk and Soy is not below 150°F/65.5°C

  • Milk is never re-steamed/no new milk added to steamed milk

  • Sanitizer and Wiping Cloths

  • No wiping cloths left sitting on counters/shelves/on or in sink

  • Wiping cloths are stored in container with sanitizes solution

  • Smallwares

  • Food contact items not stored under dripping condensate or sewage lines at the bar

  • Bar area stored smallwares put away clean

  • Bar area clean smallwares stored covered/inverted/on a clean surface

  • Bar area clean smallwares stored separated from non-food related items

  • Bar area smallwares have no peeling stickers/tape/adhesive residue

  • Single use cups/lids/reusable cups are free of splash/splatter and stored away from splash range of sinks

  • Exposed lids store sip side up

  • Sample cups stored protected

  • Splash sticks stored siren-side up

  • Ice scoops at bar are stored in clean designated storage container between use

  • Ice scoops at bar are free of chips/handle is not broken

  • Ice scoops are clean and free of splatter and adhesive build up, sanitized every 2 hours

  • Steaming pitchers/spoons are free of permanent milk build-up

  • Steaming pitchers/thermometers are rinsed after each use, sanitized every 2 hours

  • Dipper well does not contain any utensils/thermometers

  • Utensils/thermometers are not stored in container with stagnant water

  • Smallwares 2 hour timer is in place and running

  • In-use smallwares are washed, rinsed and sanitized every 2 hours.

  • All thermometers within calibration and are being used when required

  • Unpackaged cups/lids are stored inverted and in plexi cubes

  • Plexi cubes not cracked/broken/no peeling tape

  • In use plexi cubes are clean

  • Floor/Walls/Ceiling

  • Floors are free of excessive crumbs/trash/debris (including under refrigerators and cabinetry)

  • Floors are free of dark encrusted build-up (including under refrigerators and cabinetry)

  • Floors/cove molding/concrete in good repair

  • Trash/Recycling/Compost cans not overflowing

  • Recycling and/or compost bins are labeled/present where applicable

  • Drains clean/no strong odors present

  • Cabinet doors/drawers/hinges/facings/handles in good repair

  • Cabinets are free of water damage/rot and no bare wood exposed/no cabinet built over drain with no access

  • Cabinets and drawers clean

  • Countertops (including under equipment) clean

  • Shelving not damaged in cabinetry

  • Countertops have no peeling stickers/adhesive residue on counter

  • Countertops sealed to wall/splash guard juncture/horizontal gaps

  • Countertops not excessively worn/damaged/pitted and facings in good repair

  • Sink/ice bin/drain pan sealed to counter top

  • Signage clean

  • Walls clean

  • Walls free of bare wood/exposed dry wall/covering are secure and intact/chipped paint/holes

  • Ceiling/Lighting/Vents below 12 feet maintained clean and no lights are out/missing

  • Ceiling/Lighting/Vents at or above 12 feet maintained clean and no lights are out/missing

  • Ceiling is free of water damage and chipped paint/paint repair color matches

  • No ceiling tiles missing/dislodged, sprinkler rings not missing

  • Recycling/Compost Bins

  • Partner facing sorting guide magnet present on an under counter refrigerator

  • Recycling and/or compost bins are present where applicable and have appropriate bags and labels on designated bins and/or cabinet doors (Bags: blue=recycling, green=compost, clear=trash)

REFRIGERATORS, FREEZERS and CHILLED

  • Thermometer located in front of case or refrigerator

  • Thermometer does not have any breaks or gaps in the red "gauge" line /All broken thermometers removed from the equipment

  • Refrigerator/food case is not above 41°F (Canada 40°F/4°C)

  • Product temperature is at or below 41°F (Canada 40°F/4°C)

  • Refrigerator is clean (shelves/fan guards/ interior/exterior/floor)

  • FOH Refrigerator gaskets clean and not damaged (ordered/replaced by store)

  • Refrigerator shelves/door free of damage

DT Area Behind Counter Station

Drive Thru Area Behind Counter

  • General Cleanliness and Condition

  • Drive thru window area clean handoff plane/window ledges/register area

  • Drive thru window is not left except during window interactions

  • Faucet fixtures secure/free of damage/not dripping (including drainpipes)

  • Cream dispenser clean

  • Espresso Machine Clean

  • Top of espresso machine clean/no dust

  • Espresso machine food parts clean-bean hopper clean and not damaged, and espresso pour spout clean and not damaged

  • Espresso machine steam wand and area above steam wand is free of dried on/encrusted build-up

  • Espresso drain pan and plug present, Mastrena logo present

  • No lighting burned out at or above 12 feet. Drive-thru display and equipment clean

  • Food

  • Food items stored protected, approved food covering used (indicate product improperly stored)

  • Non-PHF RTD dated and within code date

  • Ambient pre-packaged RTE food within code date

  • Cream dispenser labeled with contents on exterior of unit

  • Thermometer located in the front of Cream Dispenser (where applicable)

  • Thermometer does not have any breaks or gaps in the red "gauge" line

  • Cream dispenser is not above 41°F (Canada 401/4°C)

  • Cream dispenser contents dated and within code date

  • PHF are not left on counter above 41°F (Canada 40°F/4°C) (milk/soy/cocount/ whipped cream )

  • PHF samples are not left on the counter at room temperature

  • Floor/Walls/Ceiling

  • Floors are free of excessive crumbs/trash/debris (including under refrigerators and cabinetry)

  • Floors are free of dark encrusted build-up (including under refrigerators and cabinetry)

  • Floors/cove molding/concrete in good repair

  • Trash/Recycling/Compost cans not overflowing

  • Recycling and/or compost bins are present where applicable and have appropriate bags and labels on designated bins and/or cabinet doors (Bags: blue=recycling, green=compost, clear=trash)

  • Drains clean/no strong odors present

  • Cabinet doors/drawers/hinges/facings/handles in good repair

  • FY17 QASA Self Assessment

  • Cabinets and drawers clean

  • Countertops (including under equipment) clean

  • Shelving not damaged in cabinetry

  • Countertops have no peeling stickers/adhesive residue on counter

  • Countertops sealed to wall/splash guard juncture/horizontal gaps

  • Countertops not excessively worn/damaged/pitted and facings in good repair

  • Sink/ice bin/drain pan sealed to counter top

  • Signage clean

  • Walls clean

  • Walls free of bare wood/exposed dry wall/covering are secure and intact/chipped paint/holes

  • Ceiling/Lighting/Vents below 12 feet maintained clean and no lights are out/missing

  • Ceiling/Lighting/Vents at or above 12 feet maintained clean and no lights are out/missing

  • Ceiling is free of water damage and chipped paint/paint repair color matches

  • No ceiling tiles missing/dislodged, sprinkler rings not missing

REFRIGERATORS, FREEZERS and CHILLED

  • Thermometer located in front of case or refrigerator

  • Thermometer does not have any breaks or gaps in the red "gauge" line /All broken thermometers removed from the equipment

  • Refrigerator/food case is not above 41°F (Canada 40°F/4°C)

  • Product temperature is at or below 41°F (Canada 40°F/4°C)

  • Refrigerator is clean (shelves/fan guards/ interior/exterior/floor)

  • FOH Refrigerator gaskets clean and not damaged (ordered/replaced by store)

  • Refrigerator shelves/door free of damage

BOH Dry Storage and Refrigeration

BOH Dry Storage

  • General Cleanliness and Condition

  • Items are not stored on floor preventing cleaning

  • Dry storage shelving/BOH prep station clean

  • Water filtration system clean/no dust

  • No Dust build up/splatter on ceiling/vents/lighting in BOH over 12 feet

  • Doors are in good repair and rodent-proof

  • No lighting burned out at or above 12 feet

  • No bags of trash stored on floor in back room

  • Lid closed on back room wheeled trash can

  • Smallwares

  • Food contact items are from an approved source and food grade

  • Cambros or single use Coffee Travelers stored at least 6" (15 cm) off floor and not on merchandise risers/milk crates

  • Cups, lids, napkins, pastry bags stored at least 6" (15 cm) off floor and not on merchandise risers/milk crates

  • Clean smallwares stored clean and inverted on a clean surface or covered, not mingled with non-food contact items

  • Food scoops (non-ice) stored in a clean, designated container or in the food with handle extended

  • Food

  • Stored thawed multi-day pastries dated and within code date

  • Packaged coffee/unopened soy/juice VIA/syrups/other within code date

  • RTD beverage/whole bean coffee/packaged food/pastry for donation stored at least 6" (15 cm) off floor

  • Dairy/Soy in reach in within date code

  • Salt used for water sofeners stored 6" off the floor and away from chemicals or contamination

  • Food not stored on top of turned over milk crates/brown merchandise risers /FOH retail shelving/pastry trays on the floor, approved food covering used

  • Partner food/beverage is not stored on shelving next to dry goods, clean smallwares, or single use items and at least 12" below and away

  • No Drinking/Eating (or evidence of) in food storage/food prep area

  • Mop Sink Area

  • Mop sink area clean

  • No strong odors from drain

  • Wet floor signs/brooms/dust pans/vacuums/mop bucket clean and mop not stored in dirty water

  • Trash/recycling/compost can(s) not over flowing

  • Floor/Walls/Ceiling

  • Floors are free of excessive crumbs/trash/debris (including under refrigerators and cabinetry)

  • Floors are free of dark encrusted build-up (including under refrigerators and cabinetry)

  • Trash/recycling/compost cans not overflowing

  • Recycling and/or compost bins are labeled/present where appliable

  • Drains clean/no strong odors present

  • Walls clean

  • Walls free of bare wood/exposed dry wall/covering are secure and intact/chipped paint/holes

  • Ceiling/Lighting/Vents below 12 feet maintained clean and no lights are out/missing

  • Ceiling/Lighting/Vents at or above 12 feet maintained clean and no lights are out/missing

  • Ceiling is free of water damage and chipped paint/paint repair color matches

  • No ceiling tiles missing/dislodged, sprinkler rings not missing

BOH Refrigeration Equipment

  • Food

  • Dairy in BoH refrigerator is within code date

  • Sandwiches/salads/yogurts are dated and within code date

  • No product above 41°F (Canada 40°F/4°C) In BoH refrigerator

  • Non PHF RTD within code date

  • Ice Machine

  • BOH ice machine has no mold/slime build up

  • BOH ice machine lid is closed

  • No evidence of paint peeling/rust on outside of ice machine

  • Interior of ice machine in good repair/free of damage and chips/gasket in good condition

  • BOH ice scoop is stored in designated storage container between use

  • BOH ice scoop is not chipped or handle broken and is clean and free of adhesive build-up

  • BOH ice scoop storage container/bucket interior clean

  • BOH ice bucket labeled "Ice Only

  • BOH Ice bucket is free of chips/cracks

  • BOH ice bucket is not used for something other than ice

  • Ice machine exterior dirty

  • Partner Habits

  • Partner food/beverage stored in a labeled/lidded container on the bottom shelf /ledge of refrigerator/freezer

REFRIGERATORS, FREEZERS and CHILLED CASES

  • Thermometer located in front of case or refrigerator/freezer

  • Thermometer does not have any breaks or gaps in the red "gauge" line /All broken thermometers removed from the equipment

  • Refrigerator/food case is not above 41°F (Canada 40°F/4°C)

  • Product temperature is at or below 41°F (Canada 40°F/4°C)

  • Refrigerator/freezer is clean (shelves/fan guards/ interior/exterior/floor)

  • Freezer air temperature below 0°F (-18°C)

  • Light working in BoH refrigerator/ freezer

  • BOH refrigerator/freezer gasket present and free of damage (ordered/replaced by store)

  • Refrigerator/freezer shelves/door free of damage

  • Items are not stored on top of BOH refrigerator or freezer blocking vents

Dishwashing and Handsinks Station

Dishwashing Area

  • General Cleanliness and Condition

  • Equipment drain lines from dishwasher/ice machine not placed in sewer pipe

  • Dish sink/sprayer clean

  • No soft sponges/magic eraser-like pads in food prep area/dish area

  • Approved scouring pad/brushes are free of damage

  • Clean drain board free of anything other than clean dishes

  • WASH/RINSE/SANITIZE labels present/in correct order/free of damage

  • Dish compartment sink has hot water (120 °F in CA)

  • Shelving above dish sink clean

  • No towels left sitting on counters/shelves/on or in sink

  • Smallwares

  • Smallwares are not chipped/cracked and stored clean

  • Clean smallwares stored clean and inverted on a clean surface or covered, not mingled with non-food contact items

  • Dishmachine

  • Dishmachine and dishmachine door is clean

  • At least 3.4" of detergent is present in the auto feed container of

  • detergent/pump available in stores without red auto-feed tube

  • Rinse-Aid auto-feed (blue) tube coiled and tucked behind machine (BOTH Low Temp and High Temp Dishmachines)

  • Rinse cycle did reach 180°F on panel read-out for high temp machine (HTM)

  • Sani-NC (US)/UltraSan (CAN) is present in auto feed container for low temp machines

  • Chlorine sanitizer concentration is 50-200ppm for low temp dishmachine only

  • Clear auto-feed tube is not in detergent (clear is for chlorine sanitizer low temp machines only)

Hand Sinks (FOH and BOH)

  • Accessible and used properly

  • Handwashing is not taking place in FOH dump sink (and dedicated hand sink present)

  • Dumping or rinsing is not taking place in dedicated hand sink

  • Access to hand sink is not blocked by trash cans/product

  • Smallwares/Product/food/drinks are not stored in or on designated hand sink

  • Hand sink/faucet is clean

  • All hand sinks properly stocked soap/paper towel dispenser functioning properly

  • Approved soap/paper towel dispensers properly stocked and working

  • Soap is not stored in squeeze bottle/syrup bottle at hand sink

  • No Scented hand lotion/unapproved hand soap/hand sanitizer present

  • Handwashing signs are present at hand sinks

  • Hot water available in store at hand sink 100-120°F (38-49 °C)

  • Floor/Walls/Ceiling

  • Floors are free of excessive crumbs/trash/debris (including under refrigerators and cabinetry)

  • Floors are free of dark encrusted build-up (including under refrigerators and cabinetry)

  • Floors/cove molding/concrete in good repair

  • Trash/Recycling/Compost cans not overflowing

  • Recycling and/or compost cans are labled where appliable

  • Drains clean/no strong odors present

  • Walls clean

  • Walls free of bare wood/exposed dry wall/covering are secure and intact/chipped paint/holes

  • Ceiling/Lighting/Vents below 12 feet maintained clean and no lights are out/missing

  • Ceiling is free of water damage and chipped paint/paint repair color matches

  • No ceiling tiles missing/dislodged, sprinkler rings not missing

  • Floor/Walls/Ceiling

  • Floors are free of excessive crumbs/trash/debris (including under refrigerators and cabinetry)

  • Floors are free of dark encrusted build-up (including under refrigerators and cabinetry)

  • Floors/cove molding/concrete in good repair

  • Trash cans not overflowing

  • Walls clean

  • Ceiling/Lighting/Vents below 12 feet maintained clean and no lights are out/missing

  • Ceiling is free of water damage and chipped paint/paint repair color matches

PIC Only - Complete as needed (Daily, Weekly, Monthly)

Chemicals

  • Chemicals are not stored on or above food preparation counters

  • Chemicals are stored below or 12 inches away from food/single use items/clean dishes

  • Chemicals are not stored on or above dishmachine

  • Chemicals are not stored on/above clean drain board or sanitize basin of dish sink

  • Chemicals are in labeled spray bottle/container

  • Chemicals are covered/sealed (excluding sanitizer bucket)

  • No bleach/unapproved pesticide/drain cleaner/ unapproved chemical present

  • No Scented hand lotion/unapproved hand soap/hand sanitizer present

  • Esteem Sani-NC (US)/UltraSan (CAN) not observed in store with high-temp dishmachine

Sanitizer Buckets and Bar Towels

  • Sanitizer container is properly labeled

  • Proper test strips are available and free of water damage and not expired

  • Quat- solution between 200 and 400ppm

  • Chlorine- solution between 100 and 200ppm

  • No towels left sitting on counters/shelves/on or in sink

  • In container with sanitizer solution

  • Large red sanitizer bucket not stored on counter or in sink

  • Clean towels/linens not stored with chemicals or a contamination potential/stored at least 12" away from any contamination potential

Handwashing

  • Handwashing taking place at appropriate times

  • After wiping hands on apron

  • After handling trash, recycling, or compost

  • After coughing/sneezing into hands

  • After touching face/hair/skin

  • After eating/drinking

  • After breaks

  • After handling dirty dishes or equipment

  • After blowing nose

  • After cleaning tasks

  • Before starting shift

  • Before putting gloves on

  • After using restroom

  • Partners washing hands are using soap and proper technique (incl. 10-15 second scrub)

Documentation

  • Food service permit is current and locatable.

  • Expires:

  • One partner in charge per store with valid food safety certification , or more if your jurisdiction requires it (note expiration date)

  • All partners have valid food worker cards if required

  • All partners serving alcohol have appropriate alcohol training completed and current

  • Allergen certification adequate per jurisdiction (MA)

  • Allergen Poster present in BoH

  • Heimlich maneuver signage posted where required (CA, CT, GA, MI, MD, NJ, NY, TX) Order at signage@starbucks.com

  • Most recent Health inspection report posted or on file

  • Most recent pest report is within 60 days/and available for review

  • Select date

  • Alcohol signage d posted as required

  • Temp log complete, no entries missing/when required, corrective action noted

Food Safety and Partner Habits

  • Food Handling & Food Safety

  • Smallwares 2 hour timer is in place and running

  • Partner food/beverage is not stored on shelving next to dry goods, clean

  • smallwares, or single use items shelving and at least 12" below and away

  • No Drinking/Eating (or evidence of) in food storage/food prep area

  • Partner belongings are not stored while partner is not scheduled to work

  • Partner belongings are not stored with dry goods, clean

  • smallwares, and/or clean linens on metro shelving, BOH prep station and at least 12" below and away

  • Partners are not touching pastries/sandwiches/beverage ingredients/mouth contact parts of items with bare hands

  • Hot water available in the store (100-120F/38-49C)

  • No sewage back up in store

  • Partner in charge can identify all smallwares that need to be washed, rinsed, and sanitized every 2 hours (ice scoops, in-use utensils, pitcher, spoons, lids)

  • Partner in charge knowledgeable of proper dishwashing procedures-Wash, Rinse, Sanitize, then Air Dry

  • Recycling

  • Identify which bins are used for recycling and/or compost behind the bar where applicable

  • Identify where recycling and/or compost should be placed for pick-up outside of the store or building where applicable

  • Pest Control

  • No evidence of mice/rats, flying insects, cockroaches, ants

  • Partner Uniforms

  • Aprons/cloths are clean and do not have more than one shifts accumulation of spills and splashes

  • Long hair beyond shoulder length is tied back/hair restraints are worn per jurisdictional requirement

  • Partners not wearing watches, wearing plain band only (reference partner dress code on acrylic nails, hand wrap/cast and jewelry)

  • Partner Health

  • Not working with severe chest congestion/severe runny nose

  • Not working with acute diarrhea/ vomiting/jaundice

  • Not working with fever/chills

Sign off

  • Name and Signature of Assesssor

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.