Quality Assurance Standards

• Location
  Address

• Conducted on

  Date

• Prepared by

• Partners

• Prepared by

FOOD SAFETY

• Food and Single Use Item Protection and Storage

• In-use smallwares/equipment food contact surfaces, approved, clean and in good repair

  Yes

  No

  N/A

• Non-Potentially Hazardous Foods within code date

  Yes

  No

  N/A

• Potentially Hazardous Foods within code date

  Yes

  No

  N/A

• Food approved and name labeled properly

  Yes

  No

  N/A

• Food items stored properly

  Yes

  No

  N/A

• Food contact items properly stored

  Yes

  No

  N/A

• Partners do not contact ready-to-eat foods or food contact surfaces with bare hands

  Yes

  No

  N/A

• Partner food labeled, stored properly, and no eating/drinking in food storage/prep areas

  Yes

  No

  N/A

• Ice and ice utensils protected in Bar/CBS area and/or BoH area

  Yes

  No

  N/A

• Hygiene

• Proper handwashing taking place at appropriate times

  Yes

  No

  N/A

• Hand sinks are accessible and used properly

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Partners uniforms maintained clean/hair properly restrained (per jurisdictional requirements)

  Yes

  No

  N/A

• Partner not working while ill

  Yes

  No

  N/A

• Partner non-food personal belongings stored separately from food storage areas and not left overnight

  Yes

  No

  N/A

• Wiping Cloth Usage and Sanitization

• Sanitizer present/strength at proper concentration/proper test strips available

  Yes

  No

  N/A

• In-use wiping cloths properly stored

  Yes

  No

  N/A

• Approved scouring pad in use

  Yes

  No

  N/A

• Beverage/Food Preparation

• Steaming thermometers in use/calibrated correctly

  Yes

  No

  N/A

• Thermocouple present and properly working

  Yes

  No

  N/A

• Steamed milk ≥150°F(65.5°C) and is not resteamed

  Yes

  No

  N/A

• Potentially hazardous food(PHF) is not stored at room temperature

  Yes

  No

  N/A

• Refrigeration and Cold Storage

• Refrigerated PHF ≤41°F (4°C)

  Yes

  No

  N/A

• Refrigeration units ≤41°F (4°C)

  Yes

  No

  N/A

• Hanging thermometer/temp readout present where required

  Yes

  No

  N/A

• Condiment bar carafes ≤41°F (4°C)

  Yes

  No

  N/A

• Refrigeration ventilation maintained

  Yes

  No

  N/A

• Chemical Storage and Usage

• Only approved chemicals present

  Yes

  No

  N/A

• Chemicals properly labeled/stored

  Yes

  No

  N/A

• Permits and Certifications

• Permit/Food service license to operate available as required by jurisdiction

  Yes

  No

  N/A

• Partner food safety training adequate as required

  Yes

  No

  N/A

• Proper documentation/signage available

  Yes

  No

  N/A

• Temperature logs complete in Duty Roster

  Yes

  No

  N/A

• Dishwashing

• Dishwashing sink compartments labeled and followed properly

  Yes

  No

  N/A

• Correct amount of detergent for each mechanical dishwasher load

  Yes

  No

  N/A

• Dishmachine rinse water is properly maintained for sanitizing dishes

  Yes

  No

  N/A

• Hot water available in store

  Yes

  No

  N/A

CLEANLINESS

• Trash Handling

• Trash in store disposed of as needed

  Yes

  No

  N/A

• Pest Control

• No evidence of rodents

  Yes

  No

  N/A

• No evidence of flying insects

  Yes

  No

  N/A

• No evidence of cockroaches

  Yes

  No

  N/A

• No evidence of ants

  Yes

  No

  N/A

• Cleanliness of facility

• BoH area floors/drains maintained clean

  Yes

  No

  N/A

• BoH area walls/ceilings maintained clean/lights functioning

  Yes

  No

  N/A

• BoH equipment maintained and clean

  Yes

  No

  N/A

• Mop area maintained and clean

  Yes

  No

  N/A

• BoH dish area/hand sink/storage areas maintained and clean

  Yes

  No

  N/A

• Restrooms/Toilet floors/walls/ceiling maintained/lights functioning

  Yes

  No

  N/A

• Restrooms/Toilet fixtures maintained

  Yes

  No

  N/A

• Customer area floors maintained

  Yes

  No

  N/A

• Customer area walls/ceilings maintained and lights functioning

  Yes

  No

  N/A

• Condiment bar maintained

  Yes

  No

  N/A

• Customer area furnishings maintained

  Yes

  No

  N/A

• Exterior area maintained

  Yes

  No

  N/A

• Bar area/Food Station/CBS floors maintained clean

  Yes

  No

  N/A

• Bar area/Food Station/CBS walls and ceiling maintained clean/lights functioning

  Yes

  No

  N/A

• Bar/Brewing area equipment maintained clean

  Yes

  No

  N/A

• CBS equipment maintained clean

  Yes

  No

  N/A

• Food Station equipment maintained and clean

  Yes

  No

  N/A

• Pastry and Refrigerated Display Case maintained clean

  Yes

  No

  N/A

• FoH Dish area/hand sink/storage areas maintained clean

  Yes

  No

  N/A

• Customer area furnishings maintained in good repair

  Yes

  No

  N/A

• Bar/CBS/Food Station counters maintained clean

  Yes

  No

  N/A

FACILITIES

• Restrooms floors/walls/ceilings in good repair (which restroom)

  Yes

  No

  N/A

• Restrooms fixtures in good repair

  Yes

  No

  N/A

• Floor in good repair in FoH

  Yes

  No

  N/A

• Walls in good repair in FoH

  Yes

  No

  N/A

• Ceiling in good repair in FoH

  Yes

  No

  N/A

• Cabinetry/shelving in customer area in good repair

  Yes

  No

  N/A

• Condiment bar in good repair

  Yes

  No

  N/A

• Heavy, High, or Hazardous cleaning service items meet standards

  Yes

  No

  N/A

• Awnings/soffit/drive thru equipment in good repair

  Yes

  No

  N/A

• Building entrances maintained in good repair and rodent proof

  Yes

  No

  N/A

• Sink/Dipper well/ice bin/drain pan sealed to counter

  Yes

  No

  N/A

• Counter tops in good repair

  Yes

  No

  N/A

• Cabinetry in the bar area in good repair

  Yes

  No

  N/A

• Floors in good repair in BoH

  Yes

  No

  N/A

• Walls in good repair in BoH

  Yes

  No

  N/A

• Ceiling in good repair in BoH

  Yes

  No

  N/A

• Ice machine in good repair

  Yes

  No

  N/A

• Refrigeration in good repair (indicate which refrigerator)

  Yes

  No

  N/A

• Flex drain hose not placed in sewer pipe

  Yes

  No

  N/A

• Plumbing in good repair

  Yes

  No

  N/A

• No sewage back up in facility

  Yes

  No

  N/A

• Add signature

  Sign

• Reviewed by SM:

  Sign

• Reviewed by DM:

  Sign