Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Opening or Close

Cold Prep Department

  • Is AFVT at correct concentration?

  • Corrective Action

  • Temperature of Walk in Cooler.

  • Corrective Action

  • All product at least 6 inches off the floor?

  • Corrective Action

  • Walk-In Cooler floors, baseboards, walls, ceiling, vents, lighting, and back sink area (including floors, shelves, and walls) are clean and in good repair.<br><br>Corrective Action

  • Corrective Action

  • Products in the Walk-In Cooler comply with the required temperature.

  • Corrective Action

  • All products in walk in cooler covered and labeled?

  • Corrective Action

  • The products are organized correctly and in the correct hierarchy.

  • Corrective Action

  • Are cut gloves in use?

  • Corrective Action

  • Time stamps used on leafy greens, proteins, cut fruit, and tomatoes?

  • Corrective Action

Meat Room Department

  • Meat Cooler at proper temperature

  • Corrective Action

  • Products in the Meat Room comply with proper temperature

  • Corrective Action

  • All product stored properly according to food hierarchy chart.

  • Corrective Action

  • All product at least 6 inches off the floor?

  • Corrective Action

  • All products in meat cooler covered and labeled?

  • Corrective Action

  • Are cut gloves in use?

  • Corrective Action

  • Meat Room floors, baseboards, walls, ceiling, vents, lighting, and back sink area (including floors, shelves, and walls) are clean and in good repair.

  • Corrective Action

Utility Department

  • Dish machined wash temperature at160°F and rinse at 180°F?

  • Corrective Action

  • No lime build up in dish machine.

  • Corrective Action

  • Hand dip procedure executed properly.

  • Corrective Action

  • 3 Compartment sink set up correctly with quaternary sanitizer at 150 ppm - 400 ppm?

  • Corrective Action

  • All containers stored upside down for proper air drying?

  • Corrective Action

  • Food utensils are clean and stored properly?

  • Corrective Action

  • Receiving door is clear, there are no boxes or garbage blocking the exit.

  • Corrective Action

  • Trash cans clean and liners used.

  • Corrective Action

  • Dumpster area is clean?

  • Corrective Action

Hot Cook Department

  • Hoods and filters are Installed, clean?

  • Corrective Action

  • Towels are kept in buckets?

  • Corrective Action

  • Can opener blade and gears clean.

  • Corrective Action

  • Time Stamps used on Carved Meats?

  • Corrective Action

  • Food utensils in use are stored properly?

  • Corrective Action

  • All leftovers run out by 2 pm?

  • Corrective Action

Bakery Department

  • Bakery oven is clean and in good repair?

  • Corrective Action

Line Department

  • Dining room environment is comfortable. Temperature, Music.

  • Corrective Action

  • Buffet labels are on all hot bar items.

  • Corrective Action

  • Restrooms are clean.

  • Corrective Action

Server Department

  • Are Servers washing their hands and changing gloves regularly?

  • Corrective Action

  • Ice Machine interior and exteriors clean.

  • Corrective Action

Management

  • Temperature Logs completed?

  • Corrective Action

  • Duty Rosters system been executed.

  • Corrective Action

  • Co-Workers washing hands regularly?

  • Corrective Action

  • Proper hand washing facilities stocked and accessible.

  • Corrective Action

  • All employees executing five foot rule.

  • Corrective Action

  • Clean as you go is observed in all restaurant departments.

  • Corrective Action

  • Quaternary Sanitizer in all areas between 150ppm - 400ppm.

  • Corrective Action

  • All Co-Workers wearing proper uniforms and non-skid shoes?

  • Corrective Action

  • All employees temperatures verified.

  • Corrective Action

  • No sick/symptomatic employees allowed to work.

  • Corrective Action

  • Eating and drinking restricted to non-food areas.

  • Corrective Action

  • Receiving Log used properly.

  • Corrective Action

  • Co-workers know where Right to Understand station is.

  • Corrective Action

  • Insect control devices on and working.

  • Corrective Action

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.