Title Page
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Restaurant #
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Location name
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Audit started
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Auditor
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MOD
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SCORE
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TEAM ON DUTY
1. REQUIRED DOCUMENTATION
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1.1 SHE rep or first aider is available?
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1.2 Manager certificate available
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1.3 Restaurant Safety Checklist must be completed and on file?
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1.4 Weekly Pest Walk must be completed?
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1.5 Team Member food safety training records available and current?
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1.6 Employee labour policies available?
2. HEALTH AND HYGIENE PRACTICES
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2.1 Members of the team must not be observed working with symptoms of communicable diseases?
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2.2 Members of the team meet grooming and personal hygiene standards?
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2.3 Gloves and bright coloured bandages are available?
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2.4 Proper hand-washing procedures followed?
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2.5 Hand washing sinks accessible, clean, functioning, in good repair, used only for handwashing, and has posted signs?
3. APPROVED SOURCE
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3.1 (FSC) Only approved ingredients or food evident?
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3.2 Only approved equipment and smallwares in use?
4. PROTECTION FROM CONTAMINATION
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4.1 Food and packaging are properly stored; employee food not stored with restaurant food?
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4.2 Utensils, smallwares, and food contact surfaces are properly cleaned, stored, air dried, and in good repair?
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4.3 (FSC) Cross contamination, or conditions that may lead to cross contamination must not be present?
5. CLEANING AND SANITATION
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5.1 Dish washing process set up and followed; proper sanitizer concentration and test strips available?
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5.2 Equipment is properly cleaned and free of excess buildup?
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5.3 Wiping cloths used and stored properly in a labeled sanitizer bucket with correct concentration?
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5.4 Cleaning supplies, mops, mop buckets, and dustpans available and stored clean?
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5.5 Non-food contact surfaces are clean and in good repair; shelving units not rusted?
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5.6 Floors, walls, light fixtures, and ceilings are clean and in good repair?
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5.7 Vents and exhaust hoods are clean and in good repair?
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5.8 Gaskets on all cold and hot equipment are clean and in good condition?
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5.9 Lighting sources are properly shielded?
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5.10 Trash receptacles are available, cleaned, not overflowing, and maintained?
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5.11 Dumpster area is free of debris and odor; clean and in good repair; plug? Grease barrels covered?
6. PRODUCT PROCEDURES AND TIME TEMPERATURE CONTROL
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6.1 (FSC) Thermometers in use are calibrated?
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6.2 Cold foods must be held 1- 4°C
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6.3 Hot foods must be held >65°C?
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6.4 (FSC) Foods must be cooked or heated to proper internal temperature ?
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6.5 (FSC) Hash browns and chips are within hold times?
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6.6 Ingredients must be held correctly, within hold time or expiration date, rotated properly, and labeled correctly?
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6.7 (FSC) Spoiled foods are not in use and not for sale?
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6.8 Frozen foods are thawed correctly?
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6.9 (FSC) Carryover procedures are followed?
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6.10 (FSC) Restaurant has electric power?
7. EQUIPMENT
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7.1 Cold holding equipment temperature meets standard, is functioning properly, and needs no repair?
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7.2 Hot holding equipment temperature meets standard, is functioning properly, and needs no repair?
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7.3 Three-compartment sink, prep sink, dishwasher or powers oak sink is functioning properly and needs no repair?
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7.4 All other equipment in use is functioning properly and needs no repair?
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7.5 Hot water >39°C at hand washing and restroom sinks?
8. CHEMICALS
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8.1 Approved chemicals are properly labeled and stored, used correctly?
9. PEST CONTROL AND PREVENTION
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9.1 (FSC) Pest activity not present?
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9.2 Pest control devices evident and installed, maintained; service is evident by an approved Pest Management Vendor?
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9.3 Pest activity is prevented through proper sealing of openings and the elimination of harboring conditions?
10. SEWAGE AND PLUMBING
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10.1 (FSC) Hot water >39°C is available at the dish sink?
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10.2 Back flow prevention devices at every sink?
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10.3 (FSC) At least one functioning toilet available?
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10.4 Plumbing in good repair?
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10.5 Mop sink or drains not clogged and functioning properly?
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10.6 (FSC) Water is from an approved source?
10 Core menu items
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10.1All core menu items are available?
Results
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Food Safety Deviations
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Food Safety Criticals
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MOD Signature
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Auditor Signature
