ROIP Unannounced 2018 Food Safety Visit Form

FS1-US Required supplies are at all hand washing sinks to include warm running water. Hand wash sinks are only used for hand washing and not for preparing food or storing equipment. Hand wash sinks are easily accessed by employees. If no, check all reasons that apply below:

FS2-US Hands are properly washed following proper hand washing procedures at the appropriate times. A system is in place to ensure hourly hand washing by all employees. If no, check all reasons that apply below:

FS3-US Sanitized towel buckets contain towels and sanitizer solution at the correct concentration checked with a chlorine test strip. If no, check all reasons that apply below:

FS4-US Sanitizer-soaked towels and grill cloths used at food or beverage preparation and service areas must be placed into the soiled towel bucket after using and not be left sitting out on surfaces. If no, check all reasons that apply below:

FS5-US All UHC trays, grill utensils, prep table utensils, and utensil holders are clean (no build up) and are washed and sanitized at least every 4 hours as per approved procedure. Back sink and soap/sanitizer dispensers or dishwashers must function (hot water 110 ̊ F or higher) and all supplies must be available. Check that sanitizer solution has the right concentration with an appropriate test strip. If no, check all reasons that apply below:

FS5-US-01 All soiled raw wares that came into contact with raw proteins (such as fresh beef and raw chicken) are washed and sanitized last (unless a warewasher is used). Soiled blue raw beef trays and lids are kept in blue bus box until cleaned. Back sink is properly sanitized after washing wares that came into contact with raw proteins. If no, check all reasons that apply below:

FS6-US Appropriate measures are taken to protect water and ice from foreign material, chemicals and/or bacterial contamination. Check that water filters are in date and the ice machine is free from mold or buildup. If no, check all reasons that apply below:

FS7-US Opened packages of food in storage, (including refrigerators and freezers) are covered/wrapped, labeled, and stored according to proper procedures. If not, mark what product is not stored properly:

FS8-US Blue disposable glove procedures or dedicated tongs are used to prevent cross-contamination when handling all raw meat or poultry products (including shell eggs) at the grill station and fryer station. Dedicated utensils are used for raw products (e.g. the yellow yolk breaking tool is only used to break egg yolks). If no, check all reasons that apply below:

FS9-US Clear/white disposable gloves worn for food preparation of ready to eat foods at the sandwich prep table, salad prep table, and in all other areas to prevent bare hand contact with any cooked or ready-to-eat foods. If no, check all reasons that apply below:

FS10-US Chemicals are stored away from food and packaging. If no, check all reasons that apply below:

{CRITICAL} FS11-US The restaurant building, corral and any area within 10 feet (3m) from the building (i.e. inside the Drive-thru lane) is clear from infestation by rats, mice, insects and birds. Check these areas for any signs of pests. If the restaurant has signs of a pest infestation this question is considered a fail. Include in the comments the specifics on what you observed.

FS11-US-01 Pest management program and pest prevention steps and behaviors are in place and are being managed effectively. The restaurant is properly pest proofed to prevent entry of pests (e.g. gaps under doors are sealed). Review the most recent pest control report, ensuring all recommendations have been corrected. If the pest management program and pest prevention steps and behaviors are not in place or are not complete, then mark this question as no. Include in the comments specifics on what you observed.

FS12-US Non-food spill clean-up procedures in place. If no, check all reasons that apply below:

FS13-US Walk-in freezer and any other primary storage freezers at 0° F (-18° C) or below. Secondary storage freezers are keeping all products solidly frozen. If no, check which units are not at proper temperature/keeping products frozen:

FS14-US Refrigerated products inside all refrigerated units are at or below 40° F (4° C) (including shake/sundae reservoir). If no, check which units do not meet the temperature standard:

FS15-US All refrigerated products are in code (within primary shelf life). If not, mark what product is not in code:

FS16-US Secondary shelf lives of refrigerated foods held at room temperature and in refrigerators are marked and the products are being used within their secondary shelf lives. If not, mark what product is not in code:

FS17-US Leftover heated foods are discarded (including any shake/sundae mix removed from heat treatment shake/sundae machines). If not, mark what product:

FS18-US Pyrometer with needle probe is calibrated and working correctly. If no, check all reasons that apply below:

{CRITICAL} FS19-US The internal temperatures of beef patties after cooking are at or above 155° F (69° C) and fresh beef patties at or above 175° F (80° C). If not, mark what product:

{CRITICAL} FS20-US The internal temperatures of raw chicken products after cooking are at or above 165° F (74° C). If not, mark what product:

{CRITICAL} FS21-US The internal temperatures of breakfast steak and breakfast sausage after cooking are at or above 155° F (69° C) for sausage made from beef or pork and 165° F (74° C) for sausage made from poultry.

{CRITICAL} FS22-US The internal temperatures of round eggs after cooking are at or above 155°F (69°C).

The internal temperature of Filet-O-Fish portions after cooking are at or above 150°F (66°C).

FS24 All food, food packaging, equipment (including utensils), and cleaning chemicals are from approved sources. If no, check reason(s) below:

FS25-US Managers understand employee illness symptoms and reportable illness causes for when an employee cannot be working. Managers also understand when an employee can return to work after illness.

FS26-US All managers (including shift managers) are trained and currently certified in food safety through ServSafe (or an equivalent and accredited food safety training course). If not, mark what is missing below:

FS26-US-01 All employees are trained and verified on food safety and sanitation per McDonald's current training program and in accordance with local regulations.

{CRITICAL} FS27-US Managers (or staff assigned to complete the checklist) have been trained on and can demonstrate how to properly complete the procedures on the Daily Food Safety Checklist. If no, mark all that apply below:

FS28-US At least the last 60 days of correctly completed Daily Food Safety Checklists are available and the last two correctly completed Monthly Food Safety Procedure Verifications are available. If no, mark all that apply below:

FS29-US Review the most recent health department inspection report, ensuring all food safety violations noted have been corrected or a plan is in place to correct issues. If not, mark what is missing: