SAFE Evaluation

Title Page

Name
Begining Time

Immediate Action

109/Grilled raw chicken products are cooked to 165°F/74°C.
Grilled raw chicken product(s) did not temp at 165°F/74°C or above.
115/Breaded raw chicken products are cooked to 165°F/74°C
Breaded raw chicken products are not cooked to 165°F or higher.
125/Non-chicken TCS foods/PHFs cooked to proper cooking temperatures; TCS foods/PHFs heated/reheated to proper temperatures for hot holding. (e.x. sausage, soup, cheese sauce, eggs, mac and cheese).
Non-chicken TCS foods/PHFs are not cooked to proper cooking temperatures.1
TCS foods/PHFs are not heated/reheated to proper temperatures for hot holding.1
127/Foods that require time/temperature control for safety are cooled from 140°F/60°C to 70°F/21°C or below within 2 hours, and from 140°F/60°C to 40°F/4°C or below within 6 hours. Proper date/time stickers in use for cool-down process.
Foods that require time/temperature control for safety are not cooled from 140°F/60°C to 70°F/21°C or below within 2 hours.
Foods that require time/temperature control for safety are not cooled from 140°F/60°C to 40°F/4°C or below within 6 hours.
Proper date/time stickers are not in use for the cooldown process.
215/Fruits and vegetables are properly washed prior to processing and serving. Produce wash is properly set up and used when required.
Required produce not washed in produce wash before processing
Required produce is washed/soaked in water alone.
Required produce is not being washed for 90 seconds.
Outer leaves are not removed and discarded from romaine lettuce heads.
225/Sewage disposal systems, including grease traps, are operating properly.
Sewage backup was observed.
227/Potable water is available from a public water system or a non-public system that is properly maintained.
Potable water is not available.
303/Food contact surfaces are properly cleaned and sanitized (at least every 4 hours during continuous use at room temperature with foods that require time/temperature control for safety (TCS/PHFs).
Food contact surfaces are not properly cleaned and sanitized.
313/Chemical sanitizer solutions (front counter and BOH) and produce wash are maintained at proper concentration and temperature per label instructions.
Front of House is not maintained at proper concentration/temperature.
Prep is not maintained at proper concentration/temperature.
Raw Area is not maintained at proper concentration/temperature.
313/To verify that the non-chemical sanitizing dishwashing machine meets 160°F on the dish surface, place ThermoWorks DishTemp Thermometer on the dish rack and run a wash cycle. Enter Temperature:
Enter temperature the dishwashing machine reached
401/Hands that may have become contaminated are washed using hot water and soap for 20 seconds and dried using disposable towels. Hands are washed at appropriate times before donning gloves. Care is taken after washing to avoid re-contaminating hands by touching faucet or towel dispenser handles.
Hands that may have become contaminated are not washed using hot water and soap for 20 seconds and dried using disposable towels.
Hands are not washed at appropriate times before donning gloves.
Care is not taken after washing to avoid re-contaminating hands by touching faucet or towel dispenser handles.
405/No bare hand contact occurs with ready-to-eat foods.
Bare hand contact was observed with ready-to-eat foods.
409/Persons displaying symptoms such as vomiting, diarrhea, jaundice or sore throat with fever are excluded from the establishment. Persons with exposed pustular lesions or persistent sneezing, coughing, or a runny nose that causes discharges from the eyes, nose, or mouth, are restricted from working around exposed food or food contact surfaces.
Persons displaying symptoms such as vomiting, diarrhea, jaundice or sore throat with fever are not excluded from the establishment.
Persons displaying symptoms such as vomiting, diarrhea, jaundice or sore throat with fever are not excluded from the establishment.
421/Hot and cold water is sufficient to meet peak demand. Plumbing provides adequate pressure and water is available at all sinks. Water from non-public systems tested at least annually. During a temporary interruption of the water system, water is supplied through an approved, sanitary source such as commercially bottled drinking water.
Water: not readily available at the dish machine.
Water: not readily available to kitchen hand sink.
Water: not readily available to any restrooms.
Water: not enough to meet peak water demands.
501/Pest prevention program is effective. (i.e. Any active/live cockroaches, rodents, or birds; evidence of rodent activity including droppings, nests, gnawed packaging; or pests in food).
Evidence of active/live cockroaches, rodents or birds.
Evidence of rodent activity (droppings, gnawed packaging, etc.)
Observed pest(s) in food.

High Risk

101/Cold foods that require time/temperature control for safety are maintained at 40°F/4°C or below in all cold-holding devices including reach-in refrigerated units, cold-top storage devices, walk-in cooler and ice wells
List items not in tempature in cold-holding devices
105/Hot foods that require time/temperature control for safety are maintained at 140°F/60°C or above.
List items not in temperature in hot holding devices
113/Grill deflector plates (front/side) are properly installed.
Grill deflector plates (front/side) are not properly installed
121/Raw chicken products (filet, nugget, spicy filet, and strip) held in the rail of the breading table are 33°F-40°F/1°C-4°C.
Chicken is below 33°F
Chicken is above 40°F
133/Time as a Public Health Control procedure (if applicable) is properly followed.<br>
203/Cross-contamination prevented during food storage and preparation.
Observed cross-contamination during food storage or preparation
205/Proper use of food hierarchy in storage.<br>
Foods are not stored correctly according to the food hierarchy.
207/Foods are from approved suppliers. Foods and packaging are in sound condition.
Foods are not from approved suppliers.
Foods are not in good condition.
Food packaging is not in good condition.
221/Chemicals, Produce Wash and chemical containers are used correctly and only for their intended purpose.
Chemicals/Chemical containers are not used correctly and only for their intended purpose.
Produce wash is not used correctly.
233/Raw chicken only held in thaw cabinets or on the bottom shelf of the walk-in cooler.
Raw chicken held in an inappropriate cooler.
235/Bodily Fluid Clean Up Kit is present and assembled.
Expired
Not Available
403/Yellow apron is worn properly while handling raw chicken.
Yellow apron is not worn while handling raw chicken
407/Disposable gloves are worn over other types of gloves (cut-resistant gloves, cloth gloves, etc.) when handling ready-to-eat foods. Yellow food service gloves are worn when handling raw chicken. Clear food service gloves worn when handling rinsed produce.
Disposable gloves are not worn over other types of gloves (cut-resistant gloves, cloth gloves, etc.) when handling ready-to-eat foods.
Yellow food service gloves are not worn when handling raw chicken.
Clear food service gloves are not worn when handling rinsed produce.
410/Restaurant has a written Health Policy covering foodborne and severe respiratory illnesses
The restaurant does not have a written Health Policy that covers both foodborne and severe respiratory illnesses. Other
503/Pest prevention program is effective for flies inside the Restaurant and birds outside the Restaurant.
The pest prevention program is not effective for flies inside the Restaurant and birds outside the Restaurant.
701/Operational Requirement: Team Members are being health screened before work
Team Members do not get health checked before work.

Medium Risk

128/Chicken cool-down process is being followed (e.x. time guidelines followed, food film properly vented, chicken placed on trays, chicken properly stacked, etc.)
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129/Are foods that require time/temperature control for safety (TCS/PHFs) not held or sold past their expiration date?
Foods that require time/temperature control for safety (TCS/PHFs) are held or sold past the expiration date.
135/Is an accurate food thermometer present in the Restaurant?
An accurate food thermometer is not present.
137/All cold holding equipment (with TCS foods/PHFs) are equipped with accurate thermometers that are easily viewable.
Not Present
What unit?
139/At receiving, foods show no signs of temperature abuse and foods that require time/temperature control for safety are received at proper temperatures (40°F/4°C or below).
Foods show signs of temperature abuse.
Foods are not received at the proper temperature.
141/TCS foods/PHFs are properly date labeled when prepared/opened.
Opened/Prepared foods are not properly date labeled.
143/ Is an accurate date label applied to the control label for each case of raw chicken in the thawing cabinets? The date label sticker should include the date and time the chicken was removed from the freezer.
Observed missing date labels.
Observed date labels that do not have all of the required information (date, time,).
145/Are TCS foods properly thawed under refrigeration and are quick thawing procedures being properly followed (if occurring)? See question instructions for additional details on assessing compliance for this question.
Observed mac and cheese thawing incorrectly.
Observed raw chicken thawing incorrectly.
Observed sausage thawing incorrectly.
Observed cheese sauce thawing incorrectly.
Observed red meat thawing incorrectly.
Observed soup base thawing incorrectly.
TCS food thawing at room temperature.
TCS food thawing not completely submerged under cool running water.
TCS food thawing under running water greater than 70°F (21°C).
209/All produce is in good condition
301/Food contact surfaces of equipment and utensils are durable, non-toxic, and made of safe materials. Food equipment lubricants that may contact food are approved as food additives.
Food contact surfaces of equipment and utensils are not durable, non-toxic, and/or made of safe materials.
Food equipment lubricants that may contact food are not approved as food additives.
311/The food contact surfaces of the ice machine, ice bin and beverage nozzle are properly cleaned and sanitized.
The food-contact surfaces of the ice machine are not clean.
The food-contact surfaces of the ice bin are not clean.
The food-contact surfaces of beverage nozzles are not clean.
327/Air gaps/backflow prevention devices are in place where required.
Backflow device or air gaps are not present at mop sink.
Backflow device or air gaps are not present at food prep sinks.
Backflow device or air gaps are not present at 3-part/4-part sink
Backflow device or air gaps are not present at ice machine
Backflow devices or air gaps are not present at walk-in refrigerator condensation lines.
The sprayer hose in the 3-part/4-part/prep sink falls below the rim of the sink.
Backflow devices or air gaps are not present at beverage tower drains
329/Food contact surfaces are smooth, easily cleanable, and in good condition.
Food contact surfaces are not smooth, easily cleanable, and/or in good condition.
333/SDS sheets are available for all chemicals in the Restaurant. Original containers of toxic materials have a legible manufacturer's label. Working containers of cleaners and sanitizers are labeled with the common name of the product. Only chemicals that are required for the operation and maintenance of the facility are present. Restricted pesticides are applied by a certified applicator or someone under their direct supervision. First aid supplies, personal care items such as lotions and creams, and employee medicines are properly labeled.
Observed unlabeled chemical container(s).
335/Observed unlabeled chemical container(s).
Quat test strips are not available or within expiration date
Chlorine test strips are not available or within expiration date.
Produce Wash test strips are not available or within expiration date.
347/Wiping cloths are kept clean and dry or else immersed in properly diluted sanitizer. Separate cloths are used for wiping food contact and non-food contact surfaces.
Observed in-use wiping cloths that are not stored in properly diluted sanitizer in between uses.
Wiping cloths are taken from sanitizer buckets, used to wipe surfaces, and left on the surface instead of being placed back into the bucket.
Dry, soiled wiping cloth used on Henny Penny shelf.
Dry, soiled wiping cloth used on a counter.
Wet/damp towel kept under a cutting board.
Separate wiping cloths are not being used for wiping food contact and non-food contact surfaces.
351/Manual ware washing and dishwashing facilities are properly maintained, operated, stocked, clean, and in good condition.
Manual ware washing and dishwashing facilities are not properly maintained, operated, stocked, clean, and/or in good condition.
411/Operator has ServSafe/TrainCan certification that is current within 3 years.
413/Person in Charge demonstrates knowledge of health protocols.
The person in charge is not able to name the illness symptoms that require a Team Member to be excluded from work and/or sent home.
The person in charge is not able to name the six most contagious and severe food-borne illnesses.
417/Kitchen hand-washing sinks are stocked, accessible, properly used, clean, and in good repair.
Kitchen hand-washing sinks are not stocked, accessible, properly used, clean, and/or in good repair. Other
419/BOH food handler with clean, trimmed nails without nail polish/acrylics/gels; FOH Team Members wearing nail polish in good taste/no acrylic or gel tips.
BOH food handler: nails not neatly trimmed and clean.
BOH food handler: wearing fake nails.
BOH food handler: wearing nail polish.
FOH team member: nails not neatly trimmed and clean.
FOH team member: wearing fake nails.
FOH team member: wearing glitter/metallic/multi-colored nail polish.

Low Risk

147/Frozen foods are held solidly frozen so that they are hard to the touch.
Frozen product held in freezer soft to the touch
Foods are properly protected from contamination. Foods in storage are properly covered unless cooling. Foods are protected from contamination during preparation and serving. No condensation is present above exposed food or food contact surfaces. Sanitizer buckets are not stored directly on the floor. Proper serving practices are observed so that hands do not touch the food contact or lip-contact surfaces of cups or utensils.
Observed foods in storage that are not properly covered.
Observed foods that are not protected from contamination during preparation and serving.
Observed condensation above exposed food or food contact surfaces.
Observed sanitizer buckets stored directly on the floor.
Observed bare hands touching food or the lip-contact surfaces of cups or utensils.
217/Foods are properly identified with the common name of the product on the container.
Observed a bulk dry ingredient not labeled with the common name of the product.
Observed a spray bottle of a liquid ingredient without a name label.
219/Foods and food contact packaging are stored at least six inches off the floor.
Food or food contact packaging stored directly on the floor
Bottom shelf positioned less than 6“ (15.24 cm) off the floor
229/In thaw cabinet, raw chicken products are identified with clips.
In thaw cabinet, raw chicken products are not identified with clips
231/In thaw cabinet, raw chicken products are identified with correct clips? (e.g. yellow silicone)
Correct clips are not used to identify raw chicken products.
239/Tamper-evident delivery stickers are being used on mobile orders for 3rd party deliveries.
337/Clean utensils, equipment and food contact packaging are stored in a sanitary manner. Storage containers such as canisters, bins and drawers are maintained clean. Utensil handles all point up for vertical storage or all point in the same direction for horizontal storage.
Storage containers are not maintained clean.
Utensil handles do not point up for vertical storage or the same direction for horizontal storage.
Clean utensils, equipment, and/or food contact packaging are not stored in a sanitary manner.
339/In-use utensils (including ice scoops and egg slicers) are properly handled and stored in a sanitary manner. Handles of utensils that are stored in the product do not touch the product and extend out of the container for foods that require time/temperature control for safety.
Utensils are being stored in prepared food with handles contacting the food.
Scoops are being stored in ice with handles contacting food
Ice scoop: not stored in holder
Cups/bowls with no handles being used as a scoop
Utensils left in containers of bulk foods with handles contacting food
343/Non-food contact surfaces of equipment and utensils are durable, non-toxic, easily cleanable, and in good condition.
The non-food contact surfaces of equipment and utensils are not durable, non-toxic, easily cleanable, and/or in good condition.
345/All cleaning tools are properly stored between uses to avoid contamination of other surfaces. Equipment used to clean food contact surfaces are durable and appropriate for the task.
Cleaning tools are not properly stored between uses to avoid contamination of other surfaces.
Equipment used to clean food-contact surfaces are not durable and appropriate for the task.
355/Team Member restrooms are fully stocked, clean and in good repair; toilet present and doors self-closing.
Restrooms are not fully stocked.
The restrooms are not clean.
Restrooms are not in good repair.
Doors are not self-closing.
357/Floors, walls, and ceilings are free of excessive dust, debris and standing water.
Floors have excessive dust, debris, or standing water.
Walls have excessive dust or debris.
Ceilings have excessive dust, debris, or standing water.
361/Floors, walls and ceilings are smooth, easily cleanable, and in good repair. Exposed concrete blocks and bricks are sealed and smooth unless area is used only for dry storage.
Floors are not smooth, easily cleanable, and/or in good repair.
Walls are not smooth, easily cleanable, and/or in good repair.
Ceilings are not smooth, easily cleanable, and/or in good repair.
363/Ventilation is adequate; vents, fan guards and filters are clean.
Fan guards in the walk-in refrigerator/freezer have excessive visible dust/debris build-up.
Exhaust Hoods/Hood Vents above fryers/ovens are excessively soiled.
Ceiling vents in the BOH have excessive dust/debris build-up.
Ceiling vents in the FOH have excessive dust/debris build-up.
The breading table filter has excessive visible dust/debris/coater build-up
The cold rail filter has excessive dust/debris build-up.
Filters have excessive dust/debris build-up.
Filter baffles have gaps or are installed horizontally.
367/Lighting is adequate for cleaning and food handling tasks; lights are shielded or shatterproof above exposed food and food contact surfaces, and above packaged food if the package integrity could be affected by broken glass.
Lighting is not adequate for cleaning and food handling tasks.
Lights are not shielded or shatterproof above exposed food, food-contact surfaces, or food packaging that could be affected by broken glass.
369/Interior garbage containers are cleaned and emptied as needed.
Interior garbage containers are not cleaned properly.
Interior garbage containers are not in good repair.
Interior garbage containers are overflowing
Cardboard box used as a trash receptacle.
423/Eating, drinking and tobacco use are restricted to nonfood areas. Drinking is allowed from closed containers, such as a cup with a lid and straw, handled to prevent contamination of hands or food contact surfaces. Personal items are properly stored in designated areas away from food, utensils and equipment.
Eating, drinking, and/or tobacco use are not restricted to nonfood areas.
Personal items are not stored in designated areas away from food, utensils, and equipment.
425/Good personal hygiene practices are followed; clean outer clothing is worn; hair restraints are used around exposed food and food contact surfaces. Jewelry on the hands and wrists is limited to a plain ring with no set stones.
Clean outer clothing is not worn.
Hair restraints are not used around exposed food and food-contact surfaces.
Jewelry on the hands and wrists is not limited to a plain ring with no set stones.
509/Pest activity is prevented through proper sealing of outer openings and the elimination of harborage conditions.
Gaps larger than 1/4 inch exists beneath exterior doors.
Gaps larger than 1/4 inch exist around pipes, ductwork, etc.
A harborage area exists due to excessive clutter
Wet mops/brooms/scrub brushes are not hung to dry.
Doors are left propped open when not in use.
513/Pest control devices working and installed to prevent contamination of food related items.
Interior or exterior pest control devices are not correctly placed in a manner to effectively control pests
Interior or exterior pest control devices are not correctly placed in a manner to prevent contamination of food or food contact surfaces
Insect light traps (if present) are installed higher than 6 ft. above the ground, not plugged in, turned on, or are inactive or damaged
Air curtains (if present) are not turned on, do not come on when the back door is opened, or do not blow air down and out the door
Decayed rodents in traps or on glue boards
Interior traps and bait stations smashed or otherwise no longer effective
Interior traps and bait stations can no longer keep rodents inside or protect the bait inside
Interior bait stations not securely closed, poison laid out in plastic pouches, open pellets of poison, etc.
Unprotected glue boards/sticky fly strips mounted above food or food contact surfaces
Birds nesting outside the restaurant in an area where droppings could land on deliveries or guests, etc.
517/Exterior garbage storage is covered, free of excess debris and maintained in good repair.
713/Operational Requirement: Hand sanitizer stations are easily accessible to Customers
Hand sanitizer stations are not easily accessible to customers.

Informational Only

Produce wash dispenser is functioning properly.
Allergen/Nutrition info is available in the Restaurant.

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