Information

  • Restaurant Number

  • Restaurant Manager

  • PIC

  • Reason for Visit

  • Conducted on

  • Prepared by

3 Buckets

Bucket 1 - Hand Wash

  • Hand wash timer is set/on? How many minutes left?

  • Does MIC Know when next hourly hand wash is to occur?

  • How does MIC verify all employees properly wash their hands with soap at designated hand sink?

  • Does MIC know only one person goes out to check the lobby and restrooms; and watch for anyone coming in through the kitchen door and ensures proper hand wash is conducted?

Bucket 2 - 8 pre-shift checklist

  • **Serve Safe** <br>-Posted by front counter<br>- MIC can point at it

  • **Tea liners**<br>- Tied <br>- Dated <br>- White tube trimmed

  • **FSC** <br>- 5 Prior days free of errors, complete and properly filled out<br>- Is there signatures showing that it has been checked by the managers?

  • **Sanitizer buckets**<br>- Labeled <br>- MIC shows the ability of how to read the strength of all sanitizer buckets, including shake sanitizer<br>- MIC ensures they are all 150-400

  • **Tools** <br>- There a set of back up tools available in store. <br>- Timer good and set for 4 hours.<br>- Tools changed within 15 minutes after timer goes off. (Tongs and tong pans, meat and egg spatulas, ladle and pan for liquid eggs, sear tool and sear tool pan, egg rings, cool covers, knives and cutting boards, mix in spindle, PHC and UHC drawers, rice scoop and rice scoop pans).

  • **Temps**<br>- MIC able to perform temp tacking process and can explain corrective action with no coaching<br>-MIC displays the ability to correctly take the temp of the Grill (325-375) and patty (>= 155 in 5 different sections of the patty) and knowledgeable on corrective action<br>-MIC displays the ability to correctly take the temp of the shake machine (<=41) by taking three times (FMB) and writing the highest on the FSC and knowledgeable on corrective action<br>-MIC displays the ability to correctly take the temp of the fryers (>=350) and knowledgeable on corrective action<br>-MIC displays the ability to correctly take the temp of the refrigerators (<=41.0) and knowledgeable on corrective action<br>

  • **Any Miscellaneous - FS**<br>- describe any miscellaneous-FS seen. ex, nail polish, stone earrings/jewelry, drinks in food prep areas, etc.<br>

  • **8 criticals**<br>-MIC can name the 8 criticals

Bucket 3 - 8 Criticals

  • No ill employees (vomiting, diarrhea, jaundice, fever/sore throat with fever)

  • No imminent hazards (no electricity, no water/no hot water, sewage backup, fire, natural disaster, infestation problem)

  • Immediately Washing hands at the beginning of the shift and/or after coming from break

  • Immediately Washing hands twice after using the rest room (inside the restroom and inside the kitchen area)

  • At a designated hand was sink with soap

  • Everybody to wash their hands within 15 minutes after "hand wash" timer goes off.

  • Final flip and check

  • No handling raw products with your bare/gloved hands

Any Food Safety Issues Seen. minus points if missed

  • 1st minor observed

  • 2nd minor observed

  • 3rd minor observed

  • 4rth minor observed

  • 5th minor observed

  • 6th minor observed

  • 1st major observed

  • 2n major observed

  • 3rd major observed

  • Any criticals seen?

Observation 8 critical items on standard assessment audit 40 pts possible

  • Fries 150

  • Jumbo Patty Temp 125F

  • Restrooms are stocked with soap, paper towels, and toilet tissue

  • Restroom sinks, changing tables, toilets , and floors are clean or in the process of being cleaned

  • Guest is greeted upon arrival <br>

  • Team members make an effort to be friendly through smiling and conversation

  • Guest is thanked for their visit

  • Guest received what they ordered including correct product build , condiments , napkins, straws , and receipts

Uniforms. 1 pt.

  • Uniforms within standards <br>-refer to Uniforms Job Aid<br>JIB thread only <br>dickies or black slacks<br>solid color and matching socks<br>jewelry per area policy

Cleanliness - refer to maint list. 1 pt

  • Maintenance planner completed and checked off <br>15 daily core items <br>40% by 8 am<br>80% 10am

Outside 25 pts possible

  • Entry doorsl<br>- no more soil than a dollar bill<br>

  • Entry door in good condition

  • Outside window ledges<br>soil no more than a dollar bill

  • Outside trash cans <br>- not overflowing<br>- ash tray must have cat litter or similar

  • Outside trash cans <br>no soil more than a dollar bill<br>graffiti within standard

  • Outside trash cans in good condition

  • Bonus points<br>trash cans polished

  • Directional signs<br>-soil no more than a dollar bill<br>-graffiti within standards

  • Directional signs<br>- in good condition

  • Bonus point<br>directional signs polished <br>

  • Menu board<br>soil no more than a dollar bill<br>graffiti within standard

  • Menu board POP<br> according to matrix<br>no missing seams <br>no missing numbers

  • Menu board in good condition

  • Bonus point - menu boards polished

  • Drive thru lane gum in front of window and order menu board<br>no more gum than a half sheet of paper

  • Drive thru lane<br>- trash no more than an 8 1/2 by 11 sheet of paper<br>- oil stains in front of menu boards and drive thru window not shiny or matte, must be faded stains that show cleaning attempt

  • Drive thru lane <br>- in good conditon

  • Drive thru window<br>no more soil than a dollar bill

  • Drive thru window condition<br>- window locks and in good condition<br>- Fly fan operational and in use

  • Drive thru window POP<br>- free of soil<br>- in good condition

  • Drive thru window POP<br>- current POP following matrix standards

  • Drive thru window frame<br>no more soil than a dollar bill

  • Dumpster lid closed

  • Dumpster area <br>- trash and soil accumulated no more than a 8 1/2 by 11 inch piece of paper <br>-

  • Dumpster gate/walls<br>- graffiti within standard<br>- no more soil than an by sheet of paper

  • dumpster area - in good condition

  • 80% of windows free of soil <br>- each window no more than a dollar bill

  • POP correct according to matrix<br>- notate any recommendations on current POP

  • POP free of bubbles and wrinkles<br>- no more than a dollar bill<br>- no dog ears greater then half of the height of a dollar bill

dinning room. 21 pts possible

  • Bonus point<br>iced machine on top of freestyle polished

  • 8 out of 10 chairs <br>- free of soil no more than a dollar bill per chair<br>

  • Chairs- in good condition ( seats no more than 50 percent )<br>

  • Table edges <br>-no more soil than a dollar bill per table

  • Tables in good condition

  • High chairs <br>-soil no mare then half a dollar bill and in proper working condition

  • Vents - no more soil than half a dollar bill

  • Vents in good condition

  • Dining room lighting<br>- no lights out<br>- in good condition<br>

  • Wet floor signs<br>soil no more than a dollar bill

  • Wet floor signs<br>- available and in good condition

  • Trash cans <br>- not overflowing <br>-tops and exterior free of soil less than a dollar bill

  • Trash cans <br>inside walls no more soil than a dollar bill

  • Trash cans in good condition

  • Dining room POP/picture decor<br>-no more soil than a dollar bill

  • Dining room POP/picture decor<br>- up to date and JIB standards

  • Dining room window ledges<br>- free of soil

  • Dining room frames and railings <br>- no more soil than half am 8 1/2 by 11 sheet of paper

  • Dining room walls<br>- soil no more than a half sheet of paper

  • Tile no more than 4 cracked tiles or covings

  • Dining room covings <br>- no more than 6 dirty covings <br>- coving soil less than 1/2 of a dollar bill

  • Fly lamps on and operational

Restrooms 15 pts possible

  • Restroom walls <br>- no more soil than a dollar bill <br>- graffiti within standards

  • Restroom lighting <br>- no lights out <br>- all lights have protective cover

  • Mirrors an signs <br>- soil less than 1/2 a dollar bill each

  • Mirrors and signs condition<br>- in good condition<br>- hand wash sign required

  • Restroom covings <br>- less than 3 covings with soil les than 1/2 a dollar bill

  • Restroom tile <br>- no more than 1 broken tiles/cove bases

  • Restroom toilets and sinks<br>- graffiti within standard<br>- soil should be less than 1/2 a dollar bill

  • Toilets an sinks in good condition

  • Restroom vents<br>- soil less than 1/2 a dollar bill eack

  • Dispensers and hand dryers <br>-stocked and in good working condition

  • Dispensers and hand dryers<br>- graffiti within standards<br>- soil less than 1/2 a dollar bill each

  • Bonus point<br>dispensers and trash cans in restroom polish

  • Restroom doors <br>- soil less than 1/2 a dollar bill<br>- graffiti within standard <br>

  • Bonus point - kick plates polished

  • Lighting<br>- no lights out <br>- all light have light covers

  • Restrooms free of odor

Back of the House / kitchen. 15 pts possible

  • Dry storage<br>- No more than 4 boxes without flaps cut off

  • Trash cans <br>soil no more than an 8 1/2 by 11 sheet of paper

  • Back door<br>- clear of trash and boxes more than 75% of door clear

  • Back door free of gaps ( no light coming through)

  • Back door fly fan on and in working condition

  • Oil tank pan<br>- no more soil than an 8 1/2 by 11 sheet of paper

  • Vents<br>- no more soil than 1/2 a dollar bill

  • Walls<br>- no more soil than 1/2 a sheet of paper per wall

  • Cove bases <br>- no more than 10 with more soil than a 1/2 dollar bill

  • Tile<br>- no more than 5 cracked or missing tiles including cove bases

  • Mop sink - no mops, broom, buckets, tools, etc on sink floor

  • Mop sink<br>- no trash or standing water more than an 8 1/2 by 11 sheet of paper

  • Mop buckets<br>- no more soil than an 8 1/2 by 11 sheet of paper <br>- mop is not left in water when not in use

  • Employee room<br>- if used as storage does not take more than 1/2 of employee room

  • Kitchen hoods filters<br>- no dripping oil more than half a dollar bill from hood filters<br>

  • Walk ins<br>- no empty boxes<br>- no products exposed to air <br>- door strips non missing and in good condition

Quality Prep- refer to prep list, 9 pts possible

  • Prep list modified<br>- to fit store needs

  • Prep list being followed<br>- quantities made match what prep list is asking for no more than 2 set ups in accurate

  • Prep book available and up to date<br>- prep list kept for last 7 days

  • Salad weighs <br>-12oz -15oz<br>- no cores<br>- proper build being used

  • Key set ups have accurate weights<br>-refer to set up weight job aid<br>- weigh one of each<br>- weight should be within a quarter ounce difference

  • Expired product<br>- no expired products including soda and dry storage<br>-spot check

  • No product being defrosted being use<br>- Using products only after defrost ( including : tacos, monster tacos, chicken fillets, fajita, etc)

  • Fill line standards followed<br>- anything that will go from walk in to assembly line should not be filled past container fill line.

  • All tools available and in working condition<br>- scale, ladles , scoops, tomato slicer, lettuce shredder, and label gun and tape available. (Ink on tape not faded)

quality bread 9 pts possicle

  • Quality - bread (refer to Bread Quality Job Aid)<br>

  • Sourdough bread griller settings correct <br>- adjusted to meet standards (ideally 2,2 and

  • Sourdough griller disassemble<br>- no more than 20% built up on platen<br>- chain has no excessive build up<br>

  • Round up toasters settings correctl<br>- D2 or D1 if using for sourdough bread. If adjusted to different setting must still meet quality standard

  • Disassemble round up toaster <br>- belt is not worn <br>- butter wheel properly maintained no excessive built up

  • Bread expiration and defrost<br>- no bread expired<br>- no frozen bread being used

  • Toaster teflon sheets<br>- rotated and available ( 3 different types)

  • Batch toaster time settings correct

  • Batch taster spatulas and sponges<br>- spatulas no more than 20% built up (front and back)<br>- sponges properly maintained<br>

Quality Assembly. 7 pts possible

  • Quality - Assembly (refer to Quality Job Aid)<br>- pickles submerged<br> - tomatoes properly stacked <br>- cheese to fill line<br>- lettuce green, crisp, no cores<br>- onions crisp and white<br>- bacon crisp no more than ten per sheet ( 4inch pan 10, 6 inch pan 15)

  • No more than 4 sandwiches assembled at one time<br>- proper build protein being placed last on sandwich <br>

  • Saucing procedures being followed

  • Protein cabinet<br>- proper quantities being held<br>- timers set and used correctly<br>-

  • UHC <br>-proper quantities held <br>- timers set and used correctly

  • Taco staging unit<br>- tacos held correctly<br>-bags free of sauce and not soggy<br>- tacos bagged correctly

  • Taco Staging times <br>- 3 ten min timers available and at fryer station<br>- taco staging unit marked front middle and back with corresponding timers.

  • Proper box and wrapping procedures <br>

Quality oil- refer to oil quality job aid and calendar 3 pts possible

  • Quality - Oil <br>refer to quality job aid

  • Oil calendar <br>- updated to current month with boil out and change days marked

  • Skim<br>- timer set for 15 min skimming<br>- debris in fryers more than half of a dollar bill

Station Planners- refer to glossary 4 pts possible

  • Station Planner - Grill (completed/in progress) <br>

  • Station Planner - Fryer (completed/in progress)

  • Station Planner - Guest Service (completed/in progress)

  • Station Planner - Drive Thru (completed/in progress)

On Going. 30 pts possible

  • PIC in right position, deploying up and down to delegate tasks and effectively directing team?<br>1,3,6,8 highest available<br>does not leave right primary position for more than 10min at a time

  • "2 Minute Drills" conducted at lest every 1/2 hour?<br>-cleanliness <br>- inconsistent when more than an hour passes by with no 2 min drill performed<br>-protein cabinet <br>-quality

  • "Build-To's" being communicated to team and verified by PIC?<br>- items meant to hold are highlighted<br>- half hours are marked off when past<br>-no products that are not highlighted being held. highlighted items are not excessively off of the planned amount<br>- pic actually follows up on quality of products being station

Planning Book. 6 pts possible

  • Store Visit completed/in progress including task assignments

  • Daily Placement Chart<br>completed check past 5 days<br>-must have breaks tracked and crossed off

  • Daily Graphs<br>completed check past 5 days <br>non sales generating hours are scheduled properly<br>breaks are scheduled for all shifts over 5 hours

  • Task Assignment <br>completed check past 5 days

  • Destroy<br>completed check past 5 days

  • Hourly Sales Tracking <br>completed check past 5 days <br>must be filled out until at least 10 pm to get the points

Communication Board (current and with actionable notes). 9 pts possible

  • VOG

  • Food Cost action plan

  • Food Cost Variance analysis

  • Weekly Goals and Achievements

  • Employees Reward and Recognition

  • SOS

  • Cashier Performance

  • Void Order Report

  • Alerts per 10k tracking posted

Training coordinator. 0 pts possible

  • manpower completed for current quarter

  • filling cabinet or similar set aside for training<br>

  • files labeled with employee names

  • CBT certifications posted

Financial

  • Stand bank at $1,200?

Critical Thinking

  • Visual support

  • New Action Plan -What happened -why did it happen -how can it be resolved (what tools/approaches can be put in place) -deadline -who is responsible (to execute and to follow up)

  • New Action Plan -What happened -why did it happen -how can it be resolved (what tools/approaches can be put in place) -deadline -who is responsible (to execute and to follow up)

  • New Action Plan -What happened -why did it happen -how can it be resolved (what tools/approaches can be put in place) -deadline -who is responsible (to execute and to follow up)

  • Additional Comments

  • PIC

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.