Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Pest Summary
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Vendor:
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Date:
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Frequency:
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Observation/Recent Activity:
Health Department Summary
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Date:
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Departments:
- Grocery
- Meat
- Produce
- Hot Deli/ Bakery
- Seafood
- Main
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#Critical/ GRP#:
Top 3 Shrinkage Items:
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Grocery
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Meat
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Produce
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Seafood
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Hot Deli
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Bakery
Workers' Comp Incidents
- Workers' Comp Incidents
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Date:
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Description:
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Cause:
Customer Incidents
- Customer Incidents
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Description:
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Date:
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Cause:
Grocery
Facility
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SEWAGE and wastewater properly disposed. (CLOSURE)
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No INSECTS, rodents, birds, or live animals in work area. (CLOSURE)
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NONFOOD contact surfaces are kept clean.
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Adequate VENTILATION and lighting and light guards throughout facility.
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GARBAGE/refuse properly disposed; facilities maintained.
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PREMISES; personal/cleaning items; vermin proofing.
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FLOORS, walls, and ceiling: built, maintained and clean.
Equipment
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TOXIC substances properly identified, stored, and used.
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Food Storage; food storage CONTAINERS identified.
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Consumer SELF-service equipment provided; utensils protected from contamination.
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Equipment/utensils - CLEAN in good repair; approved; sufficient capacity.
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Equipment, utensils and liners: Proper STORAGE and use.
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THERMOMETERS provided and accurate.
Food Handling
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RETURNED food is not to be reserved or reused for consumption.
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Food in good CONDITION, safe and unadulterated.
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Employees demonstrate food safety KNOWLEDGE related to their assigned duties.
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Food SEPARATED and protected.
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Food properly LABELED & honestly presented.
Temperature Reference
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Proper hot and cold HOLDING temperatures.
Hygiene
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Communicable DISEASE reporting, restrictions, exclusions.
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No DISCHARGE from eyes, nose, and mouth.
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Proper EATING, drinking or tobacco use.
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Hands clean and properly washed, proper GLOVE use. (CLOSURE)
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PERSONAL cleanliness and hair restraints.
Sanitizing
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Food contact SURFACES clean and sanitized.
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Wiping CLOTHS properly used and stored.
Documentation
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Food workers have appropriate food safety CERTIFICATION.
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Compliance Self-Audit CHECKLIST and notes are maintained. Retain for 1 year.
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CLEANING schedule logs are maintained. Retain 3 years.
Price & Expiration Check
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Missing Sale Signs
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Wrong Price
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Expired
Meat
Facility
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HOT and cold water readily available in all sinks. (CLOSURE)
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SEWAGE and wastewater properly disposed. (CLOSURE)
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No INSECTS, rodents, birds, or live animals in work area. (CLOSURE)
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NONFOOD contact surfaces are kept clean.
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Adequate VENTILATION and lighting and light guards throughout facility.
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PLUMBING, fixtures, back flow devices, drainage.
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GARBAGE/refuse properly disposed; facilities maintained.
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PREMISES; personal/cleaning items; vermin proofing.
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FLOORS, walls, and ceiling: built, maintained and clean.
Equipment
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TOXIC substances properly identified, stored, and used.
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Food Storage; food storage CONTAINERS identified.
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Consumer SELF-service equipment provided; utensils protected from contamination.
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Equipment/utensils - CLEAN in good repair; approved; sufficient capacity.
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Equipment, utensils and liners: Proper STORAGE and use.
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THERMOMETERS are provided and accurate.
Food Handling
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RETURNED food is not to be reserved or reused for consumption.
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Food in good CONDITION, safe and unadulterated.
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Employees demonstrate food safety KNOWLEDGE related to their assigned duties.
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Approved THAWING methods used.
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Food SEPARATED and protected.
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Food properly LABELED & honestly presented.
Temperature Reference
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Proper hot and cold HOLDING temperatures.
Hygiene
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Communicable DISEASE reporting, restrictions, exclusions.
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No DISCHARGE from eyes, nose, and mouth.
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Proper EATING, drinking or tobacco use.
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Hands clean and properly washed, proper GLOVE use. (CLOSURE)
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Adequate HANDWASHING facilities, supplied and accessible.
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PERSONAL cleanliness and hair restraints.
Sanitizing
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Food contact SURFACES clean and sanitized.
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WAREWASH facilities installed, maintained, used; test equipment.
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Wiping CLOTHS properly used and stored.
Documentation
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Food workers have appropriate food safety CERTIFICATION.
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Compliance Self-Audit CHECKLIST and notes are maintained. Retain for 1 year.
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Meat GRINDING logs are maintained. Retain for 1 year.
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CLEANING schedule logs are maintained. Retain 3 years.
Produce
Facility
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HOT and cold water readily available in all sinks. (CLOSURE)
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SEWAGE and wastewater properly disposed. (CLOSURE)
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No INSECTS, rodents, birds, or live animals in work area. (CLOSURE)
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NONFOOD contact surfaces are kept clean.
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Adequate VENTILATION and lighting and light guards throughout facility.
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PLUMBING, fixtures, back flow devices, drainage.
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GARBAGE/refuse properly disposed; facilities maintained.
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PREMISES; personal/cleaning items; vermin proofing.
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FLOORS, walls, and ceiling: built, maintained and clean.
Equipment
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TOXIC substances properly identified, stored, and used.
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Food Storage; food storage CONTAINERS identified.
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Consumer SELF-service equipment provided; utensils protected from contamination.
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Equipment/utensils - CLEAN in good repair; approved; sufficient capacity.
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Equipment, utensils and liners: Proper STORAGE and use.
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THERMOMETERS provided and accurate.
Food Handling
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RETURNED food is not to be reserved or reused for consumption.
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Food in good CONDITION, safe and unadulterated.
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Employees demonstrate food safety KNOWLEDGE related to their assigned duties.
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Food SEPARATED and protected.
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Food properly LABELED & honestly presented.
Temperature Reference
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Proper hot and cold HOLDING temperatures.
Hygiene
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Communicable DISEASE reporting, restrictions, exclusions.
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No DISCHARGE from eyes, nose, and mouth.
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Proper EATING, drinking or tobacco use.
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Hands clean and properly washed, proper GLOVE use. (CLOSURE)
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Adequate HANDWASHING facilities, supplied and accessible.
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PERSONAL cleanliness and hair restraints.
Sanitizing
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Food contact SURFACES clean and sanitized.
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WAREWASH facilities installed, maintained, used; test equipment.
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Wiping CLOTHS properly used and stored.
Documentation
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Food workers have appropriate food safety CERTIFICATION.
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Compliance Self-Audit CHECKLIST and notes are maintained. Retain for 1 year.
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CLEANING schedule logs are maintained. Retain 3 years.
Seafood
Facility
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HOT and cold water readily available in all sinks. (CLOSURE)
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SEWAGE and wastewater properly disposed. (CLOSURE)
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No INSECTS, rodents, birds, or live animals in work area. (CLOSURE)
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NONFOOD contact surfaces are kept clean.
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Adequate VENTILATION and lighting and light guards throughout facility.
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PLUMBING, fixtures, back flow devices, drainage.
-
GARBAGE/refuse properly disposed; facilities maintained.
-
PREMISES; personal/cleaning items; vermin proofing.
-
FLOORS, walls, and ceiling: built, maintained and clean.
Equipment
-
TOXIC substances properly identified, stored, and used.
-
Food Storage; food storage CONTAINERS identified.
-
Consumer SELF-service equipment provided; utensils protected from contamination.
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Equipment/utensils - CLEAN in good repair; approved; sufficient capacity.
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Equipment, utensils and liners: Proper STORAGE and use.
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THERMOMETERS are provided and accurate.
Food Handling
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RETURNED food is not to be reserved or reused for consumption.
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Food in good CONDITION, safe and unadulterated.
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Employees demonstrate food safety KNOWLEDGE related to their assigned duties.
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Approved THAWING methods used.
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Food SEPARATED and protected.
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Food properly LABELED & honestly presented.
Temperature Reference
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Proper hot and cold HOLDING temperatures.
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Proper COOKING time and temperature.
Hygiene
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Communicable DISEASE reporting, restrictions, exclusions.
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No DISCHARGE from eyes, nose, and mouth.
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Proper EATING, drinking or tobacco use.
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Hands clean and properly washed, proper GLOVE use. (CLOSURE)
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Adequate HANDWASHING facilities, supplied and accessible.
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PERSONAL cleanliness and hair restraints.
Sanitizing
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Food contact SURFACES clean and sanitized.
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WAREWASH facilities installed, maintained, used; test equipment.
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Wiping CLOTHS properly used and stored.
Documentation
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Food workers have appropriate food safety CERTIFICATION.
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Shellfish TAGS are retained for 3 months.
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Compliance Self-Audit CHECKLIST and notes are maintained. Retain for 1 year.
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Live molluscan shellftish tank HACCP logs are maitnained. Retain for 90 days.
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CLEANING schedule logs are maintained. Retain 3 years.
Operations
Facility
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HOT and cold water readily available in all sinks. (CLOSURE)
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SEWAGE and wastewater properly disposed. (CLOSURE)
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No INSECTS, rodents, birds, or live animals in work area. (CLOSURE)
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NONFOOD contact surfaces are kept clean.
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Adequate VENTILATION and lighting and light guards throughout facility.
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PLUMBING, fixtures, back flow devices, drainage.
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GARBAGE/refuse properly disposed; facilities maintained.
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TOILET facilities: properly constructed, supplied, cleaned.
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PREMISES; personal/cleaning items; vermin proofing.
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FLOORS, walls, and ceiling: built, maintained and clean.
Equipment
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TOXIC substances properly identified, stored, and used.
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Consumer SELF-service equipment provided; utensils protected from contamination.
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Equipment/utensils - CLEAN in good repair; approved; sufficient capacity.
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Equipment, utensils and liners: Proper STORAGE and use.
Food Handling
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RETURNED food is not to be reserved or reused for consumption.
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Food in good CONDITION, safe and unadulterated.
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Food from APPROVED sources.
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Employees demonstrate food safety KNOWLEDGE related to their assigned duties.
Temperature Reference
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Proper hot and cold HOLDING temperatures.
Hygiene
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Communicable DISEASE reporting, restrictions, exclusions.
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No DISCHARGE from eyes, nose, and mouth.
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Proper EATING, drinking or tobacco use.
-
Hands clean and properly washed, proper GLOVE use. (CLOSURE)
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Adequate HANDWASHING facilities, supplied and accessible.
-
PERSONAL cleanliness and hair restraints.
Sanitizing
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WAREWASH facilities installed, maintained, used; test equipment.
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Wiping CLOTHS properly used and stored.
Documentation
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Food workers have appropriate food safety CERTIFICATION.
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Shellfish TAGS are retained for 3 months.
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SIGNS posted; last health inspection report available - do not discard.
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SWEEP logs and bathroom logs are organized. Retain for 3 years.
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TEMPERATURE logs are maintained. Retain for 1 year.
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Compliance + HR Self-Audit CHECKLIST and notes are maintained. Retain for 1 year.
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Country of ORIGIN weekly checklists maintained and stored in office. Retain for 90 days.
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WEIGHTS & MEASURES weekly checklists maintained and stored in office. Retain for 90 days.
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INVOICES for all scheduled maintenance items are maintained. Retain for 90 days.
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PROFESSIONALISM in providing customer service, with logs maintained and returned to HQ in a timely manner.
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Store OPENING logs are maintained. Retain for 90 days.
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BUSINESS LICENSE, Health Department permits are current and displayed in a conspicuous place. Retain any expired licenses/permits until new ones arrive.
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HUDDLE-UP meeting notes are complete and up-to-date. Retain for 90 days.
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CLEANING Schedule logs are maintained. Retain 3 years.
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SAFETY checklists are maintained. Retain 1 year.
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LOSS PREVENTION checklists are maintained. Retain 1 year.
Bakery/Hot Deli
Facility
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HOT and cold water readily available in all sinks. (CLOSURE)
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SEWAGE and wastewater properly disposed. (CLOSURE)
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No INSECTS, rodents, birds, or live animals in work area. (CLOSURE)
-
NONFOOD contact surfaces are kept clean.
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Adequate VENTILATION and lighting and light guards throughout facility.
-
PLUMBING, fixtures, back flow devices, drainage.
-
GARBAGE/refuse properly disposed; facilities maintained.
-
PREMISES; personal/cleaning items; vermin proofing.
-
FLOORS, walls, and ceiling: built, maintained and clean.
Equipment
-
TOXIC substances properly identified, stored, and used.
-
Food storage; food storage CONTAINERS identified.
-
Consumer SELF-service equipment provided; utensils protected from contamination.
-
Equipment/utensils - CLEAN in good repair; approved; sufficient capacity.
-
Equipment, utensils and liners: Proper STORAGE and use.
-
THERMOMETERS provided and accurate.
Food Handling
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RETURNED food is not to be reserved or reused for consumption.
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Food in good CONDITION, safe and unadulterated.
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Employees demonstrate food safety KNOWLEDGE related to their assigned duties.
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Approved THAWING methods used.
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Food SEPARATED and protected.
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Raw whole produce WASHED prior to being cut, combined, cooked, or served.
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Food properly LABELED & honestly presented.
Temperature Reference
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Proper hot and cold HOLDING temperatures.
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RECORDS are kept to ensure food is within temperature control; dispose if unsold after 4 hours.
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Proper COOLING methods.
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Proper COOKING time and temperature.
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Previously cooked and cooled food REHEATED to 165F for at least 15 seconds within 2 hours.
Hygiene
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Communicable DISEASE reporting, restrictions, exclusions.
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No DISCHARGE from eyes, nose, and mouth.
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Proper EATING, drinking or tobacco use.
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Hands clean and properly washed, proper GLOVE use. (CLOSURE)
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Adequate HANDWASHING facilities, supplied and accessible.
-
PERSONAL cleanliness and hair restraints.
Sanitizing
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Food contact SURFACES clean and sanitized.
-
WAREWASH facilities installed, maintained, used; test equipment.
-
Wiping CLOTHS properly used and stored.
Documentation
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Food workers have appropriate food safety CERTIFICATION.
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An ADVISORY is provided to customers if serving raw or undercooked food.
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Compliance Self-Audit CHECKLIST and notes are maintained. Retain for 1 year.
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CLEANING schedule logs are maintained. Retain 3 years.
Expiration & Price Check
