Trial-Internal Health & Safety Inspection - duplicate

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• 3 basin sink sanitizer is filled

  Good

  Fair

  Poor

  N/A

• Sanitizer kits are open and readily available

  Yes

  No

  N/A

• Sanitizer is at proper ppm

  Yes

  No

  N/A

• Sanitizer temperature is between 65-85 degreees

  Yes

  No

  N/A

• Sanitizer basin marked with a 4 hour hold time during all hours of operation

  Yes

  No

  N/A

• Sanitizer solutions for manual use are maintained at proper concentration temperature per label instructions

  Yes

  No

  N/A

• Sanitizer buckets are not stored directly on the floor

  Yes

  No

  N/A

• Water temperature for non-sanitizing sink is maintained at 100 degrees

  Yes

  No

  N/A

• Handwash sinks are easily accessible

  Yes

  No

  N/A

• Ware-washing sinks are large enough to immerse largest piece of equipment being cleaned and sanitized

  Yes

  No

  N/A

• Sinks are not used for dishwashing and food prep at the same time and sanitized between processes

  Yes

  No

  N/A

• Handwash sinks are signed "Handwash Only"

  Yes

  No

  N/A

• Handwash sinks are signed "Employees must wash hands..."

  Yes

  No

  N/A

• Clean Utrnsils, food equipment, and food contact packaging are stored in a sanitary matter.

  Yes

  No

  N/A

• Storage containers such as canisters, bins, drawers, are maintained and clean.

  Yes

  No

  N/A

• Ware-washing sinks are large enough to immerse largest piece of equipment being cleaned and sanitized

  Yes

  No

  N/A

• Sponges are not stored with clean and sanitized or in-use food-contact surfaces

  Yes

  No

  N/A

• Cleaning and maintenance tools are not cleaned in food prep sinks, dishwashing machines, or dishwashing sinks

  Yes

  No

  N/A

• All cleaning tools are properly stored between uses to avoid contamination of other surfaces

  Yes

  No

  N/A

• Mop bucket does not hold any standing water

  Yes

  No

  N/A

• Wiping cloths are kept clean and dry or else immersed in properly diluted sanitizer

  Yes

  No

  N/A

Store Equipment

• All ladders and stepstools work properly with no defects

  Yes

  No

  N/A

• Handcarts in good working condition (2 wheel & 4 wheel)

  Yes

  No

  N/A

• Cooler and freezer gloves available

  Yes

  No

  N/A

• Blue nitrile gloves available

  Yes

  No

  N/A

• Store has and uses authorized safety cutters

  Yes

  No

  N/A

• No gasoline is kept within the store

  Yes

  No

  N/A

• Store has Ergo Kneel Pad

  Yes

  No

  N/A

• Wet floor cones available

  Yes

  No

  N/A

• Antifatigue mats in good condition behind counter

  Yes

  No

  N/A

• Platform step at the checkout brightly marked and readily visible

  Yes

  No

  N/A

• Reflective vest available

  Yes

  No

  N/A

• First Aid Kit with reorder label

  Yes

  No

  N/A

• Burn Kit with reorder label

  Yes

  No

  N/A

• Sharps Box with label

  Yes

  No

  N/A

• Bodily Fluid Kit with procedures

  Yes

  No

  N/A

• Yes

  No

  N/A

• Circuit breaker door marked Emergency Gas Breakers Located Inside

  Yes

  No

  N/A

• Gas shutoff breakers marked with a red dot

  Yes

  No

  N/A

• All circuit breakers labeled as to what they control

  Yes

  No

  N/A

• There is a 3 ft clearance in front of all electrical panels

  Yes

  No

  N/A

• There is a Keep Clear Posting on electrical panel doors

  Yes

  No

  N/A

• All live electrical parts enclosed

  Yes

  No

  N/A

• No extension cords

  Yes

  No

  N/A

• Power cords and plugs in good conditions

  Yes

  No

  N/A

• All electrical outlets in good condition

  Yes

  No

  N/A

• Food equipment lubricants that may contact foods are approved as food additives

  Yes

  No

  N/A

• Chemicals are used for intended purposes only

  Yes

  No

  N/A

• Containers previously used for chemicals are not used for storing, dispensing, or transporting food

  Yes

  No

  N/A

• Original containers of toxic material have legible manufacturer's labels

  Yes

  No

  N/A

• Working containers of cleaners and sanitizers are labeled with the common name of the product

  Yes

  No

  N/A

• Spill absorbent available

  Yes

  No

  N/A

• Backroom has an emergency door

  Yes

  No

  N/A

• Emergency Exits have crash bars

  Yes

  No

  N/A

• There is a 3 ft aisle leading to all emergency exits

  Yes

  No

  N/A

• There is a Keep Area Clear posting on all emergency exit doors

  Yes

  No

  N/A

• Emergency lighting tests work

  Yes

  No

  N/A

• Illuminated exit signs over all doors

  Yes

  No

  N/A

• Fire extinguishers readily accessible

  Yes

  No

  N/A

• Fire extinguishers show full charge

  Yes

  No

  N/A

• Fire extinguishers have been inspected and tag punched within the year

  Yes

  No

  N/A

• Fire extinguishers initialed every month

  Yes

  No

  N/A

Food Safety

• Foods are labeled with name and expiration dates

  Yes

  No

  N/A

• Foods are properly sealed and not exposed

  Yes

  No

  N/A

• Food is not stored with chemicals

  Yes

  No

  N/A

• Food and food contact packaging are stored at least six inches off the floor

  Yes

  No

  N/A

• No condensation is present above food or food contact surfaces

  Yes

  No

  N/A

• Vents, fan guards, and filters are clean and present

  Yes

  No

  N/A

Safety

• Surfaces are durable, non-toxic, easily cleanable, and in good condition

  Yes

  No

  N/A

• Over cooler storage area is free of heavy items (max 5 boxes of 10 lbs) and reachable by ladder

  Yes

  No

  N/A

• Minimal clutter and clear pathways eliminate tripping hazards

  Yes

  No

  N/A

• No heavy items stored above shoulder height or on top shelf of rolling shelf

  Yes

  No

  N/A

• No spills present/floors are clean

  Yes

  No

  N/A

Food Safety

• Foods are labeled with name and expiration dates

  Yes

  No

  N/A

• Food is not stored with chemicals

  Yes

  No

  N/A

• Foods are properly sealed and not exposed

  Yes

  No

  N/A

• Food and food contact packaging are stored at least six inches off the floor

  Yes

  No

  N/A

• No condensation is present above food or food contact surfaces

  Yes

  No

  N/A

• Foods show no sign of temperature abuse and foods are received at proper temperature

  Yes

  No

  N/A

• Vents, fan guards, and filters are clean and present

  Yes

  No

  N/A

• Equipment and utensils are properly cleaned (door handles/gaskets/sliding door tracks/shelves)

  Yes

  No

  N/A

• Gaskets or equipment are secured and in good condition

  Yes

  No

  N/A

Safety

• Minimal clutter and clear pathways to eliminate tripping hazards

  Yes

  No

  N/A

• No heavy items stored above shoulder height or on top shelf of rolling shelf

  Yes

  No

  N/A

• No spills present/floors are clean

  Yes

  No

  N/A

• No ice buildup

  Yes

  No

  N/A

• Cold foods that require time/temp control are maintained at 41 degrees or below in all cold holding devices

  Yes

  No

  N/A

• Hot foods that require time/temp control are maintained at 130 degrees or above

  Yes

  No

  N/A

• Refrigerated and hot holding units are equipped with accurate thermometers that are easily visible

  Yes

  No

  N/A

• Thermometers are accurate and available for use in food receiving, prep, holding, and serving areas

  Yes

  No

  N/A

• Proper cooling/thawing methods used

  Yes

  No

  N/A

• Foods requiring time/temp control are properly handled before being displayed and not left out of controlled environments for extended periods of time

  Yes

  No

  N/A

• Foods held by time alone are at proper temp before being removed from temp controlled and served/discarded within 4 hours

  Yes

  No

  N/A

• Food prepped on site is reheated to 165 degrees within 2 hours for hot holding

  Yes

  No

  N/A

Food Safety

• Foods are dated with when the product must be consumed, sold, discarded

  Yes

  No

  N/A

• No presence of expired foods

  Yes

  No

  N/A

• Food and packaging in sound condition

  Yes

  No

  N/A

• Product at least 6 in above the ground

  Yes

  No

  N/A

Safety

• Sales floor clear of tripping hazards or liquid spills

  Yes

  No

  N/A

• All sales floor displays secure and free of sharp or damaged edges

  Yes

  No

  N/A

• All sales floor aisles at least three ft wide

  Yes

  No

  N/A

Coffee Station

• Cappuccino machines properly cleaned

  Yes

  No

  N/A

• Cream and milk dispensers are properly set up and tubes cut at 45 degrees

  Yes

  No

  N/A

• Milk box labeled with expiration date

  Yes

  No

  N/A

• Milk bag labeled with 24 hr discard time

  Yes

  No

  N/A

• Milk temp is 40 degrees or below

  Yes

  No

  N/A

• Hot and iced coffee pots are properly cleaned

  Yes

  No

  N/A

• Coffee spouts are clean and in good condition

  Yes

  No

  N/A

• No ground coffee staged in brewers and old grounds are removed

  Yes

  No

  N/A

• Coffee, iced coffee, iced tea machines properly labeled and time/date marked

  Yes

  No

  N/A

Chill Zone

• F'REAL machine fully cleaned and sanitized within last 24 hours

  Yes

  No

  N/A

• Chill zone spouts clean and in good condition

  Yes

  No

  N/A

• Ice chute properly cleaned

  Yes

  No

  N/A

Sandwich & Pastry Case

• 3 food simulator thermometers present

  Yes

  No

  N/A

• Sandwich case guards are clean

  Yes

  No

  N/A

• Pastry case clean and tissue paper available

  Yes

  No

  N/A

• Pastry items Dated

  Yes

  No

  N/A

Service Counter

• Fresh condiment rail clean

  Yes

  No

  N/A

• Products on fresh condiment rail are stored in pre-proportioned soufflé cups and labeled with 7 day hold time or in container for 24 hr

  Yes

  No

  N/A

• Only approved condiment bottles used and available for guests

  Yes

  No

  N/A

• Condiment bottles are free from dried residue

  Yes

  No

  N/A

• All open sauce bottles are properly dated for 21 days

  Yes

  No

  N/A

• Pizza display is clean and maintained

  Yes

  No

  N/A

• Product identifiers and timers used properly on the grill and dog house

  Yes

  No

  N/A

• Chili/Cheese inside machine dated for 7 days

  Yes

  No

  N/A

• Spray bottle of water not used for pretzel preparations

  Yes

  No

  N/A

• Foods on the counter are identified with the common name of the product

  Yes

  No

  N/A

• Date marking is applied at time of on-site food prep to foods that require time/temp control

  Yes

  No

  N/A

• Foods and food contact surfaces are protected from potential microbiological, physical, and chemical hazards

  Yes

  No

  N/A

• No condensation present above exposed food or food contact surfaces

  Yes

  No

  N/A

• Proper serving practices are observed so hands do not touch food or lip-contact surfaces

  Yes

  No

  N/A

• Handles of utensils stored in the product do not touch the product and extend out of the container for foods that require time/temp control

  Yes

  No

  N/A

• In use utensils are properly handled and stored

  Yes

  No

  N/A

• Food contact surfaces are properly cleaned and sanitized at least every 4 hours

  Yes

  No

  N/A

• Food contact surfaces are smooth, easily cleanable, and in good condition

  Yes

  No

  N/A

• Non food contact surfaces are properly cleaned

  Yes

  No

  N/A

• 1 working toilet

  Yes

  No

  N/A

• Restrooms free of hazards or liquid spills

  Yes

  No

  N/A

• Restroom clean and sanitary

  Yes

  No

  N/A

• Floors, walls, and ceiling vents free of excessive dust

  Yes

  No

  N/A

• CO2 shutoff marked

  Yes

  No

  N/A

• Sidewalks/Parking lot free of defects, holes, and/or large cracks

  Yes

  No

  N/A

• Sidewalk edges do not need repainting

  Yes

  No

  N/A

• Sidewalks free of dripping water or slippery surfaces

  Yes

  No

  N/A

• Parking lot curbing intact

  Yes

  No

  N/A

• Ballers are Intact and Standing Correctly

  Yes

  No

  N/A

• Warning decals posted at gas pumps

  Yes

  No

  N/A

• Metal edging on each gas island intact

  Yes

  No

  N/A

• Gas pump side panels securely in place

  Yes

  No

  N/A

• Handicapped Assistance stickers on each pump

  Yes

  No

  N/A

• Handicap space lines clearly defined and the wheelchair symbol painted in the space

  Yes

  No

  N/A

• Handicap ramp is 3 ft. wide and obstruction free

  Yes

  No

  N/A

• Sewage disposal systems and grease traps operating properly

  Yes

  No

  N/A

• Air gaps/backflow prevention

  Yes

  No

  N/A

• Pest prevention system is effective

  Yes

  No

  N/A

• No pest entry points

  Yes

  No

  N/A

• No pest harborage sites

  Yes

  No

  N/A

• Garbage is maintained

  Yes

  No

  N/A

• Hot & cold temp logs are up to date

  Yes

  No

  N/A

• Yellow Emergency Response Card

  Yes

  No

  N/A

• Blue 5 Minute Rule Card

  Yes

  No

  N/A

• Safety calendar

  Yes

  No

  N/A

• Vendor procedures posted on cooler door

  Yes

  No

  N/A

• Workers Compensation Insurance Notice

  Yes

  No

  N/A

• Federal Labor Poster

  Yes

  No

  N/A

• State labor Posted

  Yes

  No

  N/A

• Have all employees completed Safety Training

  Yes

  No

  N/A