TSLC Food Service Inspection Checklist

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

GENERAL INFORMATION

• Date and Time audit began

  Date

• Name(s) of PIC/person(s) in charge (ServSafe certification or equal)

• ServSafe certifications appropriately displayed

  Yes

  No

  N/A

• Employee health poster available

  Yes

  No

  N/A

• Most recent resident satisfaction score:

• % of food prepared from fresh ingredients:

• Describe how choice and preferences are handled:

• Comments:

PROCUREMENT and RECEIVING FOOD

• Food items are purchased from approved source. (licensed by the county, state, or federal government). List primary Vendor Names

  Yes

  No

  N/A

• Deliveries are accepted at non peak times (Record normal delivery day and approximate time)

  Yes

  No

  N/A

• Food is inspected before placed into storage (free from damage, contamination, adulteration and spoilage)

  Yes

  No

  N/A

• Food deliveries are kept 6" off the floor before being stored

  Yes

  No

  N/A

• Potentially Hazardous Food (PHF) received at temperature 41° F or below

  Safe

  At Risk

  N/A

• Frozen food received at temperature 0° F or below

  Safe

  At Risk

  N/A

• Comments:

PERSONNEL HYGIENE PRACTICES

• Employees wear proper uniform including proper shoes

  Yes

  No

  N/A

• Hair restraint is worn

  Yes

  No

  N/A

• Fingernails are short, unpolished and clean

  Yes

  No

  N/A

• Jewelry is limited to watch, simple earrings and plain rings

  Yes

  No

  N/A

• Hands are washed or gloves are changed at critical points

  Yes

  No

  N/A

• Open sores, cuts, or splints and bandages on hands are completely covered while handling food

  Yes

  No

  N/A

• Hands are washed thoroughly using proper hand-washing procedures at critical points

  Yes

  No

  N/A

• Eating, Drinking or chewing gum are observed only in designated areas away from work areas

  Yes

  No

  N/A

• Staff beverages are covered with a lid and straw and stored away from food preparation area

  Yes

  No

  N/A

• Staff take appropriate action when coughing or sneezing

  Yes

  No

  N/A

• Disposal tissues are used and disposed of when coughing/blowing nose

  Yes

  No

  N/A

• Comments:

HANDWASHING

• Hand sinks accessible and stocked with soap and paper towels

  Yes

  No

  N/A

• Staff wash hands in hand-washing sinks only

  Yes

  No

  N/A

• Staff observed washing hands between tasks (handling raw meat, seafood, mops, garbage, ect...

  Yes

  No

  N/A

• Employees wash hands before starting work and returning from break

  Yes

  No

  N/A

• Comments:

DRY FOOD STORAGE

• Temperature is appropriate <br>between 50° F and 70° F

  Yes

  No

  N/A

• Evidence that temperatures are monitored and recorded

  Yes

  No

  N/A

• Record temperature

• Food is stored at least 18" below sprinkler head(s)

  Yes

  No

  N/A

• Is storage area well lit

  Yes

  No

  N/A

• Protective light shields cover all light sources

  Yes

  No

  N/A

• All food is labeled with name and delivery date

  Yes

  No

  N/A

• All food and paper supplies are 6" off the floor

  Yes

  No

  N/A

• Bulk foods are labeled with common name if not in original container<br>(Flour, rice, sugar, ect)

  Yes

  No

  N/A

• There is no bulging, dented or leaking canned goods in storage

  Yes

  No

  N/A

• Food is protected from contamination

  Yes

  No

  N/A

• All surfaces and floor are clean

  Yes

  No

  N/A

• Chemicals are stored away from food and other food related supplies

  Yes

  No

  N/A

• Comments:

COLD FOOD STORAGE

• Walk In Freezer

• Thermometer is conspicuous and accurate

  Yes

  No

  N/A

• Evidence that temperatures are monitored and recorded

  Yes

  No

  N/A

• Record temperature here. (must be < 0° F)

• Food is stored 6" off floor

  Yes

  No

  N/A

• All food is properly wrapped, labeled and dated

  Yes

  No

  N/A

• Unit is clean inside and out

  Yes

  No

  N/A

• Interior safety release is installed and functioning to prevent accidental entrapment.

  Safe

  At Risk

  N/A

• Walk In Refrigerator

• Thermometer is conspicuous and accurate

  Yes

  No

  N/A

• Evidence that temperatures are monitored and recorded

  Yes

  No

  N/A

• Record temperature here. (must be < 41° F)

• Food is stored 6" off floor

  Yes

  No

  N/A

• All food is properly wrapped, labeled and dated

  Yes

  No

  N/A

• Food being thawed is on lowest shelf(s)

  Yes

  No

  N/A

• Unit is clean inside and out

  Yes

  No

  N/A

• Interior safety release is installed and functioning to prevent accidental entrapment.

  Safe

  At Risk

  N/A

• Reach In Freezer

• Thermometer is conspicuous and accurate

  Yes

  No

  N/A

• Record temperature here. (must be < 0° F)

• Evidence that temperatures are monitored and recorded

  Yes

  No

  N/A

• All food is properly wrapped, labeled and dated

  Yes

  No

  N/A

• Unit is clean inside and out

  Yes

  No

  N/A

• Reach In Refrigerator

• Thermometer is conspicuous and accurate

  Yes

  No

  N/A

• Evidence that temperatures are monitored and recorded

  Yes

  No

  N/A

• Record temperature here. (must be < 41° F)

• All food is properly wrapped, labeled and dated

  Yes

  No

  N/A

• Food being thawed is on lowest shelf(s)

  Yes

  No

  N/A

• Unit is clean inside and out

  Yes

  No

  N/A

• Milk Refrigerator

• Thermometer is conspicuous and accurate<br>

  Yes

  No

  N/A

• Evidence that temperatures are monitored and recorded

  Yes

  No

  N/A

• Record temperature here. (must be < 41° F)

• Unit is clean inside and out

  Yes

  No

  N/A

• Comments:

FOOD HANDLING

• Frozen food is thawed under refrigeration or in cold running water

  Yes

  No

  N/A

• Food is not allowed to become cross contaminated

  Yes

  No

  N/A

• Food is handled with utensils, clean gloved hands or clean hands

  Yes

  No

  N/A

• Utensils are handled to avoid touching parts that will be in direct contact with food

  Yes

  No

  N/A

• Reusable towels are used only for sanitizing equipment surfaces and not for drying hands, utensils, floors and ect...

  Yes

  No

  N/A

• Comments:

UTENSILS and EQUIPMENT

• Drawer(s) are clean

  Yes

  No

  N/A

• Rack(s) are clean

  Yes

  No

  N/A

• Equipment is covered when clean and not in use

  Yes

  No

  N/A

• Ice scoops are stored in appropriate container and not in ice machine

  Yes

  No

  N/A

• Dishes are free of stains and food debris

  Yes

  No

  N/A

• EQUIPMENT OPERATION

• Inoperative equipment has been repaired, replaced or removed from the community

  Yes

  No

  N/A

• Pots and pans are free of carbon build up, stains and food debris

  Yes

  No

  N/A

• Only approved equipment (NSF or equivalent with the exception of toasters, mixers, microwave ovens) are installed in an approved manner

  Yes

  No

  N/A

• Comments:

CLEANING and SANITIZING

• Is can opener clean

  Yes

  No

  N/A

• Wiping cloths are stored in sanitizing solution while in use Sanitizing solution <br>100 ppm Chlorine OR 25 ppm OR 200 ppm quat

  Yes

  No

  N/A

• Is toaster clean

  Yes

  No

  N/A

• Is slicer clean

  Yes

  No

  N/A

• Slicer unplugged when not in use

  Safe

  At Risk

  N/A

• Is mixer clean

  Yes

  No

  N/A

• Is coffee machine clean

  Yes

  No

  N/A

• Is juice machine clean

  Yes

  No

  N/A

• Is soda machine clean

  Yes

  No

  N/A

• Is microwave clean

  Yes

  No

  N/A

• Is convection oven clean

  Yes

  No

  N/A

• Is range/oven clean

  Yes

  No

  N/A

• Is char broiler clean

  Yes

  No

  N/A

• Is steamer clean, free of lime build up

  Yes

  No

  N/A

• Is range hood and filters clean

  Yes

  No

  N/A

• Note Date of last professional cleaning of range hood and vendo

  Yes

  No

  N/A

• Is deep fryer clean and properly aligned under fire suppression nozzle

  Yes

  No

  N/A

• Is steam table clean and free of lime build up

  Yes

  No

  N/A

• Are carts clean and wheels free of rust and debris

  Yes

  No

  N/A

• Three Compartment Sink

• Three compartment sink is used

  Yes

  No

  N/A

• Three compartment sink WASH hot, soapy water

  Yes

  No

  N/A

• Three compartment sink RINSE clean, warm water to remove detergents

  Yes

  No

  N/A

• Three compartment sink SANITIZE one minute in clean, warm (at least 75° F) water at:<br>50ppm chlorine OR 12.5 ppm iodine OR 200 ppm quat

  Yes

  No

  N/A

• Three compartment sink AIR DRY on drainboard/sink

  Yes

  No

  N/A

• Dishmachine Chemical Type

• Yes

  No

  N/A

• Dishmachine High Temperature

• Comments:

GARBAGE STORAGE and DISPOSAL

• Kitchen garbage cans are clean and covered when not in use

  Yes

  No

  N/A

• Garbage cans are emptied as necessary

  Yes

  No

  N/A

• Boxes and containers are removed from site

  Yes

  No

  N/A

• Dumpster lid(s) are closed

  Yes

  No

  N/A

• Dumpster area is clean

  Yes

  No

  N/A

• Comments:

INTEGRATED PEST CONTROL

• Screens are on open windows and doors are in good repair

  Yes

  No

  N/A

• Door sweeps restrict the passage of light

  Yes

  No

  N/A

• No evidence of insect or pests is present

  Yes

  No

  N/A

• Comments:

SIGNATURES

• Signature of PIC

  Sign

• Signature of Auditor

  Sign