Weekly Food Safety Assessment

• Document No.

• Club Number

• Conducted on

  Date

• Prepared by

Bakery

High Five # 1 - Be Clean, Be Healthy

• Does the person in charge know the Associate illness guidelines and Big 5 illnesses? *

  Yes

  No

  N/A

• Are associates using barriers (tongs, gloves, tissue paper, etc...) when handling ready-to-eat food? *

  Yes

  No

  N/A

• Are associates washing hands when appropriate? *

  Yes

  No

  N/A

• Are associates washing hands properly, including at the designated hand sink? *

  Yes

  No

  N/A

• Are associates eating or drinking in the designated areas? *

  Yes

  No

  N/A

• Are associates in the fresh areas following the dress code?

  Yes

  No

  N/A

• Are all hand sinks supplied with soap? *

  Yes

  No

  N/A

• Are all hand sinks supplied with paper towels? *

  Yes

  No

  N/A

• Are all hand sinks supplied with hot and cold water? *

  Yes

  No

  N/A

High Five #2 - Keep It Cold, Keep It Hot

• Are cold potentially hazardous foods being held below 41 degrees? *

  Yes

  No

  N/A

• Are hot held potentially hazardous foods being held above 140 degrees? *

  Yes

  No

  N/A

• Are food items properly thawed?

  Yes

  No

  N/A

• Are refrigerated units working properly and in good repair? *

  Yes

  No

  N/A

High Five #3 - Don't Cross Contaminate

• Are the raw foods properly stored? *

  Yes

  No

  N/A

• Are spray bottles properly labeled, Chemical containers and secondary storage containers, such as spray bottles are labeled with the product's name, manufacturer's name, address, and phone number, personal protective equipment requirements, and hazard warnings? *

  Yes

  No

  N/A

• Are chemicals properly stored? *

  Yes

  No

  N/A

High Five #4 - Wash, Rinse & Sanitize

• Are food contact surfaces clean to sight and touch? *

  Yes

  No

  N/A

• Is sanitizer concentrate levels at 200ppm? *

  Yes

  No

  N/A

• Is the rack washer rinse cycle temp 160 degrees or above at plate level? *

  Yes

  No

  N/A

• Is there hot water available at the three compartment sink? *

  Yes

  No

  N/A

• Are non-food contact surfaces clean?

  Yes

  No

  N/A

• Are test strips available?

  Yes

  No

  N/A

High Five #5 - Cook It & Chill It

• Are foods cooked to the proper cooking temperatures? *

  Yes

  No

  N/A

• Are food items being cooled properly? *

  Yes

  No

  N/A

Equipment

• Are food items properly stored (covered, 6 in. off the floor)?

  Yes

  No

  N/A

• Are food containers properly labeled with the common name?

  Yes

  No

  N/A

• Is equipment in good repair and well maintained?

  Yes

  No

  N/A

• Are there available and functional thermometers in each department and refrigerated unit?

  Yes

  No

  N/A

• Are any of the cutting boards heavily scratched or scored being removed and replaced as needed?

  Yes

  No

  N/A

• Are utensils properly stored (i.e. inverted, covered, 6 inches off of the floor)?

  Yes

  No

  N/A

Physical Facilities

• Are floors, drains, walls, and ceilings clean (including vents and hoods)?

  Yes

  No

  N/A

• Are floors, walls and ceilings in good repair?

  Yes

  No

  N/A

• Are lights working and properly shielded?

  Yes

  No

  N/A

• Are items/equipment only necessary for production stored in the Fresh areas?

  Yes

  No

  N/A

• Are products that are out for sale within code dating guidelines?

  Yes

  No

  N/A

• Are all the current logs being utilized correctly?

  Yes

  No

  N/A

• Are all the latest recalls/withdrawals being followed according to the recall notice?

  Yes

  No

  N/A

• Are all regulatory contacts entered into the system and all exceptions noted on the visits corrected per company policy OP-35?

  Yes

  No

  N/A

Sanitation

• Are non-food contact surfaces of equipment and utensils free from previous day's soil or food build up?

  Yes

  No

  N/A

• Are coolers, walls, ceilings, floors and drains, free of soil, mold or dirty?

  Yes

  No

  N/A

• Are food, food packaging and utensils stored properly?

  Yes

  No

  N/A

• Is the department free of clutter, trash and debris?

  Yes

  No

  N/A

• Are associate uniforms and aprons clean, stored properly, and removed before break, lunch or using restroom?

  Yes

  No

  N/A

Cafe

High Five # 1 - Be Clean, Be Healthy

• Does the person in charge know the Associate illness guidelines and Big 5 illnesses? *

  Yes

  No

  N/A

• Are associates using barriers (tongs, gloves, tissue paper, etc...) when handling ready-to-eat food? *

  Yes

  No

  N/A

• Are associates washing hands when appropriate? *

  Yes

  No

  N/A

• Are associates washing hands properly, including at the designated hand sink? *

  Yes

  No

  N/A

• Are associates eating or drinking in the designated areas? *

  Yes

  No

  N/A

• Are associates in the fresh areas following the dress code?

  Yes

  No

  N/A

• Are all hand sinks supplied with soap? *

  Yes

  No

  N/A

• Are all hand sinks supplied with paper towels? *

  Yes

  No

  N/A

• Are all hand sinks supplied with hot and cold water? *

  Yes

  No

  N/A

High Five #2 - Keep It Cold, Keep It Hot

• Are cold potentially hazardous foods being held below 41 degrees? *

  Yes

  No

  N/A

• Are hot held potentially hazardous foods being held above 140 degrees? *

  Yes

  No

  N/A

• Are food items properly thawed?

  Yes

  No

  N/A

• Are refrigerated units working properly and in good repair? *

  Yes

  No

  N/A

High Five #3 - Don't Cross Contaminate

• Are the raw foods properly stored? *

  Yes

  No

  N/A

• Are spray bottles properly labeled, Chemical containers and secondary storage containers, such as spray bottles are labeled with the product's name, manufacturer's name, address, and phone number, personal protective equipment requirements, and hazard warnings? *

  Yes

  No

  N/A

• Are chemicals properly stored? *

  Yes

  No

  N/A

High Five #4 - Wash, Rinse & Sanitize

• Are food contact surfaces clean to sight and touch? *

  Yes

  No

  N/A

• Is sanitizer concentrate levels at 200ppm? *

  Yes

  No

  N/A

• Is there hot water available at the three compartment sink? *

  Yes

  No

  N/A

• Are non-food contact surfaces clean?

  Yes

  No

  N/A

• Are test strips available?

  Yes

  No

  N/A

High Five #5 - Cook It & Chill It

• Are foods cooked to the proper cooking temperatures? *

  Yes

  No

  N/A

• Are food items being cooled properly? *

  Yes

  No

  N/A

Equipment

• Are food items properly stored (covered, 6 in. off the floor)?

  Yes

  No

  N/A

• Are food containers properly labeled with the common name?

  Yes

  No

  N/A

• Is equipment in good repair and well maintained?

  Yes

  No

  N/A

• Are there available and functional thermometers in each department and refrigerated unit?

  Yes

  No

  N/A

• Are any of the cutting boards heavily scratched or scored being removed and replaced as needed?

  Yes

  No

  N/A

• Are utensils properly stored (i.e. inverted, covered, 6 inches off of the floor)?

  Yes

  No

  N/A

Physical Facilities

• Are floors, drains, walls, and ceilings clean (including vents and hoods)?

  Yes

  No

  N/A

• Are floors, walls and ceilings in good repair?

  Yes

  No

  N/A

• Are lights working and properly shielded?

  Yes

  No

  N/A

• Are items/equipment only necessary for production stored in the Fresh areas?

  Yes

  No

  N/A

• Are products that are out for sale within code dating guidelines?

  Yes

  No

  N/A

• Are all the current logs being utilized correctly?

  Yes

  No

  N/A

• Are all the latest recalls/withdrawals being followed according to the recall notice?

  Yes

  No

  N/A

• Are all regulatory contacts entered into the system and all exceptions noted on the visits corrected per company policy OP-35?

  Yes

  No

  N/A

Sanitation

• Are non-food contact surfaces of equipment and utensils free from previous day's soil or food build up?

  Yes

  No

  N/A

• Are coolers, walls, ceilings, floors and drains, free of soil, mold or dirty?

  Yes

  No

  N/A

• Are food, food packaging and utensils stored properly?

  Yes

  No

  N/A

• Is the department free of clutter, trash and debris?

  Yes

  No

  N/A

• Are associate uniforms and aprons clean, stored properly, and removed before break, lunch or using restroom?

  Yes

  No

  N/A

Deli/Roti/HMS

High Five # 1 - Be Clean, Be Healthy

• Does the person in charge know the Associate illness guidelines and Big 5 illnesses? *

  Yes

  No

  N/A

• Are associates using barriers (tongs, gloves, tissue paper, etc...) when handling ready-to-eat food? *

  Yes

  No

  N/A

• Are associates washing hands when appropriate? *

  Yes

  No

  N/A

• Are associates washing hands properly, including at the designated hand sink? *

  Yes

  No

  N/A

• Are associates eating or drinking in the designated areas? *

  Yes

  No

  N/A

• Are associates in the fresh areas following the dress code?

  Yes

  No

  N/A

• Are all hand sinks supplied with soap? *

  Yes

  No

  N/A

• Are all hand sinks supplied with paper towels? *

  Yes

  No

  N/A

• Are all hand sinks supplied with hot and cold water? *

  Yes

  No

  N/A

High Five #2 - Keep It Cold, Keep It Hot

• Are cold potentially hazardous foods being held below 41 degrees? *

  Yes

  No

  N/A

• Are hot held potentially hazardous foods being held above 140 degrees? *

  Yes

  No

  N/A

• Are food items properly thawed?

  Yes

  No

  N/A

• Are refrigerated units working properly and in good repair? *

  Yes

  No

  N/A

High Five #3 - Don't Cross Contaminate

• Are the raw foods properly stored? *

  Yes

  No

  N/A

• Are spray bottles properly labeled, Chemical containers and secondary storage containers, such as spray bottles are labeled with the product's name, manufacturer's name, address, and phone number, personal protective equipment requirements, and hazard warnings? *

  Yes

  No

  N/A

• Are chemicals properly stored? *

  Yes

  No

  N/A

High Five #4 - Wash, Rinse & Sanitize

• Are food contact surfaces clean to sight and touch? *

  Yes

  No

  N/A

• Is sanitizer concentrate levels at 200ppm? *

  Yes

  No

  N/A

• Is there hot water available at the three compartment sink? *

  Yes

  No

  N/A

• Are non-food contact surfaces clean?

  Yes

  No

  N/A

• Are test strips available?

  Yes

  No

  N/A

High Five #5 - Cook It & Chill It

• Are foods cooked to the proper cooking temperatures? *

  Yes

  No

  N/A

• Are food items being cooled properly? *

  Yes

  No

  N/A

Equipment

• Are food items properly stored (covered, 6 in. off the floor)?

  Yes

  No

  N/A

• Are food containers properly labeled with the common name?

  Yes

  No

  N/A

• Is equipment in good repair and well maintained?

  Yes

  No

  N/A

• Are there available and functional thermometers in each department and refrigerated unit?

  Yes

  No

  N/A

• Are any of the cutting boards heavily scratched or scored being removed and replaced as needed?

  Yes

  No

  N/A

• Are utensils properly stored (i.e. inverted, covered, 6 inches off of the floor)?

  Yes

  No

  N/A

Physical Facilities

• Are floors, drains, walls, and ceilings clean (including vents and hoods)?

  Yes

  No

  N/A

• Are floors, walls and ceilings in good repair?

  Yes

  No

  N/A

• Are lights working and properly shielded?

  Yes

  No

  N/A

• Are items/equipment only necessary for production stored in the Fresh areas?

  Yes

  No

  N/A

• Are products that are out for sale within code dating guidelines?

  Yes

  No

  N/A

• Are all the current logs being utilized correctly?

  Yes

  No

  N/A

• Are all the latest recalls/withdrawals being followed according to the recall notice?

  Yes

  No

  N/A

• Are all regulatory contacts entered into the system and all exceptions noted on the visits corrected per company policy OP-35?

  Yes

  No

  N/A

Sanitation

• Are non-food contact surfaces of equipment and utensils free from previous day's soil or food build up?

  Yes

  No

  N/A

• Are coolers, walls, ceilings, floors and drains, free of soil, mold or dirty?

  Yes

  No

  N/A

• Are food, food packaging and utensils stored properly?

  Yes

  No

  N/A

• Is the department free of clutter, trash and debris?

  Yes

  No

  N/A

• Are associate uniforms and aprons clean, stored properly, and removed before break, lunch or using restroom?

  Yes

  No

  N/A

Demo

High Five # 1 - Be Clean, Be Healthy

• Does the person in charge know the Associate illness guidelines and Big 5 illnesses? *

  Yes

  No

  N/A

• Are associates using barriers (tongs, gloves, tissue paper, etc...) when handling ready-to-eat food? *

  Yes

  No

  N/A

• Are associates washing hands when appropriate? *

  Yes

  No

  N/A

• Are associates washing hands properly, including at the designated hand sink? *

  Yes

  No

  N/A

• Are associates eating or drinking in the designated areas? *

  Yes

  No

  N/A

• Are associates in the fresh areas following the dress code?

  Yes

  No

  N/A

• Are all hand sinks supplied with soap? *

  Yes

  No

  N/A

• Are all hand sinks supplied with paper towels? *

  Yes

  No

  N/A

• Are all hand sinks supplied with hot and cold water? *

  Yes

  No

  N/A

High Five #2 - Keep It Cold, Keep It Hot

• Are cold potentially hazardous foods being held below 41 degrees? *

  Yes

  No

  N/A

• Are hot held potentially hazardous foods being held above 140 degrees? *

  Yes

  No

  N/A

• Are food items properly thawed?

  Yes

  No

  N/A

• Are refrigerated units working properly and in good repair? *

  Yes

  No

  N/A

High Five #3 - Don't Cross Contaminate

• Are the raw foods properly stored? *

  Yes

  No

  N/A

• Are spray bottles properly labeled, Chemical containers and secondary storage containers, such as spray bottles are labeled with the product's name, manufacturer's name, address, and phone number, personal protective equipment requirements, and hazard warnings? *

  Yes

  No

  N/A

• Are chemicals properly stored? *

  Yes

  No

  N/A

High Five #4 - Wash, Rinse & Sanitize

• Are food contact surfaces clean to sight and touch? *

  Yes

  No

  N/A

• Is sanitizer concentrate levels at 200ppm? *

  Yes

  No

  N/A

• Is there hot water available at the three compartment sink? *

  Yes

  No

  N/A

• Are non-food contact surfaces clean?

  Yes

  No

  N/A

• Are test strips available?

  Yes

  No

  N/A

High Five #5 - Cook It & Chill It

• Are foods cooked to the proper cooking temperatures? *

  Yes

  No

  N/A

• Are food items being cooled properly? *

  Yes

  No

  N/A

Equipment

• Are food items properly stored (covered, 6 in. off the floor)?

  Yes

  No

  N/A

• Are food containers properly labeled with the common name?

  Yes

  No

  N/A

• Is equipment in good repair and well maintained?

  Yes

  No

  N/A

• Are there available and functional thermometers in each department and refrigerated unit?

  Yes

  No

  N/A

• Are any of the cutting boards heavily scratched or scored being removed and replaced as needed?

  Yes

  No

  N/A

• Are utensils properly stored (i.e. inverted, covered, 6 inches off of the floor)?

  Yes

  No

  N/A

Physical Facilities

• Are floors, drains, walls, and ceilings clean (including vents and hoods)?

  Yes

  No

  N/A

• Are floors, walls and ceilings in good repair?

  Yes

  No

  N/A

• Are lights working and properly shielded?

  Yes

  No

  N/A

• Are items/equipment only necessary for production stored in the Fresh areas?

  Yes

  No

  N/A

• Are products that are out for sale within code dating guidelines?

  Yes

  No

  N/A

• Are all the current logs being utilized correctly?

  Yes

  No

  N/A

• Are all the latest recalls/withdrawals being followed according to the recall notice?

  Yes

  No

  N/A

• Are all regulatory contacts entered into the system and all exceptions noted on the visits corrected per company policy OP-35?

  Yes

  No

  N/A

Sanitation

• Are non-food contact surfaces of equipment and utensils free from previous day's soil or food build up?

  Yes

  No

  N/A

• Are coolers, walls, ceilings, floors and drains, free of soil, mold or dirty?

  Yes

  No

  N/A

• Are food, food packaging and utensils stored properly?

  Yes

  No

  N/A

• Is the department free of clutter, trash and debris?

  Yes

  No

  N/A

• Are associate uniforms and aprons clean, stored properly, and removed before break, lunch or using restroom?

  Yes

  No

  N/A

Meat

High Five # 1 - Be Clean, Be Healthy

• Does the person in charge know the Associate illness guidelines and Big 5 illnesses? *

  Yes

  No

  N/A

• Are associates washing hands when appropriate? *

  Yes

  No

  N/A

• Are associates washing hands properly, including at the designated hand sink? *

  Yes

  No

  N/A

• Are associates eating or drinking in the designated areas? *

  Yes

  No

  N/A

• Are associates in the fresh areas following the dress code?

  Yes

  No

  N/A

• Are all hand sinks supplied with soap? *

  Yes

  No

  N/A

• Are all hand sinks supplied with paper towels? *

  Yes

  No

  N/A

• Are all hand sinks supplied with hot and cold water? *

  Yes

  No

  N/A

High Five #2 - Keep It Cold, Keep It Hot

• Are cold potentially hazardous foods being held below 41 degrees? *

  Yes

  No

  N/A

• Are food items properly thawed?

  Yes

  No

  N/A

• Are refrigerated units working properly and in good repair? *

  Yes

  No

  N/A

High Five #3 - Don't Cross Contaminate

• Are the raw foods properly stored? *

  Yes

  No

  N/A

• Are spray bottles properly labeled, Chemical containers and secondary storage containers, such as spray bottles are labeled with the product's name, manufacturer's name, address, and phone number, personal protective equipment requirements, and hazard warnings? *

  Yes

  No

  N/A

• Are chemicals properly stored? *

  Yes

  No

  N/A

High Five #4 - Wash, Rinse & Sanitize

• Are food contact surfaces clean to sight and touch? *

  Yes

  No

  N/A

• Is sanitizer concentrate levels at 200ppm? *

  Yes

  No

  N/A

• Is there hot water available at the three compartment sink? *

  Yes

  No

  N/A

• Are non-food contact surfaces clean?

  Yes

  No

  N/A

• Are test strips available?

  Yes

  No

  N/A

High Five #5 - Cook It & Chill It

• Are food items being cooled properly? *

  Yes

  No

  N/A

Equipment

• Are food items properly stored (covered, 6 in. off the floor)?

  Yes

  No

  N/A

• Are food containers properly labeled with the common name?

  Yes

  No

  N/A

• Is equipment in good repair and well maintained?

  Yes

  No

  N/A

• Are there available and functional thermometers in each department and refrigerated unit?

  Yes

  No

  N/A

• Are any of the cutting boards heavily scratched or scored being removed and replaced as needed?

  Yes

  No

  N/A

• Are utensils properly stored (i.e. inverted, covered, 6 inches off of the floor)?

  Yes

  No

  N/A

Physical Facilities

• Are floors, drains, walls, and ceilings clean (including vents and hoods)?

  Yes

  No

  N/A

• Are floors, walls and ceilings in good repair?

  Yes

  No

  N/A

• Are lights working and properly shielded?

  Yes

  No

  N/A

• Are items/equipment only necessary for production stored in the Fresh areas?

  Yes

  No

  N/A

• Are products that are out for sale within code dating guidelines?

  Yes

  No

  N/A

• Are all the current logs being utilized correctly?

  Yes

  No

  N/A

• Are all the latest recalls/withdrawals being followed according to the recall notice?

  Yes

  No

  N/A

• Are all regulatory contacts entered into the system and all exceptions noted on the visits corrected per company policy OP-35?

  Yes

  No

  N/A

Sanitation

• Are non-food contact surfaces of equipment and utensils free from previous day's soil or food build up?

  Yes

  No

  N/A

• Are coolers, walls, ceilings, floors and drains, free of soil, mold or dirty?

  Yes

  No

  N/A

• Are food, food packaging and utensils stored properly?

  Yes

  No

  N/A

• Is the department free of clutter, trash and debris?

  Yes

  No

  N/A

• Are associate uniforms and aprons clean, stored properly, and removed before break, lunch or using restroom?

  Yes

  No

  N/A

Produce

High Five # 1 - Be Clean, Be Healthy

• Does the person in charge know the Associate illness guidelines and Big 5 illnesses? *

  Yes

  No

  N/A

• Are associates washing hands when appropriate? *

  Yes

  No

  N/A

• Are associates washing hands properly, including at the designated hand sink? *

  Yes

  No

  N/A

• Are associates eating or drinking in the designated areas? *

  Yes

  No

  N/A

• Are associates in the fresh areas following the dress code?

  Yes

  No

  N/A

• Are all hand sinks supplied with soap? *

  Yes

  No

  N/A

• Are all hand sinks supplied with paper towels? *

  Yes

  No

  N/A

• Are all hand sinks supplied with hot and cold water? *

  Yes

  No

  N/A

High Five #2 - Keep It Cold, Keep It Hot

• Are cold potentially hazardous foods being held below 41 degrees? *

  Yes

  No

  N/A

• Are refrigerated units working properly and in good repair? *

  Yes

  No

  N/A

High Five #3 - Don't Cross Contaminate

• Are the raw foods properly stored? *

  Yes

  No

  N/A

• Are spray bottles properly labeled, Chemical containers and secondary storage containers, such as spray bottles are labeled with the product's name, manufacturer's name, address, and phone number, personal protective equipment requirements, and hazard warnings? *

  Yes

  No

  N/A

• Are chemicals properly stored? *

  Yes

  No

  N/A

High Five #4 - Wash, Rinse & Sanitize

• Are food contact surfaces clean to sight and touch? *

  Yes

  No

  N/A

• Is there hot water available at the three compartment sink? *

  Yes

  No

  N/A

• Are non-food contact surfaces clean?

  Yes

  No

  N/A

• Are test strips available?

  Yes

  No

  N/A

Equipment

• Are food items properly stored (covered, 6 in. off the floor)?

  Yes

  No

  N/A

• Are food containers properly labeled with the common name?

  Yes

  No

  N/A

• Is equipment in good repair and well maintained?

  Yes

  No

  N/A

• Are there available and functional thermometers in each department and refrigerated unit?

  Yes

  No

  N/A

• Are utensils properly stored (i.e. inverted, covered, 6 inches off of the floor)?

  Yes

  No

  N/A

Physical Facilities

• Are floors, drains, walls, and ceilings clean (including vents and hoods)?

  Yes

  No

  N/A

• Are floors, walls and ceilings in good repair?

  Yes

  No

  N/A

• Are lights working and properly shielded?

  Yes

  No

  N/A

• Are items/equipment only necessary for production stored in the Fresh areas?

  Yes

  No

  N/A

• Are products that are out for sale within code dating guidelines?

  Yes

  No

  N/A

• Are all the current logs being utilized correctly?

  Yes

  No

  N/A

• Are all the latest recalls/withdrawals being followed according to the recall notice?

  Yes

  No

  N/A

• Are all regulatory contacts entered into the system and all exceptions noted on the visits corrected per company policy OP-35?

  Yes

  No

  N/A

Sanitation

• Are non-food contact surfaces of equipment and utensils free from previous day's soil or food build up?

  Yes

  No

  N/A

• Are coolers, walls, ceilings, floors and drains, free of soil, mold or dirty?

  Yes

  No

  N/A

• Are food, food packaging and utensils stored properly?

  Yes

  No

  N/A

• Is the department free of clutter, trash and debris?

  Yes

  No

  N/A

• Are associate uniforms and aprons clean, stored properly, and removed before break, lunch or using restroom?

  Yes

  No

  N/A

Freezer/Cooler

High Five # 1 - Be Clean, Be Healthy

• Does the person in charge know the Associate illness guidelines and Big 5 illnesses? *

  Yes

  No

  N/A

• Are associates eating or drinking in the designated areas? *

  Yes

  No

  N/A

High Five #2 - Keep It Cold, Keep It Hot

• Are cold potentially hazardous foods being held below 41 degrees? *

  Yes

  No

  N/A

• Are refrigerated units working properly and in good repair? *

  Yes

  No

  N/A

High Five #3 - Don't Cross Contaminate

• Are spray bottles properly labeled, Chemical containers and secondary storage containers, such as spray bottles are labeled with the product's name, manufacturer's name, address, and phone number, personal protective equipment requirements, and hazard warnings? *

  Yes

  No

  N/A

• Are chemicals properly stored? *

  Yes

  No

  N/A

High Five #4 - Wash, Rinse & Sanitize

• Are non-food contact surfaces clean?

  Yes

  No

  N/A

Equipment

• Are food items properly stored (covered, 6 in. off the floor)?

  Yes

  No

  N/A

• Are food containers properly labeled with the common name?

  Yes

  No

  N/A

• Is equipment in good repair and well maintained?

  Yes

  No

  N/A

• Are there available and functional thermometers in each department and refrigerated unit?

  Yes

  No

  N/A

• Are any of the cutting boards heavily scratched or scored being removed and replaced as needed?

  Yes

  No

  N/A

• Are utensils properly stored (i.e. inverted, covered, 6 inches off of the floor)?

  Yes

  No

  N/A

Physical Facilities

• Are floors, drains, walls, and ceilings clean (including vents and hoods)?

  Yes

  No

  N/A

• Are floors, walls and ceilings in good repair?

  Yes

  No

  N/A

• Are lights working and properly shielded?

  Yes

  No

  N/A

• Are items/equipment only necessary for production stored in the Fresh areas?

  Yes

  No

  N/A

• Are products that are out for sale within code dating guidelines?

  Yes

  No

  N/A

• Are all the current logs being utilized correctly?

  Yes

  No

  N/A

• Are all the latest recalls/withdrawals being followed according to the recall notice?

  Yes

  No

  N/A

• Are all regulatory contacts entered into the system and all exceptions noted on the visits corrected per company policy OP-35?

  Yes

  No

  N/A

Sanitation

• Are non-food contact surfaces of equipment and utensils free from previous day's soil or food build up?

  Yes

  No

  N/A

• Are coolers, walls, ceilings, floors and drains, free of soil, mold or dirty?

  Yes

  No

  N/A

• Are food, food packaging and utensils stored properly?

  Yes

  No

  N/A

• Is the department free of clutter, trash and debris?

  Yes

  No

  N/A

• Are associate uniforms and aprons clean, stored properly, and removed before break, lunch or using restroom?

  Yes

  No

  N/A

Restroom

High Five # 1 - Be Clean, Be Healthy

• Does the person in charge know the Associate illness guidelines and Big 5 illnesses? *

  Yes

  No

  N/A

• Are all hand sinks supplied with soap? *

  Yes

  No

  N/A

• Are all hand sinks supplied with paper towels? *

  Yes

  No

  N/A

• Are all hand sinks supplied with hot and cold water? *

  Yes

  No

  N/A

Sanitation

• Are non-food contact surfaces of equipment and utensils free from previous day's soil or food build up?

  Yes

  No

  N/A

• Are coolers, walls, ceilings, floors and drains, free of soil, mold or dirty?

  Yes

  No

  N/A

• Is the department free of clutter, trash and debris?

  Yes

  No

  N/A

• Has the audit been completed?

  Off

  On

• Signature

  Sign