Section 1: General Information
1. Updates to this form
Yes
No
N/A
2. Visit Flow :
3. Reference # :
4. National Store # :
5. Visit Number
1
2
3
4
5
6. Cycle Number
1
2
3
4
5
7. Address
8. Address 2
9. Manager First Name :
10. Manager Last Name :
Section 2: Hygiene & Sanitation
1. *** FS1-US - Required supplies are at all hand washing sinks to include warm running water. Hand wash sinks are only used for hand washing and not for preparing food or storing equipment. Hand wash sinks are easily accessed by employees.
Compliant
Non Compliant
N/A
2. *** FS2-US - Hands are properly washed following proper hand washing procedures at the appropriate times. A system is in place to ensure hourly hand washing by all employees.
Compliant
Non Compliant
N/A
3. *** FS3-US - Sanitized towel buckets contain towels and sanitizer solution at the correct concentration checked with a chlorine test strip.
Compliant
Non Compliant
N/A
4. *** FS4-US - Sanitizer-soaked towels and grill cloths used at food or beverage preparation and service areas must be placed into the soiled towel bucket after using and not be left sitting out on surfaces.
Compliant
Non Compliant
N/A
5. *** FS5-US - All UHC trays, grill utensils, prep table utensils, and utensil holders are clean (no build up) and are washed and sanitized at least every 4 hours as per approved procedure. Back sink and soap/sanitizer dispensers or dishwashers must function (hot water 110°F or higher) and all supplies must be available. Check that sanitizer solution has the right concentration with an appropriate test strip.
Compliant
Non Compliant
N/A
6. *** FSS-US-01 - All soiled raw wares that came into contact with raw proteins (such as fresh beef and raw chicken) are washed and sanitized last (unless a warewasher is used). Soiled blue raw beef trays and lids are kept in blue bus box until cleaned. Back sink is properly sanitized after washing wares that came into contact with raw proteins.
Compliant
Non Compliant
N/A
Section 3: Contamination Prevention
1. *** F56-US - Appropriate measures are taken to protect water and ice from foreign material, chemicals and/or bacterial contamination
Compliant
Non Compliant
N/A
2. *** FS7-US - Opened packages of food in storage. (including refrigerators and freezers) are covered/wrapped, labeled and stored according to proper procedures.
Yes
No
N/A
3. *** FS8-US - Blue disposable glove procedures or dedicated tongs are used to prevent cross-contamination when handling all raw meat or poultry products (including shell eggs) at the grill station and fryer station. Dedicated utensils are used for raw products (e.g. the yellow yolk breaking tool id only used to break egg yolks).
Yes
No
N/A
4. *** FS9-US - Clear/white disposable gloves worn for food preparation of ready to eat foods at the sandwich prep table, salad prep table, and in all other areas to prevent bare hand contact with any cooked or ready-to-eat foods.
Compliant
Non Compliant
N/A
5. *** FS10-US - Chemicals are stored away from food and packaging
Compliant
Non Compliant
N/A
6. *** FS11-US - The restaurants building, corral and any area within 10 feet (3m) from the building (i.e. inside the Drive-thru lane) is clear from infestation by rats, mice, insects and birds.
Compliant
Non Compliant
N/A
7. *** FS11-US-01 - Pest management program and pest prevention steps and behaviors are in place and are being managed effectively. The restaurants is properly pest proofed to prevent entry of pests (e.g. gaps under doors are sealed).
Compliant
Non Compliant
N/A
8. *** FS12-US - Non-food spill clean-up procedures in place.
Compliant
Non Compliant
N/A
Section 4: Storage
1. *** FS13-US - Walk-in freezer and any other primary storage freezers at 0°F (-18°C) or below. Secondary storage freezers are keeping all products solidly frozen.
Compliant
Non Compliant
N/A
2. *** FS14-US - Refrigerated products inside all refrigerated units are at or below 40°F (4°C) (including shake/sundae reservoir).
Compliant
Non Compliant
N/A
3. *** FS15-US - All refrigerated products are in code (within primary shelf life)
Compliant
Non Compliant
N/A
4. *** FS16-US - Secondary shelf lives of refrigerated foods held at room temperature and in refrigerators are marked and the products are being used within their secondary shelf lives.
Compliant
Non Compliant
N/A
5. ***FS17-US - Leftover heated foods are discarded (including any shake/sundae mix removed from heat treatment shake/sundae machines).
Compliant
Non Compliant
N/A
Section 5: Cooking
1. *** FS18-US - Pyrometer with needle probe is calibrated and working correctly.
Compliant
Non Compliant
N/A
2. *** FS19-US - The internal temperatures of beef patties after cooking are at or above 155°F(69°C) and fresh beef patties at or above 175°F (80°C).
Compliant
Non Compliant
N/A
3. *** FS20-US - The internal temperatures of raw chicken products after cooking are at or above 165°F (74°C).
Compliant
Non Compliant
N/A
4. *** FS21-US - The internal temperature of breakfast steak and breakfast sausage after cooking are at or above 155°F (69°C) for sausage made from beef or pork and 165°F (74°C) for sausage made from poultry.
Compliant
Non Compliant
N/A
5. *** FS22-US - The internal temperatures of round eggs after cooking are at or above 155°F (69°C)
Compliant
Non Compliant
N/A
6. *** FS23-US - The internal temperature of Filet-O-Fish portions after cooking are at or above 150°F (66°C).
Compliant
Non Compliant
N/A
Section 6: General
1. *** FS24-US - All food, food packaging, equipment (including utensils), and cleaning chemicals are from approved sources.
Compliant
Non Compliant
N/A
2. *** FS25-US - Managers understand employee illness symptoms and reportable illness causes for when an employee cannot be working. Managers also understand when an employee can return to work after illness.
Compliant
Non Compliant
N/A
3. *** FS26-US - All managers (including shift managers) are trained and currently certified in food safety through ServSafe (or an equivalent and accredited food safety training course).
Compliant
Non Compliant
N/A
4. *** FS26-US-01 - All employees are trained and verified on food safety and sanitation per McDonald's current training program and in accordance with local regulations.
Compliant
Non Compliant
N/A
5. *** FS27-US - Managers (or staff assigned to complete the checklist) have been trained on and can demonstrate how to properly complete the procedures on the Daily Food Safety Checklist.
Compliant
Non Compliant
N/A
6. *** FS28-US - At least the last 60 days of correctly completed Daily Food Safety Checklists are available and the last two correctly completed Monthly Food Safety Procedure Verifications are available.
Compliant
Non Compliant
N/A
7. *** FS29-US - Review the most recent health department inspection report, ensuring all food safety violations noted have been corrected or a plan is in place to correct issues.
Compliant
Non Compliant
N/A
Section 7: Additional Unscored Food Safety Questions
1. *** FreshBeef 1 - Does this McDonald's location use fresh beef patties?
Yes
No
2. *** FreshBeef 2 - What was the lowest temperature of all the Fresh Beef Patties?
Yes
No
3. *** 1.8.1 - Ice scoop being kept in holder
Compliant
Non Compliant
N/A
4. *** 1.14.3 - Food is stored at least 6 inches off the floor in the walk-in refrigerator and all food storage areas
Compliant
Non Compliant
N/A
5. *** 1.6.1 - Food contact equipment, utensils or surfaces are in good repair and not cracked or damaged
Compliant
Non Compliant
N/A
6. *** 1.6.5 - Food contact equipment including the drink tower valves, ice chutes, BIM pitchers and water rinse area do not have any visible mold or soil build-up
Compliant
Non Compliant
N/A
7. *** 1.7.1 - All Non-food contact equipment are clean (free of excessive soil or grease or food debris build-up), in good repair (not cracked or damaged)
Compliant
Non Compliant
N/A
8. *** 1.7.2 - Floors, walls, ceilings and attached equipment are good repair and are clean : A) There is no excessive grease or food build-up underneath grills, fryers, BIM, shake machine or food storage shelving. B) Floor drains are functioning and not clogged and there is no free standing or puddling water on the floor or under equipment.
Compliant
Non Compliant
N/A
9. *** 1.15.2 - In unit thermometer available in all refrigerators (internal or external acceptable)
Compliant
Non Compliant
N/A
10. *** 1.7.5 - All plumbing is in good repair and not leaking or dripping water on to the floor
Compliant
Non Compliant
N/A
11. *** 1.12.6 - In unit thermometer available in all freezers (internal or external acceptable)
Compliant
Non Compliant
N/A
12. *** 1.7.7 - The coral area does not have excessive grease or garbage on the ground and the dumpsters and grease storage containers (if present) are kept covered.
Compliant
Non Compliant
N/A
13. *** 1.4.2 - Crew members are following good hygiene practices when preparing food.
Compliant
Non Compliant
N/A
14. *** 1.16.7 - Can the manager on duty name at least 3 situations that would pose a threat to public health and for which the restaurant must immediately close and notify their local health department?
Compliant
Non Compliant
N/A
Section 8: COMPLETION
1. Auditor's Signature :