Section 1: Food
1. 1. Is the food from an approved source (licensed food establishment)?
Yes
No
N/A
2. 2. Is the food in sound condition?
Yes
No
N/A
3. 3. Is the food properly labeled?
Yes
No
N/A
4. 4. Are foods prepared at home not used?
Yes
No
N/A
5. 5. Are foods checked for proper temperatures, spoilage, contamination, and adulteration upon receipt?
Yes
No
N/A
6. 6. Are dented cans not used?
Yes
No
N/A
7. 7. Are all food packages intact?
Yes
No
N/A
8. 8. Are dry bulk food items such as flour, beans, sugar, etc., stored in clean, covered, labeled containers with approved dispensing utensils with handles up and out of food products?
Yes
No
N/A
9. 9. Is food not stored under unprotected or exposed sewer or water lines?
Yes
No
N/A
10. 10. Are no food, food equipment, or utensils stored in restrooms/vestibules?
Yes
No
N/A
11. 11. Are all foods, food equipment, and utensils stored a minimum of 6 inches above the floor?
Yes
No
N/A
12. 12. Are foods dated and stored in a manner that ensures "first in, first out"?
Yes
No
N/A
13. 13. Are potentially hazardous/ready-to-eat foods held for more than 24 hours marked with a "preparation date" and/or "disposition date"?
Yes
No
N/A
14. 14. Is it ensured that no PHF/RTE foods are served after 7 days of creation?
Yes
No
N/A
15. 15. Are potentially hazardous foods maintained below 41°F or above 135°F, with frozen foods kept frozen at all times?
Yes
No
N/A
16. 16. Is a metal probe thermometer, accurate to + or –2°F, regularly used to check food/equipment temperatures, and are thermometers supplied in all heating/cooling units?
Yes
No
N/A
17. 17. Are foods cooked to the proper internal temperatures?
Yes
No
N/A
18. 18. Are cooked/prepared foods rapidly cooled to 41°F within 6 hours or reheated to 165°F before service?
Yes
No
N/A
19. 19. Are raw foods stored below cooked and ready-to-eat foods and according to their cooking temperatures?
Yes
No
N/A
20. 20. Are frozen foods, once thawed, not refrozen, and thawed properly?
Yes
No
N/A
21. 21. Is food on display protected from consumer contamination by packaging, sneeze guards, display cases, or other effective means?
Yes
No
N/A
22. 22. Is a food-dispensing utensil available for each container at a consumer self-service unit such as a buffet or salad bar, with the handle up and out of the food product?
Yes
No
N/A
23. 23. Is unpackaged raw animal food, such as beef, lamb, poultry, and fish, not offered for consumer self-service?
Yes
No
N/A
24. 24. Is food offered for service, which is not prepared in-house, provided with ingredient statements?
Yes
No
N/A
Section 2: Food Service Employees
1. 1. Are employees with Food Safety Manager's Certification present in the food establishment and all food preparation areas at all times during hours of operation?
Yes
No
N/A
2. 2. Do food service staff wash their hands thoroughly after coughing, sneezing, or any other form of contamination, or at any time during which an interruption in food preparation occurs?
Yes
No
N/A
3. 3. Do employees wash their hands before putting on gloves?
Yes
No
N/A
4. 4. Are employees infected with a disease or symptoms that can be transmitted by food (including open sores) reported to IU-EHS and either sent home or restricted to non-food contact activities?
Yes
No
N/A
5. 5. Do employees refrain from smoking, eating, or chewing gum in the food preparation area?
Yes
No
N/A
6. 6. Are drinking cups or glasses covered and equipped with a drinking straw or device handled and stored to prevent contamination?
Yes
No
N/A
7. 7. Do food service workers refrain from touching ready-to-eat foods with their bare hands, using single-use gloves and/or suitable utensils to handle foods?
Yes
No
N/A
8. 8. Is there no cross-contamination of raw, cooked, or other foods?
Yes
No
N/A
9. 9. Is jewelry, except for a plain band-style ring, not permitted when handling food?
Yes
No
N/A
10. 10. Are false nails and nail polish prohibited, and are nails required to be cleaned and trimmed?
Yes
No
N/A
11. 11. Are watches not allowed during food preparation/handling?
Yes
No
N/A
12. 12. Are employees wearing clean outer garments, and are all kitchen employees wearing effective hair restraints?
Yes
No
N/A
13. 13. Are personal belongings stored in a separate, designated area away from food and equipment?
Yes
No
N/A
Section 3: Water And Plumbing
1. 1. Do all sinks have sufficient hot and cold water under pressure?
Yes
No
N/A
2. 2. Do hand sinks have hot water of at least 100°F?
Yes
No
N/A
3. 3. Do utensil-washing sinks have hot water of at least 110°F?
Yes
No
N/A
4. 4. Are all drains working properly, and is plumbing maintained in good repair?
Yes
No
N/A
5. 5. Are all mops hung to air dry after/between use?
Yes
No
N/A
Section 4: Equipment And Utensils
1. 1. Is equipment adequate to maintain product temperature?
Yes
No
N/A
2. 2. Does a high-temperature dishwashing machine reach a wash cycle temperature and final rinse temperatures listed in the manufacturer's specifications, with a dish surface temperature of 160°F?
Yes
No
N/A
3. 3. If a low-temperature dishwashing machine is used with a chemical agent, is the temperature and chemical concentration up to the manufacturer's specifications, with a dish surface temperature of 120°F?
Yes
No
N/A
4. 4. Does the establishment have a means to determine dish surface temperatures?
Yes
No
N/A
5. 5. Does a manual three-compartment utensil-washing sink (wash, rinse, sanitize, air-dry) contain an approved sanitizer with the appropriate concentration, and are items fully submerged in the sanitizing bay for the specified times?
Yes
No
N/A
6. 6. Are test kits, thermo-labels, and thermometers available to test sanitizing methods, and is there no evidence of food residue on cleaned and sanitized equipment and utensils?
Yes
No
N/A
7. 7. Are no cracked, scored, or chipped dishes, glasses, utensils, or cutting boards present?
Yes
No
N/A
8. 8. Are proper storage procedures followed when storing cleaned and sanitized equipment, utensils, and single-service items, with clean and sanitized items stored inverted when possible?
Yes
No
N/A
9. 9. Is all equipment for commercial use, maintained clean and sanitary, free of food residue throughout and up and under each piece of equipment?
Yes
No
N/A
Section 5: Hand Washing Facilities
1. 1. Are hand sinks adequate, accessible, and clean?
Yes
No
N/A
2. 2. Are hand sinks, including those in restrooms, provided with soap, paper towels, a water temperature of 100°F, and a wastebasket?
Yes
No
N/A
3. 3. Are hand washing signs posted at all hand sinks?
Yes
No
N/A
Section 6: Floor, Walls, And Ceilings
1. 1. Are all floors, walls, and ceilings maintained clean and in good repair, including attachments such as vents, mop sinks, etc., with no visible cracks and crevices?
Yes
No
N/A
2. 2. Are corners and baseboards under major equipment free of food debris?
Yes
No
N/A
3. 3. Are doors exiting the establishment provided with a self-closure mechanism?
Yes
No
N/A
4. 4. Are all outer openings, including doors, windows, etc., protected without gaps or cracks leading to the outdoors?
Yes
No
N/A
Section 7: Toilet Facilities
1. 1. Do all restrooms have at least one covered waste receptacle and toilet tissue?
Yes
No
N/A
2. 1. Do all restrooms have at least one covered waste receptacle and toilet tissue?
Yes
No
N/A
3. 3. Are restrooms provided with self-closing doors?
Yes
No
N/A
Section 8: Lighting And Ventilation
1. 1. Is adequate lighting provided in food preparation and storage areas?
Yes
No
N/A
2. 2. Are all lights covered with a shatter-resistant covering?
Yes
No
N/A
3. 3. Is ventilation sufficient to prevent grease and condensation from accumulating on walls and ceilings?
Yes
No
N/A
4. 4. Are ventilation hood filters and vents kept clean and free of build-up (dust, grease, etc.)?
Yes
No
N/A
Section 9: Pest Control
1. 1. Is the facility free from insects and pests or any evidence of insect/rodent activity?
Yes
No
N/A
2. 2. Are openings to the outside protected against the entrance of insects and rodents?
Yes
No
N/A
3. 3. Is the use of only approved and registered by governmental authorities pesticides allowed at the establishment?
Yes
No
N/A
4. 4. Are pest monitors placed in proper locations, dated, and removed as necessary?
Yes
No
N/A
5. 5. Is a pest sighting log on site and available at the establishment?
Yes
No
N/A
6. 6. Are conducive conditions such as leaks, food debris, gaps to the outside, and cracks/crevices not present, or are they reported to management when discovered?
Yes
No
N/A
Section 10: Toxic Materials
1. 1. Are toxic materials properly labeled, stored, and used?
Yes
No
N/A
Section 11: Garbage
1. 1. Are food preparation and storage areas clean and free from trash and food residue?
Yes
No
N/A
2. 2. Do dumpsters located outside have lids that are closed when not in use, and are they stored on an easily cleanable surface such as concrete or machine-laid asphalt?
Yes
No
N/A
3. 3. Are outdoor refuse areas free of grease and debris, with grease dumpsters having closed lids and being maintained clean?
Yes
No
N/A
Section 12: Notice/ Documentation Posted/Provided
1. 1. Does the employee health policy require that food employees and applicants report information about their health and diseases transmitted by food to the person in charge?
Yes
No
N/A
2. 2. Is there a written consumer advisory at the establishment serving or selling raw or partially cooked animal protein or seafood that informs consumers of the significantly increased risk of consuming such products?
Yes
No
N/A
3. 3. Are written fish freezing records readily available and maintained for 90 days at establishments serving raw or partially cooked fish?
Yes
No
N/A
4. 4. Are shellfish fish tags retained for 90 days from the date the container is emptied?
Yes
No
N/A
5. 5. Is the Food Service Manager's Certification current and posted in public view?
Yes
No
N/A
6. 6. Is a copy of the last inspection report available?
Yes
No
N/A
7. 7. Are approved HACCP plans on the premises when specialized processing methods are used?
Yes
No
N/A