Section 1: FOOD SAFETY
1. 1. Food is purchased from an approved source (licensed by the county, state, or federal government).
Yes
No
N/A
2. 2. Food is inspected and found to be free from contamination, adulteration, and spoilage.
Yes
No
N/A
3. 3. Unpackaged foods that were served or returned from the dining area are discarded.
Yes
No
N/A
4. 4. All foods are stored a minimum of 6" off the floor.
Yes
No
N/A
5. 5. Restrooms are not used for the storage of food, equipment, or supplies.
Yes
No
N/A
6. 6. Adequate protection is provided for all paper products.
Yes
No
N/A
7. 7. Food is being protected from dirt, unnecessary handling, over-head leakage, and other forms of contamination.
Yes
No
N/A
8. 8. All food storage containers have proper covers and are properly labeled.
Yes
No
N/A
9. 9. Foods are dispensed in the self-serve area in an approved manner.
Yes
No
N/A
10. 10. The use of sulfites in perishable foods is prohibited.
Yes
No
N/A
11. 11. Food products are labeled and stored in non-toxic containers.
Yes
No
N/A
12. 12. Raw foods are separate from cooked foods.
Yes
No
N/A
13. 13. Shellfish tags are kept for 90 days; warning signs are posted.
Yes
No
N/A
Section 2: TEMPERATURE CONTROL
1. 1. Potentially hazardous foods are maintained below 41°F or above 135°F.
Yes
No
N/A
2. 2. A thermometer, accurate to + or - 2°F, is provided either as an integral part of the refrigerator (dial outside) or is located inside each unit at its warmest point in a really visible location.
Yes
No
N/A
3. 3. An accurate metal probe thermometer or thermocouple, suitable for measuring food temperatures, is readily available and is being used to check food temperatures.
Yes
No
N/A
4. 4. Food products are being thawed in one of the following methods only: a) in refrigeration units, b) under cold running, potable water of sufficient velocity flush loose food particles, c) in a microwave oven, d) as part of the cooking process.
Yes
No
N/A
5. 5. Frozen food is maintained in a frozen state.
Yes
No
N/A
6. 6. Thawed food items are not refrozen unless cooked first.
Yes
No
N/A
7. 7. Rapid cooling and reheating procedures are used for all perishable foods.
Yes
No
N/A
Section 3: PERSONNEL
1. 1. All employees handling unpackaged food or utensils have obtained their Food Handler's Certificate/training and all records are readily available.
Yes
No
N/A
2. 2. Employees wash their hands with soap and warm water for at least 20 seconds for any of the following reasons: a) before starting work, b) immediately after using the restroom, c) between tasks, d) any time needed to prevent food contamination.
Yes
No
N/A
3. 3. Employees handling food or utensils have no open sores and are not sick.
Yes
No
N/A
4. 4. Employees are wearing clean outer garments.
Yes
No
N/A
5. 5. Tongs or other implements are used for handling food products.
Yes
No
N/A
6. 6. Hair of employees is properly confined.
Yes
No
N/A
7. 7. Employees do not smoke or use tobacco inside the facility.
Yes
No
N/A
8. 8. Clothing and personal effects are stored away in a proper manner.
Yes
No
N/A
Section 4: WATER AND SEWAGE
1. 1. All sinks are fully operable with hot and cold water under pressure.
Yes
No
N/A
2. 2. All sinks drain properly. Floor drains and floor sinks are in good working order/clean.
Yes
No
N/A
3. 3. Plumbing is in good repair, not leaking.
Yes
No
N/A
4. 4. Cross connection control device is properly installed and in good repair. (ex. vacuum breakers and back flow preventers)
Yes
No
N/A
5. 5. Grease traps are routinely cleaned.
Yes
No
N/A
Section 5: EQUIPMENT
1. 1. All equipment (i.e., stoves, grills, refrigerators, tables, sinks, etc.) is clean and well-maintained and food contact surfaces are properly washed and sanitized.
Yes
No
N/A
2. 2. Inoperable equipment has been repaired or replaced (removed from the facility).
Yes
No
N/A
3. 3. Only approved equipment is installed; ensure installment is done in an approved manner and in an approved location.
Yes
No
N/A
Section 6: UTENSILS
1. 1. Multiservice utensils are being washed by one of the following means only: a) Manually, by hand, in an approved 3 compartment sink (wash-rinse-sanitize); b) Machine washed in a dish machine, using chemical sanitization, and conforming to NSF standards; c) Machine washed in a dish machine, using high temperature sanitation and conforming to NSF standards.
Yes
No
N/A
2. 2. Testing materials (ex. Test strips) to adequately test sanitizing methods are readily available and used.
Yes
No
N/A
3. 3. All utensils are clean, sanitized, and well-maintained.
Yes
No
N/A
4. 4. Damaged or unapproved utensils have been repaired or replaced.
Yes
No
N/A
5. 5. Utensils are properly protected during storage.
Yes
No
N/A
Section 7: FLOORS/WALLS/CEILINGS
1. 1. Floors are clean, well-maintained and in good repair.
Yes
No
N/A
2. 2. Walls, ceilings, and windows are clean, well-maintained and in good repair.
Yes
No
N/A
Section 8: TOILET/DRESSING ROOM/HANDWASHING SINKS
1. 1. Toilet facilities are clean, well-maintained and in good working order.
Yes
No
N/A
2. 2. Self-closing doors in toilet and dressing rooms are working properly.
Yes
No
N/A
3. 3. Single service soap and towel dispensers installed above all handwash sinks are operable and fully stocked.
Yes
No
N/A
4. 4. Toilet tissue dispensers are full stocked.
Yes
No
N/A
5. 5. Legible handwashing signs are properly posted.
Yes
No
N/A
6. 6. Ventilation is provided in each restroom and is in proper working order.
Yes
No
N/A
Section 9: LIGHT AND VENTILATION
1. 1. Adequate lighting and ventilation are provided throughout the facility.
Yes
No
N/A
2. 2. Exhaust ventilation filters are clean and well-maintained.
Yes
No
N/A
3. 3. Light fixtures have approved safety covers.
Yes
No
N/A
Section 10: PEST CONTROL
1. 1. Facility is free from insect and rodent infestations.
Yes
No
N/A
2. 2. Live animals, birds, or fowl are not allowed in food prep areas.
Yes
No
N/A
3. 3. Outside doors and screen doors are self-closing and closures are in working order.
Yes
No
N/A
4. 4. Air curtains are operating properly.
Yes
No
N/A
5. 5. Only approved pesticides are used and must be used in the proper manner.
Yes
No
N/A
Section 11: REFUSE
1. 1. Trash containers are leak-proof and covered.
Yes
No
N/A
2. 2. Plastic bags are tied before placing in refuse containers.
Yes
No
N/A
3. 3. Outside trash bin are clean and in good repair and the lids are closed.
Yes
No
N/A
4. 4. Outside premises and refuse areas are clean and well-maintained.
Yes
No
N/A
Section 12: OPERATION
1. 1. Hazardous substances (cleaning materials) are properly labeled and stored away from food products.
Yes
No
N/A
2. 2. There are no living quarters within the facility.
Yes
No
N/A
3. 3. No smoking and first aid signs (choking) are properly posted.
Yes
No
N/A
4. 4. Cleaning equipment and soiled linens are properly stored.
Yes
No
N/A
5. 5. Returned, damaged, or unlabeled food products are properly stored.
Yes
No
N/A
6. 6. Facility has a current Department of Environmental Health and Quality Permit to operate, and it is conspicuously posted.
Yes
No
N/A
7. 7. Grade Card (if facility is issued one) is posted properly.
Yes
No
N/A