Food Safety Verification

2018 Updated Version - Criticals on the bottom

Question Title

* Resturant Number

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* Date

Date

Time

AM/PM

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* Manager on Duty

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* Completed by:

Questions worth 5pts each

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* 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

Yes

No, Check all reasons that apply below:

are easily accessed by employees. If no, check all reasons that apply below:

Hand washing sink knobs/automatic tap not working well

Soap dispenser empty / not working

No warm running water

No paper towel/working hand dryer

Soap dispenser does not contain Ecolab approved hand soap

Hand washing sink/tap obstructed and not accessible

Hand washing sink used for other purposes

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* Hands are properly washed following proper hand washing procedures at the appropriate times. Asystem is in place to ensure hourly hand washing by all employees.

Yes

No, check all reasons that apply below:

Hands not washed on hourly basis

Hand washing clock/timer not working / not in use / system not in place

Hand washing activity not monitored

Hands not washed after using restroom / taking a break

Hands not washed after handling raw products and working on other station, e.g., prep table

Hands not washed after tasks such as handling waste, touching face, hair, picking something off the floor, etc.

Other (please specify)

Question Title

* Sanitized towel buckets contain towels and sanitizer solution at the correct concentration checked with a chlorine test strip

Yes

No, Check all reason that apply below:

. If no, check all reasons that apply below:

Buckets not labeled

No towels in fresh bucket

Used towels mixed with fresh towels

Bucket is soiled

Sanitizer level is not at correct concentration

Test strips not available / damaged / expired / not in usable condition

Other (please specify)

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* 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.

Yes

No, check all reasons that apply below:

Grill towels left out on kitchen surfaces

Cloth towels left out on kitchen surfaces

Cloth towels left out on beverage/service areas

Other (please specify)

Question Title

* 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.

Yes

No, check all reasons that apply below:

UHC trays, utensils, and utensil holders are not clean

Items are not being cleaned and sanitized every 4 hours

Back sink dispenser/ware washer not operating properly

Sanitizer solution not at the correct concentration

Dirty utensils resting in back sink for more than 4 hours

Water at back sink is not 110 ˚ F or hotter

Test strips not available / damaged / expired / not in usable condition

Other (please specify)

Question Title

* 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.

Yes

No, check all reasons that apply below:

Raw ware equipment not cleaned last

Raw ware equipment not washed separately

Soiled raw beef tray(s) / lid(s) are not stored in blue bus box

Back sink/Powersoak sink not cleaned after washing raw ware equipment

Raw ware equipment is soaking in Powersoak sink

Other (please specify)