Food Safety Self-Inspection Form Dry Storage YES NO Is all food at least 6 inches off the floor? eee (60 floor can be cleaned) ‘Are food storage shelves clean and in good 5 aaa | repair? (to promote food safoty) Is food stored separately rom personalitems, OO cleaning & maintenance supplies? {to prevent micups) Food Preparation Yes NO ees ek covet TT -rreteos pepsints cosnesandsantes =O before use? (to kil the bacteria n thorn) “Are separate cutng toads usediorray = se (im meat and for other foods? (to prvent ess contamination) “Is raw meat awaiting processing kept from o oa boing held at room temperatures for ong f \\ sd parle? fake poe fom gow) “Are potentially hazardous foods preheated o.oo rapidly to 168°F botore being placed into hot holding units? (to kil off harmful bacteria) Refrigerated Storage YES NO orownentdoesboowobertes? «Captiva tndnaaoow = CO] (so doesnt dip on eadyto-2et foods) {tne danger zone where gems grow best) Are thermometers conspicuusl placed in i) “ls potentially hazardous food cooled under «= EO] 9€ warmest part of the unit? refrigeration in shallow trays, or in an ice. (hore highest temperature can be read) bath? (lo reduce time n danger zone) Is food covered? o a Are potentially hazardous foods property EG: (to prevent ecedensl contention) thawed? (not room temperature) Is food stored out fom under unprotected = «Ee uenst handles stored cutotihetoos §=6 ss condensation ines? (50 nothing ips info) produc (so they don't ergs contarsnate) ‘re refrigerators at 41°F or below? o a ‘Are wiping cloths stored in a sanitizing og (to teop colorant gms rom growing) oliion? ol the gerne they plot vp) Ae freezers at 0°F or blow? TD icameiatetermed food probe temoncter =O O (toteepozan foods fom thawing) eaameeaaet cae eaieer (for frequent temperature checks) S eaPersonal Hygiene YES “Are employees eating, drinking or smoking = auvay from food preparation and utensil washing areas? “Are food handlers washing hands routinely? *Are employees with illnesses and infections. — C) restricted from handling food and utensils? (60 thoy don* infect others) Utensil Washing YES “Are utensils washed in detergent, rinsed Oo in clear water and sanitized with the correct Concentration of chemical? (to kill bacteria) o Do hot water sanitizing machines have a final rinse temperature of 180°F? (to sanitize the dishes) Do chemical sanitizing machines provide 50 ppm chlorine? Is tableware pre-scaked before washing? (to prevent contamination) ‘Ave all utensils alr dried? (fo prevent contamination) cee Is the 3-compartment sink operated as follows? 41. Wash with hot soapy water in fst basin 2. Clear water rinse in the second 43, Sanitize 2 minutes (min) inthe third ag ‘Are wash and rinse water kept clean? Are testis provided and used formonitoring the sanitzer concentrations? (a0 hey cont lose ther enectveness) oa No pe titeee © Geeaee ® | a General Cleaning Yes ‘Are food contac surfaces cleaned and sanitized CI ster each use? (to kill germs) ‘Ave the gaskets and interiors of refrigerators. = free of debris? (so germs cant feed on them) Is the can-opener blade free of food debris Qa ‘and metal shavings? ‘Ate toot in good repair and tree ofan, a Imosture and food debris? (where insects can breed and feed) ‘Are outside garbage container lids closed? a (10 reduce attraction of rodents and other pests) Is the garbage storage area clean? a (to eiscourage insects and rodents) @ 8 Odds & Ends YES “Are toxic chemicals labeled and stored o separately rom food and utensis? |s an area provided for personal belongings a that is separate from utensils and food? (to cut cown on eross-contamination) ‘Are clean linens stored on clean dry surface? = Are hand sinks equipped with soap and a sisposable towels? (for proper hand washing) ‘Are all lights shielded? (to keep broken giess {rom faling into food and to prevent cuts) Date of Inspection Person In Charge No ooHazard Analysis Critical Control Points Manager Self-Inspection Checklist “come Date Observer Use this checklist once a week fo determine areas in your operation requiring corrective action. Record corrective action taken and keep completed records in a notebook for future reference, Personal Dress and Hygiene Yer Wo Corectve Raion Yes Wo Corrective Acton plyees wear proper tem anaes wasned erughy wing proper "6° NO Garecve tat proper oss aa handsaeshing process at cal poms.) ale resrant is won, aa Ssmoling i beervod only in doses eran ‘vay om pepraon, sve, sorage, end Fingemals te sho urged se clean-..) ‘rrenashing ares. aoa Jewel 6 ied to wate, spe eg Extn, king, or chelng gum are ‘eapinrg aa breed enn deigated sass aay from wer oe, oa Hands te washod or gloves are changed at cre’. ag. Enrloyes tak appropri ation whan cughing ot anatng aa _ en sores, cuts sets ne bandas on hands re comply coves ue Dispose tissues are used ae asposes of aning food oa when coughing o4ing nos. aa Food Storage and Dry Storage “emote ie bebeen Yes No Comore Acton There are no bulging or aking canned YS No_ Corrective Aton SOF ad 70 aa goocs in storage aa ‘fod and pape supplis ae 61 B inches Food i protected frm contamination aa ft the oe aa ‘Al suacs on tors se oean, aa Al food sable wh ae ars ery de eee ee ches aa sere aay rom ood ars foodie spies. aa “The FO (ist bs Fes Ot metho of Inventory i ig rte aa _ Large Equipment Fed scar is ean to “er No Comcetve Action ay ater pieces emipment re cean to Ye® NO Corrective Action ‘Sgt and touch oo ‘igh nd touch — equipment on serving Ins, loage sos eines, eves, ranges, Fe scars sonies between utes when fryer, ad star euioment a ‘sed wih patty hard foods. ao Exhaet eos and fit ve lan Refrigerator, Freezer, and Milk Cooler Yes Wo Carecive Aclon Yes No Carectve hon ‘harman is eonepeveue Proper hiing procncures have been snd esate au prattced aa Tompercire is aca fr piece A fos eroperiy wrapped beled of eqient ao fd aed aa ae Food sora 6 inches of oor The FEO (irs n Fst Ou) mated of inven oo iverory Beg praceas aa s Unt is dean a