Facility: Date: Reviewer: Points Possible Points Received 9 9 Meal Production records Food Temp Log Culinary Tracking Form ACP Production Records Equip. Temp Log Meal Count Records ACP Rosters Food Cooling Log Sanitation Log 4 4 K30 Forms Food Allergy FNS In-Service Civil Rights 1 1 6 6 Forms are organized and accessible Special diet menus printed Forms are kept securely Forms & JTS Alerts match Special diet menus followed Menu items are recorded appropriately 4 4 Employees wash hands between task Hand washing sign posted Trash bin available Paper towels available 5 5 Sanitizing bins in use Dishwasher at correct temps Dish rags stored dry or in sanitizer Sanitizer within range Max temp thermometer 2 2 Thermometers in all units Within appropriate range 5 5 Equipment clean Floor clean Surfaces clean Dry storage clean & organized Cold storage clean & organized 4 4 Health permit Health inspection Employee health info ServSafe Certificates 6 6 Labeled and dated FIFO observed Within expiration date Is general cleanliness observed? FORMS & PAPERWORK Are all forms and paperwork correct, complete and up to date? Are required in-services complete? Is HACCP binder available and up to date? SPECIAL DIETS Is special diet protocol followed appropriately? OBSERVATIONS - General Safety & Sanitation Is hand washing station set up and used appropriately? Are sanitizing bins, 3-compartment sink, and dishwasher set up appropriately? Are food storage areas temperature controlled? Instructions: Enter 1 on line corresponding with a deficiency. Enter 0 on line for items met or not observed. OBSERVATIONS - Food Is food stored appropriately? Is required paperwork posted?