Food Safety and Security Self Audit Checklist
Establishment name: __________________________________________________Address:_________________________________________________________________________________
Form completed by (name): _____________________________________________Date:___________________________________________________________________________________
Use this checklist once a month to evaluate your compliance with the state food code. Keep a copy for your records.
(1) Not addressing the issue (2) No standard system (3) System needs improvement (4) Good system (5) Great system (NA) Not applicable
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Employee health, hygiene and training
Employee illness log maintained
Employees with vomiting or diarrhea excluded from establishment
Employees follow proper hand-washing procedures
Employees restricted from bare hand contact with ready-to-eat and ready-toserve food
Employees restricted from eating, drinking or tobacco use in food service
areas
Employees’ personal items stored away from food storage/preparation areas
Employees trained in food safety
Employees trained in food security
Protection from contamination
Food protected and separated from cross-contamination
Food contact surface cleaned and sanitized
Wiping cloths properly used and stored in sanitizing solution
Hand washing facilities properly stocked and accessible
Salad bars and food carts monitored against tampering
Time and temperature of potentially hazardous food
(temperature logs maintained daily)
Food cooled from 140° F to 70° F in two hours and from 70° F to 41° F in
four hours
Potentially hazardous food cooked to the required minimum internal
temperature
For hot holding, food kept at 140° F or above
For hot holding, food re-heated to 165° F for 15 seconds
For cold holding, food kept at 41° F or below
Food properly date marked and labeled
Thermometers used and calibrated for accuracy
1
2
3
4
5
N/A
Corrective action needed
Date completed
Food Safety and Security Checklist (page 2 of 2)
(1) Not addressing the issue (2) No standard system (3) System needs improvement (4) Good system (5) Great system (NA) Not applicable
21
22
23
24
25
26
27
28
29
30
31
32
33
34
Approved source
Purchase products from reputable commercial supplier
Supplier records maintained on site and readily available
Products inspected for tampering prior to preparation and service
Chemicals
Toxic chemicals properly used, labeled and stored
Material Safety Data Sheets for each chemical available and accessible
Proper use of utensils and equipment
Utensils and equipment properly stored and handled
Three-compartment sink/dishwashing machine operated properly with
sanitizer checked with test strips or monitor for hot water sanitizing temp
Physical facility
Physical facility properly cleaned, maintained and aisles clear of obstruction
Unauthorized people kept out of food and records areas
Contractors/vendors monitored when they are in the food facility
Integrated Pest Management program in place for pest management
Doors opening to the loading dock locked when not in use
Proper lighting for all areas of the facility
Cameras and alarm operated for high-risk high traffic areas e.g. buffet to
protect from contamination and tampering
1
2
3
4
5
N/A Corrective action needed
Date completed
Food Security
Emergency
Readiness Maintenance
Foodand
Security
Maintenance
Management
1
2
3
4
5
N/A
Corrective action needed
Date completed
35 In case of emergency, employees know whom to contact:
1) Person in charge, 2) Police/Fire, 3) Utilities, 4) Local public
health department
36 New employee required to complete employment application
37 New employee references checked
38 Restricted areas marked “employees only”
39 Employees trained on emergency procedures
This
checklist
is adapted
from Minnesota
Departments
of Argiculture
and Health
(AG02458-01)
the Twin
Metro
APC FoodMN
Security
(2005)
Once a month, mail, email
or fax
the completed
self-audit
checklist to Fardowza
Omar,
Environmental
Health-Food
Safety 250and
S. Fourth
St.,Cities
Rm 414
Minneapolis,
55415Checklist
or
[email protected] fax (612) 673-2635
Twin
Cities Checklist
Metro Advanced
This checklist is adapted from Minnesota Departments of Agriculture and Health (AG02458-01) and the Twin Cities Metro APC Food
Security
(2005) Practice Center
Advanced Practice Centers
1st Edition, Fall 2007