Food Safety Survey Date of the Visit * MM DD YYYY Time of the Visit * Hour Minute Second AM PM Kitchen Visited * Antelias Central Kitchen Arsal - LACODE Baalbeck - LACODE Beit Em Ziad Werdeniye - SBT Black Pearl Nabatiye - SBT Dalhamiyeh - LACODE Fakiha - LACODE Hermel - LACODE Kfour Municipality Kitchen Layali El Moulouk Marjeyoun - SBT LSR Kitchen - Amshit Moulin D'or - Mazraa Poupa Marjeyoun - SBT Salam Kitchen Baalbeck - SBT Soboh W Massa Nabatiye - SBT Souk El Tayeb - Mar Mikhael SBT Community Kitchen Ansar Kitchen Focal person * First Name Last Name PERSONAL HYGIENE * Employees wear clean and proper uniform including closed-toe shoes. Strongly Disagree Disagree Neutral Agree Strongly Agree Effective hair restraints are properly worn. Strongly Disagree Disagree Neutral Agree Strongly Agree Fingernails are short, unpolished and clean (no artificial nails). Strongly Disagree Disagree Neutral Agree Strongly Agree Jewelry is limited to a plain ring, such as a wedding band, watch and no bracelets. Strongly Disagree Disagree Neutral Agree Strongly Agree Hands are washed properly, frequently and at appropriate times. Strongly Disagree Disagree Neutral Agree Strongly Agree Burns, wounds, sores, scabs, and splints are covered with water-proof bandages and completely covered with a foodservice glove while handling food. Strongly Disagree Disagree Neutral Agree Strongly Agree Eating, drinking, chewing gum and smoking are allowed only in designated areas away from preparation, service, storage and ware washing areas. Strongly Disagree Disagree Neutral Agree Strongly Agree Employees use disposable tissues when coughing or sneezing and then immediately wash hands. Strongly Disagree Disagree Neutral Agree Strongly Agree Employees appear in good health. Strongly Disagree Disagree Neutral Agree Strongly Agree Hand sinks are unobstructed, operational and clean. Strongly Disagree Disagree Neutral Agree Strongly Agree Hand sinks are stocked with soap, disposable towels and warm water. Strongly Disagree Disagree Neutral Agree Strongly Agree A handwashing reminder sign is posted. Strongly Disagree Disagree Neutral Agree Strongly Agree Employee restrooms are operational and clean. Strongly Disagree Disagree Neutral Agree Strongly Agree Corrective Actions * FOOD PREPARATION * All food stored or prepared in facility is from approved sources. Strongly Disagree Disagree Neutral Agree Strongly Agree Frozen food is thawed under refrigeration or in cold running water and then cooked to the proper temperature. Strongly Disagree Disagree Neutral Agree Strongly Agree Thawed food is not refrozen. Strongly Disagree Disagree Neutral Agree Strongly Agree Preparation is planned so ingredients are kept out of the temperature danger zone. Strongly Disagree Disagree Neutral Agree Strongly Agree Food is tasted using the proper procedure. Strongly Disagree Disagree Neutral Agree Strongly Agree Procedures are in place to prevent cross-contamination. Strongly Disagree Disagree Neutral Agree Strongly Agree Food is handled with suitable utensils, such as single use gloves or tongs. Strongly Disagree Disagree Neutral Agree Strongly Agree Food is prepared in small batches to limit the time it is in the temperature danger zone. Strongly Disagree Disagree Neutral Agree Strongly Agree Clean reusable towels are used only for sanitizing equipment and surfaces and not for drying hands, utensils or floor. Strongly Disagree Disagree Neutral Agree Strongly Agree Food is cooked to the required safe internal temperature for the appropriate time. Strongly Disagree Disagree Neutral Agree Strongly Agree The internal temperature of food being cooked is above 60°C. Strongly Disagree Disagree Neutral Agree Strongly Agree Corrective Actions * HOT HOLDING * Hot holding unit is clean. Strongly Disagree Disagree Neutral Agree Strongly Agree Food is heated to the required safe internal temperature before placing in hot holding. Hot holding units are not used to reheat potentially hazardous foods. Strongly Disagree Disagree Neutral Agree Strongly Agree Hot holding unit is pre-heated before hot food is placed in unit. Strongly Disagree Disagree Neutral Agree Strongly Agree Temperature of hot food being held is at or above 60ºC. Strongly Disagree Disagree Neutral Agree Strongly Agree Food is protected from contamination. Strongly Disagree Disagree Neutral Agree Strongly Agree Corrective Actions * COLD HOLDING * Temperature of cold food being held is at or below 5ºC. Strongly Disagree Disagree Neutral Agree Strongly Agree Food is protected from contamination. Strongly Disagree Disagree Neutral Agree Strongly Agree Corrective Actions * REFRIGERATOR, FREEZER & MILK COOLER * Food is stored 6 inches off the floor in walk-in coolers. Strongly Disagree Disagree Neutral Agree Strongly Agree Refrigerator and freezer units are clean and organized. Strongly Disagree Disagree Neutral Agree Strongly Agree Proper chilling procedures are used. Strongly Disagree Disagree Neutral Agree Strongly Agree All food is properly wrapped, labeled and dated. Strongly Disagree Disagree Neutral Agree Strongly Agree Air temperature of all refrigerators and freezers is monitored using accurate thermometers and documentation is on file. Strongly Disagree Disagree Neutral Agree Strongly Agree Corrective Actions * FOOD STORAGE & DRY STORAGE * Temperature of dry storage area is between 10ºC and 21ºC. Strongly Disagree Disagree Neutral Agree Strongly Agree All food and paper supplies are stored 6 to 8 inches off the floor. Strongly Disagree Disagree Neutral Agree Strongly Agree All food is labeled with name and date received. Strongly Disagree Disagree Neutral Agree Strongly Agree Open bags of food are stored in containers with tight fitting lids and labeled with common name. Strongly Disagree Disagree Neutral Agree Strongly Agree The FIFO (First In, First Out) method of inventory management is used. Strongly Disagree Disagree Neutral Agree Strongly Agree There are no dented on the seam, bulging or leaking canned goods. Strongly Disagree Disagree Neutral Agree Strongly Agree All food surfaces are clean. Strongly Disagree Disagree Neutral Agree Strongly Agree Chemicals are clearly labeled and stored away from food and food-related supplies. Strongly Disagree Disagree Neutral Agree Strongly Agree There is a regular cleaning schedule for all food surfaces. Strongly Disagree Disagree Neutral Agree Strongly Agree Food is stored in original container or a food grade container and is labeled with name and date received. Strongly Disagree Disagree Neutral Agree Strongly Agree Corrective Actions * CLEANING & SANITIZING * Three-compartment sink is properly set up for ware washing. Strongly Disagree Disagree Neutral Agree Strongly Agree Dish machine is working properly (gauges and chemicals are at recommended levels). Strongly Disagree Disagree Neutral Agree Strongly Agree Water is clean and free of grease and food particles. Strongly Disagree Disagree Neutral Agree Strongly Agree Water temperatures are correct for wash and rinse. Strongly Disagree Disagree Neutral Agree Strongly Agree If heat sanitizing, the utensils are allowed to remain immersed in 77ºC water for 30 seconds. Strongly Disagree Disagree Neutral Agree Strongly Agree If using a chemical sanitizer, it is mixed correctly and a sanitizer strip is used to test chemical concentration. Strongly Disagree Disagree Neutral Agree Strongly Agree All washed/sanitized items are allowed to air dry. Strongly Disagree Disagree Neutral Agree Strongly Agree Wiping cloths are stored in sanitizing solution while in use. Strongly Disagree Disagree Neutral Agree Strongly Agree Corrective Actions * UTENSILS & EQUIPMENT * All small equipment and utensils, including cutting boards and knives, are cleaned and sanitized between uses. Strongly Disagree Disagree Neutral Agree Strongly Agree Work surfaces are cleaned and sanitized between uses. Strongly Disagree Disagree Neutral Agree Strongly Agree Thermometers are cleaned and sanitized after each use. Strongly Disagree Disagree Neutral Agree Strongly Agree Thermometers are calibrated on a regular basis. Strongly Disagree Disagree Neutral Agree Strongly Agree Can opener is clean. Strongly Disagree Disagree Neutral Agree Strongly Agree Drawers and racks are clean. Strongly Disagree Disagree Neutral Agree Strongly Agree Clean utensils are handled in a manner to prevent contamination of areas that will be in direct contact with food or a person’s mouth. Strongly Disagree Disagree Neutral Agree Strongly Agree Corrective Actions * LARGE EQUIPMENT * Food slicer is broken down, cleaned and sanitized before and after every use. Strongly Disagree Disagree Neutral Agree Strongly Agree Exhaust hood and filters are clean. Strongly Disagree Disagree Neutral Agree Strongly Agree Corrective Actions * GARBAGE STORAGE & DISPOSAL * Outdoor garbage cans/dumpsters are clean, water-tight and kept covered. Strongly Disagree Disagree Neutral Agree Strongly Agree Garbage cans are emptied as necessary. Strongly Disagree Disagree Neutral Agree Strongly Agree Boxes and containers are removed from the site. Strongly Disagree Disagree Neutral Agree Strongly Agree Loading dock and area around dumpster are clean and odor free. Strongly Disagree Disagree Neutral Agree Strongly Agree Corrective Actions * PEST CONTROL * Outside doors have screens, are well-sealed and are equipped with a self-closing device. Strongly Disagree Disagree Neutral Agree Strongly Agree No evidence of pests is present. Strongly Disagree Disagree Neutral Agree Strongly Agree There is a regular schedule of pest control by a licensed pest control operator. Strongly Disagree Disagree Neutral Agree Strongly Agree Corrective Actions * Surveyor Name * First Name Last Name Thank you!
