Appendix II - SFSP Site Insepction Form.pdf

Date of review

State of Florida Department of Agriculture Food Safety (S)

Summary

DEMONSTRATION OF KNOWLEDGE: Sufficient Record Keeping

Question# Question Response Priority

1.2.3 Delivery temperatures are documented with corrective actions and maintained at facility

EMPLOYEE HEALTH: Good Employee Health

2.1.1 No sick/symptomatic food handler(s) at work

PREVENTING CONTAMINATION BY HANDS: Clean Hands, Properly Washed

PREVENTING CONTAMINATION BY HANDS: No Bare Hand Contact with Ready-To-Eat Foods / Exemption When Applicable

4.2.1 When gloves are required, food handlers do not contact ready-to-eat foods with bare hand

4.2.2 Single-use gloves used properly

PREVENTING CONTAMINATION BY HANDS: Handwashing Facilities are Adequate

Question#

4.1.1

4.1.2

Question

Proper handwashing procedure

Handwashing at appropriate times

Response Priority

Critical Findings = 0 Major Findings = 0 Minor Findings = 0

Location:

Location Information

Evaluation Information

Start Time:

End Time:

Specialist:

Other Info

Site Type: Open

Address:

Address 2:

City/State/Zip:

Email:

APPROVED SOURCE: Food Obtained From Approved Source

5.1.1 Food supplies are from an approved source

PROTECTION FROM CONTAMINATION: Contamination Prevented in Food Storage and During Preparation

6.1.3 Food and food contact items stored in appropriate locations (non-disposables)

PROTECTION FROM CONTAMINATION: Food Contact Surfaces are Properly Constructed / Cleanable

6.3.1 Utensils/equipment food contact surfaces are in good repair

PROTECTION FROM CONTAMINATION: Food Contact Surfaces Clean and Sanitized

6.6.5 Food Contact Surfaces cleaned and sanitized

PROTECTION FROM CONTAMINATION: Health Department Protection from Contamination

TIME / TEMPERATURE CONTROL FOR SAFETY (TCS): Proper Cold Holding Requirements Met

7.5.1 TCS foods held in cold holding ≤ 41°F (5°C).

TIME / TEMPERATURE CONTROL FOR SAFETY (TCS): Accurate Thermometer Available

6.9.6

Question

Trash receptacles back of house are of sufficient availability/capacity. Trash containers are maintained cleaned

4.3.2

4.3.4

4.3.5

Question

Handwashing sink used only for handwashing

Soap available at all handwashing sinks

Single use towels/heated-air or high-velocity hand drying device present at all handwashing sinks

CHEMICALS: Chemicals / Toxic Substances Properly Identified, Stored, Used

INSECTS / RODENTS / ANIMALS: Insects / Rodents / Animals not present

FACILITY: Critical Water Service

11.1.1 No sewage backed-up into facility; no water service.

FACILITY: Plumbing Properly Installed; Proper Back Flow Devices

FACILITY: Adequate Toilet Facilities

11.3.1 Minimum of one functioning toilet available in the facility

Reviewer Signature

Manager Signature

11.2.1

Question

Hot and cold water are available at facility

10.1.1

Question

No pest activity observed

8.2.1

8.2.2

Question

Chemicals properly labeled Chemicals properly stored