PACE 2024 Food Safety Aduit Form

Restaurant is free of infestation and/or signs of active pest (animal/insect) infestation in the restaurant building, adjoining corral, and any area within 10 feet (3m) of the building.

• YES

• NO

The internal temperatures of beef patties after cooking are at or above 155°F (69°C).

• YES

• NO

PRODUCT NAME:

The internal temperatures of raw plant based and chicken products after cooking are at or above 165°F (74°C).

• YES

• NO

PRODUCT NAME:

The internal temperature of Filet-O-Fish portions after cooking are at or above 155°F (69°C).

• YES

• NO

The internal temperatures of breakfast sausage made from raw pork and breakfast steak are at or above 155°F (69C).

• YES

• NO

PRODUCT NAME:

Cooked McMuffin raw round eggs have gelled yolks (are not runny). Internal temperatures are at or above 155°F (69°C).

• YES

• NO

The on-duty manager (or staff assigned to complete the checklist) can demonstrate they have been trained on properly completing the Food Safety Daily Checklist including the ability to take corrective action.

• YES

• NO

List

• fresh beef

• produce

• cheese/eggs/dairy

• canadian bacon

• apple slices

• mike

• shake/sundae mixes

• other

List

• supplies not available (soap/anti-microbial soap)

• soap dispenser not functioning properly

• no warm running water of at least 100˚F

• handwashing sink knobs/automatic tap not working

• no paper towel/working hand dryer

• handwashing sink used for other purposes

• handwashing sink/taps not reachable, obstructed or not accessible

• other

List

• hands not washed on hourly basis

• hand washing clock/timer not working/not in use/system not in place

• hand washing activity not monitored

• hands not washed after using restroom

• hands not washed after taking a break

• hands not washed after handling raw products and working on other station, e.g., prep table

• hands not washed after tasks (i.e. handling waste, cell phone, touching face, hair, picking items off floor, etc.)

• proper hand washing procedure not followed

• other

List

• fresh bucket with sanitized towels not prepared

• no towels in fresh bucket

• sanitizer level is less than 50 ppm

• test strips not available/ damaged / expired / not in usable condition

• **clean and/or soiled buckets not placed in convenient and accessible location

• other

: Sanitizer-soaked towels and grill cloths used at food, beverage preparation, and service areas placed into the soiled towel bucket after using and not left sitting out on surfaces.

• grill towels left out on kitchen surfaces

• cloth towels left out on kitchen surfaces

• cloth towels left out on beverage/service areas

• soiled towels mixed with fresh towels in the clean towel bucket

• other

List

• in-use UHC trays, utensils and utensil holders have excessive grease or build-up

• items are not being cleaned and sanitized every 4 hours

• back sink dispenser/ware washer not operating properly

• sanitizer solution not at the correct concentration

• water at back sink is not 110˚F or hotter

• test strips not available or damaged/ expired/ not in usable condition

• proper wash, rinse and sanitize procedures are not being followed

• other

List

• excessive build up of dirt/grease / mold on floors/walls/ceiling

• excessive build up of dirt/grease / mold on equipment

• standing/puddling water on the floor

• **restrooms and facilities not cleaned regularly (minimum every 2 hours)

• **restrooms and facilities not stocked

• **storage room not clean and/or has a foul odor

• Other

List

• floors/drains/walls/ceiling not in good repair (e.g. broken/missing tiles)

• broken equipment/utensils/trays/etc. in use

• grease traps in use not functioning properly

• ice build-up in freezer

• Other

List

• water filter(s) not dated (if not serviced by Coke)

• water filters bypassed

• ice transfer bucket or ice scoop not clean

• ice scoop not stored in holder

• water/ice not protected from possible contamination

• ice machine bin, or ice chute has visible mold or build up

• ** ice bucket stored upright

• Other

List

• product not covered

• ** product not labeled

• product not off the floor

• product not away from the wall

• product not stored according to procedure (e.g., raw above ready to eat)

• ** shake/sundae reservoir lid not in place

• ** all non-essential equipment, stationery and other items are not removed from food preparation areas

• ** there is no plan for glass/porcelain/crockery breakage clearance

• Other

List

• gloves not discarded when removed/are being reused

• double set of gloves being worn

• blue gloves not removed at the proper time after handling raw products

• blue gloves not removed properly (from the wrist and turning inside out)

• yellow yolk breaking tool not available

• yellow yolk breaking tool used for items other than raw eggs

• yellow yolk breaking tool is improperly stored in contact with food or utensils used for cooking food

• utensils other than yellow yolk breaking tool used to break raw egg yolks

• dedicated tongs are used for anything other than handling raw protein products

• bare hands used with raw product at grill/fryer

• Other

List

• gloves not worn when preparing sandwiches, salads, or burritos

• gloves not changed and hands not washed if become contaminated

• gloves not discarded when removed or being reused

• gloves worn for non-food tasks and not changed/replaced before resuming food preparation

• clear gloves are used for handling raw products

• double set of gloves being worn

• apron/hair/beard cover not used properly to prevent product contamination

• uniform not clean

• ** uniform not in good repair

• excessive jewelry on hands and wrists (more than a smooth ring/wedding band)

• finger nails are not trimmed, filed and maintained so the edges and surfaces are cleanable and not rough

• false nails, dirty fingernails or nail polish and not wearing intact disposable gloves

• employees consuming food and/or beverages in food prep or service areas

• ** gloves not worn or hands not cleaned and disinfected before adding ice / shake or sundae mix

• ** aprons not removed before use of toilet

• ** false and/or dirty fingernails

• Other

List

• chemical spray bottles/containers stored in the kitchen near food or open packages

• chemical spray bottles/containers stored in the service area

• chemicals are stored in dry storage near to food and packaging

• chemicals stored in food containers

• chemicals improperly used (ex. spraying around open food or packaging)

• ** chemicals not clearly labeled

• Other

List

• pest management program is not in place

• pest management program is not working effectively

• restaurant is not pest proofed

• drive-thru window is not closed when not in active use (and there are no cars in the drive-thru)

• ⃝report is older than 60 days or no pest service report is available for review

• ⃝most recent pest control report recommendations not corrected or there is no action plan to correct

• dead cockroach(es)

• trapped rodent(s)

• trailing ant activity in one area

• high large fly activity greater than 5 in one area

• Other

List

• 3N1 cleaner/disinfectant not available

• staff not trained in the use of the non-food spill procedures

• non-food spill procedures not available

• non-food spill procedures not followed

• Other

List

• walk-in freezer or other primary storage freezer is above 0°F and the unit is not in defrost

• walk-in freezer or other primary storage freezer is above 10°F even if the unit is in defrost

• product is not solidly frozen in two-door reach-in freezer

• product is not solidly frozen in grill side reach-in freezer

• product is not solidly frozen in wall-mounted freezer

• Other

List

• walk-in refrigerator

• prep table refrigerator

• pass-through prep line refrigerator

• two-drawer grill side refrigerator

• service area refrigerator

• shake/sundae machine

• blended ice machine

• any other unlisted secondary/reach-in refrigerator

List

• produce held at the prep table or chilled rail

• cheese/eggs/dairy

• canadian bacon

• apple slices/butter pats at room temperature or chill pans

• product held in refrigerators are not properly marked

• product held in refrigerators not within proper secondary shelf life

• Other

List

• shake/sundae mix

• sauces/soups/gravies

• food donation products not stored in freezer

• products held without a timing mechanism

• breakfast meats

• egg products

• beef patties

• fried chicken products

• fried fish products

• hotcakes

• marinator

• simplified breakfast cabinet

• Other

List

• probe not complete/missing

• pyrometer not in calibration

• pyrometer/probes damaged

• ** pyrometer/probes dirty

• ** needle not sanitized when used for ready to eat product

• ** needle not sanitized after unacceptable temperature

• Other

List

• food not from approved sources

• packaging not from approved sources

• equipment not from approved sources

• cleaning chemicals not from approved sources

• Other

List

• manager does not know all symptoms that would result in employees not being allowed to work

• manager does not know the procedures to follow when presented with an ill employee

• manager does not know when an ill employee would be allowed to return to work

• manager does not know the reportable illness causes

• employee(s) are observed exhibiting any of the reportable illness symptoms

• other

List

• certification date is not current

• certification for managers not issued by ANSI accredited organization

• certification records for all managers not available for review during the visit

• employee training tracking document not available for review during the visit

• not all employees have been trained and verified

• Other

List

• last two completed Monthly Food Safety Procedure Verifications are not available

• digital Food Safety less than 80% completion for the last 60 days of Food Safety Daily Checklists

• last 60 days completed Daily Food Safety Book (records) not available

• evidence of systematic failures (e.g., more than 6 missed or incorrect in 30 days) in Daily Food Safety

• Other

List

• health department inspection report not available

• critical violations noted by Health Department have not been corrected

• plan not in place to correct issues

• Other

List

• orange container not utilized for nut containing mix-ins

• dedicated scoop not utilized or available

• nut-free mix-ins kept in the orange container

• ** allergen information not available for staff

• ** staff not aware of the correct procedure to follow when dealing with customer request for allergen

• ** local requirements not adhered to

• Other

Are hands-free water taps (faucets) installed for kitchen handwashing units?

• YES

• NO

Are hands-free paper towel dispensers installed in place of hands air-dryers?

• YES

• NO

Are hand sanitizers or handwashing station available close to kitchen entry?

• YES

• NO