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 RecordsACP Rosters Food Cooling Log Sanitation Log

4 4K30 Forms Food Allergy FNS In-Service

Civil Rights

1 1

6 6Forms are organized and

accessibleSpecial diet menus printed Forms are kept securely

Forms & JTS Alerts matchSpecial diet menus

followedMenu items are recorded

appropriately

4 4Employees wash hands

between task Hand washing sign posted Trash bin availablePaper towels available

5 5

Sanitizing bins in useDishwasher at correct

tempsDish rags stored dry or in

sanitizerSanitizer within range Max temp thermometer

2 2

Thermometers in all units Within appropriate range5 5

Equipment clean Floor clean

Surfaces cleanDry storage clean &

organizedCold storage clean &

organized4 4

Health permit Health inspection Employee health infoServSafe Certificates

6 6Labeled and dated FIFO observed Within expiration date

Is general cleanliness observed?

FORMS & PAPERWORKAre all forms and paperwork correct, complete and up to date?

Are required in-services complete?

Is HACCP binder available and up to date?

SPECIAL DIETSIs special diet protocol followed appropriately?

OBSERVATIONS - General Safety & SanitationIs 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 - FoodIs food stored appropriately?

Is required paperwork posted?

6" from floor, 12" from ceiling

Open foods resealed appropriately

Employee food stored in designated area

1 11 1

4 4Portion size accurate All items served Milk choice given

Recipes followed4 4

Food labeled Dated All items sampledTime recorded

1 1

4 4

Shadow board organizedAll tools shadowed on

board Tools reconciled per policyTools logged correctly

5 5Chemicals stored

appropriately Perpetual chemical logBody fluid cleanup kit

availableMSDS Sheets available Chemicals labeled

5 5Hair restraints worn Uniform worn No false eyelashes

Jewelry policy observed No polished or fake nails

Staffing vacancies: Equipment issues:

Are staff abiding by DJJ Policy 9.3 (i)7

ISSUES

Are leftovers returned to inventory or discarded appropriately?Are frozen foods thawed appropriately?

OBSERVATIONS - Menu

CHEMICAL CONTROL

BEST PRACTICE

FINAL SCORE100%

Is menu followed?

Are sample bags kept correctly?

Is appropriate counting procedure used?

TOOL CONTROLAre tools controlled per policy?

Are chemicals controlled per policy?

STAFF

NOTES