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PACE 2023 Food Safety Audit Form

This food hygiene audit form or food safety audit provides a comprehensive inspection of a food processing facility to evaluate its compliance with established food hygiene and safety standards, as well as a company's specific hygiene policies and practices.
Lakeshore Partnership / North Lakeshore Food Safety
01/02/2023

PACE 2023 Food Safety Audit Form

This food hygiene audit form or food safety audit provides a comprehensive inspection of a food processing facility to evaluate its compliance with established food hygiene and safety standards, as well as a company's specific hygiene policies and practices.

    NOTES TO GENERAL MANGER / SUPERVISOR

    Date Of Visit

    MANAGER ON DUTY

    CRITICAL FOOD SAFETY

    FS1-US

    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.

    FS2-US

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

    PRODUCT NAME:

    FS3-US

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

    PRODUCT NAME:

    FS4-US

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

    FS5-US

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

    PRODUCT NAME:

    FS6-US

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

    FS7-US

    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.

    FS8-US TCS for Refrigerated Products (5 Points)

    List

    FS9-US Hygiene & Sanitation (5 Points)

    List

    FS10-US Handwashing procedure (5 Points)

    List

    FS11-US Sanitized towel/cloth buckets (3 Points)

    List

    FS12-US Sanitizer-soaked towels/cloths (1 point)

    : 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.

    FS13-US Utensil and trays sanitizing (3 Points)

    List

    CONYAMINATION PREVENTION

    FS14-US State of cleanliness (3 Points)

    List

    FS15-US State of repair (3 Points)

    List

    FS16-US Water and Ice (3 Points)

    List

    FS17-US Food product opened (3 Points)

    List

    FS18-US Raw food product handling (5 Points)

    List

    STORAGE

    FS19-US Good Hygiene Practices (5 Points)

    List

    FS20-US Chemical management (3 Points)

    List

    FS21-US Pest management (3 Points)

    List

    FS22-US Non-food/biohazard spill procedures are in place. (1 Point)

    List

    FS23-US Frozen products (5 Points)

    List

    FS24-US Refrigerated products (5 Points)

    List

    FS25-US Shelf lives (3 Points)

    List

    FS26-US Leftover heated foods (3 Points)

    List

    COOKING

    FS27-US Pyrometer (5 Points)

    List

    GENERAL

    FS28-US Sourcing (5 Points)

    List

    FS29-US Employee health (5 Points)

    List

    FS30-US Staff training (5 Points)

    List

    FS31-US Food Safety Checklists (5 Points)

    List

    FS32-US Health Department Inspections (5 Points)

    List

    FS33-US Allergen management (3 Points)

    List

    NO SCORE QUESTIONS

    FS34 HST1

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

    FS35 HST2

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

    FS36 HST3

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

    SCORE INFO:

    • Screenshot2022-12-31113215.jpg

    MANAGER IN CHARGE SIGNATURE:

    Click here to sign

    FOOD SAFETY COORDINATOR SIGNATURE

    Click here to sign
Source: Lakeshore Partnership / North Lakeshore Food Safety (Community Member)

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