FOOD SAFETY AND SANITATION AUDIT FORM

Purchasing & Receiving

Points

Preparation & Production

Score

Morrison; 1/10

Points

101*

Frozen foods received solidly frozen so they are hard to the

touch; properly inspected.

301*

Potentially hazardous foods cooked and reheated to proper

internal temperatures. Food handlers are actively monitoring
temperatures.

102*

Potentially hazardous refrigerated foods received at 41F or

below; properly inspected; temperatures checked.

302*

Potentially hazardous foods are not left out of temperature

control for extended periods of time.

103*

Food from commercial suppliers; food and packaging in sound

condition; source tags for shellfish held for at least 90 days
from the date original container is emptied.

303*

Potentially hazardous foods properly cooled.

304*

351

151
152

Thermometers accurate and readily available for use. Bi-metal dialtype thermometers not used.
Foodservice-related chemicals all from 'EcoLab' or approved
vendor.

13

Number of Critical Deficiencies in Purchasing & Receiving

201*

202*

203*

Storage

Points
3

Score an additional 2 points here if the temperature of the

product tested in item 201 is over 51F.

Walk-in cooler maintaining potentially hazardous foods at 41F

or below. Use this second line item if there are already critical
violations cited in 201 and there are additional violations in a
separate walk-in cooler.

Score an additional 2 points here if the temperature of the

product tested in item 202 is over 51F.

Cold potentially hazardous foods maintained at 41F or below

at reach-in refrigerator.

204*

Cold potentially hazardous foods maintained at 41F or below

at reach-in refrigerator. Use this second line item if there are
already critical violations cited in 203 and there are additional
violations in a separate reach-in cooler.

353*

Fruits and vegetables properly washed and rinsed with

approved Chemical Wash or 'double washed' prior to
processing & serving.

354

Foods protected from potential microbiological, physical and

chemical contamination.

355

In-use utensils properly handled.

2
26

Retail Service/Distribution

401*

Cold potentially hazardous foods maintained 41F or below in

all cold holding devices including all display reach-in
refrigerated units and cold wells in the retail area.

Cold potentially hazardous foods maintained 41F or below in

all cold holding devices including all display reach-in
refrigerated units and cold wells in the retail area. Use this
second line item if there are already critical violations cited in
item 401 and there are additional violations in a separate
service area cooler.

205*

Potentially hazardous foods not left out of temperature control

for extended periods of time.

206*

Foods free of all microbiological, physical or chemical

contamination.

207*

Date marking is applied at time of preparation to ready-to-eat,

potentially hazardous foods prepared on site intended to be
held cold more than 24 hours, and does not exceed 4 days
shelf life.

208*

Food products not held or stored past manufacturer's

expiration/use by/sell-by dates.

252

Frozen foods properly thawed.

Score an additional 2 points here if the temperature of the

product tested in item 401 is over 51F.

Refrigerated storage units equipped with accurate thermometers

that are easily viewable.
Food protected from potential microbiological, physical and
chemical contamination.

Number of Critical Deficiencies in Preparation & Production

Score an additional 2 points here if the temperature of the

product tested in item 204 is over 51F.

251

Score

352

Walk-in cooler maintaining potentially hazardous foods at 41F

or below.

Score an additional 2 points here if the temperature of the

product tested in item 203 is over 51F.

Foods free of microbiological, physical or chemical

contamination.
Thermometers accurate and readily available for use. Bi-metal dialtype thermometers not used.

402*

Score an additional 2 points here if the temperature of the

product tested in item 402 is over 51F.
403*

404*

3
1

406*

Score
Points

2
3

Score an additional 2 points here if the temperature of the

product tested in item 403 is below 130F.

Score an additional 2 points here if the temperature of the

product tested in item 404 is below 130F.
Potentially hazardous foods not left out of temperature control
for extended periods of time.
Foods free of microbiological, physical or chemical
contamination.

2
3

407*

253

Food properly covered, stored and protected.

408*

Food products not held or sold past Use-by/Sell-by dates.

254

Foods properly identified.

451

Thermometers accurate and readily available for use. Bi-metal dialtype thermometers not used.

452

Proper serving practices observed.

453

255
256

Foods stored minimum 6" off floor. Marked floor perimeters

observed.
Frozen foods received and held solidly frozen so that they are hard
to the touch.

257

Single service articles and linens properly stored.

454

258

In-use utensils properly handled and stored.

457

38
Number of Critical Deficiencies in Storage

Food protected from potential microbiological, physical and

chemical contamination.
Proper ingredient statements on all commercially packaged
products distributed for retail sale. Ingredient statements may be
required for foods prepared on site in some states.
In-use utensils properly handled.

0
0

1
2
31

Number of Critical Deficiencies in Retail Service/Distribution

* Critical Deficiencies

Hot potentially hazardous foods maintained 140F or above in

the retail area.

Hot potentially hazardous foods maintained 140F or above in

the retail area. Use this second line item if there are already
critical violations cited in item 403 and there are additional
violations in a separate hot holding unit in the retail area.

Score

0
0

FOOD SAFETY AND SANITATION AUDIT FORM

Patient/Resident Service/Distribution
421*

422*

423*

424*

Points

Cold potentially hazardous foods maintained 41F or below in

all cold holding devices including all display reach-in
refrigerated units and cold wells in patient/resident services
area.

Score an additional 2 points here if the temperature of the

product tested in item 421 is over 51F.

Cold potentially hazardous foods maintained 41F or below in

all cold holding devices including all display reach-in
refrigerated units and cold wells in patient/resident services
area. Use this second line item if there are already critical
violations cited in 421 and there are additional violations in a
separate patient/resident services area cooler.

Hot potentially hazardous foods maintained 140F or above in

the patient/resident services area.

Score an additional 2 points here if the temperature of the

product tested in item 423 is below 130F.

Score an additional 2 points here if the temperature of the

product tested in item 424 is below 130F.

Points

651

Non-food contact surfaces properly cleaned.

652

Floors, walls, and ceilings free of excessive dust, debris, and

standing water.

653

Ventilation adequate; vents, fan guards, and filters clean.

654

Floors, walls, and ceilings properly constructed and in good repair.

655

Interior garbage containers cleaned, lined, and emptied as needed.

656

Dining area tables and chairs clean and orderly.

657

Tableware properly presented.

3
10

Points

Score

426*

Potentially hazardous foods not left out of temperature control

for extended periods of time.

427*

Foods free of microbiological, physical or chemical

contamination.

428*

Food products not held or sold past Use-by/Sell-by dates.

471

Thermometers accurate and readily available for use. Bi-metal dialtype thermometers not used.

472

Proper serving practices observed.

473

Food protected from potential microbiological, physical and

chemical contamination.

477

In-use utensils properly handled.

Cleaning & Sanitizing

701*

Food contact surfaces properly cleaned and sanitized.

702*

Facilities for manual washing and sanitizing of equipment and

utensils properly maintained and operated.

703*

Sanitizer solutions at proper concentration and temperature.

704*

Dishwashing machines operating properly (temperature and

pressure).

751

Clean utensils and equipment properly stored.

752

Sanitizer test kits available and used.

753

Wiping cloths stored in approved sanitizer and properly used;

sanitizer spray bottles used and stored properly.

29
Number of Critical Def. in Patient/Resident Service/Distribution

0
0

2
17

Premises & Equipment

Points

501*

All food contact surfaces of equipment and utensils in good

condition, durable, non-toxic, and easily cleanable.

502*

Adequate hot and cold water available and from an approved

source.

503*

Plumbing in good working order (adequate pressure, air

gaps/backflow prevention devices in place).

Score

Number of Critical Deficiencies in Staff Facilities

Staff Standards

Points

801*

Proper handwashing practices followed.

802*

Infected associates or those who present a risk of transmitting

foodborne pathogens are restricted from food handling.
No bare hand contact with ready-to-eat food.

551

Chemicals and spray bottles properly labeled, used and stored in a

designated area.

803*

552

Cleaning tools and brushes appropriate for use, properly stored.

804*

Gloves properly maintained and used appropriately.

831

Good hygiene practices: clean outer clothing, proper hair restraints

used, etc.

832

Eating, drinking, and tobacco use restricted to designated areas.

833

Personal items properly stored in designated areas away from food,

utensils, and equipment.

555

Non-Food contact surfaces properly cleaned.

All non-food contact surfaces of equipment and utensils in good
condition, durable, non-toxic, and easily cleanable.
Floors, walls, and ceilings free of excessive dust, debris, and
standing water.

556

Ventilation adequate; vents, fan guards, and filters clean.

557

Interior garbage containers cleaned, lined, and emptied as needed.

558

Floors, walls, and ceilings properly constructed and in good repair.

559

Lighting adequate; safety shields in place and in good condition.

560

No pest entry points or harborage sites.

561

Pest control devices properly installed and maintained.

562

Exterior garbage storage and removal adequate, covered, and kept

clean.

1
21

Number of Critical Deficiencies in Staff Standards

Score

Pest prevention program is effective.

554

0
0

504*

553

Score

Score an additional 2 points here if the temperature of the

product tested in item 422 is over 51F.

Hot potentially hazardous foods maintained 140F or above in

the patient/resident services area. Use this second line item if
there are already critical violations cited in item 423 and there
are additional violations in a separate hot holding unit in the
patient/resident services area.

Customer Areas

Score

Morrison; 1/10

0
0

FOOD SAFETY AND SANITATION AUDIT FORM

28
Number of Critical Deficiencies in Premises & Equipment

0
0

Morrison; 1/10

FOOD SAFETY AND SANITATION AUDIT FORM

Staff Facilities
861*
881
882

Handwashing facilities in food preparation areas adequate and

accessible.
Handwashing facilities in food prepartion areas clean and fully
stocked.
Restrooms clean, fully stocked, and in good repair. Doors are selfclosing. Trash cans covered where required.

Points

QA Program Management

Score

At least one manager working in this unit has a current 'Food

Safety Manager Certificate'.

951

Policies and Procedures Manual readily available.

Food safety signage posted appropriately.

2
2

883

Area(s) for eating, drinking and tobacco use designated.

954

Facility is appropriately licensed/permitted to operate.

884

Area(s) for storage of personal belongings designated.

956*

Master Cleaning Schedule for the entire operation is effective.

Total Number of Points minus Points for cold

temperatures >51oF and hot temperatures <130oF.
Total Number of Possible Points
Total Number of Critical Deficiencies
Total Score

0
0

Number of Critical Deficiencies in QA Management

0
234
0
0%

Record any deliveries received during the audit time.

201a

Record three walk-in cooler product temperatures.

202a

Record three walk-in cooler product temperatures.

301a

Record total number of locations where foods are cooked.

353a

Morrison Vegetable Washing Instruction sign (MQAS-21) posted in

the designated produce washing area.

402a

Record three cold holding product temperatures in the retail area.

404a

Record three hot holding product temperatures in the retail area.

422a

Record three cold holding product temperatures in the

patient/resident services area.

424a

Record three hot holding product temperatures in the

patient/resident services area.

502a

Record hot water temperature at hand sinks.

504a

Record information from most recent pest control service report.

505

All mechanical equipment storing or holding hot or cold potentially

hazardous food is functioning properly.

801a

Document associates washing hands.

805

Associates advised of required health information reporting

responsibilities; documentation current.

A Food Safety Audit Action Plan form is posted on Morrison Today, with the Food Safety Audit documents.

Score

4
12

The following items are evaluated during a Food Safety Audit. They are all assigned zero (0) points.
102a

Points

901*

953

Number of Critical Deficiencies in Staff Facilities

Morrison; 1/10

0
0