Kitchen Audit Test - Convivial Life

Kitchen Audit - TEST

Step 1 of 8

12%

Audit Area

Name of Person Completing Audit Form

First(Required)

Last(Required)

Name of Person Who Completed Audit (if different)

First

Last

Convivial Life Community(Required)

Community Space Audited(Required)

Audit Completion Date(Required)

MM slash DD slash YYYY

Personal Hygiene

PH-1. Hand sinks are unobstructed, operational, and clean.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

PH-2. Hand sinks are stocked with soap, disposable towels, and warm water.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

PH-3. Staff use proper handwashing techniques with soap and warm water and wash hands at appropriate times during food preperation and task changes.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

Food Storage

FS-1. All food is properly wrapped, labeled, and dated.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

FS-2. Open bags of food are stored in containers with tight-fitting lids or in zip locked bags and labeled with the common name and date.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

FS-3. Unopened food products are discarded on or before the expiration date.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

Food Preparation and Service

FPS-1. Hot foods are held at 135°F or higher on the steam table.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

FPS-2. Cold foods are held at 41°F or lower.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

FPS-3. Pasteurized egg products are used for soft-cooked and undercooked eggs (i.e., sunny side up, soft scrambled, soft boiled).(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

Dishware Cleaning and Sanitation

1. Low temperature dishwasher wash cycle reaches a minimum of 120°F.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

2. Final rinse provides 50 ppm chlorine (hypochlorite) on dish surfaces.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

3. Water inside dish machine is clean and free of grease and food particles.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

Equipment Safe/Clean

1. Refrigerators, freezers, and ice machines are clean and in safe operating condition.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

2. Ice scoops held in an approved holder. Ice buckets are stored inverted.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

3. Utensils/equipment are clean and in good condition (e.g., not cracked or chipped).(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

Refuse/Pest Control

1. There is no evidence of pests in the food storage, preparation, or service areas.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

2. All garbage cans are covered.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

Emergency Management

1. Facility maintains an adequate supply of non-perishable food and potable water to sustain all healthcare residents and staff for at least 3 days (72 hours).(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

2. All emergency supply foods have not expired.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

3. Fire extinguishers are easily accessible.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

Signage and Logs

1. Substitution log complete.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

2. Dish machine log complete.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)

3. Temperature of fridge/freezer log complete.(Required)

Yes

Not Audited

If no, please explain the resolution approach.(Required)

Date resolution to be complete.(Required)

MM slash DD slash YYYY

Please include the reasoning why this was not evaluated for this audit.(Required)