"Self Assessment Checklist" - Alaska

Self Assessment Checklist is a legal document that was released by the Alaska Department of Environmental Conservation - a government authority operating within Alaska.

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Self Assessment Checklist
Facility __________________________________________Date(s)_______________
Completed by: _____________________________________
PROCEDURES
CORRECTIVE ACTIONS:
(Who, What, How, & When)
Correct procedure not being followed for cooling soups. Bill will
2/13
Example- Cooling
retrain employees on proper procedures. Will follow-up next
time soups are cooled.
Employee Training
Certified Food Protection Manager on
staff
All new employees have cards
Employee Health
Employees observed to assure not
working ill
Employees know foodborne illness
symptoms/conditions
Check that records are current for:
Applicant and Food Employee Reporting
Interview Form
Food Employee Reporting Agreement
Record of Staff Absences due to Illness
Handwashing
Observe employee handwashing practices
Handwash sinks:
Soap & paper towels provided
Accessible & used for no other purpose
Water temp & pressure adequate
No Bare Hand Contact w/RTE
Observe employee handling of RTE
foods
Utensils/tissues/single use gloves used
w/ RTE foods
Source
Review products for approved
source/labeling
Review records: shellfish/raw seafood
□ _______________________________
Receiving and Storage
Products checked for temp,
List item / temp
contamination & package damage at
receiving
Meat, poultry & raw foods stored below
cooked & RTE foods
Raw foods segregated from each other
Cleaning & Sanitizing
Self Assessment Checklist
Facility __________________________________________Date(s)_______________
Completed by: _____________________________________
PROCEDURES
CORRECTIVE ACTIONS:
(Who, What, How, & When)
Correct procedure not being followed for cooling soups. Bill will
2/13
Example- Cooling
retrain employees on proper procedures. Will follow-up next
time soups are cooled.
Employee Training
Certified Food Protection Manager on
staff
All new employees have cards
Employee Health
Employees observed to assure not
working ill
Employees know foodborne illness
symptoms/conditions
Check that records are current for:
Applicant and Food Employee Reporting
Interview Form
Food Employee Reporting Agreement
Record of Staff Absences due to Illness
Handwashing
Observe employee handwashing practices
Handwash sinks:
Soap & paper towels provided
Accessible & used for no other purpose
Water temp & pressure adequate
No Bare Hand Contact w/RTE
Observe employee handling of RTE
foods
Utensils/tissues/single use gloves used
w/ RTE foods
Source
Review products for approved
source/labeling
Review records: shellfish/raw seafood
□ _______________________________
Receiving and Storage
Products checked for temp,
List item / temp
contamination & package damage at
receiving
Meat, poultry & raw foods stored below
cooked & RTE foods
Raw foods segregated from each other
Cleaning & Sanitizing
CORRECTIVE ACTIONS:
PROCEDURES
(Who, What, How, & When)
Observe employee cleaning & sanitizing
practices
Food contact surfaces cleaned &
sanitized at required frequency
Food contact surfaces clean & sanitized
between different raw foods & between
raw & RTE
Dishwashing equipment properly
operated & maintained
Test kits provided/used
Cooking
Observe employees for correct temping
List item/final temp
procedures
Observe thermometer
calibration/calibrate thermometers
Equipment operating properly to
maintain temperatures
Food cooked to proper time and temp
Cooling
Spot check cooling procedures for each
List item/final temp
PHF food item that is cooled
Reheating for Hot-Holding
Observe employees for correct temping
List item /final temp
procedures
Spot check reheating procedures and
temps for each food item
Hot Holding
Observe employees for correct temping
List item / temp
procedures
Equipment maintaining product temp
______________________________
Cold Holding
Observe employee procedures for
List item / temp
checking product temp
Equipment maintaining product temp
_____________________________
Consumer Advisory
Observe placement of consumer
advisories.
Menu products reviewed, any new foods
needing a consumer advisory added
____________________ __________
Time as a Public Health Control
Food appropriately marked
Marked food discarded, consumed or
used within 4 hours
____________________ __________
Donated Foods
Observe receiving procedures & review
CORRECTIVE ACTIONS:
PROCEDURES
(Who, What, How, & When)
records
Observe processing of donated foods
Donated foods stored separately
____________________ _____
Highly Susceptible Populations
No restricted foods on purchasing
records & menus
____________________ __________
Protection From Contamination
RTE foods protected during preparation
RTE segregated during display & service
Thawing
Food thawed under refrigeration,
running cool water, microwave, or part
of continuous cooking process
Curing, Smoking, Reduced Oxygen
Packing, Acidifying, Dehydrating, and
Thermally Processed Low-Acid Food
HACCP plan is current for the process
HACCP plan is being followed
Good Retail Practices
COMMENTS/CORRECTIVE ACTIONS
(Who, What, How & When)
Personal Cleanliness
Observe food workers for:
Clean outer garments & aprons
Hair restraints worn
No jewelry worn that could fall into food
Single use gloves worn over artificial
fingernails
Toilet Facilities
Restrooms & fixtures clean & well
maintained
Paper towels, soap & toilet paper
provided
Insect, Rodent and Animal Control
No evidence of rodents/insects
All outer openings protected
No unauthorized animals allowed
Pesticide/Toxic Chemicals properly
used/stored
Used according to label directions
In-use containers labeled & used at
proper concentrations
Stored away from food & food contact
utensils
Plumbing
Hot & cold running water under
pressure & available at all sinks
No cross-connections / back flow
(check utility sinks & hoses)
Garbage – refuse disposal
Dumpsters covered & storage areas
clean
In-use containers cleaned & emptied
Physical Facilities
Walls, floors and ceilings maintained
Food contact surfaces maintained
Lighting & ventilation adequate &
maintained
Premises maintained free of litter