Nourishment Pantry or Serving Station Inspection F-371 Food Sanitation

Unit ______

Storage Cabinets Variable FINDING Boxes and cans are clean, sealed and undamaged Containers / boxes of food are stored without contact with the floor The area is free of pests and evidence of pests Non food items are not stored with food items Room and food are free of signs of dampness or mold Opened and repackaged foods are clearly dated and within use by date Chemicals are not stored near food or in accessible areas All food items are clearly labeled as to contents Area is free of refuse and staff items Refrigeration Variable Refrigerator temperatures are less than 41 degrees F – equal to or less than Both internal and external thermometers are present Log is maintained evidencing monitoring of temperatures All food is adequately covered / contained Refrigerators are clean and free of spillage Repackaged foods have been dated and labeled per policy Leftover food is labeled and dated Food items are within ‘use by’ guidelines or expiration dates (see policy) Freezers Variable Freezer temperatures are less than 0 degrees F – equal to or less than Both internal and external thermometers are present Log is maintained evidencing monitoring of temperatures All food is adequately covered / contained Freezers are clean and free of ice build up Repackaged foods have been dated and labeled per policy Food is free of signs of freezer burn Food is free of signs of thaw and re-freeze Equipment and Environment Variable Microwaves are clean and in operating condition Coffee pots are clean and not accessible to residents when hot Toasters and other small appliances are clean Electrical cords are properly grounded and in good condition Fans and vent covers are clean and free of dirt or mold Eighteen (18) inches clearance maintained for sprinkler heads Trash Removal Variable When food is present, trash containers are covered Trash is removed promptly from the pantry Ice Machine Variable Ice sanitation is maintained / scoops not stored in ice Ice machine drain has 1 air inch gap of clearance to drain Floor drains are clear and odor-free Stop here if meals are not served from this pantry.

“Confidential – Privileged Under Virginia Code §8.01-581.16 and 17 – For Quality Assurance Use Only” Nourishment Pantry or Serving Station Inspection – continued Serving Station Review

Employee Appearance/Hygiene Variable FINDINGS Employees who are plating food are wearing hair nets Employees handling food are wearing gloves Handwashing and glove changes during food prep & handling No employees with signs of illness, infection or open wounds Staff observe personal hygiene (do not touch hair, nose, without washing hands) Good hand washing techniques are observed Preparation Areas Variable Food surfaces are thoroughly cleaned before & after food prep Food preparation equipment is clean and in good operable condition Sink used for handwashing has supplies available Housekeeping activities are not taking place while food is present Steam Table Observation Variable Food is cooked to proper internal temperature (see guidance) prior to placement on steam table Final temps taken and recorded before placement on table Temp of food on steam table is held at 135 degrees F or higher Steam table temperatures are logged for each meal Staff responsible for handling food wear gloves and change PRN Plating of food begins within 30 minutes of food placement on steam table Dishware Variable Clean dishes are stored in a manner that prevents contamination Dishes are in good condition without chips or stains Dishwasher temperatures are at 150F wash/180F rinse *OR washed at 120F with 50ppm hypochlorite solution Daily logs are maintained of dishwasher temps and (if applicable) sanitizing solutions Dishes, equipment and utensils are air dried Dishes, pans and utensils are not stacked wet Dishes are not washed in this area COMMENTS

“Confidential – Privileged Under Virginia Code §8.01-581.16 and 17 – For Quality Assurance Use Only”