Food preparation issues such as records, reheating, cooking temperatures, cooling, holding times and temperatures, separation and segmentation, personnel and personal contact with foods are examined

Albrecht, Julie A.

Kraus, Donna

English

DigitalCommons@University of Nebraska

University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln Historical Materials from University of Nebraska-Lincoln Extension Extension 2005 Food Safety Self Inspection Form Donna Kraus Julie A. Albrecht University of Nebraska&#8211Lincoln, jalbrecht1@unl.edu Follow this and additional works at: https://digitalcommons.unl.edu/extensionhist  Part of the Agriculture Commons, and the Curriculum and Instruction Commons Kraus, Donna and Albrecht, Julie A., "Food Safety Self Inspection Form" (2005). Historical Materials from University of Nebraska-Lincoln Extension. 70. https://digitalcommons.unl.edu/extensionhist/70 This Article is brought to you for free and open access by the Extension at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in Historical Materials from University of Nebraska-Lincoln Extension by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. F-27NF569Food Safety Self Inspection Form*By Donna Kraus, Program Assistant and Julie A. Albrecht, Extension Food SpecialistStatus of Observations: IN — Item found in compliance; OUT — Item found out of compliance; N.O. — Not observed:N.A. — Not applicable*Adapted from: Report of the FDA Retail FoodProgram Database of Foodborne Illness Risk Factors —http://vm.cfsan.fds.gov/~dms/retrsk.htmlFood Source_____ All foods are from regulated food processing plants._____ All shellfish are from NSSP listed sources._____ Game and wild mushrooms are only used with approvalfrom regulatory authority.________________________________________________________________________________________________________________________________________________________________________________________________________Records_____ Shellstock tags/labels are retained for 90 days from thedate the container is emptied._____ Written documentation of parasite destruction aremaintained for fish products._____ CCP monitoring records are maintained in accordancewith HACCP plan when required.________________________________________________________________________________________________________________________________________________________________________________________________________Reheating_____ PHF’s are reheated to 165oF for 15 seconds._____ Food reheated in a microwave is heated to 165oF orhigher._____ Commercially processed ready to eat food, if reheated,is held at 135oF or above.________________________________________________________________________________________________________________________________________________________________________________________________________Cooking Temperatures_____ Poultry, stuffed fish, meat and pastas are cooked to165oF for 15 seconds._____ Raw eggs broken for immediate service are cooked to145oF for 15 Seconds._____ Comminuted fish, meats, game animals are heated to155oF for 15 seconds._____ Wild game animals to 165oF for 15 seconds._____ Raw animal foods cooked in microwave to 165oF.________________________________________________________________________________________________________________________________________________________________________________________________________Cooling_____ Cooked PHF is cooled to 135oF — 70oF in 2 hours andfrom 70oF — 41oF in 4 hours._____ PHF (from ambient ingredients) is cooled to 41oF within4 hours._____ Foods received at a temperature according to law arecooled to 41oF within 4 hours.________________________________________________________________________________________________________________________________________________________________________________________________________File under:   FOODS AND NUTRITIONF-27, SafetyRevised June 2005Extension is a Division of the Institute of Agriculture and Natural Resources at the University of Nebraska–Lincoln cooperating with the Countiesand the United States Department of Agriculture.University of Nebraska–Lincoln Extension educational programs abide with the nondiscrimination policies of the University of Nebraska–Lincolnand the United States Department of Agriculture.© 2005, The Board of Regents of the University of Nebraska on behalf of the University of Nebraska–Lincoln Extension.  All rights reserved.Cold Holding_____ PHF is maintained at 41oF or below, except duringpreparation, cooking, cooling, or when time is used asa public health control.________________________________________________________________________________________________________________________________________________________________________________________________________Hot Holding_____ PHF is maintained at 135oF or above, except duringpreparation, cooking, cooling, or when time is used asa public health control.________________________________________________________________________________________________________________________________________________________________________________________________________Time_____ Ready to eat PHF held at 41oF for 7 days, is discardedas required._____ Commercially prepared, ready to eat PHF is date markedas required.________________________________________________________________________________________________________________________________________________________________________________________________________Separation/Segregation/Protection_____ Raw animal foods are kept separate from raw readyto eat food and cooked ready to eat food._____ After food is served to a consumer, food is notre-served._____ Food is protected from environmental contamination.________________________________________________________________________________________________________________________________________________________________________________________________________Food Contact Surfaces_____ Food contact surfaces and utensils are clean to sightand touch and sanitized before use.________________________________________________________________________________________________________________________________________________________________________________________________________Personnel Check List_____ Hands are clean and properly washed when and asrequired._____ Personnel only eat, drink and use tobacco in desig-nated areas._____ Personnel do not work with exposed food if experienc-ing persistent sneezing, coughing, or runny nose._____ Personnel do not use a utensil more than once to tastefoods._____ Personnel do not contact exposed, ready-to-eat foodwith bare hands._____ There is a hand-washing facility conveniently locatedfor employees._____ There are hand cleansers, sanitary towels and handdrying devices in the hand washing facility.________________________________________________________________________________________________________________________________________________________________________________________________________Chemical Check List_____ No unapproved food or color additives are used._____ All chemicals are properly identified, stored and used.________________________________________________________________________________________________________________________________________________________________________________________________________

Food Safety Self Inspection Form

UNL | Libraries

University of Nebraska - Lincoln 
DigitalCommons@University of Nebraska - Lincoln 
Historical Materials from University of 
Nebraska-Lincoln Extension Extension 
2005 
Food Safety Self Inspection Form 
Donna Kraus 
Julie A. Albrecht 
University of Nebraska&#8211Lincoln, jalbrecht1@unl.edu 
Follow this and additional works at: https://digitalcommons.unl.edu/extensionhist 
 Part of the Agriculture Commons, and the Curriculum and Instruction Commons 
Kraus, Donna and Albrecht, Julie A., "Food Safety Self Inspection Form" (2005). Historical Materials from 
University of Nebraska-Lincoln Extension. 70. 
https://digitalcommons.unl.edu/extensionhist/70 
This Article is brought to you for free and open access by the Extension at DigitalCommons@University of Nebraska - 
Lincoln. It has been accepted for inclusion in Historical Materials from University of Nebraska-Lincoln Extension by an 
authorized administrator of DigitalCommons@University of Nebraska - Lincoln. 
F-27
NF569
Food Safety Self Inspection Form*
By Donna Kraus, Program Assistant and Julie A. Albrecht, Extension Food Specialist
Status of Observations: IN — Item found in compliance; OUT — Item found out of compliance; N.O. — Not observed:
N.A. — Not applicable
*Adapted from: Report of the FDA Retail Food
Program Database of Foodborne Illness Risk Factors —
http://vm.cfsan.fds.gov/~dms/retrsk.html
Food Source
_____ All foods are from regulated food processing plants.
_____ All shellfish are from NSSP listed sources.
_____ Game and wild mushrooms are only used with approval
from regulatory authority.
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Records
_____ Shellstock tags/labels are retained for 90 days from the
date the container is emptied.
_____ Written documentation of parasite destruction are
maintained for fish products.
_____ CCP monitoring records are maintained in accordance
with HACCP plan when required.
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Reheating
_____ PHF’s are reheated to 165oF for 15 seconds.
_____ Food reheated in a microwave is heated to 165oF or
higher.
_____ Commercially processed ready to eat food, if reheated,
is held at 135oF or above.
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Cooking Temperatures
_____ Poultry, stuffed fish, meat and pastas are cooked to
165oF for 15 seconds.
_____ Raw eggs broken for immediate service are cooked to
145oF for 15 Seconds.
_____ Comminuted fish, meats, game animals are heated to
155oF for 15 seconds.
_____ Wild game animals to 165oF for 15 seconds.
_____ Raw animal foods cooked in microwave to 165oF.
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Cooling
_____ Cooked PHF is cooled to 135oF — 70oF in 2 hours and
from 70oF — 41oF in 4 hours.
_____ PHF (from ambient ingredients) is cooled to 41oF within
4 hours.
_____ Foods received at a temperature according to law are
cooled to 41oF within 4 hours.
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
File under:   FOODS AND NUTRITION
F-27, Safety
Revised June 2005
Extension is a Division of the Institute of Agriculture and Natural Resources at the University of Nebraska–Lincoln cooperating with the Counties
and the United States Department of Agriculture.
University of Nebraska–Lincoln Extension educational programs abide with the nondiscrimination policies of the University of Nebraska–Lincoln
and the United States Department of Agriculture.
© 2005, The Board of Regents of the University of Nebraska on behalf of the University of Nebraska–Lincoln Extension.  All rights reserved.
Cold Holding
_____ PHF is maintained at 41oF or below, except during
preparation, cooking, cooling, or when time is used as
a public health control.
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Hot Holding
_____ PHF is maintained at 135oF or above, except during
preparation, cooking, cooling, or when time is used as
a public health control.
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Time
_____ Ready to eat PHF held at 41oF for 7 days, is discarded
as required.
_____ Commercially prepared, ready to eat PHF is date marked
as required.
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Separation/Segregation/Protection
_____ Raw animal foods are kept separate from raw ready
to eat food and cooked ready to eat food.
_____ After food is served to a consumer, food is not
re-served.
_____ Food is protected from environmental contamination.
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Food Contact Surfaces
_____ Food contact surfaces and utensils are clean to sight
and touch and sanitized before use.
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Personnel Check List
_____ Hands are clean and properly washed when and as
required.
_____ Personnel only eat, drink and use tobacco in desig-
nated areas.
_____ Personnel do not work with exposed food if experienc-
ing persistent sneezing, coughing, or runny nose.
_____ Personnel do not use a utensil more than once to taste
foods.
_____ Personnel do not contact exposed, ready-to-eat food
with bare hands.
_____ There is a hand-washing facility conveniently located
for employees.
_____ There are hand cleansers, sanitary towels and hand
drying devices in the hand washing facility.
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Chemical Check List
_____ No unapproved food or color additives are used.
_____ All chemicals are properly identified, stored and used.
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________


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Food Safety Self Inspection Form

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