FOOD SAFETY CHECKLIST

PHE WMO -HSE-F-P-OHE-03-001

Location : Date :

A. PERSONAL HYGIENE Y/N/N.A COMMENT

1 Employees wear clean and proper uniform including shoes.

Karyawan memakai seragam yg sesuai & bersih termasuk

sepatu kerja
2 Effective hair restraints are properly worn
Memakai penutup kepala
3 Fingernails are short, unpolished, and clean (no artificial nails).
Kuku dipotong pendek dan bersih (tdk ada hiasan kuku)
4 Jewelry is limited to a plain ring, such as wedding band and a
watch and no bracelets
Dilarang memakai cincin , jam tangan dan gelang
5 Hands are washed properly, frequently, and at appropriate times
Cuci tangan sesering mungkin dan pada waktu yang tepat
6 Burns, wounds, sores or scabs, or splints and water-proof
bandages on hands are bandaged and completely covered with
a foodservice glove while handling food
Bila ada luka-luka di tangan hendaknya ditutup dengan plaster
dan memakai sarung tangan ketika menyajikan makanan.
7 Eating, drinking, chewing gum, smoking, or using tobacco are
allowed only in designated areas away from preparation,
service, storage, and ware washing areas.
Makan, minum, mengunyah permen karet, merokok atau
memakai tembakau diijinkan hanya di area yang ditunjuk jauh
dari tempat penyiapan, penyajian, penyimpanan dan pencucian
makanan
8 Employees use disposable tissues when coughing or sneezing
and then immediately wash hands.
Karyawan yang batuk atau bersin harus memakai tisu sekali
pakai dan segera mencuci tangannya
9 Employees appear in good health
Karyawan dalam kondisi sehat
10 Hand sinks are unobstructed, operational, and clean
Tempat cuci tangan tidak ada sumbatan, dapat dioperasikan
dan bersih
11 Hand sinks are stocked with soap, disposable towels, and warm
water
Di tempat cuci tangan tersedia sabun, handuk sekali pakai dan
air panas

12 A handwashing reminder sign is posted

Tempat cuci tangan di tempeli tulisan sebagai tanda
13 Employee restrooms are operational and clean
Tempat istirahat untuk karyawan dapat berfungsi dengan baik
dan bersih
B. FOOD PREPARATION
1 All food stored or prepared in facility is from approved sources
Semua makanan yang disimpan atau disiapkan di dalam fasilitas
adalah dari sumber yang sudah disetujui.
2 Food equipment utensils and food contact surfaces are properly
washed, rinsed, and sanitized before every use.
Alat-alat untuk memasak harus dicuci, dibilas dan dibersihkan
sebelum digunakan
3 Frozen food is thawed under refrigeration, cooked to proper
temperature from frozen state, or in cold running water

Bahan makanan beku dicairkan di kulkas, dimasak dengan suhu

yang tepat atau dengan bilasan air yang mengalir
4 Thawed food is not refrozen
Makanan beku yang sudah cair tidak di bekukan kembali
5 Preparation is planned so ingredients are kept out of the
temperature danger zone to the extent possible
Memasak harus terencana untuk menghindari rusaknya bahan
makanan dari suhu yang extreme
6 Food is tasted using the proper procedure
Mencicipi makanan dengan prosedur yang benar
7 Procedures are in place to prevent cross-contamination.
Tata cara penanganan dilakukan untuk mencegah kontaminasi
silang
8 Food is handled with suitable utensils, such as single use gloves
or tongs.
Mengambil makanan dengan alat yang sesuai seperti dengan
sarung tangan dan penjepit
9 Food is prepared in small batches to limit the time it is in the
temperature danger zone.
Makanan disiapkan didalam batch kecil untuk membatasi
waktunya dalam zona bahaya temperatur
10 Clean reusable towels are used only for sanitizing equipment
and surfaces and not for drying hands, utensils, or floor

Serbet serbet untuk peralatan makan tidak digunakan untuk lap

tangan , ataupun lantai

11 Food is cooked to the required safe internal temperature for the

Appropriate time. The temperature is tested with a calibrated
food thermometer.
Makanan di masak pada temperatur yang sessuai dengan
waktunya
Temperatur di uji dengan termometer makanan yang
terkalibrasi

12 The internal temperature of food being cooked is monitored and

documented
Temperatur memasak harus di monitor dan dicatat

C. HOT HOLDING
1
Hot holding unit is clean.
Alat pemanas dalam keadaan bersih

2 Food is heated to the required safe internal temperature before

placing in hot holding.
 Suhu alat pemanas disesuaikan dengan makanan yg di simpan
3 Hot holding units are not used to reheat potentially hazardous
foods
Alat pemanas tidak boleh untuk menghangatkan makanan yang
bisa memicu bahaya
4
Hot holding unit is pre-heated before hot food is placed in unit.
Alat pemanas makanan di hangatkan terlebih dahulu sebelum
menyimpan makanan panas
5 Food is protected from contamination
Makanan terlindung dari kontaminasi
D COLD HOLDING
1 Refrigerators are kept clean and organized.

Kulkas dalam keaadaan bersih dan terawat

2 Temperature of cold food being held is at or below 41 ºF.
Suhu pendingin tetap stabil pada atau dibawah 41 ºF. (5 ºC.)
3 Food is protected from contamination.

Makanan terlindung dari kontaminasi

E REFRIGERATOR, FREEZER, AND MILK COOLER
1 Thermometers are available and accurate.
Dilengkapi thermometer yang akurat
2 Temperature is appropriate for pieces of equipment.
Temperatur sesuai dengan jenis tempat penyimpanan
3 Food is stored 6 inches off floor or in walk-in cooling equipment
Bahan makanan di simpan dengan jarak 6 inchi ( 15 cm)dari
lantai
4 Refrigerator and freezer units are clean and neat.
Refrigerator dan freezer dalam kondisi bersih dan rapi
5 Proper chilling procedures are used.
Disesuaikan dengan prosedur penyimpanan ditempat pendingin
6 All food is properly wrapped, labeled, and dated.
Semua makanan dibungkus , diberi label dan diberi tanggal
7 The FIFO (First In, First Out) method of inventory management
is used
Menggunakan metode pengelolaan inventory yaitu metode
FIFO
8 Ambient air temperature of all refrigerators and freezers is
monitored and documented at the beginning and end of each
shift
Suhu ruangan semua refrigerator dan freezer selalu dimonitor
dan dicatat pada setiap penggantian petugas jaga

F. FOOD STORAGE AND DRY STORAGE

1 Temperatures of dry storage area is between 50 ºF and 70 ºF or
State public health department requirement
Suhu ruangan dry store antara 50 ºF ( 10 ºC) dan 70 ºF (20 ºC)
sesuai dengan peraturan DepKes

2 All food and paper supplies are stored 6 to 8 inches off the floor.
Semua makanan , dan pembungkus makanan disimpan antara
15 cm hingga 20 cm dari lantai
3 All food is labeled with name and received date. Y
 Semua makanan diberi label nama dan tanggal penerimaan
4 Open bags of food are stored in containers with tight fitting lids
and labeled with common name
Makanan tanpa pembungkus disimpan dalam wadah tertutup
dan di beri nama
5 The FIFO (First In, First Out) method of inventory management
is used
Menggunakan metode pengelolaan inventory yaitu metode
FIFO
6 There are no bulging or leaking canned goods.

Tidak ditemukan kaleng makanan yang menggelembung atau

bocor
7 Food is protected from contamination.

Makanan terlindung dari kontaminasi

8 All food surfaces are clean.
Semua tempat makanan dalam keadaan bersih

9 Chemicals are clearly labeled and stored away from food and
food- related supplies
Bahan bahan kimia diberi label yang jelas dan disimpan terpisah
jauh dari bahan makanan dan sejenisnya

10 There is a regular cleaning schedule for all food surfaces.

Semua permukaan makanan dibersihkan secara berkala
11 Food is stored in original container or a food grade container
Makanan disimpan kedalam wadah asli atau sejenisnya
G. CLEANING AND SANITIZING
1 Three-compartment sink is properly set up for ware washing.

Tersedia tiga bak cuci untuk pencucian peralatan

2 Dish machine is working properly (such as gauges and
chemicals are at recommended levels).
Mesin pencuci piring digunakan dengan benar(ukuran detergen
yang dipakai sesuai rekomendasi)
3 Water is clean and free of grease and food particles.
Tersedia air yang bersih bebas minyak dan sisa makanan
4 Water temperatures are correct for wash and rinse.
Suhu air yang tepat untuk cuci dan bilas
5 If heat sanitizing, the utensils are allowed to remain immersed in
171 ºF water for 30 seconds
Jika melakukan sanitasi, dianjurkan pada suhu 171ºF ( 77 ºC)
selama 30 detik
6 If using a chemical sanitizer, it is mixed correctly and a sanitizer
strip is used to test chemical concentration
Jika sanitasi menggunakan bahan kimia hendaknya dicampur
dengan benar dan menggunakan alat pengukur konsentrasi
7 Small ware and utensils are allowed to air dry.
Alat masak yang ukurannya kecil boleh dikeringkan dengan
pengering udara
8 Wiping cloths are stored in sanitizing solution while in use
Menggunakan kain/lap yang bersih untuk mengeringkan
H. UTENSILS AND EQUIPMENT
1 All small equipment and utensils, including cutting boards and
knives, are cleaned and sanitized between uses.
Semua peralatan dan perkakas kecil, termasuk telenan
dan
pisau, selalu dalam keadaan bersih waktu digunakan.
[Type text]

2 Small equipment and utensils are washed, sanitized, and air-

dried.
Peralatan dan alat alat sederhana dicuci ,disanitasi serta di
keringkan dengan pengering udara
3 Work surfaces and utensils are clean.
Permukaan area kerja dan peralatan senantiasa bersih
4 Work surfaces are cleaned and sanitized between uses.
Permukaan area kerja dibersihkan dan di sanitasi diantara waktu
memasak
5 Thermometers are cleaned and sanitized after each use
Termometer dibersihkan dan disanitasi setelah digunakan
6 Thermometers are calibrated on a routine basis.

Termometer senantiasa dikalibrasi secara rutin

7 Can opener is clean.
Pembuka kaleng senantiasa bersih
8 Drawers and racks are clean
Laci laci serta rak rak senantiasa bersih

9 Clean utensils are handled in a manner to prevent contamination

of areas that will be in direct contact with food or a person’s
mouth
Peralatan bersih disimpan untuk menghindari kontaminasi .

I. LARGE EQUIPMENT
1 Food slicer is clean.
Pengiris makanan / talenan dalam keadaan bersih
2 Food slicer is broken down, cleaned, and sanitized before using
Pengiris makanan /talenan dibersihkan dan disanitasikan
sebelum digunakan
3 Boxes, containers, and recyclables are removed from site.
Kotak kotak ,kontainer dan barang barang daur ulang di pindah
tempat
4 Loading dock and area around dumpsters are clean and odor-
free.
Area bongkar muat serta sekitar dumpster dalam keadaan
bersih
5 Exhaust hood and filters are clean.
Exhaust dan filter filternya dalam keadaan bersih
J GARBAGE STORAGE AND DISPOSAL
1 Kitchen garbage cans are clean and kept covered.
Tong sampah dapur dalam keadaan bersih dan tetap tertutup
2 Garbage cans are emptied as necessary.
Sebaiknya tong sampah secepatnya dikosongkan/ dibersihkan
3 Boxes and containers are removed from site.
Area bebas dari kotak kotak dan kontainer
4 Loading dock and area around dumpster are clean.
Area bongkar muat dan sekitar dumpster dalam keadaan bersih
5 Dumpsters are clean.
Dumpster dalam keadaan bersih
K PEST CONTROL
1 Outside doors have screens, are well-sealed, and are equipped
with a self-closing device
Pintu luar dilengkapi screen/ tabir , dan dilengkapi dengan alat
penutup pintu otomatis
2
There is a regular schedule of pest control by a licensed pest
control operator

Jadwal pest control yang teratur dibawah pengawasan operator

pest kontrol
3 No evidence of pests is present.

Tidak dijumpai hama / serangga

 FOOD SAFETY CHECKLIST SUMMARY
PHEWMO -HSE-F-P-OHE-03-001

DESCRIPTION COMMENT / RECOMMENDATION

A PERSONAL HYGIENE

B FOOD PREPARATION

C HOT HOLDING

D COLD HOLDING
REFRIGERATOR,
E FREEZER, AND
MILK COOLER

FOOD STORAGE AND

F
DRY STORAGE

CLEANING
G
AND
SANITIZING

UTENSILS
H
AND
EQUIPMENT

I LARGE EQUIPMENT

GARBAGE STORAGE
J
AND DISPOSAL

K PEST CONTROL

Inspected by,

1. (Doctor on duty)
2. (PDC Ref)