食品安全与卫生内部检查评分表 Food Safety & Hygiene Internal Inspection Scoring form - 表单模板

Q1:检查团队 Inspection Team

填空1

Q2:检查日期 Inspection Date

日期

Q3:1. 员工按规定着装 Personal Grooming habit demonstrated

1

2

3

4

5

Q4:2. 个人物品（水杯）在指定地点存放 Are personal items（drinking bottle) kept at designated area?

1

2

3

4

5

Q5:3. 遵守个人卫生要求（不得留长指甲、涂指甲油、无假指甲、厨房和管事部首饰不外露、餐饮服务人员首饰简约、头发保持整齐始终在帽内等） Follow personnel hygiene practices (No long nail, nail polish, No false nails, no exposed jewelry in the kitchen and STW, simple jewelry for FB service staff, and hair kept neat and always inside the hat, etc.)

1

2

3

4

5

Q6:4. 实施有效的晨检，并保留记录 Carry out effective morning health check and keep records.

1

2

3

4

5

Q7:5. 员工知道洗手流程 Hand washing procedure known/demonstrated

1

2

3

4

5

Q8:6. 指定洗手池，配有温水、擦手纸、垃圾桶、洗手液及消毒液和洗手流程标准 Dedicated hand washing station completed with warm water/paper towels/foot pedal waste bin/hand soap and sanitizer/hand washing instruction.

1

2

3

4

5

Q9:7. 所有人员遵循良好个人卫生习惯 Are good personal behavior practices being followed by all personnel?

1

2

3

4

5

Q10:8. 所有工作区域的化学品应清晰标识，并根据需求使用，且均贴好标签放在指定区域 All chemicals in the working areas should be clearly labeled and used as needed, and all should be affixed with labels and placed in the designated areas.

1

2

3

4

5

Q11:9. 清洁布是否处于良好状态，不使用时正确储存？ Is the cleaning cloth in good condition and stored properly when not in use?

1

2

3

4

5

Q12:10. 食品区域直接和非直接接触食品的设备、器具等状态良好，并保持每天或定期清洁、消毒（例如切片机、榨汁机、搅拌机、绞肉机、距骨机、冰箱、抽真空机、蒸烤箱、油烟罩、水池等） The equipment and utensils in the food area that come into direct or non-direct contact with food are in good condition and should be cleaned and disinfected daily or regularly.

1

2

3

4

5

Q13:11. 垃圾是否分类，垃圾桶是否为非手动式，且随时盖好，并处于清洁和工作状态 Whether the garbage is classified, whether the trash cans are non-manual, always closed, and in a clean and working state

1

2

3

4

5

Q14:12. 员工清楚知道所有化学品的用途及关键配比浓度 Employees are well aware of the uses of all chemicals and the key proportion concentrations

1

2

3

4

5

Q15:13. 垃圾袋是否使用全降解材质？ Are the garbage bags made of fully degradable materials?

1

2

3

4

5

Q16:14. 所有清洁设备和工具在使用后应保持良好状态，干净并正确储存 Are all items of cleaning equipment and tools in good condition and cleaned, dried & stored correctly after cleaning?

1

2

3

4

5

Q17:15. 备用或洗好的餐具和厨具清洁且正确储存 Are spare or washed tableware and kitchenware clean and stored correctly?

1

2

3

4

5

Q18:16. 在清洁过程中，无因清洁工具（包括钢丝球、带海绵的百洁布等）使用造成的物理和微生物危害 Are potentially microbial cross contamination and physical contamination occurring from cleaning tools? (Including steel wool balls, scouring pads with sponges, etc.)

1

2

3

4

5

Q19:17. 制冰机状态良好、保持清洁，并定期清洁和消毒，记录完整 Are ice machines maintained in good condition, kept clean, with regular cleaning/disinfection and records kept?

1

2

3

4

5

Q20:18. 冰铲状态良好、保持清洁，并存放在含有正确浓度消毒剂的容器中（有效氯浓度250ppm） Are ice scoops maintained in good condition and kept clean in a container with sanitizer at proper concentration? (Effective chlorine concentration: 250mg/L)

1

2

3

4

5

Q21:19. 砧板确保每次彻底清洁消毒，且每天浸泡消毒 The cutting board should be thoroughly cleaned and disinfected each time and soaked for disinfection every day

1

2

3

4

5

Q22:20. 洗碗机/洗杯机正常运行，每日检查并保持记录（洗碗机最后过水温度最低82℃；如使用化学消毒，次氯酸钠浓度250ppm，5分钟以上） Is the dishwasher/glasswasher operating correctly and checked daily, with records kept?

1

2

3

4

5

Q23:21. 清洗设备以及化学品分配装置正常工作，且有适当填充 Is any dosing/dispensing equipment used for equipment and dishware washing functioning & filled properly?

1

2

3

4

5

Q24:22. 厨房应有指定清洗厨具区域，且该区域不会引起食品区域污染 Is there a dedicated area for pot washing that would not cause contamination risk for food and food preparation activities?

1

2

3

4

5

Q25:23. 食品区域内化学品存放不应对食品造成化学污染风险（例如喷壶内化学品用完后放于指定架子上） Are chemicals in the food preparation area appropriately kept to prevent chemical contamination?

1

2

3

4

5

Q26:24. 加工环境清洁干净（排水沟、地板、墙面、天花板、通风口、柜/冰箱底、设备、用具等） The processing area is clean (drain, floors, walls, ceiling panel, ventilation, under counter/fridge, equipment and utensils)

1

2

3

4

5

Q27:25. 破损餐具存放在指定破损箱内 Dedicated breakage bin for broken tableware

1

2

3

4

5

Q28:26. 通风设施以及空调系统均维护良好，并保持清洁 Are ventilation and air conditioning units maintained in good condition and kept clean?

1

2

3

4

5

Q29:27. 下水道和地漏保持通畅、易于清洗并保持干净 Are drains/gullies suitably designed, unclogged, readily cleanable and clean?

1

2

3

4

5

Q30:28. 用于食品清洗、加工的水槽、水龙头和排水系统维护良好，保持干净，定期清洁和消毒 Are sinks, water taps and associated draining boards used for food washing/preparation maintained in good condition, kept clean, with regular cleaning/disinfection?

1

2

3

4

5

Q31:29. 是否依照清洁计划清洁厨房所有设施设备，确保相关区域及设施、设备、工器具、餐饮具、餐厨具等干净卫生 Whether all kitchen facilities and equipment are cleaned in accordance with the cleaning plan to ensure relevant areas, facilities, equipment, tools, tableware and kitchenware are clean and hygienic

1

2

3

4

5

Q32:30. 有效的培训，并保持相关记录 Effective training and records kept

1

2

3

4

5

Q33:31. 各项记录及时完成且完整 All records were completed in a timely and complete manner

1

2

3

4

5

Q34:实际得分 Actual Score

填空1

Q35:得分占比 Score %

填空1

Q36:评级 Rating

A 优良 Excellent（90-100%）

B 良好 Good（80-89%）

C 一般 Average（70-79%）

D 需要改进 Improvement needed（60-69%）

E 不合格 Fail（≤60%）

Q37:评估人员签名 Assessed By

填空1

Q38:问题描述及整改建议（如有）

填空1