Date Started: ___________

Answer questions 1-15:
Y = Yes
N = No

Add the initials of family members in each column head

CHILL

Did You ...	A ME_____	B _______	C _______	D _______
1. Use a cold pack for packed lunches or picnic foods?
2. Refrigerate leftovers right away?
3. Defrost foods in: — the refrigerator or — cold water or — the microwave?
Total	Y= N=	Y= N=	Y= N=	Y= N=

 

FRIDGE EXAM The refrigerator is set at ________ degrees. Food storage containers found: ____ tall containers ____ shallow containers

 

CLEAN

Did You ...	A ME_____	B _______	C _______	D _______
4. Wash hands with warm water and soap for 20 seconds before preparing food?
5. Wash hands with warm water and soap for 20 seconds before eating?
6. Clean countertops before preparing food?
7. Rinse fruits and vegetables with cold running water before preparing them?
8. Rinse fruits and vegetables with cold running water before eating them?
Total	Y= N=	Y= N=	Y= N=	Y= N=

 

Family Handwashing Scoreboard:
Date:	Name:	When washed:
____________________	____________________	____________________
____________________	____________________	____________________
____________________	____________________	____________________

 

SEPARATE

Did You ...	A ME_____	B _______	C _______	D _______
9. Clean the cutting boards used for raw meat, fish and poultry before using for any other foods?
10. Keep raw meat, fish and poultry wrapped properly in the refrigerator so juices do not drip on other foods?
11. Put cooked meat, fish or poultry on a different platter than the one with the raw juices?
Total	Y= N=	Y= N=	Y= N=	Y= N=

 

Cutting Board Critique Number of cutting boards: Type (plastic, wood, etc.):

 

COOK

Did You ...	A ME_____	B _______	C _______	D _______
12. Rotate food in the microwave to avoid "cold spots?"
13.. Bring sauces, soups and gravy to a boil when reheating?
14. Make sure eggs were cooked properly?
15.. Not eat cookie dough or cake batter that was made with raw eggs?
Total	Y= N=	Y= N=	Y= N=	Y= N=

 

Safe Temperature Summary
Kind of Meat: ______	Date Cooked: ______	Food thermometer temp: ______
Kind of Poultry: ______	Date Cooked: ______	Food thermometer temp: ______
Kind of Fish: ______	Date Cooked: ______	Food thermometer temp: ______

 

Date Completed:

Student signature:

Parent/Guardian signature:

---