cbi-test13-withServReportFields

• Account Name

• Account #

• SiteID

• Contact

• Location
  Address

• Phone Number

• email Address

• Conducted On

  Date

• Prepared By

  Select Carl Popke Chris Hayes Chris Zimmerman Dan Volker David Birchett Jason Casto Jason Roberts Jerry Jimene Jim Foley John Lockwood Seamus Daley

  • Carl Popke
  • Chris Hayes
  • Chris Zimmerman
  • Dan Volker
  • David Birchett
  • Jason Casto
  • Jason Roberts
  • Jerry Jimene
  • Jim Foley
  • John Lockwood
  • Seamus Daley

• Insert a Picture of the Dishmachine and the Area around it

  Media

Dishmachine General Info

• Make

  CMA

  ADS

  Hobart

  Jackson

  Other

• Model

• Voltage

  110

  220

  480

• Serial Number

Dishmachine Dispensers

• Dishmachine Dispenser

  Knight

  Beta

  Other

• Serial Number

Encapsulated / Solid Bowls

• Encapsulated / Solid Bowl

  Knight

  Beta

  Other

• Serial Number

• Dishmachine Water Hardness

• Dishmachine Water TDS

• Dishmachine Detergent

  Select Swisher Bio-Clean Swisher Extra Strength Plus Swisher Liquid Metal Safe Swisher Meta Safe Swisher Multi-Temp Detergent Swisher Power Clean Swisher Sparkle Dish Machine Detergent

  • Swisher Bio-Clean
  • Swisher Extra Strength Plus
  • Swisher Liquid Metal Safe
  • Swisher Meta Safe
  • Swisher Multi-Temp Detergent
  • Swisher Power Clean
  • Swisher Sparkle Dish Machine Detergent

• Dishmachine Rinse Additive

  Swisher Bio-Rinse

  Swisher Low Temp Rinse

  Swisher Speed Dry

  Swisher Spots Away

  Swisher Super Rinse

• Dishmachine Sanitizer

  Swisher Bio-San

  Other

Dishmachine Current Results

• Water / Ice Tea Glasses

  excellent

  good

  needs improvement

  not applicable

  not observed

• Describe

• Stemware

  excellent

  good

  needs improvement

  not applicable

  not observed

• Describe

• Plates and Saucers

  excellent

  good

  needs improvement

  not applicable

  not observed

• Describe

• Cups and Bowls

  excellent

  good

  needs improvement

  not applicable

  not observed

• Describe

• Flatware

  excellent

  good

  needs improvement

  not applicable

  not observed

• Describe

Dishmachine Inspection

Machine Controls

• Pre Wash Temperature

  OK

  Needs Repair

• Was Repair Completed

• Wash Tank Temperature

  OK

  Needs Repair

• Was Repair Completed

• Power Rinse Temperature

  OK

  Needs Repair

• Was Repair Completed

• Final Rinse Temperature

  OK

  Needs Repair

• Was Repair Completed

• Final Rinse Pressure

  OK

  Needs Repair

• Was Repair Completed

• Fresh Water Feedback

  OK

  Needs Repair

• Was Repair Completed

• Energy Saver

  OK

  Needs Repair

• Was Repair Completed

Mechanical Operation

• Fill Valve

  OK

  Needs Repair

• Was Repair Completed

• Wash Arms / Rinse Arms

  OK

  Needs Repair

• Was Repair Completed

• Final Rinse Jets

  OK

  Needs Repair

• Was Repair Completed

• Final Rinse Solenoid

  OK

  Needs Repair

• Was Repair Completed

• Overflows

  OK

  Needs Repair

• Was Repair Completed

• Drain Valves

  OK

  Needs Repair

• Was Repair Completed

• Rinse Saver

  OK

  Needs Repair

• Was Repair Completed

• Conveyor Belt / Chain

  OK

  Needs Repair

• Was Repair Completed

• Curtains / Racks

  OK

  Needs Repair

• Was Repair Completed

Operator Procedures

• Racking

  OK

  Needs Repair

• Was Repair Completed

• Presssrapping

  OK

  Needs Repair

• Was Repair Completed

• Presoaking

  OK

  Needs Repair

• Was Repair Completed

• Deliming

  OK

  Needs Repair

• Was Repair Completed

• Curtain Cleaning

  OK

  Needs Repair

• Was Repair Completed

• Tank Water Change / Fill

  OK

  Needs Repair

• Was Repair Completed

• Scrap Tray Cleaning

  OK

  Needs Repair

• Was Repair Completed

• Equipment Cleaning

  OK

  Needs Repair

• Was Repair Completed

• Insert a Picture of the Presoak Area

  Media

Presoak General Info

• Presoak Dispenser Model

  Dema

  Accupro

  Beta

  Other

• Presoak Product

  Swisher Plasticlean

  Swisher Silver Brite

  Swisher Silver Soak

  Swisher Striker

• oz./gal dispensed

Dishmachine Inspection

• Chemical Pick up tubing

  OK

  Needs Repair

• Was Repair Completed

• Check Valves

  OK

  Needs Repair

• Was Repair Completed

• Chemical calibration

  OK

  Needs Repair

• Was Repair Completed

• Dispenser Product Stickers

  OK

  Needs Repair

• Was Repair Completed

• Insert a Pictiore of the Three Compartment Sink Area

  Media

Pot & Pan Three Sink General Info

• Pot & Pan Dispenser Model

  Dema 651

  Dema 652

  Other

• Pot & Pan Product

• oz./gal dispensed

• Third Sink Sanitizer Dispenser

  Dema 651

  Dema 652

  Other

• Sanitizer Product

  Swisher Sani-Rinse II

  Steramine Tablets

• ppm level

Pot and Pan Current Results

• Pots and Pans

  excellent

  good

  needs improvement

  not applicable

  not observed

• Describe

• Dishes

  excellent

  good

  needs improvement

  not applicable

  not observed

• Describe

• Food Preparation Surfaces

  excellent

  good

  needs improvement

  not applicable

  not observed

• Describe

Pot & Pan Inspection

• Dispenser repairs

  OK

  Needs Repair

• Was Repair Completed

• Pick up tubing

  OK

  Needs Repair

• Was Repair Completed

• Feed tubing to sinks

  OK

  Needs Repair

• Was Repair Completed

• Check Valves

  OK

  Needs Repair

• Was Repair Completed

• Chemical calibration

  OK

  Needs Repair

• Was Repair Completed

• Water valve connections

  OK

  Needs Repair

• Was Repair Completed

• Saddle valve

  OK

  Needs Repair

• Was Repair Completed

• Chlorine Test Strips

  OK

  Needs Repair

• Was Repair Completed

• Quaternary Test Strips

  OK

  Needs Repair

• Was Repair Completed

• Wall Chart

  OK

  Needs Repair

• Was Repair Completed

• Wash/Rinse/Sanitizer Stickers

  OK

  Needs Repair

• Was Repair Completed

• Fill to this Line Stickers

  OK

  Needs Repair

• Was Repair Completed

• Dispenser Product Stickers

  OK

  Needs Repair

• Was Repair Completed

• Insert a Picture of the Ancillary Kitchen Area

  Media

Kitchen Ancillary General Info

• Ancillary Dispenser Model

  Accupro

  Beta

  Other

Glass Cleaner Product

• Swisher Blue RTU Glass Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Glass Cleaner, Aerosol

• Tip Color

• oz./gal dispensed

• Swisher Glass Kleen

• Tip Color

• oz./gal dispensed

• Swisher Select Glass & Hard Surface Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Ultra Glass Cleaner

• Tip Color

• oz./gal dispensed

APC Product

• Swisher Aerosol All Purpose Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Brisa General Purpose Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Citrus Plus

• Tip Color

• oz./gal dispensed

• Swisher OCP Hi-Ox

• Tip Color

• oz./gal dispensed

• Swisher Pine Plus

• Tip Color

• oz./gal dispensed

• Swisher Select Neutral APC

• Tip Color

• oz./gal dispensed

• Swisher Select Pine Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Ultra Citrus Neutral

• Tip Color

• oz./gal dispensed

Floor Cleaner Product

• Swisher Concrete Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Cyclone Detergent & Floor Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Dust Mop Treatment

• Tip Color

• oz./gal dispensed

• Swisher EZ Floor Cl

• Tip Color

• oz./gal dispensed

• Swisher Gold Medalist Floor Finish

• Tip Color

• oz./gal dispensed

• Swisher Quarry Tile Floor Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Steady Step

• Tip Color

• oz./gal dispensed

• Swisher Ultra Quarry Tile Floor Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Wash N Go

• Tip Color

• oz./gal dispensed

Degreaser Product

• Yes

  No

  N/A

• Tip Color

• oz./gal dispensed

• Swisher Hercules

• Tip Color

• oz./gal dispensed

• Swisher Neon - Spray Cleaner / Degreaser

• Tip Color

• oz./gal dispensed

• Swisher Purple Mean Clean

• Tip Color

• oz./gal dispensed

• Swisher Red - Degreaser

• Tip Color

• oz./gal dispensed

• Swisher Select All Purpose Degreaser

• Tip Color

• oz./gal dispensed

• Swisher Select HD Degreaser & Floor Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Synplex Steam Clean Compound

• Tip Color

• oz./gal dispensed

• Swisher Touch Up

• Tip Color

• oz./gal dispensed

• Swisher Ultra Degreaser

• Tip Color

• oz./gal dispensed

Other Products Installed

• Swisher DeLime

• Tip Color

• oz./gal dispensed

• Swisher Select Delimer

• Tip Color

• oz./gal dispensed

• Swisher Fryolator Deep Fat Fry Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Fryolator Deep Fat Fry Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Grease-Off Griddle & Hood Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Oven & Grill Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Oven Blaster - Alkaline Oven Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Oven Blaster - Alkaline Oven Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Oven/Grill Foaming Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Select Grill /Oven Majic

• Tip Color

• oz./gal dispensed

• Swisher Select Grill /Oven Majic

• Tip Color

• oz./gal dispensed

• Swisher Select Oven & Grill Cleaner (RTU)

• Tip Color

• oz./gal dispensed

• Swisher Clear RTU No Rinse Sanitizer

• Tip Color

• oz./gal dispensed

• Swisher Sani-Kleen

• Tip Color

• oz./gal dispensed

• Swisher Dumpster Dandy

• Tip Color

• oz./gal dispensed

• Swisher Dumpster Dandy

• Tip Color

• oz./gal dispensed

• Swisher Lime - Veggie Wash

• Tip Color

• oz./gal dispensed

• Swisher Select Block and Tile Whitener

• Tip Color

• oz./gal dispensed

• Swisher Stainless Steel Polish, Oil based

• Tip Color

• oz./gal dispensed

• Swisher Stainless Steel Polish, Water Based

• Tip Color

• oz./gal dispensed

• Swisher Wasp & Hornet Killer

• Tip Color

• oz./gal dispensed

• Swisher WB SSP - water based stainless polish

• Tip Color

• oz./gal dispensed

• Swisher Bac Man

• Tip Color

• oz./gal dispensed

• Swisher Bac Man

• Tip Color

• oz./gal dispensed

• Swisher Bac Man

• Tip Color

• oz./gal dispensed

• Swisher Main Drain - drain maintainer / cleaner

• Tip Color

• oz./gal dispensed

• Swisher Antibacterial Foam Soap

• Tip Color

• oz./gal dispensed

• Swisher Bacti Crème Hand Soap-Bulk

• Tip Color

• oz./gal dispensed

• Swisher Coconut Hand Soap

• Tip Color

• oz./gal dispensed

• Swisher Foam Alcohol Hand Sanitizer

• Tip Color

• oz./gal dispensed

• Swisher Foam Luxury Soap

• Tip Color

• oz./gal dispensed

• Swisher Luxury Hand Soap-Bulk

• Tip Color

• oz./gal dispensed

• Swisher Pink Hand Soap-Bulk

• Tip Color

• oz./gal dispensed

• Swisher Brassy Metal Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Cameo Crème Cleanser

• Tip Color

• oz./gal dispensed

• Swisher Flying Insect Killer

• Tip Color

• oz./gal dispensed

• Swisher Freeze Gum Remover

• Tip Color

• oz./gal dispensed

• Swisher Freezer Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Glow Cleaner Polish

• Tip Color

• oz./gal dispensed

• Swisher Lemon Plus Furniture Polish

• Tip Color

• oz./gal dispensed

• Swisher Lemon Shine Furniture Polish

• Tip Color

• oz./gal dispensed

• Swisher Marble & Granite Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Ultimate Floor Finish 622

• Tip Color

• oz./gal dispensed

• Swisher Knockout Floor Stripper

• Tip Color

• oz./gal dispensed

• Swisher Floor Sealer

• Tip Color

• oz./gal dispensed

• Swisher Air Freshener - Citrus Lemon

• Tip Color

• oz./gal dispensed

• Swisher Air Freshener - Snappy Apple

• Tip Color

• oz./gal dispensed

• Swisher Air Freshener - Tropic Breeze

• Tip Color

• oz./gal dispensed

• Swisher Odor Go

• Tip Color

• oz./gal dispensed

• Swisher Ordor-Kleen

• Tip Color

• oz./gal dispensed

• Swisher Refresh

• Tip Color

• oz./gal dispensed

• Swisher Ultra Air Freshener-Fresh Linen

• Tip Color

• oz./gal dispensed

• Swisher Ultra Air Freshener-Mango

• Tip Color

• oz./gal dispensed

• Swisher Yellow - Odor Neutralizer

• Tip Color

• oz./gal dispensed

• Swisher Yellow RTU Odor Neutralizer

• Tip Color

• oz./gal dispensed

• Swisher Ant & Roach Ant Killer

• Tip Color

• oz./gal dispensed

• Swisher Bathroom Kleen

• Tip Color

• oz./gal dispensed

• Swisher Tub & Tile Kleen

• Tip Color

• oz./gal dispensed

• Swisher Ultra Tub & Tile

• Tip Color

• oz./gal dispensed

• Swisher AFB Acid Free Bowl Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Visclean

• Tip Color

• oz./gal dispensed

• Swisher Winter Green Bowl Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Foaming Germicidal Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Health Care Disinfectant

• Tip Color

• oz./gal dispensed

• Swisher Lemon Kleen Disinfectant

• Tip Color

• oz./gal dispensed

• Swisher Nutra Bac

• Tip Color

• oz./gal dispensed

• Swisher Select Lemon Disinfectant Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Ultra Disinfectant

• Tip Color

• oz./gal dispensed

• Swisher Ultra Non-Acid Bathroom Cleaner

• Tip Color

• oz./gal dispensed

• Swisher Shootout Carpet Spotter

• Tip Color

• oz./gal dispensed

• Chemical Pick up tubing

  OK

  Needs Repair

• Was Repair Completed

• Check Valves

  OK

  Needs Repair

• Was Repair Completed

• Chemical calibration

  OK

  Needs Repair

• Was Repair Completed

• Quaternary Test Strips

  OK

  Needs Repair

• Was Repair Completed

• Wall Charts

  OK

  Needs Repair

• Was Repair Completed

• Wall Brackets

  OK

  Needs Repair

• Was Repair Completed

• Dispenser Product Stickers

  OK

  Needs Repair

• Was Repair Completed

• MSDS on location for all products

  OK

  Needs Repair

• Was Repair Completed

• MSDS Book/Station

  OK

  Needs Repair

• Was Repair Completed

• In this section, identify any potential upselling opportunities.

• Warewashing Program

  YES

  NO

  N/A

• Enter estimated weekly revenue dollars $

• Laundry / Housekeeping

  YES

  NO

  N/A

• Enter estimated weekly revenue dollars $

• Linen Program

  YES

  NO

  N/A

• Enter estimated weekly revenue dollars $

• Waste Program

  YES

  NO

  N/A

• Enter estimated weekly revenue dollars $

• Swisher Total Image

  YES

  NO

  N/A

• Enter estimated weekly revenue dollars $

• Paper (towel, tissue, seat covers, etc.)

  YES

  NO

  N/A

• Enter estimated weekly revenue dollars $

• Handcare Program (soap / sanitizer)

  YES

  NO

  N/A

• Enter estimated weekly revenue dollars $

• Air Freshener

  YES

  NO

  N/A

• Enter estimated weekly revenue dollars $

• Other items sold

  YES

  NO

  N/A

• Description of what was sold

• Enter estimated weekly revenue dollars $

• Any other items requiring attention or any additional comments

• signature

  Sign