Title Page
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Conducted on
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Prepared by
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Location
Dining rooom
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Emergency exits clear and emergency lights in ready state?
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Housekeeping and hygiene maintained in dining room
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Tables and chairs in good working order?
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Clean Throughout(no personal belongings, opened food items, coffee or drink cups)
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Adequate lighting?
Food service employees
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Worker sanitizes food prep area after handling raw food?
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Worker washes hands after coughing, sneezing or any other form of contamination?
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Worker not smoking, eating or chewing gum in the food preparation area?
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Workers not wearing any jewelry prior to commencing direct food handling?
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No personal belongings in area near food?
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Workers have no visible signs of infection, cold, illness or open sores?
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Worker using proper gloves for task at hand?
Food serving area
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Tongs are changed every 30 mins?
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Area is clean with no food spilled on floor or in front of hot food?
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Liquid dispensers(ex pop, water or milk) are clean? Look under nozzles and surrounding areas?
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Condiment stations clean?( look under nozzles for dried on residue)
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Dessert area clean?
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Hand Sanitizer stations empty?
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Utensils and plates clean and free of debris?
General Observations
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General Observations?
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Kitchen Supervisor or Manager
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HSE Review
