Title Page

  • Conducted on

  • Prepared by

Store Room Environmental Safety

  • Exits clear

  • Floors free from spills and tripping hazards

  • No items within 18” of sprinkler head

  • Hair Nets by exits

  • Fire extinguisher not blocked

Cleanliness culinary/dry storage

  • Floors free from spills

  • Vents clean

  • Sprinklers clean, dust free

  • Walls clean

  • Equipment

  • Ceilings

  • Hot water in hand sinks

  • Can opener clean<br>Veggie<br>Hot cook<br>

  • Cutting boards clean/correct type<br>Red- Raw Animal<br>Green-Produce<br>White- Cooked/Ready to eat

  • Cold Prep labeling/dating<br><br>Record item type and date expired

  • Cut gloves being used

  • Walk in cooler labeling/ dating<br><br>Record item type and date expired

  • Cook’s cooler labeling and dating<br><br>Record item type and date expired

  • Culinary cooler/ freezer log

  • No ice build up in freezer

  • Proper hand hygiene/ Glove use

  • Sanitation bucket in use<br>Random check 1 bucket

Patient Services

  • Vents clean, free of dust

  • Sprinklers free from dust

  • Walls clean

  • Floors clean

  • Equipment working and clean<br>Check gaskets and vents

  • Ceilings clean

  • Patient services cooler/freezer log complete

  • Patient service labeling/dating<br> (Dippers, CA fridges)

  • Dipper temp logs <br>Correct form in use, temps taken at appropriate times and with corrective action if needed

  • Dish Machine log completed

  • Dish machine pressure log filled out

  • Pot sink set up and sanitizer titration

  • Sanitation buckets in use <br>Random check 1 bucket

  • Carts cleaned

Retail

  • Vents clean, free from dust

  • Sprinklers free from dust

  • Walls clean

  • Floors clean

  • Equipment dust free and working

  • Ceilings clean

  • Hot water at hand sinks

  • Sanitation buckets in use<br>Random check 1 bucket

  • Soda nozzles clean

  • Steam table labeling and dating<br>Check boxed lunches<br>Record item type and date expired

  • Steam table Temp logs complete

  • Salad bar cooler labeling and dating<br>Record item type and date expired

  • Salad bar temp logs

  • Grill area labeling and dating<br>Record item type and date expired

  • Grill temp logs

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