Director WalkthroughFAN

• Conducted on

  Date

• Prepared by

Store Room Environmental Safety

• Exits clear

  Yes

  No

  N/A

• Floors free from spills and tripping hazards

  Yes

  No

  N/A

• No items within 18” of sprinkler head

  Yes

  No

  N/A

• Hair Nets by exits

  Yes

  No

  N/A

• Fire extinguisher not blocked

  Yes

  No

  In use

Cleanliness culinary/dry storage

• Floors free from spills

  Yes

  No

  N/A

• Vents clean

  Yes

  No

  N/A

• Sprinklers clean, dust free

  Yes

  No

  N/A

• Walls clean

  Yes

  No

  N/A

• Equipment

  Yes

  No

  N/A

• Ceilings

  Yes

  No

  N/A

• Hot water in hand sinks

  Yes

  No

  In use

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

  Yes

  No

  In use

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Cut gloves being used

  Yes

  No

  N/A

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

  Yes

  No

  In use

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

  Yes

  No

  N/A

• Culinary cooler/ freezer log

  Yes

  No

  In use

• No ice build up in freezer

  Yes

  No

  N/A

• Proper hand hygiene/ Glove use

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Patient Services

• Vents clean, free of dust

  Yes

  No

  N/A

• Sprinklers free from dust

  Yes

  No

  N/A

• Walls clean

  Yes

  No

  N/A

• Floors clean

  Yes

  No

  In use

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

  Yes

  No

  In use

• Ceilings clean

  Yes

  No

  N/A

• Patient services cooler/freezer log complete

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Dish Machine log completed

  Yes

  No

  N/A

• Dish machine pressure log filled out

  Yes

  No

  N/A

• Pot sink set up and sanitizer titration

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Carts cleaned

  Yes

  No

  In use

Retail

• Vents clean, free from dust

  Yes

  No

  N/A

• Sprinklers free from dust

  Yes

  No

  N/A

• Walls clean

  Yes

  No

  N/A

• Floors clean

  Yes

  No

  N/A

• Equipment dust free and working

  Yes

  No

  N/A

• Ceilings clean

  Yes

  No

  N/A

• Hot water at hand sinks

  Yes

  No

  In use

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

  Yes

  No

  N/A

• Soda nozzles clean

  Yes

  No

  In use

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

  Yes

  No

  N/A

• Steam table Temp logs complete

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Salad bar temp logs

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Grill temp logs

  Yes

  No

  N/A