ELKS LODGE SELF-INSPECTION

• Charles City Elks Lodge No. 418 2111 Clark Street Charles City, IA 50616

• Conducted on

  Date

• Prepared by

• 2111 Clark Street Charles City, IA 50616
  Address

• Personnel

1.0 - Access Roads, Walkways, Parking Areas

• 1.a - Free of debris, cracks, broken pavement?

  Yes

  No

  N/A

• 1.b - Different elevations between adjacent walkways provided with guards or well marked?

  Yes

  No

  N/A

• 1.c - Walkways flat, well-drained, without holes?

  Yes

  No

  N/A

• 1.d - Fences and barricades secured and in good condition?

  Yes

  No

  N/A

• 1.e - Pathways and parking areas have adequate lighting?

  Yes

  No

  N/A

• 1.f - Walkways have safe clearance from motorized equipment?

  Yes

  No

  N/A

• 1.g - Signs indicating "PARK AT YOUR OWN RISK"?

  Yes

  No

  N/A

2.0 - Stairs, Ramps and Elevators/Lifts

• 2a - Standard stair rails or handrails provided on stairways with four or more stairs and ramps?

  Yes

  No

  N/A

• 2b - Handrails well secured with no sharp or rough parts?

  Yes

  No

  N/A

• 2c - Stair treads and risers free of chips, cracks, unevenness?

  Yes

  No

  N/A

• 2d - Stair treads & ramps slip resistant?

  Yes

  No

  N/A

• 2e - Stair treads & ramps have adequate lighting?

  Yes

  No

  N/A

• 2f - Stairs have at least 6 1/2 feet overhead clearance?

  Yes

  No

  N/A

• 2g - Elevators/lifts inspected as required by local law?

  Yes

  No

  N/A

3.0 Floor & Wall Openings

• 3a - Large glass areas subject to human impact well marked?

  Yes

  No

  N/A

• 3b - Floor opening provided with guard rail or cover?

  Yes

  No

  N/A

• 3c - Grate type covers designed not to affect foot traffic?

  Yes

  No

  N/A

• 3d - Safe, non-skid floors?

  Yes

  No

  N/A

4.0 - Entrances/Exits

• 4.a - Emergency lighting provided in corridors & stairways?

  Yes

  No

  N/A

• 4.b - All exits marked and properly illuminated?

  Yes

  No

  N/A

• 4.c - All doors, passages, stairs that aren't exits properly marked?

  Yes

  No

  N/A

• 4.d - All exits and passageways free of obstructions?

  Yes

  No

  N/A

• 4.e - At least two exits provided from upper floors?

  Yes

  No

  N/A

5.0 - Exit Doors

• 5.a - All exit doors open in the direction of exit?

  Yes

  No

  N/A

• 5.b - Cold storage room doors provided with inside release?

  Yes

  No

  N/A

• 5.c - Doors opening into street provided with warnings or barriers to prevent stepping into path of vehicles?

  Yes

  No

  N/A

6.0 - Storage Areas

• 6.a -Storage areas clean, dry & free of obstructions?

  Yes

  No

  N/A

• 6.b - Storage area locked while unattended?

  Yes

  No

  N/A

• 6.c - Flammables & combustibles stored away from heating devices and open flames?

  Yes

  No

  N/A

• 6.d - Trash and debris in metal covered containers and regularly removed?

  Yes

  No

  N/A

7.0 Emergency & First Aid

• 7.a - Emergency numbers posted at each phone?

  Yes

  No

  N/A

• 7.b - Employees instructed on reporting emergencies?

  Yes

  No

  N/A

• 7.c - Employees instructed on use of portable extinguishers?

  Yes

  No

  N/A

• 7.d - First Aid kit's clean and fully stocked?

  Yes

  No

  N/A

8.0 Outdoor Fixtures & Playgrounds

• 8.a - Benches & tables free of cracks, slivers and broken parts?

  Yes

  No

  N/A

• 8.b - Water fountains & taps in good repair without broken parts?

  Yes

  No

  N/A

• 8.c - BBQ free of sharp edges or missing parts?

  Yes

  No

  N/A

• 8.d - Playground equipment clean and in good repair?

  Yes

  No

  N/A

9.0 Swimming Pool

• 9.a - Appropriate caution signs posted?

  Yes

  No

  N/A

• 9.b - Properly enclosed to prevent falling into pool or access to children?

  Yes

  No

  N/A

• 9.c - Glass cups & plates not allowed in pool area?

  Yes

  No

  N/A

• 9.d - Remove diving board?

  Yes

  No

  N/A

• 9.e - Certified lifeguard on duty when pool is open?

  Yes

  No

  N/A

10.0

• 10.a - Metal container with cover provided for greasy rags?

  Yes

  No

  N/A

• 10.b - Knives stored in holders when not in use?

  Yes

  No

  N/A

• 10.c - Electrical cords and plugs of appliances in good condition?

  Yes

  No

  N/A

• 10.d - Food processing equipment properly guarded and in good repair?

  Yes

  No

  N/A

• 10.e - Glass stored away from storage & food storage areas?

  Yes

  No

  N/A

• 10.f - Gas & beverage concentrate cylinders secured against tipping?

  Yes

  No

  N/A

• 10.g - Drain & other floor openings covered?

  Yes

  No

  N/A

• 10.h - Non-skid mats provided in line with sinks, ice machine, range, etc.

  Yes

  No

  N/A

• 10.i - Mats clean and free of grease and other build-up?

  Yes

  No

  N/A

• 10.j - Food stored off the floor?

  Yes

  No

  N/A

• 10.k - Food covered & stored in refrigerator when not being prepared; proper temperature maintained?

  Yes

  No

  N/A

• 10.l - Hood & filters over range clean & not laden with grease?

  Yes

  No

  N/A

• 10.m - Suppression system in hood inspected in the last 6 months?

  Yes

  No

  N/A

• 10.n - Chairs, stools & tables in good condition?

  Yes

  No

  N/A

• 10.o - Board of Health certified server and inspection?

  Yes

  No

  N/A

11.0 Restrooms, Locker Rooms, Showers and Saunas

• 11.a - Well-maintained, dry, clean, sanitized & free of debris?

  Yes

  No

  N/A

• 11.b - Adequate lighting; burned-out bulbs promptly replaced?

  Yes

  No

  N/A

• 11.c - Hand towel, soap, toilet paper & sink fixtures secured and in good repair?

  Yes

  No

  N/A

• 11.d - Toilet stall & locker walls, doors & latches secure and in good repair?

  Yes

  No

  N/A

• 11.e - Walking surfaces made of non-skid materials?

  Yes

  No

  N/A

• 11.f - Appropriate warning signs posted: "CAUTION - SLIPPERY WHEN WET" or "DO NOT USE OVER 15 MINUTES," etc.?

  Yes

  No

  N/A

12.0 Personal Protection Devices

• 12.a - Appropriate protective devices provided for chemicals on site, including masks, safety aprons, gloves, goggles, etc.?

  Yes

  No

  N/A

• 12.b - Compliance with "Right to Know" requirements where applicable?

  Yes

  No

  N/A

13.0 Protection Devices

• 13.a - All automatic fire sprinkler system supply valves wide-open?

  Yes

  No

  N/A

• 13.b - All heat/smoke detection systems in operation?

  Yes

  No

  N/A

• 13.c - Portable extinguishers serviced in the last 12 months and tagged?

  Yes

  No

  N/A

• 13.d - Pressures in appropriate range on gauge?

  Yes

  No

  N/A

• 13.e - Extinguishers properly mounted at stations?

  Yes

  No

  N/A

• 13.f - Extinguishers recharged, as required?

  Yes

  No

  N/A

• 13.g - All sleeping quarters provided with smoke detectors unless provided with automatic sprinklers and carbon monoxide detectors?

  Yes

  No

  N/A

Sign Off

• On site representative

  Sign

• Auditor's signature

  Sign