Title Page
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Site conducted
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Conducted on
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Inspected By
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Accompanied By
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Location
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Inspection Code: <br>Yes - Meets Standard<br>No - Does Not Meet Standard<br>Not Reviewed
Sign Off
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Name and Signature
Environmental Safety
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Are daily cleaning and sanitation procedures being followed and documented? <br>29 CFR 1910.141; 29 CFR 1926.51; 29 CFR 1928.110; OSHA guidance on Mitigating & prevention of COVID-19 updated 06-10-21
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Is the area free from clutter with materials properly stored safely to prevent tripping, fire or pest hazards? <br>29 CFR 1910.22; 29CFR 1926.25; FSH 6709.11 38.33
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Are garbage cans intended for disposing of food emptied daily and outfitted with solid tight-fitting covers?
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Are wiping cloths clean, stored properly?
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Are floors free from damage, holes or cracks? <br>CFR 29 1910.22
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Are ceilings free from holes or missing tiles? <br>1910
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Are overhead lights working and protected from breakage? <br>CFR 29 1910.269
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Are utensils and equipment clean, in good working order and stored properly?
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Are spills cleaned up promptly?
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Are all food areas free of evidence of insects or rodents? <br>CFR 21 Food Code FDA Codebook 2017 Controlling Pests 6-501.11
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Do staff and student practice proper hygiene? (Clothes clean, no jewelry, hair restrained etc.) <br>CFR 21 Food Code Employee Health and Personal Hygiene Handbook
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Is the area free from damaged, worn or unsafe messaging?
Restroom Facilities
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Are toilets and washing facilities clean and stocked with supplies (soap, towels, toilet paper)? FDA Codebook 2017 Handwashing signage 6-301.14; CFR 21
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Are fixtures in toilets and washing facilities working and in good repair?
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Are tiles clean and free from damage?
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Are showers, sinks and toilets free from leaks?
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Is there evidence of mold or mildew?
Storage
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Are storage racks tightly assembled and free of sagging from overload or damage?
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Are storage areas kept free of tripping and fire hazards?
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Are materials stored to ensure liquids are kept away from/below paper products?
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Are dry storage rooms/areas organized and clean with no food stored on the floor?
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Do employees have a safe way to stock and unstock the shelves?
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Are grease containers appropriate and grease collection is at an acceptable level? <br>CFR 21 Food Code FDA 2017 5-402.12 Grease Trap.
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Are cleaning supplies properly labeled?
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Are mopping supplies properly cleaned and stored?
Hazardous Chemicals
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Are eyewash stations serviceable, inspected, not blocked, signposted, tested weekly, and signed off? <br>NFPA 101; ANSI Z358.1 Sec 5.5.2; CFR 29 1910.132
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Are all containers of hazardous materials clearly labeled with their contents? <br>CFR 21 Food Code FDA 2017 Annex 4, Table 2b. Added Chemical Hazards at Retail, Along with Their Associated Foods and Control Measures
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Are all chemicals stored according to the manufacturer’s recommendations and local or national fire codes.
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Are all employees & students required to use personal protective clothing and equipment (gloves, eye protection, etc.) when handling chemicals?
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Are employees prohibited from eating in areas where hazardous chemicals are present?
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Is personal protective equipment provided, used and maintained whenever necessary?
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Are there procedures in place and being followed for obtaining and returning hazardous chemicals?
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Are Safety Data Sheets (SDS) available, up-to-date and students can demonstrate their use?
Electrical Safety
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Are extension cords used only for temporary use with correct voltage and rated for usage? <br>CFR 1910.269
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Are power cords free of splices, taps, and damaged insulation?
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Is daisy chaining present?
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Are live electrical parts on tools, equipment, building wiring, and electrical panels enclosed to prevent contact?
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Do circuits become overloaded? If so why?
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Are breaker boxes clear and can they be accessed?
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Are electrical GFCI outlets used in wet locations? <br>29 CFR 1910.334; 1910.304; 1926.404
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Do electrical cords and equipment used at wet locations have waterproof covers or seals to keep moisture out?
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Are lockouts/tagouts used as needed to control hazard energy? <br>29 CFR 1910.147
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Are all outlets and covers in good repair?
First Aid
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Are first aid and blood borne pathogen kits available, accessible and stocked using a list of required items posted? CFR 1910.151(b), 1926.50( c ), ANSI/ISEA Z3-8.1, 1910.151 , 1926.50(d)(1), PRH Exhibit 5-4
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Are the AED machines inspected to ensure good working order with current batteries and pads (not expired)?
Fire Safety
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Are all fire extinguishers present in their correct location? PRH-5.9-R5.a-f ; CFR 1910.157(c)(4) NFPA 10
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Are all extinguishers hung or stand mounted, unobscured, unobstructed and freely visible? CFR 1910.157 (c)(1) NFPA 10
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Do all fire extinguishers with pressure gauges show correct pressure? <br>PRH 5.9-R5.a-f; CFR 1910.157.(c) (4) NFPA 10
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Are all extinguishers free from signs of corrosion (incl. tap-test)? <br>PRH-5.9R5.a-f; CFR 1910.157(f)(2)(iii) NFPA 10
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Are alarm pull stations and smoke detectors in good working order? <br>CFR 29 1910.164
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Are fire extinguishers tagged, serviced and inspected by the building manager or designee? CFR 29 1910.157( c )(1), NFPA 10
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Is the fire alarm panel in good working order? <br>NFPA 72 NFPA 70 29 CFR. 164-165; 1926.150
Escape Routes/Exits
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Are occupancy loads posted with adequate exit discharge routes that lead outside? 1910.36 (c)
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Are exits clearly marked and well lit?
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Are escape routes clear and free from debris and obstruction? CFR 1910.37(a)(3) ;NFPA 101B
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Are all internal fire doors closed (not wedged open)? <br>NFPA LSC 19.3.6.3.10
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Are exterior exit doors clear and unobstructed on both sides? <br>CFR 1910.37 (a) (3)
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Do exterior exit doors open easily from the inside without a key? CFR 1910.36 (d)(1)
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Are external pathways from the exits away from the building clear? CFR 1910.37 (b) (4) 1910.37 (d) (1)
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Has the area documented a safety drill in the past 30 days?
Food Safety
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Do potentially hazardous food meet temperature requirements during storage, preparation, display, service, and transport? <br>CFR 21 Food Code FDA 2017 3-202.11; Applicable Sections of Parts 3-4 & 3-5
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Thawing meats stored6” off ground?
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Is food properly dated and documented for rotation control?
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Are thermometers provided and conspicuous? <br>CFR 21 Food Code FDA 2017 4-204.112
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Are food and ice dispensing utensils properly stored? <br>CFR 21 Food Code FDA 2017 3-304.12 In-Use Utensils, Between-Use Storage.
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Are ServSafe Certificates posted in visible location?
Food Service Sanitation
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Are food contact surfaces adequately designed, maintained, and located? <br>CFR 21 Food Code FDA 2017 4-202.11 Food-Contact Surfaces.
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Are sneeze guards clean?
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Are non-food contact surfaces adequately maintained and located? <br>CFR 21 Food Code FDA 2017 4-202.16 Nonfood-Contact Surfaces
Dishwashing
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Are dishwashing chemical ratios and temperatures checked and documented - temps at 165 for wash and 185 for rinse?
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Are three compartments sink properly installed and used with an adequate supply of pH paper and sanitization test strips? <br>CFR 21 Food Code .4-301.12 Manual Warewashing, Sink Compartment
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Are dishwashing test strips and heat-sensitive tapes being used and not expired?
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Do water sources provide hot and cold water with adequate pressure and temperatures?
Hoods
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Are hood filters washed weekly?
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Are hoods cleaned according to HAACP stickers?
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Are cooking devices properly placed under suppression system?
Temperature Controls
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Is food stored and labeled properly in walk-in freezer?
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Condensing units are free from ice buildup?
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Is food stored and labeled properly in walk-in cooler?
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Are temperature logs up-to-date and displayed properly?