FSJC Food Service Template

• Site conducted

  Select

• Conducted on

  Date

• Inspected By

• Accompanied By

• Location
  Address

• Inspection Code: <br>Yes - Meets Standard<br>No - Does Not Meet Standard<br>Not Reviewed <br>On-the-Spot Correction

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

ENVIRONMENTAL SAFETY

• 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

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Area is free from clutter with materials properly stored safely to prevent fire, tripping or pest hazards <br>29 CFR 1910.22; 29 CFR 1926.25; FSH 6709.11 38.33

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Clean drinking water is provided (from a fountain or with individual drinking cups) and are the containers clean

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Ventilation adequate to prevent odors

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Waste containers kept clean and emptied as needed

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Spills are cleaned up promptly

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Floors free from carpeting damage, holes or cracks (tripping hazards) <br>29 CFR 1910.22

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Ceilings free from damage or missing tiles

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Lighting fully functional and in good repair <br>29 CFR 1910.269

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

RESTROOM FACILITIES

• Toilets and washing facilities clean and stocked with supplies (soap, towels, toilet paper)

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Fixtures in toilets and washing facilities working and in good repair

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Tilework clean and free from damage

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Showers, sinks and toilets free from leaks

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

STORAGE

• Storage racks tightly assembled and free of sagging from overload or damage

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Storage areas kept free of tripping and fire hazards

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Materials stored to ensure liquids are kept below paper products

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Employees have a safe way to stock and unstock the shelves

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Cleaning supplies properly labeled

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Mopping supplies properly cleaned and stored

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Materials stored to ensure liquids are kept below/away from paper products

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

HAZARDOUS CHEMICALS

• Eye wash stations serviceable, inspected, not blocked, signposted, tested weekly and signed off <br>NFPA 101 ANSI Z358.1 Sec5.5.2; CFR 29 1910.132

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Procedures in place and being followed for obtaining and returning hazardous chemicals

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Containers of hazardous materials clearly labeled with their contents

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Chemicals stored according to the manufacturer’s recommendations and local or national fire codes.

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Safety Data Sheets (SDS) available, up-to-date and can students demonstrate their use

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Flammable or toxic chemicals kept in closed containers when not in use

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Personal protective clothing and equipment used (gloves, eye protection, etc.) when handling chemicals

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Signage prohibiting eating in areas where hazardous chemicals are present?

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

STUDENT LIVING AREA (BAYS/ROOMS)

• Free from clutter with materials properly stored safely to prevent fire, tripping or pest hazards 29 CFR 1910.22; 29 CFR 1926.25; FSH 6709.11 38.33

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Floors free from carpeting damage, holes or cracks (tripping hazards)<br>29 CFR 1910.22

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Window sills, curtains/shades clean and in good repair

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Walls and ceiling and walls painted and in good repair

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Lighting fully functional and in good repair <br>29 CFR 1910.269

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Ventilation adequate, no odors

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Trash cans clean and in good repair

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Lockers and beds numbered, clean and in good repair

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Outlets working and free from damage with covers intact <br>CFR 1910.303(b)(1), 1910.304, NEC Section 210.52

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• No unauthorized extension cords in use

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Area free from damaged, worn or unsafe messaging

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

ELECTRICAL SAFETY

• Extension cords used only for temporary use with correct voltage and rated for usage? <br>CFR 1910.269

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Power cords free of splices, taps, and damaged insulation?

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Electrical parts on tools, equipment, building wiring, and electrical panels enclosed to prevent contact?

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Circuits become overloaded If so why?

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Breaker boxes clear and can they be accessed when needed

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Electrical cords and equipment used at wet locations have waterproof covers or seals to keep moisture out

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Outlets and covers in good condition with GFCI circuits being used in wet locations <br>CFR 1910.303(b)(1), 1910.304, NEC Section 210.52

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

FIRST AID

• First aid kit complete (A list of required items inside each kit is helpful)

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• AED machines inspected to ensure good working order with current batteries (not expired)

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• 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

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

FIRE SAFETY

• Fire extinguishers present in their correct location  <br>PRH-5.9-R5.a-f ; CFR 1910.157(c)(1) and(4) NFPA 10

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Fire extinguishers with pressure gauges show correct pressure?  PRH 5.9-R5.a-f; CFR 1910.157.(c) (4) NFPA 10

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Extinguishers free from signs of corrosion (incl. tap-test)   PRH-5.9R5.a-f; CFR 1910.157(f)(2)(iii) NFPA 10

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Alarm pull stations, carbon monoxide and smoke detectors in good working order <br>CFR 29 1910.164

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Fire extinguishers tagged, serviced and inspected by the building manager or designee CFR 29 1910.157( c )(1), NFPA 10

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Fire alarm panel unobstructed and in good working order <br>NFPA 72 NFPA 70 29 CFR. 164-165;

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

ESCAPE ROUTES AND EXITS

• Occupancy loads posted with adequate exit discharge routes that lead outside <br> 1910.36 (c)

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Exits clearly marked, well lit and free from obstruction <br>CFR 1910.37(a)(3) ;NFPA 101B

  Yes

  No

  Not Reviewed

  N/A

  On-the-Spot Correction

• Internal fire doors closed (not wedged open) <br>NFPA LSC 19.3.6.3.10

  YES

  NO

  Not Reviewed

  N/A

  On-the-Spot Correction

• YES

  NO

  Not Reviewed

  N/A

  On-the-Spot Correction

• Exterior exit doors open easily from the inside without a key <br>CFR 1910.36 (d)(1)

  YES

  NO

  Not Reviewed

  N/A

  On-the-Spot Correction

• External pathways from the exits away from the building clear  <br>CFR 1910.37 (b) (4) 1910.37 (d) (1)

  YES

  NO

  Not Reviewed

  N/A

  On-the-Spot Correction

• Has the area documented a safety drill in the past 30 days?

  YES

  NO

  Not Reviewed

  N/A

  On-the-Spot Correction

Sign Off

• Name and Signature

  Sign