GRG Restaurant Location - Inspection

• Client Name and id

• Conducted on

  Date

• Client Policy Date

  Date

• FEIN

• NAICS

• Total # of Claims to date

• Total # of open claims

• Total # Of Employees

• Current WC codes in use

• States operating in

• Prepared by

• Location
  Address

• Does the total number of employees seem accurate?

  Yes

  No

  N/A

• Do the current worker’s comp codes seem accurate?

  Yes

  No

  N/A

• Are the states the client operates in accurate?

  Yes

  No

  N/A

• Does the NAICS seem accurate?

  Yes

  No

  N/A

• Areas of concern the business contact has surrounding safety/WC that they want inspected for sure before the end of the visit.

• Do you currently have an existing and updated IIPP?

  Yes

  No

  N/A

• Would the client be interested in additional help in this area?

  Yes

  No

  N/A

• Do you currently have an existing and updated Emergency Action Plan?

  Yes

  No

  N/A

• Would the client be interested in additional help in this area?

  Yes

  No

  N/A

• Do you currently have a Safety Committee?

  Yes

  No

  N/A

• Would you like more information on this?

  Yes

  No

  N/A

• Yes

  No

  N/A

• How frequently do they meet?

  Weekly

  Quarterly

  Semi-Annually

  Other

• Do you currently have an updates SDS Binder?

  Yes

  No

  N/A

• would you like some assistance in setting one up?

  Yes

  No

  N/A

• Has client been sited by OSHA in the last year?

  Yes

  No

  N/A

• Do you have a return to work program in place?

  Yes

  No

  N/A

• Are all proper OSHA & labor laws posted and completed?

  Yes

  No

  N/A

• Is proper PPE provided to the employees ?

  Yes

  No

  N/A

• Are employees wearing PPE correctly?

  Yes

  No

  N/A

EXTERIOR

• Dumpster, compactor & grease pickup areas clean & orderly?

  Yes

  No

  N/A

• Are entryways and handrails in good condition?

  Yes

  No

  N/A

• Parking lot in good condition, no potholes, no broken parking blocks?

  Yes

  No

  N/A

• Emergency shutoffs for gas, water, and electric are located and accessible? On/off positions clearly marked and have tools to shut off?

  Yes

  No

  N/A

DINING ROOM

• Tables and chairs in safe condition for use?

  Yes

  No

  N/A

• Are high chairs clean, sturdy and have working child restraint straps?

  Yes

  No

  N/A

• Hanging lights, fans, pictures, plants and décor items are properly secured?

  Yes

  No

  N/A

• Are FOH employees practicing proper ergonomic techniques and safety terms?

  Yes

  No

  N/A

WAIT AND BUS STATIONS

• Supplies, Plates, flatware, napkins, etc. are organized and clean? Stored on proper shelving for safe lifting (not too high)?

  Yes

  No

  N/A

• Are servers/bussers/employees following “safe lifting” techniques when dishes and glassware in and out of the dish station?

  Yes

  No

  N/A

KITCHEN/PREP

• Slicer is properly guarded and set in the zero position, unplugged and clean?

  Yes

  No

  N/A

• All electrical panels are identified, labeled and switch plates in place? (No open blanks) The electrical box has a 36 inches clearance all around?

  Yes

  No

  N/A

• Can opener clean and sanitized?

  Yes

  No

  N/A

• Are kitchen rolling carts used when transporting heavy items?

  Yes

  No

  N/A

• Are there sanitation buckets available? Proper sanitation level?

  Yes

  No

  N/A

• Designated “mop” sink for mop use only, is cleaned daily, and mop heads/squeegees are observed clean?

  Yes

  No

  N/A

• Are wet floor signs being used when floor is wet?

  Yes

  No

  N/A

• Is machinery properly guarded?

  Yes

  No

  N/A

• All exit doors clear and exit signs displayed?

  Yes

  No

  N/A

COOK LINE

• Wet floor signs used when needed?

  Yes

  No

  N/A

• Knives are properly stored when not in use?

  Yes

  No

  N/A

• Chemicals stored away from food products and properly labeled?

  Yes

  No

  N/A

• Has Ansul system been serviced within the last six months and the activator reads “cocked” or “open”? Are the nozzles clean, free of corrosion and grease?

  Yes

  No

  N/A

• Hoods and filters are in place and cleaned daily and the exhaust system is cleaned at least quarterly? Is the service tag current?

  Yes

  No

  N/A

• Are there sanitation buckets available? Proper sanitation level?

  Yes

  No

  N/A

• Is there a fire extinguisher easily accessible available? Is service tag current?

  Yes

  No

  N/A

• Are reachins/refrigerated drawers set at proper temperature, have a thermometer and are the door gaskets in good condition? The thermometer reads 40 degrees or less?

  Yes

  No

  N/A

• Grill brush in good condition with bristles fully intact?

  Yes

  No

  N/A

WALK IN REFRIGERATORS & FREEZERS

• Kitchen Freezers set at proper temperature (0˚ or less), have a thermometer, and door gaskets in good condition?

  Yes

  No

  N/A

• Walkins set at proper temperature (40˚ or less), have a thermometer, and door gaskets in good condition?

  Yes

  No

  N/A

• The door is in good working order and clean? Release mechanism is in proper working order?

  Yes

  No

  N/A

• Food products are covered, labeled and stored properly for safe lifting and cross contamination?

  Yes

  No

  N/A

• All products stored at least six inches off the ground?

  Yes

  No

  N/A

• Are heavy items stored in easier to reach places?

  Yes

  No

  N/A

• Product is rotated using FIFO (first in, first out)?

  Yes

  No

  N/A

ICE MACHINES

• Scoops, holders and buckets are clean, in good condition, and properly stored? Ice scoops have no split edges or cracks?

  Yes

  No

  N/A

• Are covers in place for the lighting?

  Yes

  No

  N/A

• Flooring is dry, floor drains are cleaned regularly & functional? No ice on the floor?

  Yes

  No

  N/A

DISH WASHING AREA

• Does the dishwasher come up to minimum temperature? 180º chemical High Temp wash, 160º rinse?

  Yes

  No

  N/A

• Dishwasher / 3 Comp sink PH levels of the sanitizer within range?

  Yes

  No

  N/A

• All chemicals/cleaning agents stocked & connected correctly? Secondary containers labeled? PH kit & Sanitizer kit available?

  Yes

  No

  N/A

• Are SDS books proper PPE for chemicals used available?

  Yes

  No

  N/A

• No excess water on floor?

  Yes

  No

  N/A

• Are all dish area walls clean and free of mold?

  Yes

  No

  N/A

• Are all chemicals stored in a designated area?

  Yes

  No

  N/A

• Are dishwashers practicing proper ergonomic techniques (such as reducing the amount of pivoting while working and ensuring their feet are facing the direction of their work?)

  Yes

  No

  N/A

DRY STORAGE

• Products are stored properly for safe lifting? Labels are correct, and shelves are organized?

  Yes

  No

  N/A

• Is lighting adequate, in good working order and are covers in place?

  Yes

  No

  N/A

• PPE wellstocked and accessible?

  Yes

  No

  N/A

• If applicable: Co2 tanks properly secured?

  Yes

  No

  N/A

• All exits clearly marked and in working order?

  Yes

  No

  N/A

• Is there a stepstool/step ladder available, in good condition, and being used? Is there a proper box cutter being used? (No knives!)

  Yes

  No

  N/A

OFFICES

• Office chairs are in good repair and provide adequate support?

  Yes

  No

  N/A

• Are cables and wires off the floor?

  Yes

  No

  N/A

• IIPP manual present in office, team is aware of its location?

  Yes

  No

  N/A

ADMINSTRATION

• OSHA forms 300 Logs up to date with the current year?

  Yes

  No

  N/A

• EAP (Emergency Action Plans) up to date & in a visible area?

  Yes

  No

  N/A

GENERAL

• Is the first aid kit stocked with adequate supplies?

  Yes

  No

  N/A

• Floors, sidewalks, decks, carpets, rugs, mats, entrances, are clean, functional, and free of slip/trip/fall hazards in all areas?

  Yes

  No

  N/A

• Is lighting adequate, works properly, and covers in place in all areas? Is there emergency lighting in all areas?

  Yes

  No

  N/A

• All employees wearing proper slip resistant shoes?

  Yes

  No

  N/A

• Are cut gloves available and being used?

  Yes

  No

  N/A

• Have any employees expressed any concern or provided recommendations during the safety inspection? If so, please elaborate under Comments and Observations

  Yes

  No

  N/A

• Is the SDS binder accessible and complete?

  Yes

  No

  N/A

• Are all fire extinguishers charged and inspection tag dated within 1 year? How many extinguishers were found and checked?

  Yes

  No

  N/A

• Have automatic fire sprinklers been inspected/maintained?

  Yes

  No

  N/A

• Is there a stepstool/stepladder available, in good condition, and being used?

  Yes

  No

  N/A

• Safety Posters posted and easily visible?

  Yes

  No

  N/A

• Sinks stocked with hand soap and paper towels?

  Yes

  No

  N/A

Innoworks Support Questions

• Do you currently utilize the Innoworks-provided AFLAC plan to reduce false Worker’s Comp claims (free of charge)

  Yes

  No

  N/A

• Would you like more information on this plan and how it can help reduce costs?

  Yes

  No

  N/A

• Would you like more information on other Innoworks-provided services, such as medical insurance benefits and 401(K)?

  Yes

  No

  N/A

• What would you like more information about?

  Medical Benefits

  401k

Signature

• Site Safety Rep Signature

  Sign