• Enter Employee Name

  • Enter Date & Time


  • Proper Hand Washing Observed

  • Staff only wash hands in handwash sink

  • Employees wear appropriate uniform
    including proper shoes

  • Hair restraints worn

  • Fingernails trimmed

  • Jewelry is restricted

  • Glove use policy followed

  • Open sores, cuts, or bandages
    completely covered while handling food

  • Eating, drinking or Chewing gum
    prohibited in food prep areas

  • Staff take appropriate action
    when coughing or sneezing


  • Hand wash stations available & stocked
    with anti-microbial hand soap, hand sanitizer
    and single-use towels?

  • Hand Washing signage displayed

  • Sanitizing solution available in critical areas

  • Employee Signature

  • Supervisor Name & Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.