Audit

INDUSTRIAL HYGIENE INSPECTION FORM

RATING SYSTEM 1= UNSATISFACTORY. 2 = SATISFACTORY 3 = EXCELLENT

1. GALLEY

Cleanliness of Slats and Shelves

Stability of Materials

Food Properly Stored on Shelves / Slats - Not Floor

Leftovers Properly Covered and Labeled with time and date when stored

No leftovers older than 48 hours

Cleanliness of Slats and Shelves

Stability of Materials

Food Properly Stored on Shelves / Slats - Not Floor

Leftovers Properly Covered and Labeled with time and date when stored

No leftovers older than 48 hours

General Housekeeping

Comments (Identified Problems) and actions taken:

2. Food Handlers / Cleaning Staff

Personnel free from Open Lesions

Personnel free from Respiratory Signs /Symptoms

Clean Uniforms

Good hand washing practices

Use of gloves and hats / hairnets

Sanitary work practices

Comments (Identified Problems) and actions taken:

3. Scullery Area

Sinks /Drains clean and clear of waste / sanitized daily with logs

Dishwasher at proper temperature ( 165 degrees F. or higher)

Waste properly Disposed of

General Housekeeping

Comments (Identified Problems) and actions taken:

Kitchen / Food preparation area

Pots / pans, and utensils properly stored - clean and dry

Fire extinguisher

Fire blanket

Mat slicer clean -guard properly installed

Can opener

Mixing machine

Ranges, hoods, and filters clean -free of grease buildup

Exhaust vents clear of dust buildup

CO2 system for range (fire extinguishers)

Trash regularly removed

Floors free of slip and trip hazards

Comments (Identified Problems) and actions taken:

5. Galley Area

Tables and chairs clean

All sauces, dressings, condiments, etc. in date

All perishables in refrigerator

Milk machine

Coffee mess clean and stocked

Ice machine

Drink machines

General housekeeping

Comments (Identified Problems) and actions taken:

6. Dry storage area

Proper storage on pallets or shelves

Stability of materials

All containers, bags, and boxes properly sealed

All items in date

General housekeeping

Comments (Identified Problems) and actions taken:

1. Living area

Floors

Lavatories and mirrors

Sower floors, walls and spigots

Showers cleaned with bleach solution (anti- fungus)

Soap dishes

Benches and shelves

Mops, brooms, clean buckets and properly stored

Urinals and commodes cleaned and sanitized

Toilet paper and paper towels stocked

Use of disinfectants

Waste bins emptied

Comments (Identified Problems) and actions taken:

2. Hallways

Floors and passageways clean

Walls and handrails

Lighting- normal and emergency

Escape routes clearly identified

Use of disinfectant

Comments (Identified Problems) and actions taken:

3. Bedrooms

Floors cleaned and exit path clear

Lighting

Muster map posted

Use of disinfectant

Waste bins emptied

Linen changed weekly

Towels changed daily

Comments (Identified Problems) and actions taken:

4. Stairwells

Lighting

Handrails

Passageway clear-no trip, slip hazards

General housekeeping

Comments (Identified Problems) and actions taken:

5. Recreation areas

Floors

Chairs, benches

Waste bins emptied

General housekeeping

Comments (Identified Problems) and actions taken:

6. Water Fountains

All fountains and spigots cleaned daily

Drains free of debris

Use of disinfectants

Comments (Identified Problems) and actions taken:

7. Laundry area

Dryer filters free of dust and lint buildup

Machines clean

Proper storage of detergents

General housekeeping

Clean folding area

Comments (Identified Problems) and actions taken:

Over All Comments :

Over All Comments :

Review Conducted by :

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Results reviewed with PIC:

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Results reviewed with Catering Supervisor:

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Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.