Title Page

  • Main Cafeteria, Main Men's & Women's, First Aid Room, Clean Room, Pea Receiving, Pea Bin and Picking Tables

  • Conducted on

  • Prepared by

Cafeteria

  • All lunch boxes and food stored properly?

  • Would you like to attach a picture?

  • Microwaves clean and in working order?

  • Would you like to attach a picture?

  • All fridges are clean and in working order?

  • Would you like to attach a picture?

  • Are tables, chairs, floors, walls, and ceilings kept clean and properly maintained?

  • Would you like to attach a picture?

  • Is lighting adequate, properly maintained, and protected against breakage?

  • Would you like to attach a picture?

  • Are waste or recycling bins overflowing?

  • Would you like to attach a picture?

  • Is there any evidence of pests in the area?

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

Men's Rest Room

  • Locker area clean and all items stored properly?

  • Would you like to attach a picture?

  • Are floors, walls, and ceilings kept clean and properly maintained?

  • Would you like to attach a picture?

  • Is lighting adequate, properly maintained, and protected against breakage?

  • Would you like to attach a picture?

  • Are there temporary repairs present?

  • Would you like to attach a picture?

  • Are all sinks, toilets, paper towel and soap dispensers in working order?

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

Women's Rest Room

  • Locker area clean and all items stored properly?

  • Would you like to attach a picture?

  • Are floors, walls, and ceilings kept clean and properly maintained?

  • Would you like to attach a picture?

  • Is lighting adequate, properly maintained, and protected against breakage?

  • Would you like to attach a picture?

  • Are there temporary repairs present?

  • Would you like to attach a picture?

  • Are all sinks, toilets, paper towel and soap dispensers in working order?

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

First Aid Room

  • Are equipment, floors, walls, and ceilings kept clean and properly maintained?

  • Would you like to attach a picture?

  • Is lighting adequate, properly maintained, and protected against breakage?

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

Clean Room

  • Are floors, walls, and ceilings kept clean and properly maintained?

  • Would you like to attach a picture?

  • Is lighting adequate, properly maintained, and protected against breakage?

  • Would you like to attach a picture?

  • Are all sinks working in order?

  • Would you like to attach a picture?

  • Are all soap dispensers in working order?

  • Would you like to attach a picture?

  • Are all hand dryers in working order?

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

Pea Receiving

  • Are doors properly sealed and closer working?

  • Would you like to attach a picture?

  • Are all lights in area working, clean and in good repair?

  • Would you like to attach a picture?

  • Are equipment, floors, walls, and ceilings kept clean and properly maintained?

  • Would you like to attach a picture?

  • Does condensate drip into exposed product zones?

  • Would you like to attach a picture?

  • Are chemicals controlled with no unauthorized accesses?

  • Would you like to attach a picture?

  • Is there evidence of excessive grease on equipment?

  • Would you like to attach a picture?

  • Are unsecured tools or parts left out?

  • Would you like to attach a picture?

  • Are repairs being done in a safe manner?

  • Would you like to attach a picture?

  • Are there temporary repairs present?

  • Would you like to attach a picture?

  • Is there excessive product on the floor? Is this a result of some equipment failure or design error?

  • Would you like to attach a picture?

  • Is there any evidence of pests in the area?

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

Picking Tables & Bin Area

  • Are doors properly sealed and closer working?

  • Would you like to attach a picture?

  • Are all lights in area working, clean and in good repair?

  • Would you like to attach a picture?

  • Are equipment, floors, walls, and ceilings kept clean and properly maintained?

  • Would you like to attach a picture?

  • Is lighting adequate, properly maintained, and protected against breakage?

  • Would you like to attach a picture?

  • Does condensate drip into exposed product zones?

  • Would you like to attach a picture?

  • Are chemicals controlled with no unauthorized accesses?

  • Would you like to attach a picture?

  • Is there evidence of excessive grease on equipment?

  • Would you like to attach a picture?

  • Are unsecured tools or parts left out?

  • Would you like to attach a picture?

  • Are repairs being done in a safe manner?

  • Would you like to attach a picture?

  • Are there temporary repairs present?

  • Would you like to attach a picture?

  • Is there excessive product on the floor? Is this a result of some equipment failure or design error?

  • Would you like to attach a picture?

  • Is there any evidence of pests in the area?

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

  • Other issue in area?

  • Location and explanation of issue

  • Would you like to attach a picture?

Personnel Practices

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  • Are all of the employee's PPE in place and are they used correctly?

  • Is there evidence of food in the production areas?

  • Would you like to attach a picture?

  • Is clothing appropriate for the job being performed?

  • Are designated eating and smoking areas posted as such?

  • Would you like to attach a picture?

  • Are personal hygiene standards enforced? Are signs posted?

  • Are hair restraints/beard nets worn and in accordance with company policy?

  • Are all jewelry, nail polish, and watches prohibited?

  • Are items found in shirt pockets?

  • Any other personal practices that need to be addressed?

  • Explanation of issue

  • Would you like to attach a picture?

  • Any other personal practices that need to be addressed?

  • Explanation of issue

  • Would you like to attach a picture?

  • Any other personal practices that need to be addressed?

  • Explanation of issue

  • Would you like to attach a picture?

  • Any other personal practices that need to be addressed?

  • Explanation of issue

  • Would you like to attach a picture?

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. You should independently determine whether the template is suitable for your circumstances.