Health Department Inspection

Fire Department Inspection

Kitchen Hood Inspection

HVAC Inspection

Sprinkler System Inspection

Staffing Roster

Organizational Chart

Employee Training Hours
(16 Hours Annually)

CPR & First Aid Certification
(One per Shift)

Daily Activity Log
(24 Hour Period)

Rounds Conducted
(Once per Hour)

Documented Head Counts
(3 Per Day)

Arrival & Departure Log

Fire Extinguisher Check Log

Smoke Detector Check Log

Emergency Lighting Check Log

Exit Signage Check Log

Menu w/ Approval from Dietician

Drug Screening Documentation
(10% of State Population per Month)

Inventory of Resident Personal Property

Resident Orientation Program

Inmate State Pay Signature Log

Worksite Staff Visit Log

Detailed List of Worksites

List of all Programming Available at Facility

Key Control & Procedures


Vermin & Pest Control

Fire or Emergency Drills
(One per Month)


Number of Beds

Number of State Residents

Employee Files

Background Check
(Pre Employment)

List of Prohibitions

Code of Ethics
(Each Employee Shall Sign)

Employee Age Requirement
(18 Years Old or Older)

Employee Compensation
(At Least Minimum Wage)

Female Staff on Duty

24 Hour Awake Supervision

Public Information Officer

Facility has Fully Licensed & Approved Medical Provider.

Resident Records are Kept & are Secure

Access to a Legal Library Provided

Visitation List Utilized

Legal Supplies Provided as Needed

No Residents in a Position of Authority

No Residents Perform Security Duties

Resident Rights Posted

Grievance Procedures Posted

Visitation Scheduled Posted

Laundry Schedule Posted

No Employees on Supervision

Special Diet Options Offered

Hygiene Products Provided


Food Preparation Area Sanitation

Kitchen Utensils Clean & Properly Stored

Ice Maker & Scoop Sanitation
(Properly Stored)

Spice Bin & Scoop Sanitation
(Properly Stored)

Stove Sanitation

Oven Sanitation

Deep Fryer Sanitation

Meat Slicer Sanitation

Microwave Sanitation

Can Opener Sanitation

Stove Hood Sanitation

Serving Line Sanitation

Dishwashing - Area Sanitation

Dishwashing - Accurate Temperature Reading

Dishwashing - Sanitation Rinse Used

Personnel - Clean Clothing & Hair Restraints

Personnel - Workers Checked for Cuts or Open Wounds. Screened for Infectious Diseases

Personnel - No Eating or Drinking

Personnel - Workers Properly Supervised

Kitchen Floors - Clean & In Good Repair

Kitchen Walls - Clean & In Good Repair

Kitchen Ceiling - Clean & In Good Repair

Hand Washing - Sink Installed & Maintained

Hand Washing - Soap Available

Hand Washing - Towels or Drying Device

Hand Washing - Proper Waste Receptacle

Freezer - Sanitation

Freezer - Lighting & Shield

Freezer - Correct Temperature
(0 Degrees or Less)

Refrigerator - Sanitation

Refrigerator - Lighting & Shield

Refrigerator - Correct Temperature
(40 Degrees or Less)

Dry Storage - Sanitation

Dry Storage - All Product Off the Floor

Dry Storage - Lighting

Certified Food Manager on Staff

Choking Poster Displayed
(KRS 217.285)

Garbage Cans Cleaned & Covered

Insect & Rodent Control

Janitor Equipment Stored Correctly & Clean

Toxic Items Properly Stored & Secured

Kitchen Tool Accountability

All Outer Openings Protected


Wiring Issues & Condition
(KY Fire Code)

Ceiling Sanitation & Condition
(KY Fire Code)

Evacuation Plans Current & Posted
(KY Fire Code)

1 to 8 Ratio - Toilets & Urinals
(Contract Section 30.030)

1 to 8 Ratio - Showers
(Contract Section 30.030)

1 to 8 Ratio - Sinks
(Contract Section 30.030)

Telephones Available for Resident Use
(Contract Section 30.030)

Adequate Laundry Facilities
(Contract Section 30.030)

Temperature Range - 65 / 85 Degrees
(Contract Section 30.030)

All Tools Secured or Supervised
(Contract Section 30.040)

MSDS Sheets Available & Current

Chemical Properly Stored & Secured

Living Area Amenities (Bed, Sheets, Pillow, Storage, & Chair)
(Contract Section 30.030)

Electrical Boxes & Light Switch Covers in Place & In Good Condition
(KY Fire Code)

Living Area Square Footage - 50 ft. per Resident (Contract Section 30.030)

Room Lighting & Night Lights are in Place & Functional (Contract Section 30.030)

Emergency Lighting is in Place & Functional
(KY Fire Code)

Fire Extinguishers are Functional
(KY Fire Code)

Exits Free From Obstructions
(KY Fire code)

Hallways Free From Clutter & Obstruction

Exit Signage in Place & Functional
(KY Fire Code)

Two Separate Entrances
(Contract Section 30.030)

General Housekeeping & Clutter Buildup
(KY Fire Code)

Common Area Sanitation -
(Recreation, Weight, & TV Areas)
(Contract Section 30.060)

Visitation Area Sanitation
(Contract Section 30.030)

Shower Sanitation
(Contract Section 30.060)

Restroom Sanitation
(Contract Section 30.060)

Living Area Sanitation
(Contract Section 30.060)

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.