Title Page

  • Name of Establishment

  • Conducted on

  • Performed by

Employees

  • Did all kitchen staff wear a complete and clean set of uniform?

  • Did all kitchen staff wear aprons according to their prep station (e.g., seafood, vegetable)?

  • Did the employees wear hair restraints?

  • Did the employees follow the food safety procedure (e.g., wash and sanitize hands)?

Facilities & Equipment

  • Dishes, pots, pans, and utensils are cleaned and stored properly

  • Sinks are cleaned & sanitized

  • Dishwasher was cleaned after use

  • Tray return window and surrounding area is cleaned

  • Wiped down and disinfected (if needed) the kitchen counters, table, and stove top

  • Oven spills and debris are removed and cleaned

  • Kitchen floors were mopped, swept and sanitized

  • Cleaning rags washed after use or placed on dirty laundry bin

  • All tools were cleaned, locked and inventoried

  • Cleaning equipment properly stored after use

Waste Disposal

  • Waste bins are properly segregated

  • Waste bins are emptied & taken to the dumpster

  • Waste bins are cleaned and sanitized

Completion

  • Overall Assessment

  • Name & Signature of Kitchen Manager

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