Title Page

  • Name of Establishment

  • Conducted on

  • Performed by


  • 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


  • Overall Assessment

  • Name & Signature of Kitchen Manager

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.