Title Page
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Name of Establishment
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Conducted on
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Performed by
Employees
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Did all kitchen staff wear a complete and clean set of uniform?
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Did all kitchen staff wear aprons according to their prep station (e.g., seafood, vegetable)?
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Did the employees wear hair restraints?
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Did the employees follow the food safety procedure (e.g., wash and sanitize hands)?
Facilities & Equipment
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Dishes, pots, pans, and utensils are cleaned and stored properly
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Sinks are cleaned & sanitized
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Dishwasher was cleaned after use
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Tray return window and surrounding area is cleaned
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Wiped down and disinfected (if needed) the kitchen counters, table, and stove top
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Oven spills and debris are removed and cleaned
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Kitchen floors were mopped, swept and sanitized
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Cleaning rags washed after use or placed on dirty laundry bin
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All tools were cleaned, locked and inventoried
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Cleaning equipment properly stored after use
Waste Disposal
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Waste bins are properly segregated
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Waste bins are emptied & taken to the dumpster
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Waste bins are cleaned and sanitized
Completion
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Overall Assessment
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Name & Signature of Kitchen Manager