LEV RESTAURANT SAFETY INSPECTION CHECKLIST

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• This LEV Store Safety Inspection Checklist is designed to help as identify and initiate corrective actions for physical form as a guide, should be conducted at least once monthly by supervisory personnel. Questions or Help? Call Ruth

• Clark (LEV Risk Manager) cell 702-353-7519 or riskmanagement@finelv.com

• Name or Store Number:

• Location:

• Date:

• Managers Name:

FLOORS & WALKING SURFACES

• Are ALL employees wearing approved slip-resistant footwear?

  Yes

  No

  N/A

• Are the floor surfaces at the stores entrances in good condition? (no broken tile; missing grout, loose mats; torn carpets, damaged thresholds, etc)

  Yes

  No

  N/A

• Are the floor surfaces in the main dining areas in good condition?

  Yes

  No

  N/A

• Is the floor being cleaned according to our recommended schedule?

  Yes

  No

  N/A

• Are any floor mats or carpets in good condition? (edges not rolled up)

  Yes

  No

  N/A

• Are steps or stairs in main dining areas or just outside in good repair?

  Yes

  No

  N/A

• If at location, are hand rails provided for stairs & in good condition?

  Yes

  No

  N/A

• Are primary walkways clear of obstructions such as boxes, materials, or other tripping hazards?

  Yes

  No

  N/A

• Are stairs and ramps equipped with hand rails & in good condition?

  Yes

  No

  N/A

• Was all the grease and dirt lifted from the grout

  Yes

  No

  N/A

• Is lighting adequate in all areas of the store (Inside and Outside)?

  Yes

  No

  N/A

• Are pathways to exits clear of obstructions, trash, etc?

  Yes

  No

  N/A

• Are cleaning agents used appropriate for the job task?

  Yes

  No

  N/A

• Are primary walkways clear of obstructions such as boxes, bun racks, materials, or other tripping hazards?

  Yes

  No

  N/A

• Are ramps equipped with hand rails & in good condition?

  Yes

  No

  N/A

• Are the floor surfaces in the kitchen areas in good condition?

  Yes

  No

  N/A

• Are floor mats or carpets in good condition, edges not rolled?

  Yes

  No

  N/A

• Are secondary walkways (kitchen & walk-in freezers or coolers) clear of obstructions such as boxes, materials, or other tripping hazards?

  Yes

  No

  N/A

• Are floors and/or floor mats around the Fryers free of grease

  Yes

  No

  N/A

• N NA Corrective Actions

• N NA Corrective Actions

Page 2

• Do you have your legal posters up to date and visible

  Yes

  No

  N/A

• Are the floors around the ice machines always free of standing water and ice cubes?

  Yes

  No

  N/A

• Are the floors around the sinks areas free of standing water?

  Yes

  No

  N/A

• Are floors free of spills?

  Yes

  No

  N/A

• Are floor mats placed in front of the sink/dishwasher & in good condition?

  Yes

  No

  N/A

• Are floor mats placed in front of the ice machine & in good condition?

  Yes

  No

  N/A

• Are floors around soft-drink syrup boxes free of sticky buildup?

  Yes

  No

  N/A

• Are floor drains adequately covered and drains secure?

  Yes

  No

  N/A

• Are steps or stairs outside of public areas clearly marked with yellow or orange tape or other identifiable markings?

  Yes

  No

  N/A

LADDER SAFETY

• Verify employee’s are properly trained: No carrying items, face the ladder, 3 point contact, correct shoes, etc

  Yes

  No

  N/A

• Are step ladders or step stools available? (primarily storage rooms)

  Yes

  No

  N/A

• Are all ladders in good condition? (good base of support, rungs)

  Yes

  No

  N/A

• Are all Ladders properly stored & secured when not in use?

  Yes

  No

  N/A

• Are roof ladder always locked to prevent access?

  Yes

  No

  N/A

• Are appropriate ladders used for ongoing tasks?

  Yes

  No

  N/A

STORE ROOMS/WALK-IN COOLERS & FREEZERS

• Are CO2 gas systems maintained and in good working order?

  Yes

  No

  N/A

• Are storage racks in good condition and strong enough to support the weight of bulk materials stored on them?

  Yes

  No

  N/A

• (shelves are NOT bent or “sagging” from old age or over- loading)

  Yes

  No

  N/A

• Are storage racks secured properly to prevent tipping over when loaded?

  Yes

  No

  N/A

• Are lighter materials such as cups & paper products stored on the top shelves?

  Yes

  No

  N/A

• Are heavier, frequently used items stored on the middle shelves?

  Yes

  No

  N/A

• Are the floor surfaces leading into the walk-in coolers or freezers textured to help prevent slips/falls when wet?

  Yes

  No

  N/A

• Are the floor surfaces in the walk-in freezers in good condition? (no ice buildup at entrance of walk-in freezers or coolers)

  Yes

  No

  N/A

• Are the metal floor ramps and base supports leading into tripping hazards? (Base should be adequately bolted to the surface. Note any missing bolts.)

  Yes

  No

  N/A

• Are the doors of the walk-in coolers or freezers equipped properly?

  Yes

  No

  N/A

• Do the doors to the walk-in cooler or freezer shut properly?

  Yes

  No

  N/A

Page 3

• (a seal should be made when closed properly to prevent condensation & ice buildup)

  Yes

  No

  N/A

• Are lights working properly inside walk-in cooler or freezer?

  Yes

  No

  N/A

• Are pathways clear of trip hazards?

  Yes

  No

  N/A

• Are floors clear of standing water or ice?

  Yes

  No

  N/A

• Are the A/C condensers working properly inside the walk-in coolers?

  Yes

  No

  N/A

• Are light covers in place?

  Yes

  No

  N/A

• Are supplies securely stacked?

  Yes

  No

  N/A

MATERIAL HANDLING

• Are dollies and/or push carts available to carry heavy bulk items & in good condition?

  Yes

  No

  N/A

• Are wheeled casters available for the garbage cans & in good condition?

  Yes

  No

  N/A

• Are soda syrup box racks in an easily accessible area on waist height shelves?

  Yes

  No

  N/A

EQUIPMENT/APPLIANCE SAFETY

• Is the grease filtration system working properly?

  Yes

  No

  N/A

• Is the grease shuttle device in good working condition?

  Yes

  No

  N/A

• Is regular scheduled ANSUL cleaning taking place?

  Yes

  No

  N/A

• Is there adequate personal protective equipment (PPE) fryers? (gloves, etc)

  Yes

  No

  N/A

• Are box cutters or knives adequately stored when not in use?

  Yes

  No

  N/A

• Is there a separate container to place knives that need to be washed? (knives should not be placed in the sink basin with other glass & plate dishes)

  Yes

  No

  N/A

• Are cut-resistant or metal mesh gloves available for use when using knives?

  Yes

  No

  N/A

• Are ALL Appliances in good working order?

  Yes

  No

  N/A

• Is the dishwasher machine working properly?

  Yes

  No

  N/A

• Is the Trash Compactor working properly?

  Yes

  No

  N/A

• Is all other equipment working properly?

  Yes

  No

  N/A

• Is an unbreakable scoop used (instead of a glass) to dispense ice?

  Yes

  No

  N/A

• Are heat resistant potholders provided and used?

  Yes

  No

  N/A

• Are employees who are cooking wearing clothing that is not loose fitting or could otherwise catch fire?

  Yes

  No

  N/A

• Is long hair tied back?

  Yes

  No

  N/A

• Is dangling jewelry and rings removed?

  Yes

  No

  N/A

• Are cleaning mops, deck brushes and squeegees in good condition?

  Yes

  No

  N/A

• Is there an adequate number of wet floor cones/signs available for all situations?

  Yes

  No

  N/A

• Are floor “Caution” Signs available & in good condition?

  Yes

  No

  N/A

• Are mop buckets equipped with casters for easy movement?

  Yes

  No

  N/A

• Are face-shields and safety goggles provided where needed?

  Yes

  No

  N/A

CHEMICAL SAFETY

• Are all cleaning chemicals properly stored?

  Yes

  No

  N/A

• Are all cleaning chemical containers properly labeled?

  Yes

  No

  N/A

• N NA Corrective Actions

• N NA Corrective Actions

• N NA Corrective Actions

Page 4

• Is PPE available to employees when using cleaning chemicals? (gloves, goggles, etc)

  Yes

  No

  N/A

• If used, are compressed gas cylinders properly secured with a chain?

  Yes

  No

  N/A

• Are material safety data sheets (MSDS) available on all chemicals?

  Yes

  No

  N/A

ELECTRICAL EQUIPMENT

• Are all extension cords equipped with ground prong?

  Yes

  No

  N/A

• Are power cords for small appliances equipped with ground prong? (some appliances may be double insulated and not required to have ground prong)

  Yes

  No

  N/A

• Are power cords for cleaning equipment equipped with ground prong?

  Yes

  No

  N/A

• Are all circuit breaker boxes clear of obstruction? (no inches)

  Yes

  No

  N/A

• Are all circuit breaker switches properly labeled?

  Yes

  No

  N/A

• Are all unused switches adequately covered in circuit breaker box?

  Yes

  No

  N/A

• Are face plates installed on all electrical receptacles?

  Yes

  No

  N/A

• Are face plates installed on all light switches?

  Yes

  No

  N/A

• Do all light fixtures contain bulbs and covered properly?

  Yes

  No

  N/A

FIRE/LIFE SAFETY

• Are portable fire extinguishers properly wall-mounted in strategic locations?

  Yes

  No

  N/A

• Are portable fire extinguishers properly inspected? (fire documented on the tag)

  Yes

  No

  N/A

• Do all fire extinguishers appear to be in working order and properly charged?

  Yes

  No

  N/A

• Is there at least 3 ft. of clearance (unobstructed access) to the portable fire extinguishers?

  Yes

  No

  N/A

• Does the automatic extinguishing system have a current inspection tag?

  Yes

  No

  N/A

• Are all exits marked & properly illuminated?

  Yes

  No

  N/A

• Are all exits unlocked during business hours?

  Yes

  No

  N/A

• Are all non-exit Doors clearly marked as “Not An EXIT”?

  Yes

  No

  N/A

• If the restaurant is equipped with a sprinkler system, is heads and any stored materials?

  Yes

  No

  N/A

• Is the ANSUL system properly inspected by qualified technician at least once annually?

  Yes

  No

  N/A

• Is there at least 3 feet of clearance around the sprinkler system main control valve?

  Yes

  No

  N/A

• Are emergency lights working properly?

  Yes

  No

  N/A

OTHER RELEVANT SAFETY CONSIDERATIONS

• Type any other safety concerns here: